Putting Barnsley People First
A meeting of the NHS Barnsley Clinical Commissioning Group Governing Body will be held on Thursday 9 June 2016, 9.30 am at the Grimethorpe Pentecostal Church, Brierley Road, Grimethorpe, Barnsley S72 7EH
AGENDA (Public)
Item Session GB Enclosure Time Requested Lead to 1. Apologies 09.30 am
2. Quoracy
3. Patient Story 09.30 am 10 mins 4. Declarations of Interest Relevant to the GB/Pu/16/06/04 09.40 am Agenda Nick Balac 5mins
5. Questions from the Public on Barnsley Nick Balac 09.45 am Clinical Commissioning Group Business 10 mins
6. Minutes of the Meeting held on 12 May 2016 Approve GB/Pu/16/06/06 09.55 am Nick Balac 5 mins
7. Minutes of the Extraordinary Meeting held Approve GB/Pu/16/06/07 10.00 am on 26 May 2016. Nick Balac 5 mins
8. Matters Arising Report Note GB/Pu/16/06/08 10.05 am Nick Balac 5 mins
Strategy
9. Report of the Chief Officer Information GB/Pu/16/06/09 10.10 am Lesley Smith 10 mins Quality Governance
10. Special Education Needs Update Information GB/Pu/16/06/10 10.20 am Brigid Reid 10 mins 11. Quality Highlights Report Assurance GB/Pu/16/06/11 10.30 am Brigid Reid 10 mins
12. Social Prescribing Information GB/Pu/16/06/12 10.40 am Lesley Jane 10 mins Smith
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13. CCG Committees Terms of Reference Approve GB/Pu/16/06/13 10.50 am Vicky Peverelle 10 mins
14. Risk and Governance Exception Report Assurance & GB/Pu/16/06/14 11.00 am Approval Vicky Peverelle 10 mins
Finance and Performance
15. Integrated Performance Report Assurance GB/Pu/16/06/15 11.10 am Heather Wells 15 mins Vicky Peverelle
16. Budgets 2016/17 Approve GB/Pu/16/06/16 11.25 am Heather Wells 10 mins Committee Reports and Minutes
17. Minutes of the Audit Committee held on 23 Assurance GB/Pu/16/06/17 11.35 am May 2016 Chris Millington 5 mins
18. Minutes of the Finance and Performance Assurance GB/Pu/16/06/18 11.40 am Committee held on 5 May 2016 Nick Balac 5 mins
19. Minutes of the Quality and Patient Safety Assurance GB/Pu/16/06/19 11.45 am Committee held on 31 March 2016 Mehrban Ghani 5 mins
20. Minutes of the Equality Steering Group held Assurance GB/Pu/16/06/20 11.50 pm on 18 February 2016 Brigid Reid 5 mins
21. Primary Care Co-Commissioning Committee Assurance GB/Pu/16/06/21 11.55 pm Assurance Report Chris Millington 5 mins
22. Date and Time of the Next Meeting: 12.00 pm Close 14 July 2016 at 09.30 am at the Rockingham Centre, Sheffield Road, Hoyland, Barnsley S74 OPY.
Signed
Dr Nick Balac – Chairman
Exclusion of the Public: The CCG Governing Body should consider the following resolution: “That representatives of the press and other members of the public be excluded from the remainder of this meeting due to the confidential nature of the business to be transacted - publicity on which would be prejudicial to the public interest” Section 1 (2) Public Bodies (Admission to meetings) Act 1960
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GB/Pu/16/06/04
Putting Barnsley People First
GOVERNING BODY
9 June 2016
Declarations of Interests Report
1. PURPOSE OF THE REPORT
To provide the Governing Body with all Governing Body members declarations of interest.
2. EXECUTIVE SUMMARY
This report details all Governing Body members declared interests for members to update and to enable the Chair and members to foresee any potential conflicts of interests.
3. THE GOVERNING BODY IS ASKED TO:
Review that their individual declared interests are up to date Receive and note the Governing Body members declarations of interest
Agenda time allocation for report: 5 minutes
Report of: Vicky Peverelle
Designation: Chief of Corporate Affairs
Report Prepared by: Lynne Richards
Designation: Governance, Assurance and Engagement Facilitator.
1 GB/Pu/16/06/04
1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
The report is especially relevant to the following risks on the Governing Body Assurance Framework: 2.1 and 5.2.
1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist
Financial Implications Not relevant
Contracting Implications Not relevant
Quality Not relevant
Consultation / Engagement Not relevant
Equality and Diversity Not relevant
Information Governance Not relevant
Environmental Sustainability Not relevant
Human Resources Not relevant
2 Putting Barnsley People First
REGISTER OF INTERESTS
NHS Barnsley Clinical Commissioning Group
This register of interests includes all interests declared by members and employees of Barnsley Clinical Commissioning Group. In accordance with the Clinical Commissioning Groups constitution and the Clinical Commissioning Groups Accountable Officer will be informed of any conflict of interest that needs to be included in the register within not more than 28 days of any relevant event (e.g. appointment, change of circumstances) and the register will be updated regularly (at no more than 3-monthly intervals)
Register: Governing Body
GOVERNING BODY
Name Position Details of interest
Nick Balac Chair of Barnsley Partner at St Georges Medical Practice (PMS) Clinical Commissioning Practice holds Barnsley Clinical Commissioning Group Vasectomy contract Group Member Royal College General Practitioners
Member of the British Medical Association
Member Medical Protection Society
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GOVERNING BODY
Name Position Details of interest
The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG
Mehrban Ghani Medical Director for GP Partner at White Rose Medical Practice, Cudworth, Barnsley Barnsley Clinical Commissioning Directorship at SAAG Ltd, 15 Newham Road, Rotherham Group The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG
Madhavi GP Member Barnsley GP partner at The Grove Medical Practice Guntamukkala Clinical Commissioning Member of British Medical Association and member of Royal College of Group General Practitioners
The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG
John Harban GP Member Barnsley GP Partner at Lundwood Medical Centre and The Kakoty Practice, Barnsley Clinical Commissioning AQP contracts with the Barnsley Clinical Commissioning Group to supply Group Vasectomy, Carpal Tunnels and Nerve Conduction Studies services
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GOVERNING BODY
Name Position Details of interest
Owner/Director Lundwood Surgical Services
Wife is Owner/Director of Lundwood Surgical Services
Member of the Royal College of General Practitioners
Member of the faculty of sports and exercise medicine (Edinburgh)
The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG
Anne Marie Practice Manager Business Manager at The Kakoty Practice, Barnsley Hoyle Member Barnsley Clinical Cllr Alice Cave, BMBC Elected Councillor is related Commissioning Group Member of Yorkshire NAPC Steering Group
Director Barnsley Enterprise for Living Well (CIC)
Member of the Institute of Healthcare Management
The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG
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GOVERNING BODY
Name Position Details of interest
Nick Luscombe GP Member Barnsley GP partner at Huddersfield Road Partnership Clinical Commissioning Practice lead for a small dispensing branch surgery Group A fierce advocate of the adoption of first world standards of medical practice into Barnsley health care
Member of the British Medical Association but not actively
Medical student and F2 tutor for University of Sheffield
Lawrence King GP Member Barnsley Salaried GP at Kingswell Surgery Clinical Commissioning Local Medical Committee Member Group
Sudhagar GP Member Barnsley GP Partner at Royston Group Practice, Barnsley Krishnasamy Clinical Commissioning Member of the Royal College of General Practitioners Group GP Appraiser for NHS England
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GOVERNING BODY
Name Position Details of interest
Executive member of Barnsley Local Medical Committee
Member of the Medical Defence Union
Director of SKSJ Medicals Ltd
The practice is a member of Barnsley Healthcare Federation which may provide services for Barnsley CCG
Chris Millington Lay Member, Partner Governor Barnsley Hospital NHS Foundation Trust Barnsley Clinical Commissioning Group
Vicky Peverelle Chief of Corporate No interests to declare Affairs, Barnsley Clinical Commissioning Group
Brigid Reid Chief Nurse, Volunteer registered Nurse, St Gemma’s Hospice, 329 Harrogate Road, Barnsley Clinical Moortown, Leeds LS17 6QD Commissioning Partner works at Leeds Teaching Hospital NHS Trust which provides services Group to Barnsley patients via Specialised Commissioning and could tender to supply
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GOVERNING BODY
Name Position Details of interest
others.
Mark Smith GP Member Barnsley Senior Partner at Victoria Medical Centre also undertaking training and minor Clinical surgery roles. Commissioning Group
Lesley Smith Chief Officer, Husband is Director of Ben Johnson Ltd a York based business offering office Barnsley Clinical interiors solutions, furniture, equipment and supplies for private and public Commissioning sector clients. Group Board Member (Trustee), St Anne’s Community Services, Leeds Member of the Regional Leadership Council (RLC), Yorkshire and Humber Leadership Academy, Health Education England Chair, South Yorkshire Cancer Strategy Group Chief Officer lead, Working Together o Living With and Beyond Cancer Programme (in conjunction with McMillan Cancer Support) o CVD Stroke Chair, Working Together, Programme Executive Group
Mike Simms Secondary Care No interests to declare Clinician, Barnsley Clinical Commissioning Group
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GOVERNING BODY
Name Position Details of interest
Heather Wells Chief Finance Partner holds a Senior Management position with BUPA –potential supplier of Officer, Barnsley services to the NHS. Clinical Commissioning Group
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GB/Pu/16/06/06
Putting Barnsley People First
Minutes of the Meeting of the BARNSLEY CLINICAL COMMISSIONING GROUP GOVERNING BODY (PUBLIC SESSION) held on Thursday 12 May 2016 at 09.30 am in the Boardroom, Hillder House, 49/51 Gawber Road, Barnsley S75 2PY
MEMBERS PRESENT:
Dr Nick Balac (in the chair) Chair Dr Mehrban Ghani Medical Director Dr Madhavi Guntamukkala Member Dr John Harban Member Ms Marie Hoyle Member Dr Lawrence King Member Dr Sudhagar Krishnasamy Member Dr Nick Luscombe Member Mr Chris Millington Lay Member Ms Heather Wells Chief Finance Officer Mrs Lesley Smith Chief Officer Ms Brigid Reid Chief Nurse Mr Mike Simms Secondary Care Clinician
IN ATTENDANCE:
Mr Khawer Ashfaq Medicines Management Pharmacist (for minute reference GB 16/107 only) Mrs Chris Lawson Head of Medicines Optimisation (for minute reference GB 16/108 only) Mrs Susan Metcalf PTS Review Programme Lead (for minute reference GB 16/106 only) Ms Kay Morgan Governing Body Secretary Ms Hilary Mosley Health Improvement Nurse Principle (for minute reference GB 16/109 only) Mrs Vicky Peverelle Chief of Corporate Affairs Ms Kirsty Waknell Communications Manager
APOLOGIES:
Dr Mark Smith Member
MEMBERS OF THE PUBLIC:
Miss Alison Edwards CCG Quality Co-ordinator (observing member of CCG staff) Ms Nora Everitt Member of the Public Mrs Margaret Sheard Member of the Public
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GB/Pu/16/06/06
The Chairman welcomed members of the public to the Governing Body meeting.
Agenda Item Action Deadline
GB 16/99 QUORACY
The Chairman declared that the meeting was quorate.
GB 16/100 PATIENT STORY
The Governing Body received a Patient Story which reflected a positive experience about the support that a patient and his family had received from Dementia services, in particular the Memory Team. The Chairman invited the views of the Governing Body in relation to the Patient Story.
It was recognised that dementia patients were not necessarily aware of the impact of their illness on family members and interest from families was not always evident in every dementia case. The Story had provided a good example of service integration to provide holistic care and best outcomes for the patients and their families.
It was important to maintain the level and flexibility of Dementia services in Barnsley to prevent hospital and care home admissions. An evaluation of the Memory Team will come to the Governing Body in June 2016.
The Chief Nurse informed the meeting that 12 May 2016 was International Nurses Day. It was noted that a group of nurses from Primary Care were currently meeting to undertake work on infection control. The Chair commended the key contribution nurses were making to healthcare.
The Governing Body noted the Patient Story.
GB 16/101 DECLARATIONS OF INTEREST, SPONSORSHIP, HOSPITALITY AND GIFTS RELEVANT TO THE AGENDA
The Governing Body considered the Declarations of Interest Report. Dr N Luscombe commented that all GP elected members would have an interest in agenda item 11 Clinical Pharmacists.
The Chairman indicated that the use of clinical
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GB/Pu/16/06/06
Agenda Item Action Deadline
pharmacists in Primary Care was a national initiative. The CCG was investing in clinical pharmacists to improve outcomes for the people of Barnsley and address sustainability in Primary care in addition there would be no financial gain to Practices.
Agreed Action:
Dr J Harban’s declaration would to be updated to VP 09.06.16 read:
‘AQP contracts with the Barnsley Clinical Commissioning Group to supply Vasectomy, Carpal Tunnels and Nerve Conduction Studies services’.
GB 16/102 QUESTIONS FROM THE PUBLIC ON BARNSLEY CLINCIAL COMMISSIONING GROUP BUSINESS
The Chairman invited questions from the public.
Availability of Care Home Placements for People with Dementia
A member of the public referred to the Patient Story and her own personal experience of finding a care home placement for a relative with dementia. In response, the Chairman commented that there had been an increase in availability of dementia places within care homes. However, for more advanced cases of dementia placements were required in specialised care home secure units. There were however lesser numbers of these types of placements.
The numbers of very severe dementia cases may decline due to support provided from the Memory Team and a focus on providing cognitive skill sets for people with dementia. It was noted that there was also a wealth of support within the local community for people with dementia, their families and carers. The Chief Nurses commented that she had requested Healthwatch and the Barnlsey Metropolitan Borough Council to assist with guidance to relatives choosing a care home.
Public Involvement and Engagement
A member of the public extended an invitation to Governing Body members to attend a Barnsley Save our
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GB/Pu/16/06/06
Agenda Item Action Deadline
NHS Campaign Group public meeting on Saturday 14 May 2016.
The member of the Public referred to the NHS England publication NHS Citizen and public and patient involvement tool and queried the involvement of the public and patients in the Sustainability Transformation Plan (STP) and vanguards. A meeting had been held on 25 April 2016 but wider promotion and engagement was required.
The Chief Officer advised that there was a LS 12.05.16 Communication and Engagement Strategy for the STP and if there were deficiencies with Public engagement then this would need to be addressed. The Chief Officer and the member of the public agreed to further discuss this issue outside of the meeting.
GB 16/103 MINUTES OF THE PREVIOUS MEETING HELD ON 14 APRIL 2016
The Minutes of the meeting held on 14 April 2016 were verified as a correct record of the proceedings.
GB 16/104 MATTERS ARISING REPORT
The Governing Body considered the Matters Arising Report and the following main points were noted:
Minute reference GB 15/96 - Patient X-rays
It was reported that seven Practices could now access and view patient X-rays at Practice level. It was noted that GP NHS.net email addresses were required to access the system. The Chair of the Practice Managers Group was working to move this project at pace.
Minute reference GB 15/185, 14/347 & 15/210 - Hospital Discharge Notifications (D1 letters)
From a patient safety perspective it was agreed that a letter be sent to GPs, practice nurses, advanced nurse practitioners and Practice Managers as a matter of urgency to advise of the current difficulties with D1’s. MG 31.05.16
The Governing Body noted the Matters Arising Report.
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Agenda Item Action Deadline
STRATEGY
GB 16/105 REPORT OF THE CHIEF OFFICER
The Chief Officer updated the Governing Body on key issues and developments relevant to the strategic direction of the CCG.
The following key points were noted:
Yorkshire Ambulance Service
The Chief Officer referred members to the proposed changes to the way in which 999 and NHS 111 services will be commissioned and managed. From 1 April 2016 NHS Wakefield CCG will act as lead commissioner and contractor for 999 and the Greater Huddersfield CCG for NHS 111.
Discussion took place. In response questions raised it was noted that:
Performance of the contract will be monitored and managed by the relevant lead commissioner and contractor. A contract performance floor level would be determined for all CCGs, with reference to quality and safety measures.
A hub and spoke type model of emergency services, linked to the Urgent and Emergency Care Network Strategy would be introduced.
The proposed changes formalised responsibilities in relation to the commissioning, contracting and performance management of 999 and NHS 111 Service.
The CCG had previously diverted management time to address poor performance. In future this would be handled by the lead commissioner and the new arrangements would bring economies of scale.
An explanation was provided regarding the terminologies of ‘hear and treat’ and ‘see and treat’. The role and use of Rightcare Barnsley by the ambulance and NHS 111
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Agenda Item Action Deadline
service in the provision of care for Barnsley people was highlighted.
The Chairman concluded discussion indicating that the new arrangements demonstrated excellent principles of collaboration and would lead to a reduction in health inequalities.
South Yorkshire and Bassetlaw Sustainability Transformation Plan (STP)
The Chief Officer provided feedback from a meeting to discuss the STP held on 11 May 2016. It had been recognised that South Yorkshire and Bassetlaw had a long history of working successfully together and had established itself in terms of a collaborative. However the ability of the collaborative to deliver at scale and pace was questioned.
The Chief Officer advised that an STP event will be held on 10 June 2016. She would raise comments received about the involvement of the public in the STP at the event.
Barnsley Accountable Care Partnership Board
It was noted that the Barnsley Hospital NHS Foundation Trust had confirmed their intention to become a partner of the Barnsley Accountable Care Partnership Board. The Barnsley Hospice will also be invited to attend the Board in a non-voting capacity.
The Governing Body approved the proposed changes to the way ambulance services are commissioned going forward including:
i) The Strategic Approach to Commissioning Ambulance 999 & NHS 111 Services in Yorkshire and the Humber 2015-2019
ii) The Memorandum of Understanding for the collaborative commissioning of 999 ambulance services between Clinical Commissioning Groups across Yorkshire and the Humber.
iii) The Memorandum of Understanding for the collaborative commissioning of NHS 111
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Agenda Item Action Deadline
services between Clinical Commissioning Groups across Yorkshire and the Humber.
And noted the report for Governing Bodies which sets out the proposal for the collaborative commissioning of 999 & NHS 111 services by Yorkshire and Humber CCGs, with a lead commissioner/contractor.
Agreed actions:
To query public engagement and involvement in LS 09.06.16 development of the STP at an STP event on 10 June 2016
The Governing Body noted the contents of the Chief Officer Report.
QUALITY AND GOVERNANCE
GB 16/106 PTS REVIEW PAPER
The PTS Review Programme Lead provided the Governing Body with the final report of the four South Yorkshire CCGs on the outcome of the South Yorkshire- wide Patient Transport Services. Members noted the project risks and the roles and responsibilities for the PTS Procurement Team. It was highlighted that there was a role for a clinical lead on the Procurement Team.
The Chairman highlighted that engagement in the review had predominantly been from the Sheffield area. In response the PTS Review Programme Lead clarified that wider representation would be acquired from all CCGs within the review. It was noted that the review provided a real opportunity to commission a quality service for patients who regularly use and depend on the patient Transport service.
The Governing Body approved the following recommendations:
That patient transport services should be procured on a South Yorkshire CCG-wide basis (Sheffield, Rotherham, Doncaster and Barnsley
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Agenda Item Action Deadline
CCGs)
The procurement route should be the Competitive Dialogue procedure carried out in accordance with The Public Contracts Regulations 2015
That lot 2 for core PTS services should be procured on the basis of a Lead Provider Model
The length of contract should be 5 years plus an option to extend for a year and then a further year (5+1+1). This will enable providers to invest in the service, finance fleet, implement new technology and continually improve services.
There should be a separate Any Qualified Provider (AQP) procurement for a ‘Take, Go and Collect’ service for repatriations and transport to care homes out of area from hospital to put in place a framework of qualified providers who can undertake these journeys.
Agreed Actions
The Practice Manager Member and Lay Member to MH/CM/S 09.06.16 be involved in development of services and public M engagement approach.
To request expressions of interest for the clinical KM 09.06.16 lead role on the PTS Procurement Team and advise the PTS Review Programme Lead accordingly.
GB 16/107 REVIEW OF THE “AUTOMATED DISPENSING – IN PATIENT AUTOMATION PROJECT” BUSINESS CASE
The Lead Medicines Management Pharmacist provided the Governing Body with an update on the “Automated Dispensing- inpatient automation program” at the Barnsley Hospital NHS Foundation Trust (BHNFT).
With regard to Patient Hospital Discharge Letters (D1’s) the Medical Director explained that inaccuracies in prescribing occurred before submission to the pharmacy. It was noted that ward based pharmacists and electronic prescribing could reduce medication errors. Cultural issues would also need to be addressed to improve the quality and timeliness of D1’s.
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GB/Pu/16/06/06
Agenda Item Action Deadline
The original business case for the pharmacy automation project had indicated that there would be a release of manpower in pharmacy and a redeployment of pharmacists to work at ward level. The meeting was advised that a skill reassessment of pharmacists had been undertaken and there was an increased presence of pharmacists in ward areas.
The Chairman indicated that the CCG would not be complacent with regard to the return on investment.
The Governing Body noted the report.
Agreed Actions
To develop an action plan to acquire additional value MG/KA 09.06.16 for the CCGs investment in the Pharmacy automation scheme.
GB 16/108 CLINCIAL PHARMACISTS
The Head of Medicines Optimisation presented the Governing Body with an overview about the introduction of Clinical Pharmacists into Primary Care Settings across Barnsley. It was noted that the business case for the programme had been approved by the Governing Body and Membership Council.
The Head of Medicines Optimisation reported that the interviews for the clinical pharmacist posts would be on 18 and 19 May 2016 with pharmacists commencing in post from June to September 2016. The pharmacists would be inducted and supported by the Medicines Optimisation Team. It was noted that the Scheme would be monitored to quantify return of investment.
It was highlighted that the clinical pharmacist service would increase capacity in Primary Care and assist with the shortage of GPs. The service would be promoted to Practices and patients. The Chief Nurse commented that the ‘First Port of Call' Training would incorporate the clinical pharmacist and social prescribing schemes.
The Governing Body noted the report and that Clinical pharmacist into Primary Care was an invest to save scheme, would increase capacity in primary
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Agenda Item Action Deadline
Care.
GB 16/109 COMMUNITY SHOP
The Health Improvement Nurse Principle provided the Governing Body with an update on how the previous CCG grant to the Community Shop was facilitating and enhancing the health offer that they provide. The Chairman commented that the CCG’s investment had enabled empowerment of people to help themselves and others. It was noted that an additional Community Shop would be opened in Athersley by the Autumn 2016
As a social presence, it was recognised that the Community Shop and other similar organisations, in partnership with the CCG and local area council networks could help deliver the strategic local agenda for the people of Barnsley.
The Governing Body noted the Community Shop Update.
Agreed Actions:
The Health Improvement Nurse Principle and Mrs HM 09.06.16 Margaret Sheard to further discuss partnership working between the company shop and area council networks,
GB 16/110 RISK AND GOVERNANCE EXCEPTION REPORT
The Chief of Corporate Affair’s provided the Governing Body with the Risk and Governance Exception Report, including the full Register of Interests and an update on the process for appointing the CCG’s External Auditors from 2017/18.
Risk Register
The Chairman commented that the score for risk reference CCG 14/10, ‘Capacity of Primary Care’, would decrease with the introduction of Clinical Pharmacists.
The Governing Body:
Agreed:
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Agenda Item Action Deadline
That the red (extreme) risks on the GBAF were appropriately scored and there is sufficient assurance that they are being effectively managed as at 12 May 2016
Reviewed and Noted
The risks rated as extreme on the Risk Register The risks escalated from the Risk Register as gaps in control against risks on the Assurance Framework The Registers of Interests, Sponsorship, Gifts and Hospitality The update regarding the procurement of the External Audit service from 2017/18.
The Governing Body did not Identify any positive assurances relevant to the risks on the GBAF
FINANCE AND PERFORMANCE
GB 16/111 INTEGRATED PERFORMANCE REPORT
The Chief Finance Officer and Chief of Corporate Affairs introduced the Integrated Performance Report to the Governing Body.
Finance
The Chief Finance Officer informed the meeting that subject to audit , the CCG was reporting the achievement of all financial targets and duties , including a surplus £8,280,000 in line with NHS England expectations.
No significant issues had been identified by the external auditors at this point. However, further work around third party assurances was required to complete the audit.
The Audit Committee would consider the CCG’s Annual Report and Accounts, together with documentation from internal and external auditors on 23 May 2016, prior to making recommendations to the extraordinary meeting of the Governing Body on 26 May 2016.
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Agenda Item Action Deadline
Performance
The Chief of Corporate Affairs presented the CCGs key performance indicators and exception report. It was noted that year to date performance against the A&E 4 hour indicator was at 93% for April 2016. This improved performance needed to be sustained and this was being monitored via the Systems Resilience Group.
In response to questions raised about diagnostic tests the Chief of Corporate Affairs clarified that the dip in performance was linked to the industrial action by junior doctors and the impact of Easter bank holidays in March 2016. It was further confirmed that diagnostic tests were being undertaken at weekends.
The Governing Body noted the contents of the report including:
2015/16 performance to date year end financial outturn the delivery of all financial duties, subject to the findings and opinion of external audit.
COMMITTEE REPORTS AND MINUTES
GB 16/112 MINUTES OF THE MEMBERSHIP COUNCIL HELD ON 15 MARCH 2016
The Governing Body noted the minutes of the Membership Council held on 15 March 2016.
GB 16/113 MINUTES OF THE AUDIT COMMITTEE HELD ON 28 APRIL 2016
The Governing Body received the minutes of the Audit Committee held on 28 April 2016. It was noted that the Audit Committee had considered the NHS Barnsley CCG 2015/16 Annual Report and Accounts in detail and had proposed some amendments. The Committee had been assured on the quality, accuracy and robustness of the Annual Report and Accounts.
Agreed Action
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Agenda Item Action Deadline
The Governing Body agreed to convey their LS 09.06.16 appreciation to Ms Anne Arnold for her support to and chairing of the Audit Committee and to the Finance and Corporate Affairs Team for their work on the CCG’s Annual Report, Annual Governance Statement and Annual Accounts.
GB 16/114 MINUTES OF THE FINANCE AND PERFORMANCE COMMITTEE HELD ON 7 APRIL 2016
The Governing Body received the minutes of the Finance and Performance Committee held on 7 April 2016. A typographical error was noted on page 4, first bullet point to read: ‘The majority of activity and finance proposals have been agreed’.
GB 16/115 MINUTES OF THE PATIENT AND PUBLIC ENGAGEMENT COMMITTEE HELD ON 24 MARCH 2016
The Committed considered the minutes of the Patient and Public Engagement Committee held on 24 March 2016. It was noted that:
All CCG commissioning managers were utilising the Engagement Toolkit and checklist. The Patient Council were to review the CCG Engagement Strategy.
GB 16/116 PRIMARY CARE COMMISSIONING COMMITTEE ASSURANCE REPORT
Mr C Millington highlighted that the Primary Care Commissioning Committee had reviewed the prioritisation of the Primary Care Transformation Fund Bids and noted the year-end financial position in respect of the Primary Care Commissioning delegated budget. The Chairman commented that the CCG had made significant investment in Primary Care.
The Chief of Corporate Affairs advised that the Primary Care Transformation Fund was primarily to resource estates and technology proposals. It was noted that the portal for submission of proposals was between the 2 and 30 June 2016.
The Governing Body noted the Primary Care
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Agenda Item Action Deadline
Commissioning Committee Assurance Report.
Agreed Action:
To inform Practices regarding the outcome of the VP 20.05.16 prioritisation of the Primary Care Transformation Fund Bids.
To distribute the final guidance and template for VP 09.06.16 Primary Care Transformations bids to practices when received by the CCG.
GB 16/117 CLINICAL TRANSFORMATION ASSURANCE REPORT
The Governing Body noted the Commissioning Assurance Transformation Board Clinical Transformation Assurance Report.
GB 16/118 MINUTES OF THE HEALTH AND WELLBEING BOARD HELD ON 5 APRIL 2016
The Governing Body noted the minutes of the Health and Wellbeing Board held on 5 April 2016.
GB 16/119 MINUTES OF THE COMMISSIONERS WORKING TOGETHER BOARD HELD ON 2 FEBRUARY 2016
The Governing Body noted the minutes of the Commissioners Working Together Board held on 2 February 2016.
GENERAL
GB 16/120 GOVERNING BODY ASSURANCE WORK PLAN AGENDA AND TIMETABLE
Members received the Governing Body Work Plan / Agenda Timetable 2016/17. The Chief Nurse indicated that she had submitted comments for updating of the work plan to the Governing Body Secretary.
GB 16/121 QUESTIONS FROM THE PUBLIC
The Chairman invited questions from the public.
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Hospital Discharge Summary Letters (D1’s)
A member of the public referred to problems previously discussed about D1’s and asked if the Governing Body intended to take action to resolve issues? In response it was advised that the quality and timeliness of D1’s had been a long standing concern of the CCG and Primary Care. The Chairman said that the public could be assured that the CCG had taken all necessary action and were supporting the Barnsley Hospital NHS Foundation Trust (BHNFT) to bring about the required improvement in D1’s. The CCG has received assurance from the BHNFT that action was being taken to improve D1’s.
Patient Transport
In response to a questions raised it was clarified that the safeguarding of patients would be a key quality element Patient Transport Service Specification. The Chief Nurse clarified that within the last three years there had been no Serious Incidents relating to Patient Transport Services.
Community Pharmacists
A member of the public highlighted that the public would not necessarily be aware about the differences between Community Pharmacists and Clinical Pharmacists and advised of intended budget cuts for Community Pharmacies.
The Chairman indicated that unfortunately it was not with in the CCG’s power to influence nationally imposed budget reductions for Community Pharmacists. The CCG would however continue to provide support for Community Pharmacists.
Agreed Action
Mr C Millington and Ms Kirsty Waknell with the /KW/NE 09.06.16 member of the public raising the question to consider the Comms messages to the public in respect of the Primary Care Clinical pharmacists Scheme.
GB 16/122 DATE AND TIME OF THE NEXT MEETING
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The next meeting of the Governing Body will be held on:
Thursday 9 June 2016 at 9.30 am, Grimethorpe Pentecostal Church, Brierley Road, Grimethorpe, Barnsley S72 7EH
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GB/Pu/16/06/07
Putting Barnsley People First
Minutes of the Meeting of an Extraordinary Meeting of the BARNSLEY CLINICAL COMMISSIONING GROUP GOVERNING BODY held on Thursday 26 May 2016 at 09.30 am in the Boardroom, Hillder House, 49/51 Gawber Road, Barnsley S75 2PY
MEMBERS PRESENT:
Dr Nick Balac (in the chair) Chair Dr Mehrban Ghani Medical Director Dr Madhavi Guntamukkala Member Dr John Harban Member (from minute reference GBEO 16/03 03.1) Ms Marie Hoyle Member Dr Sudhagar Krishnasamy Member Dr Nick Luscombe Member Mr Chris Millington Lay Member (from minute reference GBEO 16/03 03.1) Dr Mark Smith Member Ms Heather Wells Chief Finance Officer Ms Brigid Reid Chief Nurse Mr Mike Simms Secondary Care Clinician
IN ATTENDANCE:
Ms Anne Arnold Interim Chair Audit Committee Ms Kay Morgan Governing Body Secretary Mr Richard Walker Head of Assurance Ms Linda Wild KPMG Audit Manager
APOLOGIES:
Dr Lawrence King Member Mrs Vicky Peverelle Chief of Corporate Affairs Mrs Lesley Smith Chief Officer
Agenda Item Action Deadline
GBEO QUORACY 16/01 The Chairman declared that the meeting was quorate.
GBEO DECLARATIONS OF INTEREST, SPONSORSHIP, 16/02 HOSPITALITY AND GIFTS RELEVANT TO THE AGENDA
No declarations of interest, sponsorship, hospitality and gifts relevant to the agenda were received.
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GB/Pu/16/06/07
Agenda Item Action Deadline
GBEO NHS BARNSLEY CCG ANNUAL REPORT AND 16/03 ACCOUNTS 2015/16
The Governing Body were presented with the CCG’s Annual Report, Governance Statement and Accounts and advised that the Audit Committee had reviewed the documents in detail. The Audit Committee recommended that Governing Body:
Approve and adopt the Annual Report and Accounts 2015/16 Authorise the Accountable Officer to sign and date the Performance Report, Accountability Report, the Governance Statement, the Statement of Accountable Officers Responsibilities and the Statement of Financial Position on the CCG’s behalf Authorise the Chair and Accountable officer to sign and provide to KPMG the Management Representation Letter 2015/16.
The interim Chair of the Audit Committee commented that the production of the Annual Report and Accounts was a significant exercise undertaken each year to defined timescales. The Audit Committee had recognised that despite losing two key members of staff there had been a strong team effort in producing the year end accounts.
The Audit Committee had undertaken scrutiny including a ‘page turner’ review of the draft Annual Report, Governance Statement and Accounts on 28 April 2016 and reviewed these documents again on 23 May 2016. All amendments proposed by the Audit Committee had been incorporated into the final documents presented before the Governing Body.
The Chief Finance Officer advised the Governing Body that subsequent to the Audit Committee meeting on 23 May 2016:
Two outstanding Service Auditors Reports had been received from NHS Business Services Authority regarding Prescription Services, and HSCIC regarding GP Payments Services. These had been reflected in the CCG’s Governance Statement.
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GB/Pu/16/06/07
Agenda Item Action Deadline
At 4.00 pm on 25 May 2016 the External Auditors had advised the CCG of a mapping error in NHSE’s Accounts template. This has affected all CCGs with level 3 co-commissioning status but was a purely presentational error with no impact on the CCGs financial targets.
03.1 Annual Report & Governance Statement
The Head of Assurance presented the Annual Report to the Governing Body. It was noted that the draft Annual Report had been received by the Governing Body in April 2016.
The Head of Assurance drew members attention to:
The Statement as to Disclosure from each individual member of the Governing Body. It was clarified that this confirmation would also be sought from Governing Body members who were absent from the meeting.
The proposed amendments to section 4.9.3, ‘Third Party Assurances’ in respect of a Service Auditor Report from PwC for HSCIC’s GP Payments Services. The CCG had determined that the issues identified in the HSCIC letter did not represent a significant risk to the CCG in terms of materiality and in the light of other compensating controls operated by the CCG.
The Governing Body noted and approved the revised text for section 4.9.3.
In response to a questions raised, it was clarified sections 5.2.1 (Salaries and Allowances) and 5.2.2 (Pension Benefits) were subject to Audit review and this was reflected in the KPMG Opinion. The figures recorded in these sections were also confirmed to be correct.
The Governing Body approved the Chief Officer as Accountable Officer to sign off the relevant sections of the Performance Report and Accountability Report.
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GB/Pu/16/06/07
Agenda Item Action Deadline
03.2 Annual Accounts
The Chief Finance Officer presented the Governing Body with the CCG’s Annual Accounts 2015/16. It was noted that the CCG had met all its required financial targets.
The Governing Body considered the Annual Accounts and approved the Chief Officer as Accountable Officer to sign off the financial statements.
03.3 KMPG ISA 260 Summary of Audit Findings 2015/16
The KPMG Manager presented the Governing Body with the ISA 260 Summary of Audit Findings. The KPMG Manager reported that KPMG intended to issue an unqualified audit opinion on the accounts and an unqualified value for money conclusion, following the Governing Body adoption of them on 26 May 2016 and receipt of the signed accounts and Management Representation Letter. There were no recommendations in respect of the CCGs control environment.
The KPMG Audit Manager reported that there had been a slight delay in preparation for the audit, unfortunately, the hard copy working papers provided for the audit were not cross referenced or provided en-bloc electronically as requested.
It was recognised that despite losing two key members of staff from the Finance Team, there had been a strong team effort in producing the year end accounts. Looking ahead the learning from this year’s audit process would be incorporated into a revised year end timetable to ensure all required information was available at the specified time for year-end audits in future years.
The KPMG Audit Manager drew members’ attention to the proposed fee for the audit £57,050 plus VAT. It was noted that the fee was £800
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GB/Pu/16/06/07
Agenda Item Action Deadline
above that highlighted within the audit plan and this was due to additional audit resource required as a result of the working papers provided for the audit not being in line with agreed expectations. In addition as a result of carrying out additional audit procedures via NHSE to gain assurance on Co-commissioning expenditure extra fees will be charged. Approval would be sought from the Chief Finance Officer and Public Sector Audit Appointments Limited for the increase in audit fee.
03.4 Head of Internal Audit Opinion & Annual Report 2015/16
The Governing Body received and noted the Head of Internal Audit Opinion & Annual Report 2015/16.
03.5 Annual Report of the Local Counter Fraud Specialist 2015/16
The Governing Body received and noted the Annual Report of the Local Counter Fraud Specialist 2015/16
03.6 Management Representation Letter
The Governing Body received the Management Representation Letter and approved the letter for sign off by the Chairman and Chief Officer as Accountable Officer. The letter reflected the national template and no additional disclosures specific to Barnsley CCG were proposed or required.
03.7 Statement as to Disclosure to Auditors
It was noted that this item had been previously discussed under minute reference GB EO 16/03 3.1.
03.8 Approval and Adopt the Annual report and Accounts and approve the letter of Representation
The Governing Body:
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GB/Pu/16/06/07
Agenda Item Action Deadline
Confirmed that the Statement as to Disclosure to Auditors is accurate Approved and adopted the Annual Report and Accounts 2015/16 Authorised the Accountable Officer to sign and date the Performance Report, the Governance Statement, the Statement of Accountable Officer’s Responsibilities, the Accountability Report, and the Statement of Financial Position on the CCG’s behalf.
GBEO DATE AND TIME OF THE NEXT MEETING 16/04 The next meeting of the Governing Body will be held on:
Thursday 9 June 2016 at 9.30 am, Grimethorpe Pentecostal Church, Brierley Road, Grimethorpe, Barnsley S72 7EH
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GB/Pu/16/06/08
Putting Barnsley People First
GOVERNING BODY
9 June 2016
MATTERS ARISING REPORT The table below provides an update on actions arising from the previous meeting of the Governing Body (public session) held on 12 May 2016. Table 1
Minute ref Issue Action Outcome/Action
GB 16/101 Declarations of Interest, Sponsorship, Hospitality and Gifts Relevant to the Agenda
To amend Dr J Harban’s declaration VP COMPLETE and update Register to read:
AQP contracts with the Barnsley Clinical Commissioning Group to supply Vasectomy, Carpal Tunnels and Nerve Conduction Studies services.
GB 16/102 Questions from the Public – Public Involvement & Engagement STP
The Chief Officer and the member LS COMPLETE of the public to further discuss Public Involvement & Engagement in the South Yorkshire and Bassetlaw Sustainability Transformation Plan outside of the meeting.
GB 16/105 Report of the Chief Officer – South Yorkshire and Bassetlaw Sustainability Transformation Plan
To query public engagement and LS COMPLETE involvement in development of the STP at an STP event on 10 June 2016
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Minute ref Issue Action Outcome/Action
GB 16/106 PTS Review Paper
The Practice Manager Member and MH CM COMPLETE Lay Member to be involved in SM development of services and public engagement approach.
To request expressions of interest KM COMPLETE for the clinical lead role on the PTS Procurement Team and advise the PTS Review Programme Lead accordingly.
GB 16/107 Review of the “Automated Dispensing – In Patient Automation Project” Business Case
To develop an action plan to acquire MG KA additional value for the CCGs investment in the Pharmacy automation scheme.
GB 16/109 Community Shop
The Health Improvement Nurse HM Principle and Mrs Margaret Sheard to further discuss partnership working between the company shop and area council networks.
GB 16/113 Minutes of The Audit Committee held on 28 April 2016
To convey their appreciation to Ms LS COMPLETE Anne Arnold for her support to and chairing of the Audit Committee and to the Finance and Corporate Affairs Team for their work on the CCG’s Annual Report, Annual Governance Statement and Annual Accounts.
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Minute ref Issue Action Outcome/Action
GB 16/116 Primary Care Commissioning Committee Assurance Report
To inform Practices regarding the VP COMPLETE outcome of the prioritisation of the Primary Care Transformation Fund Bids.
To distribute the final guidance and VP COMPLETE template for Primary Care Transformations bids to practices when received by the CCG.
GB 16/121 Questions from the Public – Community Pharmacists
Mr C Millington and Ms Kirsty CM KW COMPLETE Waknell with the member of the NE public who raised the original question to consider the Comms messages to the public in respect of the Primary Care Clinical pharmacists Scheme
1. ITEMS FROM PREVIOUS MEETINGS CARRIED FORWARD TO FUTURE MEETINGS Table 2 provides an update/status indicator on actions arising from earlier Board meetings held in public. Table 2
Minute Issue Action Outcome/Actions Ref GB 15/42 Terms of Reference Clinical Senate
The Chairman to ascertain interest NB Pending – Dr M in the membership of the Clinical Guntamukkula to attend Senate from GPs. Clinical Senate
GB 15/96 Summary of Lorenzo demonstration Pharmacy Robot
Patient X-rays to be made VP In Progress. Seven available to respective GPs Practices can access & view Patient X-rays at Practice level. GP NHS.net email address required to access the system. The Chair of the Practice Managers Group Page 3 of 5
Minute Issue Action Outcome/Actions Ref is working at pace to move this project forward.
GB 15/155 Report of the Chief Officer – Establishment of Urgent and Emergency Care Networks
To raise transfer of work from the HW/VP To build into contract District Nursing Service to Primary discussions after evidence Care at the South West Yorkshire provided through NHS Partnership Trust through membership. No Contracting arrangements. evidence provided as yet.
GB 15/185 Hospital Discharge Notifications 14/347 & 15/210 To write to GPs, Practice Nurses, MG Advanced Nurse Practitioners and practice Managers advising of the current difficulties with D1’s and that information provided in D1’s should be where appropriate checked for accuracy.
GB 15/193 Minutes of the Patient and Public Schedule completed Engagement Committee (16 July detailing all participating 2015) Practices: RAG rated for clarity To provide updates on the Patient CM Partner Telephone System to the All work in line with action Governing Body plans is ongoing to resolve issues around the Patient Partner Telephone System
Patient Partner System to be promoted to Practices.
Progress reported requested from Mike Austin
GB 15/182 Minutes of the Clinical Transformation Board 1 October 2015
To consider and proposed options NB/VP Corporate processes for a consistent approach to the being renewed provision of minutes to the 09.05.2016. Governing Body on 10 December 2015. Page 4 of 5
Minute Issue Action Outcome/Actions Ref
GB 15/307 Integrated Performance Report
To determine the commencement VP Bid included for Primary date for provision of primary care Care Transformation Fund triage by i-Heart Barnsley in the A&E Department at BHNFT
GB 16/67 The Chief Officer agreed to communicate to both providers the CCG’s frustration that the A & E Department were not diverting LS COMPLETE patients to the I HEART service and how these two providers could work together to benefit each other.
GB 16/76 QUARTERLY UPDATE ON CHILDRENS SERVICES
The Chief Nurse to submit a report BR COMPLETE - Scheduled about Education, Health and Care for Governing Body Plans and the role of the Agenda 9 June 2016 Designated Clinical Officer to the next meeting of the Governing Body on 12 May 2016.
GB 16/77 UPDATE ON CHILD SEXUAL EXPLOITATION
The Chief Nurse agreed to acquire BR 327 Licensed drivers have the detail of CSE training and received safeguarding report back to the next meeting of training focussed on the Governing Body on 12 May drivers coming into 2016. contact with vulnerable children and adults. All remaining 367 drivers will complete training by no later than end of July.
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GB/Pu/16/06/09
Putting Barnsley People First
GOVERNING BODY
9 June 2016
REPORT OF THE CHIEF OFFICER
1. PURPOSE OF THE REPORT
To update the Governing Body on key issues and developments relevant to the strategic direction of the CCG.
2. EXECUTIVE SUMMARY
This report provides an update on the following issues:
Stronger Communities Partnership Medical Interoperability Gateway (MIG) Project Update Year End Assurance Letter Pre-consultation for children’s surgery and anaesthesia and hyper acute stroke services – to note the report Communications and engagement strategy and the future plans for public consultation comments.
3. THE GOVERNING BODY IS ASKED TO:
Note the report and provide comment on the communications and engagement strategy and the future plans for public consultation for children’s surgery and anaesthesia and hyper acute stroke services.
Agenda Item – 10 Minutes Allocation of Time
Report Of Lesley Smith
Designation Chief Officer
1
GB/Pu/16/06/09 1. DISCUSSION / ISSUES
1.1 STRONGER COMMUNITIES PARTNERSHIP
The Stronger Communities Partnership Group met on the 24 May 2016. The key elements of the meeting were as follows:
1) The terms of reference were agreed which included the vision:
'Through collaborative working we aim to ensure a coordinated approach to prevention and early intervention, ensuring that individuals and families have easy access to all forms of early help, making best use of their own skills and resources and preventing needs escalating. Wherever possible we will work in a co-productive manner focusing on ‘what works’. We recognise that achievement of our vision will require a longer-term shift to focusing on the causes rather than symptoms of need but with the benefit of better outcomes and reduced demand on more costly, specialist services.'
2) There was a discussion regarding the development of the 4 delivery groups for; early help (all ages), early help (children), resilient and healthy communities and anti-poverty and the progress these groups are making.
Early Help (Children). Children's centres converted into family centres successfully. Early help for children booklet available. Explains offer to children.
Early help (adults) - delivered 2 workshops - social prescribing and falls. It is also overseeing the universal information and advice work which is nearing completion.
Anti-poverty. Teams have been brought together and co located at civic centre to assist with coordination of information and advice. Further efforts to review ways of working and self-serve methods.
3) Development of an All Age Early Help Plan for the Borough. The SCP have agreed the development of this which will be borough wide. Fundamental to this is an agreed set of definitions, principles and outcome measures which will be shared at a later date.
4) Housing and Health update. Berneslai Homes are the managing agent on behalf of BMBC responsible for the management and maintenance of 18,800 council houses. They deliver a range of core and added value services detailed below:
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GB/Pu/16/06/09
1.2 MEDICAL INTEROPERABILITY GATEWAY (MIG) PROJECT UPDATE
Of the 36 practices in Barnsley, 30 practices have switched on the MIG to date. A further 2 practices are expecting to switch the MIG on. The remaining 4 practices will be contacted individually to try and work through any outstanding issues.
Work has commenced to rollout access to the MIG with the Barnsley Hospice, BHNFT and SWYPFT in the next phase.
1.3 YEAR END ASSURANCE LETTER
The CCG had its Annual Review Meeting for 2015/16 on 19 April 2016. A copy of the informal feedback letter is attached at Appendix A. NHS England’s assessment of the CCG against the five assurance components has been reported as GOOD, subject to regional and national moderation.
1.4 COMMISSIONERS WORKING TOGETHER PROGRAMME CHILDREN’S SURGERY AND ANAESTHESIA AND HYPER ACUTE STROKE SERVICES
Pre-consultation for children’s surgery and anaesthesia and hyper acute stroke services
Between January and April 2016, the CWT Programme held an open pre- consultation for the review of children’s surgery and anaesthesia services and also hyper acute critical care services across the region.
The purpose of the pre-consultation communications and engagement work was to gather views to inform plans and the development of the options for future service configuration. These options will inform the consultation that will be opening to the public in September 2016.
3
GB/Pu/16/06/09 Complementing the overarching communications and engagement activity and support from the core team, local CCG based activity was also carried out. Each CCG followed similar methods and approaches for engaging with their respective stakeholders and local populations. A copy of the report is attached at Appendix B; page 4 of the report explains the methods and approaches for engaging with stakeholders and the local population in Barnsley.
Communications and engagement strategy and the future plans for public consultation
During the pre-consultation phase views were gathered from key stakeholders to inform plans for future service configuration and consultation.
Preparations are now underway to enter a 12 week or 16 week public consultation (depending on guidance from the OSC) on the options for reconfiguring children’s surgery and anaesthesia and hyper acute stroke services across our commissioning and provider partners in the region. The draft Strategy is attached at Appendix C, and Governing Body is asked for comment.
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Direct 0113 82 47511 NHS England – North (Yorkshire & the Date:26/05/16 Humber) 3 Leeds City Office Park Meadow Lane Leeds LS11 5BD
Dr Nick Balac, Chair Lesley Smith, Accountable Officer Barnsley CCG
Dear Nick and Lesley
RE: CCG 2015/16 ANNUAL REVIEW
Thank you for meeting with us on 19 April for your Annual Review Meeting. The purpose of this letter is to provide informal feedback on the key issues we discussed, and to confirm next steps for the publication of the 2015/16 CCG Headline Assurance Assessment.
We discussed the good work in 2015/16 on Rightcare Barnsley in establishing a single point of access, and on the development of primary care. The CCG has maintained a focus on health inequalities, through the HIT scheme, and implemented some innovative work in general practice workforce which we would like to share across Y&H. We also acknowledged the improved relationships between the CCG and the hospital Trust which has resulted in an agreed contract for 2016/17 within the nationally-required timescales. I congratulated the CCG on ensuring continued improvement through your commissioning for the people of Barnsley.
The sustainability of local acute services remains an issue. You described the work in progress to develop a strategic solution to this, through the development of an Accountable Care Organisation (ACO) and the wider Sustainability and Transformation plan (STP) work on acute services. The CCG has started to consider what the STP and ACO will mean for the overall governance structure of the CCG.
We acknowledged the work that is underway to develop the STP for South Yorkshire & Bassetlaw. I thanked Lesley for her significant contribution to date in drawing the STP together. Your continued leadership and clinical engagement from the wider CCG membership will be essential to the successful delivery of the plan. As part of the STP, we expect to see the successful completion of the work on hyper acute stroke and children’s services within 2016/17. As we discussed there is excellent work being undertaken collaboratively, but it is essential for the sustainability of services that the implementation of these plans moves at pace.
We discussed the achievement of NHS Constitution standards, and agreed that the necessary improvement in A&E performance in 2016/17 will require a step change in the service model, which is being led through the STP. It will be important for you to ensure that the STP addresses this within 2016/17 in order to secure improved emergency access for your population.
Whilst there is still work to do, in order to finalise the Better Care Fund plan, we discussed the strength of the 2016/17 Operating Plan and the work the CCG has done to firmly embed the Right Care approach in their QIPP planning.
We discussed the annual assurance assessment of the CCG, in the context of the 2015/16 CCG Assurance Framework. Our assessment of your CCG, against the five assurance components, is as follows:
Well Led Delegated Financial Performance Planning Organisation Functions Management Good Good Good Good Good
It is important to note that this assessment is provisional, and subject to regional and national moderation.
As you will be aware, NHS England is required in the 2016/16 Mandate for the NHS, to publish a Headline Assessment of the CCG by the end of June. The Headline Assessment will be determined by the lowest of the assessments across the five components.
It is clear from our discussions that the CCG is continuing to improve and delivering well through your leadership and the hard work of the organisation. Thank you.
I will write to you again at the end of June, with your finalised Headline Assurance Assessment. In the meantime, please do not hesitate to contact Alison Knowles or Mark Janvier should you require any further information.
Yours sincerely
Moira Dumma Director of Commissioning Operations
Communications and engagement report: pre- consultation for children’s surgery and anaesthesia and hyper acute stroke services
April 2016
1. Introduction
As Commissioners Working Together (CWT), we are a collaborative of eight clinical commissioning groups (CCGs) across South and Mid Yorkshire, Bassetlaw and North Derbyshire and NHS England.
Some people have better experiences, better outcomes and better access to services than others – and to ensure that everyone experiences the highest quality and safest service possible, we are working with all local hospitals and care providers, staff and patient groups to understand how best to do this for the benefit of everyone in the region.
Over the last year, we have focused on four key areas – reviewing both hyper acute stroke and children’s surgery and anaesthesia services, urgent and emergency care and have also developed a partnership with Macmillan for people living with and beyond cancer.
Between January and April 2016, we held an open pre-consultation for the review of children’s surgery and anaesthesia services and also hyper acute critical care services across the region.
The purpose of the pre-consultation communications and engagement work was to gather views and input to inform plans and the development of the options for future service configuration. These options will inform our consultation that will be opening to the public in September 2016.
2. Methods and approach
During pre-consultation, we focused our efforts on three key groups:
Patients, carers, families and the wider public
Clinicians and staff working in the services
Place-based stakeholders such as Overview and Scrutiny Committees (OSCs), Health and Wellbeing Boards, MPs and other interested groups.
A comprehensive stakeholder map – developed with input from all CCGs – helped to shape and inform the approach and develop appropriate methods and ways of connecting with our identified audiences. We followed the NHS England Planning, Assuring and Delivering Service Change for Patients Guidance (November 2015) and had conversations with and learned from colleagues in parts of the country where successful, large-scale engagement has already taken place (eg Manchester and Wakefield).
Our approach was inclusive and included:
Overarching strategic communications and engagement from the Commissioners Working Together team
CCG-led local conversations and awareness raising based on comprehensive, place- based communications and engagement plans
Regionally-led clinical and managerial engagement
Clinically informed materials
Clinically led communications materials
Patient and public involvement in development of materials
Our methods have included:
Digital communications and engagement through our website, with background about why changes are being considered and materials. This was the central point for signposting and survey responses
An online survey, asking the questions:
What matters to you when accessing children’s surgery and anaesthesia services?
What matters to you when accessing critical care for people who have had a stroke?
Social media – Twitter and Facebook led
Events, supported by the same toolkit (presentation, topline messages and Q&A)
Broadcast and print media releases and conversations
One to one briefings and updates with place-based stakeholders, via regular chief officer briefings
Briefings with Healthwatch
Setting up a Joint Health Overview and Scrutiny Committee
A working group with all communications and engagement leads from our eight CCG’s, along with communications leads from the region’s acute provider organisations and NHS England has been meeting regularly since June 2015. As well as helping to shape the communications and engagement approach, the group has met to discuss what materials were needed to support local conversations (which were subsequently developed by the core team) and update on engagement progress. As well as promoting the pre-consultation, each CCG has been leading on local conversations with local groups and communities – ranging from established patient and public participation groups to health ambassadors (representing community and interest groups such as the homeless, asylum seekers and the deaf community), parent and carer groups (including a group for parents with children who have autism), stroke groups, disability networks and local employers. These have been complemented by regional events with clinicians, staff involved in the services and patient and public representatives.
3. Overview of communications and engagement activity
The pre-consultation period started in January 2016 and since early February, the website has seen a significant increase in traffic, with 6,756 page views between 1 February and 15 April. The top three page destinations throughout pre-consultation were:
/what-we-do/childrens-surgery/share-your-thoughts
/what-we-do/critical-care-stroke-patients
/what-we-do/children’s-surgery
Interest in the Commissioners Working Together Twitter and Facebook presence has also grown – with Twitter followers increasing at a rate of around 50 a month and tweet impressions averaging around 15,000. Profile visits reached almost 1,300 in February and over 1,100 in March. Facebook has also helped raise awareness of the pre-consultations, with videos of the clinical leads and patients reaching more than 700 users. A blog from the clinical lead for children’s surgery services was read by 140 individual users with Twitter being the main source of traffic.
For further awareness raising, contact was made with the region’s key media with briefings given and a press release issued. This also resulted in an article in the Health Service Journal (HSJ) – a national trade publication.
Collectively, as a core team and as individual CCG’s we have held, attended and shared information at 22 events. This includes patient and public participation groups, parent and carer forums and stroke support groups. Attendance at the events has varied from audiences of 15 to over 200.
We have also been gathering views on a one-to-one basis in outpatient clinics, local authority settings, sixth form colleges, stroke groups and parent and carer forums.
By the end of the pre-consultation phase, we received 247 online responses as well as written feedback from each of the events. We estimate that more than 500 face to face conversations have taken place; though the awareness of the need to look at changing the two service areas has reached many thousands.
3.1 Overview of clinical engagement In establishing the workstreams and subsequent pre-consultations, clinical spokespeople were identified and have been involved in helping shape the messaging for our various communications and engagement methods and materials.
At least five clinical workshops were held centrally throughout the pre-consultation phase and Commissioners Working Together workstream leads continue to work with clinical representatives from each commissioning and provider organisation in South and Mid Yorkshire, Bassetlaw and North Derbyshire to ensure all plans and developments are clinically-sound and sustainable.
We have also actively engaged with and worked alongside a number regional clinical experts from the Yorkshire and Humber Strategic Clinical Network throughout this process, where they have attended events, acted as spokespeople and been kept informed through regular e-bulletins and face to face meetings.
3.2 Overview of MP engagement
Building on existing relationships, each individual clinical commissioning group held the responsibility for communicating and engaging with their local MPs through regular briefings with the respective Chief Officers.
4. Overview of communications and engagement activity by area
Complementing the overarching communications and engagement activity and support from the core team, local CCG based activity was also carried out. Each CCG followed similar methods and approaches for engaging with their respective stakeholders and local populations.
4.1 NHS Barnsley Clinical Commissioning Group
NHS Barnsley Clinical Commissioning Group (Barnsley CCG) carried out various communications and engagement activity for the two workstreams, alongside promoting the pre-consultations, and how to get involved, via their website which was supported by social media signposting from their Facebook and Twitter accounts (over 9,700 followers).
Quantitative communications included the promotion of the pre-consultations via e-bulletins to various partner organisations and patient and public groups from across Barnsley. This included information being distributed to their patient council, OPEN (a public engagement network of around 200 members), GP patient reference groups (PRG’s) and to local partners from across health and social care, as well as their local authority and voluntary sector organisations.
Patient and public communications and engagement
Qualitative engagement in Barnsley with patients and the public included the pre- consultations being discussed at the Barnsley Patient Council meeting on 24 February 2016. The meeting was attended by members of local GP patient reference groups from across Barnsley with a presentation given by a member of the CWT core team alongside open, participatory discussion on the pre-consultations. Feedback from this meeting has been incorporated into the overall themes.
Further qualitative engagement for the pre-consultation into hyper acute stroke services included attendance at an Afternoon Tea Party and Dance held by the Rotary Clubs of Barnsley, which provided an afternoon of company, discussions and entertainment for lonely, elderly and socially isolated people from across the borough. Over 200 people were in attendance and took part in a number of informal, face to face discussions. Again, the feedback was then incorporated centrally.
Staff and partner communications and engagement
Qualitative engagement with partner organisations, which did also include some patient groups and representatives, was the presentation of and discussions on the work of Commissioners Working Together and the pre-consultations at Barnsley CCG’s Commissioning Plans Event on 12 February 2016. As well as having a stand with information to take away, round table discussions on the workstreams were had with the 50+ people in attendance.
Barnsley CCG built on their strong relationships with their partner and provider organisations for further quantitative communications and engagement activity. Promotion of the pre- consultations and the opportunities to get involved was included in:
Voluntary Action Barnsley’s weekly e-bulletin as well as through social and digital media (their own website and Facebook and Twitter accounts)
South West Yorkshire Partnership NHS Foundation Trust circulated the information to all practice governance coaches in Barnsley, including physical and community services as well as mental health. Information was also sent widely to staff within physical and community services, including district nurses.
Barnsley Hospital NHS Foundation Trust promoted the pre-consultations via their own existing networks, including Barnsley Parents and Carers Forum.
Via their volunteering and engagement team, Barnsley Metropolitan Council promoted the pre-consultations to their staff, area teams and through their Service User and Carer Groups database (of which there are over 200 members).
Communications and engagement with seldom heard groups and those in protected characteristics
As well as qualitative engagement at the Rotary Club event for elderly and socially isolated people, Barnsley CCG targeted the following groups for promotion of and involvement in the pre-consultations:
Barnsley BME Women and Children Forum
Healthwatch Children and Young People
Barnsley Maternity Service User Group 4.2 NHS Bassetlaw Clinical Commissioning Group
NHS Bassetlaw Clinical Commissioning Group (Bassetlaw CCG) posted information on the pre-consultations and the links to the central online surveys on their own website and supported the awareness raising via their social media accounts (over 2,900 followers on Twitter and 50 on Facebook).
Patient and public communications and engagement
Qualitative engagement by Bassetlaw CCG throughout the pre-consultation phase included attendance at their Patient Experience Steering Group. The group, consisting of patient representatives from across Bassetlaw, received a presentation on the two pre-consultations with the opportunity for follow up, participatory discussion.
Quantitative communications and engagement included the dissemination of pre- consultation information through various community and voluntary sector organisations in the area. These included:
Bassetlaw Action Centre
Advice Bureau, and;
Bassetlaw Community Voluntary Services.
Staff and partner communications and engagement
Further awareness raising included the dissemination of information through Bassetlaw CCG’s Working Voices project. This is an ongoing partnership project between the CCG and the workforce of five local employers – Eatons Electrical, Ryton Park Primary School, BPL, North Nottinghamshire College and Bassetlaw CAB.
Regular updates on the work of Commissioners Working Together and the pre-consultations were also given at Bassetlaw CCG’s Governing Body meetings throughout the phase.
4.3 NHS Doncaster Clinical Commissioning Group
NHS Doncaster Clinical Commissioning Group (Doncaster CCG) actively promoted the pre- consultations, engaging with a wide range of local communities for involvement in the two pre-consultations. This was complemented by hosting locally tailored online surveys on their website which was signposted to from their own Twitter account of over 9,500 followers
The former chair of Doncaster CCG also promoted the pre-consultations through his regular comment piece in the Doncaster Star.
Patient and public communications and engagement
Qualitative engagement for the pre-consultation into children’s surgery and anaesthesia services included attendance at seven participatory events with various patient and public groups including; two local colleges, Doncaster Parent’s Voice, Doncaster’s patient and participation group network and Happy Hands, Doncaster’s Deaf Parent Group. Similarly, qualitative engagement for the hyper acute stroke services pre-consultation included attendance at three participatory events with a local stroke group, Doncaster Speakability and the Doncaster Stroke Support Group.
Vox pop sessions were also carried out at the Civic Building in Doncaster, engaging members of the public in 1:1 conversations about the two pre-consultations and feeding their views into the overall feedback.
Quantitative engagement on the two workstreams included the distribution of information, including how to get involved to targeted patient and public groups across Doncaster, including children’s centres, parent partnerships, carers’ services and charities.
Staff and partner communications and engagement
Quantitative communications and engagement activity was carried out with Doncaster CCG’s partner organisations through the distribution of information and survey questions for all internal and external publications of the following:
Doncaster Metropolitan Borough Council
Public Health
Doncaster and Bassetlaw Hospitals NHS Foundation Trust
Rotherham, Doncaster and South Humber NHS Foundation Trust
The Doncaster Chamber of Commerce
St Leger Homes (who provide housing services for the 21,000 council-owned homes in Doncaster)
The online survey was also distributed to a number of BME community groups and to the CCG’s Health Ambassadors who represent a range of seldom heard community groups such as the homeless and asylum seekers.
Communications and engagement with seldom heard groups and those in protected characteristics
Through their various communications and engagement activity, Doncaster CCG also targeted the below groups with information and opportunities to get involved:
Doncaster Men’s Group
Doncaster Age UK
Doncaster Mencap
Doncaster Mind
Doncaster Autistic Society
Doncaster Deaf Parent and Toddler Group The LADDER group (supporting young people across Doncaster with a range of disabilities)
4.4 NHS Hardwick and NHS North Derbyshire Clinical Commissioning Groups
NHS Hardwick and NHS North Derbyshire Clinical Commissioning Groups (CCGs) submitted joint communications and engagement activity plans and reports and worked jointly to target their respective populations and audiences.
Information on the pre-consultations was posted on their individual websites and supported by social media signposting through their respective Twitter accounts (over 3,700 combined followers).
Patient and public communications and engagement
Qualitative engagement covering the two CCGs included attendance at two participatory events and meetings where information was shared and discussions had on the two pre- consultations. This included a focus group at the Derbyshire Stroke Centre on Thursday 17 March 2016. Feedback from this group has been incorporated into the central themes.
Quantitative communications and engagement by the two CCGs included the contacting of and dissemination of information to at least ten specific patient and public groups relevant to each service. The opportunity to have a face to face discussion with a member of either Hardwick or North Derbyshire CCG was also offered to these groups, which included, the North Derbyshire Stroke Club, Dales and High Peak Council for Voluntary Service, the Derbyshire Parent forum and Cypress Parent Support Group.
Staff and partner communications and engagement
Quantitative communications and engagement across the two areas included the mass communication of pre-consultation information through each CCG’s internal and external publications, chief officer blogs, GP newsletters and information shared with the provider organisations in the region, Chesterfield Royal Hospitals NHS Foundation Trust and Derbyshire Community Health Services.
Due to the engagement with and by building on their relationships with partners, information was then cascaded independently via the local Healthwatch and NVDA (a registered charity supporting health related voluntary organisations across Derbyshire) to their own stakeholders and audiences.
The executive teams of each CCG provided regular updates to the region’s Health and Wellbeing Board and information was also shared amongst all Patient Participation Groups (PPGs) and practice managers in the region.
4.5 NHS Rotherham Clinical Commissioning Group
Overarching communications and engagement methods carried out by NHS Rotherham Clinical Commissioning Group (Rotherham CCG) included the publishing of the pre- consultations on their website with links to the central feedback surveys on the Commissioners Working Together site. This was supported by further digital and social media engagement with signposting from the CCG’s Twitter account (to over 7000 followers).
Quantitative communications also included the inclusion of the pre-consultations in emails out to all 31 Rotherham GP practices as part of their regular GP e-bulletin, alongside articles printed in internal and external partner publications and newsletters, for example, those of The Rotherham NHS Foundation Trust and Rotherham Metropolitan Borough Council.
Patient and public communications and engagement
Rotherham CCG had a strong focus on qualitative engagement with various face to face conversations having taken place throughout the pre-consultation phase. These conversations included targeted engagement with local groups for stroke survivors and those having suffered from other neurological conditions. Presentations on the two workstreams were given to these individual groups in February and March 2016 with discussions then feeding into the overall pre-consultation feedback.
For the children’s surgery and anaesthesia workstream, qualitative engagement was carried out with the Rotherham Parent’s Forum. The forum is an active group of parents and carers who work with health and care organisations who provide services for disabled children and their families in Rotherham.
Further qualitative engagement with patients and the public included presentations to and discussions with the Rotherham PPG network, made up of patient and public representatives from across all GP practices in the area. Workstream leads from the central Commissioners Working Together team also attended this participatory event and were able to discuss the pre-consultations and also answer any questions the audience had.
Staff and partner communications and engagement
Information on the work of Commissioners Working Together and how to get involved with the two pre-consultations was also shared via qualitative engagement with a number of Rotherham CCG’s partner organisations. For example, the CCG had regular catch ups with Healthwatch Rotherham throughout the pre-consultation period as well as chief officer and chair conversations with the local health overview and scrutiny committee.
Communications and engagement with seldom heard groups and those in protected characteristics
Communications and engagement targeted to groups as identified in the protected characteristics included the sending of information, including how to get involved and respond to the pre-consultations, to the Rotherham Disability Network and Older People’s Forum with an offer of attendance at participatory events and focus groups.
4.6 NHS Sheffield Clinical Commissioning Group
Complementing the various methods used by NHS Sheffield Clinical Commissioning Group (Sheffield CCG) during the pre-consultation phase was their overarching use of digital engagement and social media. Information on both Commissioners Working Together workstreams was published on the CCG’s website which included links and information on how to get involved via the CWT main site. This was supported by signposting from their Twitter account (to over 9,500 followers).
Patient and public communications and engagement
In terms of qualitative engagement, Sheffield CCG built on their strong links with their largest provider organisation, Sheffield Teaching Hospitals NHS Foundation Trust (STH) where the pre-consultation questions for hyper acute stroke services were incorporated into the stroke service’s own patient feedback survey. A dedicated volunteer attended the hospital based six-week review clinic and talked through the questionnaire and pre-consultation information with all patients and carers who accessed the stroke service within the pre-consultation phase. From this, 63 1:1 patient conversations were had by STH’s stroke service and fed into our patient and public feedback.
Qualitative engagement for the children’s surgery pre-consultation included attendance at and conversations with the Sheffield Parent Carer forum and attendance at Sheffield Children’s Hospital NHS Foundation Trust’s outpatient department for 1:1 conversations with parents and carers of children who either needed or had gone for a follow up appointment following elective surgery.
Quantitative communications and engagement activity in Sheffield for both pre-consultations included the signposting to the central online surveys in multiple and various online forums including; Involve Me, Citizen Space, Mumsnet, the Health and Wellbeing Board, Healthwatch and a mail out to Voluntary Action Sheffield and members of various voluntary and community groups in the city.
Staff and partner communications and engagement
Qualitative engagement with Sheffield CCG’s partner organisation’s boards included regular updates to Sheffield’s Health and Wellbeing Board with partners providing support and feedback. Ongoing, face to face updates and information on the pre-consultations, with opportunities for feedback, were also given to the joint overview and scrutiny committee. Information and plans for the pre-consultations were also shared by the CCG at the Sheffield Engagement Leads Group which includes communications and engagement representatives from Sheffield City Council, NHS provider organisations and Healthwatch. It was from linking with this group that STH then incorporated the pre-consultation questions into their stroke service patient feedback survey.
Sheffield CCG also contacted each of the GP practices (of which there are 88 in Sheffield), practice managers and patient participation groups across the city to raise awareness of Commissioners Working Together, our work and how to get involved in the pre- consultations.
Communications and engagement with seldom heard groups and those in protected characteristics
In Sheffield, information on the pre-consultations, including how to get involved, was disseminated through the Equality Hub Network representing the following groups across the city: Age hub for younger and older people
BME hub
Carers’ hub
Disability hub
LGBT hub
Religion/belief hub (including those of no religion)
Women’s hub
4.7 NHS Wakefield Clinical Commissioning Group
NHS Wakefield Clinical Commissioning Group (Wakefield CCG) also supported their more targeted communications and engagement activity through the use of social and digital media. The online surveys, and links to the Commissioners Working Together site, were posted on their website and signposted to via their own Twitter account of over 8,400 followers.
Patient and public communications and engagement
Qualitative engagement with patients and the public included the attendance at two participatory events, one of PIPEC (the CCG’s patient group) and the other, a patient reference group network meeting with representatives from across Wakefield’s patient groups. Presentations were given on the two pre-consultations, followed by discussions with the groups and feedback given centrally.
Quantitative patient and public communications and engagement included contact being made with and the dissemination of pre-consultation information to a number of targeted groups relevant to each workstream. These included:
Individual members of a former Wakefield Stroke Group
St George’s Stroke Survivor Group
Age UK
Carers Wakefield
Healthwatch
Young Lives consortium
NOVA (an umbrella voluntary and community sector forum)
Staff and partner communications and engagement
Staff and partners of Wakefield CCG were also targeted through a variety of communications and engagement methods. This included CCG staff briefings, internal and external bulletins, including GP newsletters and information on the pre-consultations was shared with the CCG’s provider organisations, public health colleagues and board updates to the overview and scrutiny committee.
Communications and engagement with seldom heard groups and those in protected characteristics
In terms of targeted communications and engagement activity to seldom heard groups and those within protected characteristics, Wakefield CCG’s stakeholder engagement database is based on the nine protected characteristics with information cascaded to all groups, including voluntary, community and other interested groups and sectors. Information on the pre-consultations and how to get involved was also sent specifically to:
The Wakefield District Disabled Patient Partnership Support group, and;
DIAL – the disabled information and advice service.
5. Themes emerging throughout the pre-consultation
5.1 Children’s surgery and anaesthesia pre-consultation
The following points were consistent in the feedback in terms of what people said mattered to them. The top three strongest themes are highlighted:
Safe, caring, quality care and treatment. Access to specialist care. Care close to home. Communication – between children, parents, carers and their clinicians – and also between hospitals. Being seen as soon as possible.
The following points were also raised:
Having appropriate facilities, especially for parents and carers who need to stay over. Successful operations. A willingness to travel for specialist care. Consideration for children with complex needs – especially around pre-surgery service.
5.2 Critical care for people who have had a stroke pre-consultation
The following points were consistent in the feedback in terms of what people said mattered to them. The top three strongest themes are highlighted:
Being seen quickly when get to a hospital. Being seen and treated by knowledgeable staff. Safety and quality of the service. Fast ambulance response times / travel times. Good access to rehabilitation services locally.
The following points were also raised: More education on the prevention of strokes. Involving family and carers (as they know the patient best and can advise while in critical condition).
The detailed verbatim patient and public feedback received in the online survey and during conversations is available on request.
Patient and public sample quotes when asked what mattered to them when accessing care:
Feedback from patients/public Service area
“A service of the highest quality ensuring Children’s surgery and anaesthesia that the wishes and feelings of the child and family come first and professional help and guidance is given in the simplest of terms.”
“Good outcome and excellent quality care, Children’s surgery and anaesthesia choice of hospitals”
“That they’ll have the best possible care, Children’s surgery and anaesthesia that they wouldn’t be frightened and could have mum, dad or relative with them as much as possible, that they suffered as little discomfort as possible before, during and after surgery.”
“If my child was havin an op, I’d probably Children’s surgery and anaesthesia say id want to know the risks, I want to know information about the procedure, is it the best staff possible and the best location”
“Prompt treatment, good rehabilitation and Hyper acute stroke services robust care plans and referrals where appropriate to other services and an overall seamless package of care.”
“Person centred care, support for patient Hyper acute stroke services and family” “experienced caring staff, rapid treatment Hyper acute stroke services and aftercare”
“fast quality service, information and advice Hyper acute stroke services for me and my family”
6. Evaluation and next steps for consultations
During this pre-consultation phase, through various qualitative and quantitative communications and engagement methods and activities, we provided multiple opportunities for the communities of South and Mid Yorkshire, Bassetlaw and North Derbyshire to get involved and help shape the future of hyper acute stroke and children’s surgery and anaesthesia services.
All feedback from the pre-consultation communications and engagement activity and conversations will be used to help inform the development of the two business cases for change which are due to be developed and agreed by June 2016 prior to options for consultations being considered. We will clearly state how the views of people have been taken into consideration within the options, appraisal, business case and consultation materials.
The methods and approach of communications and engagement activity will also be built on to produce a full communications and engagement strategy and plans for public consultations which are due to open in September 2016.
In the meantime, we will continue to have an open, honest and accessible approach to communications and engagement and will continue to keep all our stakeholders and those involved so far, up to date with the work and progress of Commissioners Working Together and its’ individual workstreams.
Communications and engagement strategy and plans for public consultation
April 2016
Contents:
Commissioners Working Together overarching communications and engagement strategy for public consultation
Communications and engagement plan for public consultation on children’s surgery and anaesthesia services
Communications and engagement plan for public consultation on hyper acute stroke services
Communications and engagement strategy for public consultation
Introduction
As Commissioners Working Together, we are a collaborative of eight NHS clinical commissioning groups across South and Mid Yorkshire, Bassetlaw and North Derbyshire and NHS England. Some people have better experiences, better outcomes and better access to services than others – and to ensure that everyone experiences the highest quality and safest services possible, we are working with all local hospitals and care providers, staff and patient groups to understand how best to do this for the benefit of our combined population of 2.8 million. Our key partners are:
NHS Barnsley Clinical Commissioning Group
NHS Bassetlaw Clinical Commissioning Group
NHS Doncaster Clinical Commissioning Group
NHS England
NHS Hardwick Clinical Commissioning Group
NHS North Derbyshire Clinical Commissioning Group
NHS Rotherham Clinical Commissioning Group
NHS Sheffield Clinical Commissioning Group
NHS Wakefield Clinical Commissioning Group
We also work with voluntary and community sector partners as well as gaining assurance and input from national and regional clinical advisors and experts.
Between January and April 2016 we held an open pre-consultation for the review of children’s surgery and anaesthesia and hyper acute stroke services. During this phase we gathered the views of our key stakeholders to inform plans for future service configuration and consultation. We are now preparing to enter XX week public consultations on the options for reconfiguring children’s
surgery and anaesthesia and hyper acute stroke services across our commissioning and provider partners in the region.
Effective communication and engagement is a two-way process. Our activity will focus on informing, sharing, listening and responding. Being proactive is central to our communications and engagement strategy of:
Proactively and effectively communicating our purpose, priorities, messages and values.
Developing effective, two-way mechanisms where we share news, we listen and respond whilst being open and transparent.
Identifying relevant and effective methods for audience and stakeholder engagement.
In all communications and engagement activity, we will work with all our local partners and tailor our messages and methods accordingly to each individual group to ensure we maximise all opportunities for connecting with, informing and engaging with our target audiences.
Aims and Objectives
Raise awareness and understanding of the current provision and need for changes to children’s surgery and anaesthesia and hyper acute stroke services in South and Mid Yorkshire, Bassetlaw and North Derbyshire
Ensure patients, families, carers and the public are involved, are able to share their views on the proposed options and are listened to
Inform key staff and clinicians in each locality about proposed change options and keep them updated throughout the consultation process
Ensure existing patients, family and carers have the information they need about any changes to services
Inform all stakeholders of new proposed models of care and opportunities to have their say in the consultations
Provide high quality support, advice and updates on consultation activity to the Commissioners Working Together board, partners and staff within each member organisation.
Key Messages
Alongside service and consultation specific messages, underpinning all our communications will be the following overarching messages of Commissioners Working Together:
We know that there’s variation in people’s experiences of services across our region, with some people getting better access and outcomes than others.
We know that many people are treated in hospital when their needs could be better met elsewhere or closer to home.
If we are to continue providing high quality, safe and sustainable NHS services – we need to change, together.
Our ambition is to develop excellent healthcare together by reconsidering how services are delivered, redefining how we work together as commissioners, and coming together with all our partners and stakeholders to find the best solutions for our populations.
Planning and commissioning across a larger area is becoming increasingly urgent as more and more people use NHS services, are living longer and using more advanced technology to improve care.
For some services, there won’t be enough trained and experienced staff in the future if we continue to provide services the way we do today, with the quality and accessibility of services being reduced.
At the same time, costs are increasing. If we don’t act now, more people will suffer from unnecessary poor health.
Target Audiences
Prior to the pre-consultation phase, a full stakeholder mapping exercise was carried out to identify all stakeholders involved in and affected by any proposed changes to the services reviewed (Appendix 1).
Through various and tailored communications and engagement methods, the following groups have been identified for targeted communications and engagement activity:
Patients and the public - including seldom heard groups and those identified in the following protected characteristics (Equality Act 2010):
- Age
- Disability
- Gender reassignment
- Pregnancy and maternity
- Race (Appendix 2: BME breakdown per population)
- Religion or belief
- Sex
- Sexual orientation
National and local patient groups
Local Authorities, MPs and councillors
Public health
Governing body members of all CCGs
Executive board members of all providers
Clinicians – acute, primary and community care
Foundation trust and CCG members
Clinical Senates
Healthwatch
Voluntary sector organisations
Health and Wellbeing boards
Local, regional and trade media
Communications Approach
Overall communications and engagement activity will be pro-actively co-ordinated by the Commissioners Working Together communications team who will work with the programme management team, workstream leads and communications and engagement leads from our commissioner and provider partners to ensure all activity is joined up, timely and appropriate.
After evaluating the communications and engagement activity carried out during the pre-consultation phase, we agreed that our activity for consultations will follow and build on the approach already taken and in place. Our inclusive approach will include:
Overarching strategic communications and engagement planning and support from the Commissioners Working Together team.
CCG-led local conversation and awareness raising based on comprehensive, place-based communications and engagement plans.
Regionally-led clinical and managerial engagement.
Clinically informed communication materials.
Clinically led conversations.
Patient and public involvement in the development of communication materials.
We have established a working group with all communications and engagement leads from our CCG partners, along with communications leads from the region’s acute provider organisations and NHS England, which has been meeting regularly since June 2015. As well as helping to shape and evaluate our communications and engagement approach, the group will meet to discuss and update on consultation feedback and progress.
Our communications and engagement approach for consultation has been further developed from patient and public response during our pre-consultation phase in terms of which methods were most favoured - which we will now use as a focus for our approach eg, website, social media, e-bulletins (Appendix 3).
To further strengthen our communications and engagement working group and activity we will build on our relationships with our public health and also local authority communications colleagues – allowing us to work together to disseminate messages and target existing networks, eg, for seldom heard groups and those included in the protected characteristics.
Communications Principles
All communications and engagement activity carried out by and on behalf of Commissioners Working Together will be:
Accessible and inclusive – to all our audiences
Clear and concise – allowing messages to be easily understood by all
Consistent and accountable – in line with our vision, messages and purpose
Flexible – ensuring communications and engagement activity follows a variety of formats, tailored to and appropriate for each audience
Open, honest and transparent – we will be clear from the start of the consultations what our plans are, what is and what isn’t negotiable, the reasons why and ultimately, how decisions will be made
Targeted – making sure we get messages to the right people and in the right way
Timely – making sure people have enough time to respond and are kept updated on a regular basis
Two-way – we will listen and respond accordingly, letting people know the outcome of all conversations.
Methods
No single communications channel will be effective in reaching and engaging all our audiences, therefore it is important that a variety of different communications and engagement methods are used, presenting relevant information in a timely and proactive way that best meets the needs of our individual stakeholders (as identified during pre-consultation).
Although full details of communications and engagement methods for individual audiences will be included in the communications and engagement planners for each of the consultations, some of our quantitative, qualitative and participatory methods will include the following:
Stakeholder briefings
Attendance at partner and stakeholder meetings and events
Focus groups
Flyers
Newsletters and e-bulletins
Local, regional and trade print and broadcast media
Internal bulletins
Public website
Online surveys
Deliberative events
Videos and vox pops
Alongside these methods, a key mechanism for consultation communications and engagement activity will be through the use of social media. We know from the Commissioners Working Together pre- consultations and also by identifying key trends and best practice from similar health and care transformation projects in other regions, that social media is an effective way of communicating and engaging with a variety of audiences.
Social media is a useful way of:
Disseminating information and signposting
Raising awareness
Collecting demographic data
Demonstrating willingness to engage in dialogue with a target audience
Speaking to a large number and variety of audiences in real-time.
By developing and creating a number of communications materials and assets, through social media we will listen and respond to and motivate our audience to both share the information we are communicating and also engage with us by taking part in the consultations.
Branding
Brand identity is important – particularly when multiple partners are involved. As a partnership we want to be seen as joined up, open and honest, approachable, clinically sound and responsive.
We have developed a Commissioners Working Together logo and identity that will be used on all communications and engagement materials for the two public consultations. Based on feedback from the pre-consultations, a single logo avoids confusion between the eight partners and will be clear to anyone across the region that the consultations are being delivered on behalf of all partners and organisations in the Commissioners Working Together partnership.
Consultation and engagement legislation
Throughout our communications and engagement activity for consultations into children’s surgery and anaesthesia and hyper acute stroke services, we as a collaborative of clinical commissioning groups will abide by the following legislation:
Health and Social Care Act 2012
The Health and Social Care Act 2012 makes provision for Clinical Commissioning Groups (CCGs) to establish appropriate collaborative arrangements with other CCGs, local authorities and other partners. It also places a specific duty on CCGs to ensure that health services are provided in a way which promotes the NHS Constitution – and to promote awareness of the NHS Constitution.
Health Commissioners must involve and consult patients and the public:
in their planning of commissioning arrangements
in the development and consideration of proposals for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and In decisions affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.
The Act also updates Section 244 of the consolidated NHS Act 2006 which requires NHS organisations to consult relevant Overview and Scrutiny Committees (OSCs) on any proposals for a substantial development of the health service in the area of the local authority, or a substantial variation in the provision of services.
The NHS Constitution
The NHS Constitution came into force in January 2010 following the Health Act 2009. The constitution places a statutory duty on NHS bodies and explains a number of patient rights which are a legal entitlement protected by law. One of these rights is the right to be involved directly or through representatives: In the planning of healthcare services The development and consideration of proposals for changes in the way those services are provided, and In the decisions to be made affecting the operation of those services.
Commissioners will ensure that the duties required in legislation are met and that patient, the public and stakeholders have the opportunity to have meaningful input in shaping future health services within the scope of the programme.
In undertaking public consultation commissioners we ensure that it is clear to public, patients and stakeholders what they are able to shape or influence and what areas are set due to national policy or safety reasons.
The Equality Act 2010
The Equality Act 2010 unifies and extends previous equality legislation. The characteristics that are protected by the Act are: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation.
Section 149 of the Equality At 2010 states all public authorities must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘equality of opportunity,’ and c) foster good relations between persons who share a relevant protected characteristics and persons who do not share it.
The Gunning Principals of Consultation
The four ‘Gunning Principals’ are recommended as a framework for all engagement activity but are particularly relevant for consultation and would be used, in the event of a judicial review, to measure whether the process followed was appropriate. The Gunning Principles state that:
Consultation must take place when the proposal is still at a formative stage: Decision-makers cannot consult on a decision that has already been made. If the outcome has been pre-determined, the consultation is not only unfair, but it is also pointless.
This principle does not mean that the decision-maker has to consult on all possible options of achieving a particular objective. A decision-maker can consult on a ‘preferred option’, and even a ‘decision in principle’, so long as its mind is genuinely open - ‘to have an open mind does not mean an empty mind.’
If a decision-maker has formed a provisional view as to the course to be adopted, or is ‘minded’ to take a particular course subject to the outcome of consultations, those being consulted should be informed of this ‘so as to better focus their responses’.
Sufficient reasons must be put forward for the proposal to allow for intelligent consideration and response: Consultees should be made aware of the basis on which a proposal for consultation has been considered and will thereafter be considered. Those consulted should be aware of the criteria that will be applied when considering proposals and what factors will be considered ‘decisive’ or ‘of substantial importance’ at the end of the process.
Adequate time must be given for consideration and response: Unless statutory time requirements are prescribed, there is no necessary time frame within which the consultation must take place. The decision- maker may adopt a policy as to the necessary time-frame (e.g. Cabinet Office guidance, or compact with the voluntary sector), and if it wishes to depart from that policy it should have a good reason for doing so. Otherwise, it may be guilty of a breach of a legitimate expectation that the policy will be adhered to.
The product of consultation must be conscientiously taken into account: If the decision-maker does not properly consider the material produced by the consultation, then it can be accused of having made up its mind; or of failing to take into account a relevant consideration.
Evaluation and Monitoring
Evaluation will play an important part in our communications and engagement activity, evidencing whether we have achieved our objectives by engaging with our target audiences successfully. We will monitor our activity throughout the consultation period to ensure we are reaching our audiences effectively and providing equal and appropriate opportunities for involvement and feedback.
Through monitoring and evaluation we will be able to learn lessons and gain valuable insight into public and stakeholder sentiment and behaviour, allowing us to tailor our methods appropriately. Examples of how we will monitor our activity include:
Media and social media monitoring
Stakeholder meetings for discussions and feedback (particularly Healthwatch and OSC)
Staff feedback via briefings
Patient and public feedback via our various methods
Where necessary we will update the strategy to adapt to staff, clinical, patient, public and stakeholder feedback. It is vital that we are able to demonstrate that we listen to comments and suggestions from all our stakeholders, including seeking assurance from independent advisors, in order that they are fully involved and engaged in the reconfiguration of services.
DRAFT Communications and engagement plan for public consultation on children’s surgery and anaesthesia services
Introduction
As Commissioners Working Together, we are a collaborative of eight clinical commissioning groups across South and Mid Yorkshire, Bassetlaw and North Derbyshire and NHS England. Some people have better experiences, better outcomes and better access to services than others – and to ensure that everyone experiences the highest quality and safest services possible, we are working with all local hospitals and care providers, staff and patient groups to understand how best to do this for the benefit of our combined population of 2.8 million.
Between January and April 2016 we held an open pre-consultation for the review of children’s surgery and anaesthesia services. During this phase we gathered the views of our key stakeholders to inform plans for future service configuration and consultation. We are now preparing to enter a XX week public consultation on the options for reconfiguring children’s surgery and anaesthesia services across our commissioning and provider partners in the region:
NHS Barnsley Clinical Commissioning Group Barnsley Hospital NHS Foundation Trust
NHS Bassetlaw Clinical Commissioning Group Chesterfield Royal Hospital NHS Foundation Trust
NHS Doncaster Clinical Commissioning Group Doncaster and Bassetlaw Hospitals NHS Foundation Trust
NHS Hardwick Clinical Commissioning Group Sheffield Children’s Hospital NHS Foundation Trust
NHS North Derbyshire Clinical Commissioning Group Sheffield Teaching Hospitals NHS Foundation Trust
NHS Rotherham Clinical Commissioning Group The Mid Yorkshire Hospitals NHS Trust
NHS Sheffield Clinical Commissioning Group The Rotherham NHS Foundation Trust
NHS Wakefield Clinical Commissioning Group
We will be consulting on the following options: XXX
Aims and objectives
Raise awareness and understanding of the current provision and need for changes to children’s surgery and anaesthesia services in South and Mid Yorkshire, Bassetlaw and North Derbyshire Ensure patients, families, carers and the public are involved, able to have their say on the proposed options, and are listened to Inform key staff and clinicians in each locality about proposed change options Ensure patients, family and carers have the information they need about any changes to children’s services Inform all stakeholders of new proposed models of care and opportunities to be involved
Target audiences
The following audiences will be targeted through tailored communications activity. We will use a variety of methods to connect with each of our key stakeholders, ensuring our messages remain consistent and appropriate for each.
Patients and the public (including parent and carer forums, Foundation trust and CCG members seldom heard groups and identified protected characteristics) Clinical Senate
Local Authorities, MPs and councillors Healthwatch
Governing body members of all CCGs Health and Wellbeing boards
Executive board members of all providers Local, regional and trade media
Clinicians – acute, primary and community care Public health Key messages
As with pre-consultation, our key messages will focus on the reasons why changes are needed to children’s surgery and anaesthesia services whilst highlighting the importance of, and opportunities to get involved in, and take part in the consultation. These messages include:
We know that across our region some people have better experiences, better outcomes and better access to services than others. We want everyone to experience the highest quality and safest service possible.
We improving children’s surgery services for everyone across South and Mid Yorkshire, Bassetlaw and North Derbyshire – and we need your help!
Why are we changing services? At the moment:
- Different hospitals refer children in different ways
- Doctors in our smaller hospitals don’t treat as many children as our bigger ones
- Nationally, there aren’t enough health care professionals qualified to treat children, and;
- Some people have better experiences than others – we want this to change.
Note: Key messages will be tailored and confirmed once the business case for change is agreed and there are definite options for consultation.
Communications and engagement methods
To deliver the aims of our communications and engagement plan, we will carry out a range of activity across all geographic areas covered by the Working Together partnership, including both providers and commissioners. The methods and messages used to communicate will be tailored for each audience to maximise every opportunity for public and stakeholder involvement.
A key mechanism for consultation communications and engagement activity will be through the use of social media. We know from the Commissioners Working Together pre-consultations and also by identifying key trends and best practice from similar health and care transformation projects in other regions, that social media is an effective way of communicating and engaging with a variety of audiences.
Social media is a useful way of:
• Disseminating information and signposting
• Raising awareness
• Collecting demographic data
• Demonstrating willingness to engage in dialogue with a target audience
• Speaking to a large number and variety of audiences in real-time.
By developing and creating a number of communications materials and assets, through social media we will listen and respond to and motivate our audience to both share the information we are communicating and also engage with us by taking part in the consultations.
Further details of specific qualitative, quantitative and participatory communications and engagement methods for individual audiences are included in the planners below.
Engagement planner
Type of engagement Audience Method examples Responsibility
Qualitative Patients and the public, Focus groups CCG and provider partners parent and carer forums, supported by the Commissioners MPs, Local Authorities Attendance at relevant groups/events Working Together team
Stakeholder briefings
Vox pops
Seldom heard groups Attendance at existing groups eg, and protected parents with children with learning characteristics disabilities, Mosques, homeless charities, LGBT forums, sixth form colleges
Disseminate information through existing networks for 1:1 and group
conversations (eg, via public health colleagues to reach rural communities, BME groups, gypsy and traveller communities, asylum seekers, refugees, mental health support groups)
Quantitative Patients and the public, Online survey Commissioners Working healthcare staff Together team Flyers in various locations: GP practices, outpatient departments, libraries, supermarkets, children’s
centres, schools and nurseries
Seldom heard groups Flyers translated into most popular and protected languages (identified through census characteristics data in Appendix 2) and disseminated in various locations
Participatory Patients and the public, Deliberative events (x8) Commissioners Working parent and carer forums, Together team supported by seldom heard groups, Listening events CCG and provider partners healthcare staff and Focus groups clinicians
Attendance at existing groups and Seldom heard groups and protected
characteristics events
Focus groups
Social media All Twitter and Facebook – blanket and Commissioners Working targeted posts to various groups, Together team supported by including health and care organisations, CCG and provider partners patient groups, Healthwatch organisations, local authorities, press accounts, LGBT networks, youth groups, high profile local/regional businesses, activity centres, schools, parent and carer groups (eg, Mumsnet)
Communications planner
Communication Type Audience Method examples Responsibility
Promotion/ Participation Patients and the public including Newsletters Commissioners Working Together targeted to parents and carers, team supported by CCG and voluntary sector organisations Social media provider partners and staff Media
Blogs/case studies
Event presence
‘Market stalls’
Attendance at partners AGMs
Submissions to targeted Seldom heard groups and publications and protected characteristics newsletters, eg, parent’s assembly, BME community newspapers
Updates and briefings Staff from all partners, members NHS internal comms Commissioners Working Together of all organisations, GPs, practice team supported by CCG and staff, Local Authorities, MPs, E-bulletins provider partners as appropriate councillors, board and governing Briefing papers body members, OSC Verbal briefings/attendance at partner and stakeholder meetings
Media Patients, the public and staff Press releases Commissioners Working Together including trade publications team supported by CCG and Media interviews provider partners
Media briefings
Submissions to targeted Seldom heard groups and publications and
protected characteristics newsletters, eg, BME community newspapers
Social media All Twitter and Facebook – Commissioners Working Together blanket and targeted posts team supported by CCG and to various groups, provider partners including health and care organisations, patient groups, Healthwatch organisations, local authorities, press accounts, LGBT networks, youth groups, high profile local/regional businesses, activity centres, schools, parent and carer groups (eg, Mumsnet)
DRAFT Communications and engagement plan for public consultation on hyper acute stroke services
Introduction
As Commissioners Working Together, we are a collaborative of eight clinical commissioning groups across South Yorkshire and Bassetlaw and North Derbyshire and NHS England. Some people have better experiences, better outcomes and better access to services than others – and to ensure that everyone experiences the highest quality and safest services possible, we are working with all local hospitals and care providers, staff and patient groups to understand how best to do this for the benefit of our combined population of 2.8 million.
Between January and April 2016 we held an open pre-consultation for the review of critical care for people who have had a stroke (hyper acute stroke services). During this phase we gathered the views of our key stakeholders to inform plans for future service configuration and consultation. We are now preparing to enter a XX week public consultation on the options for reconfiguring hyper acute stroke services across our commissioning and provider partners in the region:
NHS Barnsley Clinical Commissioning Group Barnsley Hospital NHS Foundation Trust
NHS Bassetlaw Clinical Commissioning Group Chesterfield Royal Hospital NHS Foundation Trust
NHS Doncaster Clinical Commissioning Group Doncaster and Bassetlaw Hospitals NHS Foundation Trust
NHS Hardwick Clinical Commissioning Group Sheffield Children’s Hospital NHS Foundation Trust
NHS North Derbyshire Clinical Commissioning Group Sheffield Teaching Hospitals NHS Foundation Trust
NHS Rotherham Clinical Commissioning Group The Rotherham NHS Foundation Trust
NHS Sheffield Clinical Commissioning Group
Our consultation has also been informed by the review into hyper acute stroke services by the Yorkshire and the Humber Strategic Clinical Network which made the recommendation, based on current and projected activity, that the number of hyper acute stroke services (HASUs) should be reduced from five to three or four in South Yorkshire and Bassetlaw.
We will be consulting on the following options: XXX
Aims and objectives
Raise awareness and understanding of the current provision and need for changes to hyper acute stroke services across South Yorkshire, Bassetlaw and North Derbyshire Ensure patients, families, carers and the public are involved, able to have their say on the proposed options, and are listened to Inform key staff and clinicians in each locality about proposed change options Ensure patients, family and carers have the information they need about any changes to hyper acute stroke services Inform all stakeholders of new proposed models of care and opportunities to be involved
Target audiences
The following audiences will be targeted through tailored communications activity. We will use a very of methods to connect with each of our key stakeholders, ensuring our messages remain consistent and appropriate for each.
Patients and the public (including stroke support groups, Foundation trust and CCG members seldom heard groups and identified protected characteristics) Clinical Senate
Local Authorities, MPs and councillors Healthwatch
Governing body members of all CCGs Health and Wellbeing boards
Executive board members of all providers Local, regional and trade media
Clinicians – acute, primary and community care Public health Key messages
As with pre-consultation, our key messages will focus on the reasons why changes are needed to hyper acute stroke services whilst highlighting the importance of and opportunities to get involved in and taking part in the consultation. These messages include:
We know that across our region some people have better experiences, better outcomes and better access to services than others. We want everyone to experience the highest quality and safest service possible.
We are improving critical care stroke services for everyone across South Yorkshire, Bassetlaw and North Derbyshire – and we need your help!
Why do we need to change services? At the moment:
- We need more stroke doctors and nurses to run our services – but there aren’t enough locally or nationally
- Not all stroke patients are seen by a stroke doctor or admitted onto a stroke unit as quickly as they should be
- There is also a shortage of speech and language and occupational therapists who help rehabilitate people who have had a stroke
- How fast tests are done, which helps to diagnose patients, varies from hospital to hospital
For the above reasons, it is getting harder to provide high quality services and doctors, nurses and healthcare staff all agree that this needs to change.
Note: Key messages will be tailored and confirmed once the business case for change is agreed and there are agreed options for consultation.
Communications and engagement methods
To deliver the aims of our communications and engagement plan, we will carry out a range of activity across all geographic areas covered by the Working Together partnership, including both providers and commissioners. The methods and messages used to communicate will be tailored for each audience to maximise every opportunity for public and stakeholder involvement.
A key mechanism for consultation communications and engagement activity will be through the use of social media. We know from the Commissioners Working Together pre-consultations and also by identifying key trends and best practice from similar health and care transformation projects in other regions, that social media is an effective way of communicating and engaging with a variety of audiences.
Social media is a useful way of:
• Disseminating information and signposting
• Raising awareness
• Collecting demographic data
• Demonstrating willingness to engage in dialogue with a target audience
• Speaking to a large number and variety of audiences in real-time.
By developing and creating a number of communications materials and assets, through social media we will listen and respond to and motivate our audience to both share the information we are communicating and also engage with us by taking part in the consultations.
Further details of specific qualitative, quantitative and participatory communications and engagement methods for individual audiences are included in the planners below.
Engagement planner
Type of engagement Audience Method examples Responsibility
Qualitative Patients and the public, Focus groups CCG and provider partners parent and carer forums, supported by the Commissioners MPs, Local Authorities Attendance at relevant groups/events Working Together team
Stakeholder briefings
Vox pops
Seldom heard groups Attendance at existing groups eg, and protected Mosques, homeless charities, LGBT characteristics forums, social network groups
Disseminate information through existing networks for 1:1 and group conversations (eg, via public health colleagues to reach rural communities, BME groups, gypsy and traveller communities, asylum seekers,
refugees, mental health support groups)
Quantitative Patients and the public, Online survey Commissioners Working healthcare staff Together team Flyers in various locations: GP practices, outpatient departments, libraries, supermarkets, stroke support
groups, post offices, social network groups
Seldom heard groups Flyers translated into most popular and protected languages (identified through census characteristics data in Appendix 2) and disseminated in various locations, eg social network groups, Women’s Institute, Mosques, LGBT groups/events, activity centres (eg for people with learning disabilities).
Participatory Patients and the public, Deliberative events (x8) Commissioners Working parent and carer forums, Together team supported by seldom heard groups, Listening events CCG and provider partners healthcare staff and Focus groups clinicians
Seldom heard groups Attendance at existing groups and and protected events characteristics
Focus groups
Social media All Twitter and Facebook – blanket and Commissioners Working targeted posts to various groups, Together team supported by including health and care organisations, CCG and provider partners patient groups, Healthwatch organisations, local authorities, press accounts, LGBT networks, youth groups, high profile local/regional businesses, activity centres, the Stroke Association, Patient Opinion etc
Communications planner
Communication Type Audience Method examples Responsibility
Promotion/ Participation Patients and the public including Newsletters Commissioners Working Together targeted to parents and carers team supported by CCG and and staff Social media provider partners
Media
Blogs/case studies
Event presence
‘Market stalls’
Attendance at partners AGMs
Submissions to targeted Seldom heard groups and publications and protected characteristics newsletters, eg, parent’s assembly, BME community newspapers
Updates and briefings Staff from all partners, members NHS internal comms Commissioners Working Together of all organisations, GPs, practice team supported by CCG and staff, Local Authorities, MPs, E-bulletins provider partners as appropriate councillors, board and governing Briefing papers body members, OSC Verbal briefings/attendance at partner and stakeholder meetings
Media Patients, the public and staff Press releases Commissioners Working Together including trade publications team supported by CCG and Media interviews provider partners
Media briefings
Submissions to targeted Seldom heard groups and publications and protected characteristics newsletters, eg, parent’s assembly, BME
community newspapers
Social media All Twitter and Facebook – Commissioners Working Together blanket and targeted posts team supported by CCG and to various groups, provider partners including health and care organisations, patient groups, Healthwatch organisations, local authorities, press accounts, LGBT networks, youth groups, high profile local/regional businesses, activity centres, the Stroke Association, Patient Opinion etc
List of appendices:
Appendix 1 – Stakeholder map
Appendix 2 – Population demographics per area
Appendix 3 – Favoured methods of communication as outlined in pre-consultation feedback
Appendix 1
Commissioners Working Together Stakeholder map: Power/influence and interest level
Little or no interest Moderate interest High interest
High All media: (currently at low interest, high power but some titles Regulators (Monitor, CQC). Monitor is currently MPs: Sarah Champion, Kevin Barron and John Healey Power/Influence will shift right as the programme progresses and will require working with Rotherham Hospital trust on an action (Rotherham); John Mann (Bassetlaw); Harry Harpham, Paul watching brief): BBC online, BBC Look North, BBC East Midlands, plan and may also be involved in discussions with other Blomfield, Nick Clegg, Louise Haigh, Clive Betts, Angela Smith ITV Calendar, ITV Central East BBC Radio Leeds, BBC Radio hospitals. All of the hospitals will be subject to CQC (Sheffield); Rosie Winterton, Ed Miliband, Jon Trickett, Caroline Sheffield, BBC Radio Derby, Dearne FM, Hallam FM, Trax FM, Sine inspections Flint (Doncaster); Mary Creagh, Yvette Cooper, Paul Sherriff (Mid FM, Rother FM, Capital FM, Derbyshire Times, Worksop Guardian, Yorks); Natascha Engel, Toby Perkins, Dennis Skinner (NE NHS England area teams:(East Midlands, Yorkshire and Gainsborough Standard, The Star, Sheffield Telegraph, Barnsley Derbyshire, Hardwick); Dan Jarvis, Michael Dugher (Barnsley) Chronicle, Doncaster Star, Doncaster Free Press, Wakefield Express, the Humber) Pontefract and Castleford Express, Yorkshire Evening Post, Council cabinet members with relevant portfolio : Sheffield - Clinical Senates: (East Midlands, Yorkshire and the Rotherham Advertiser Jackie Drayton (CYP), Mazher Iqbal (public health), Mary Lea Humber) (health, care independent living). Doncaster – Nuala Fennelly Health and Wellbeing Boards: Barnsley, Derbyshire, (CYP), Pat Knight (public health and wellbeing), Chris McGuinness Doncaster, Nottinghamshire, Rotherham, Sheffield, (vol sector). Chesterfield – Chris Ludlow (health and wellbeing), Wakefield Helen Bagley (health and wellbeing). Barnsley – Margaret Bruff (children and safeguarding), Jenny Platts (communities). Wakefield – O M Rowley (CYP), P A Garbutt (adults and health). N E Derbyshire – Lilian Robinson (community safety and health). Bassetlaw – none listed for health. Rotherham – currently decisions taken by government appointed commissioners.
Joint OSC members:
Clinical staff working in the services where change may happen (Barnsley Hospital, Chesterfield Royal Hospital. Doncaster and Bassetlaw Hospitals, Mid Yorkshire Hospitals, Rotherham Hosptial, Sheffield Children’s Hospital, Sheffield Teaching Hospital)
Chairs and chief officers of all CCGs: Barnsley – Nick Balac, Lesley Smith. Bassetlaw – Steve Kell, Phil Metham. Doncaster – Nick Tupper, Chris Stainforth. Hardwick – Steven Lloyd, andy Gregory. North Derbyshire – Ben Milton, Jackie Pendleton. Rotherham – Julie Kitlowski, Chris Edwards. Sheffield – Tim Moorhead, Maddy Ruff. Wakefield – Phillip Earnshaw, Jo Webster.
Members of all CCGS, via the governing body and comms teams in each CCG.
Moderate Local Authority commissioners Healthwatch: Sheffield – Carrie McKenzie (chief officer). Barnsley Power/Influence – Carrianne Stones (chief officer). Rotherham – Tony Clabby (chief All mental health provider trust boards: (via chairs and officer). Doncaster – Philip Kerr (chief officer). Bassetlaw – chief executives) Rotherham, Doncaster and South Christine Watson (chief officer). Derbyshire – Karen Ritchie (chief Humber – Lawson Pater, Kathryn Singh. South West officer). Wakefield – Nicholas Esmond (chief officer). Yorkshire Partnership – Ian Black, Steven Michael. Nottinghamshire – Joe Pidgeon (chief officer). Sheffield Health and Social Care – Alan Walker, Kevan Taylor. Nottinghamshire Healthcare – Professor Dean Patient groups related to any potential service changes (will Fathers, Ruth Hawkins. move up the grid if become organised)
Voluntary organisations working with people who Working Together Provider Partnership may be affected by changes All foundation trust governors: (via membership offices in trusts). Barnsley, Sheffield Teaching, Sheffield Children’s, Rotherham, Doncaster and Bassetlaw, Chesterfield.
All acute hospital trust boards: (via chairs and chief executives). Barnsley – Stephen Wragg, Diane Wake. Doncaster and Bassetlaw – Chris Scholey, Mike Pinkerton. Chesterfield – Helen Phillips, Gavin Boyle. Mid Yorkshire – Jules Preston, Stephen Eames. Rotherham – Martin Havenhand, Louise Barnett. Sheffield Children’s – Nicholas Jeffrey, Simon Morrit. Sheffield Teaching – Tony Pedder, Sir Andrew Cash.
Ambulance service trust boards: (via chairs and chief executives). East Midlands – Pauline Tagg, Sue Noyes. Yorkshire – Della Cummings, Rod Barnes.
Unions representing staff where changes could be made. Regional reps for Unite, Royal Colleges, MiP, Unison, GMB.
Little or no Staff at NHS Greater East Midlands Commissioning Support unit Staff in CCGs power/influence Staff in NHS provider organisations (acute, mental health, ambulance)
Staff in GP practices
Voluntary groups (could move up and right)
Communities and community groups (could move up and right)
All foundation trust members (via membership offices in trusts). Barnsley, Sheffield Teaching, Sheffield Children’s, Rotherham, Doncaster and Bassetlaw, Chesterfield.
General stakeholder list for reference:
NHS Organisations/ Partnerships NHS England – Area Teams NHS Rotherham CCG NHS Doncaster CCG NHS Sheffield CCG NHS Barnsley CCG NHS Bassetlaw CCG NHS North Derbyshire CCG NHS Hardwick CCG NHS Wakefield CCG Yorkshire and Humber Clinical Senate East Midlands Clinical Senate The Working Together Provider Partnership Barnsley Hospital NHS Foundation Trust Chesterfield Royal Hospital NHS Foundation Trust Doncaster and Bassetlaw Hospitals NHS Foundation Trust The Mid Yorkshire Hospitals NHS Trust The Rotherham NHS Foundation Trust Sheffield Children’s NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust Yorkshire Ambulance Service East Midlands Ambulance Service Public Health England NHS Yorkshire & Humber Commissioning Support Unit NHS Greater East Midlands Commissioning Support Unit Acute Clinical Care Operational Delivery Network
Wider Public Sector Organisations/ Partnerships Healthwatch Health and Wellbeing Boards MPs Local Overview and Scrutiny Committees Council members and staff
Public/ Patients and Groups Public Patients National & local patient/ pressure groups Voluntary groups Community groups BME groups
Staff and Members Staff at all of the provider and commissioner organisations GP Members of the CCGs Senior teams and Boards/ Governing Bodies at each of the commissioner organisations Unions
Appendix 2
Demographic data per area
Barnsley
231,221 total population
49.1% male
50.9% female
White: 96.03%
White Irish: 0.24%
White gypsy or Irish traveller: 0.07%
White other: 1.46%
Mixed /multiple ethnic groups – white and black Caribbean – 0.27%
Mixed /multiple ethnic groups – white and black African – 0.07%
Mixed /multiple ethnic groups – white and Asian – 0.18%
Mixed /multiple ethnic groups – other mixed – 0.16%
Asian/Asian British – Indian – 0.19%
Asian/Asian British – Pakistani – 0.09%
Asian/Asian British- Bangladeshi – 0.02%
Asian/Asian British – Chinese – 0.19%
Asian/Asian British – other Asian – 0.21%
Black/African/Caribbean/Black British: African – 0.43%
Black/African/Caribbean/Black British – Caribbean – 0.06%
Black/African/Caribbean/Black British – Other black –0.03%
Other ethnic group – Arab – 0.07%
Other ethnic group – any other ethnic group – 0.11%
Bassetlaw:
112,863 total population
56,024 male
56,839 female
White: 94.5%
White Irish: 0.33%
White gypsy or Irish traveller: 0.08%
White other: 2.44%
Mixed /multiple ethnic groups – white and black Caribbean – 0.4%
Mixed /multiple ethnic groups – white and black African – 0.07%
Mixed /multiple ethnic groups – white and Asian – 0.2%
Mixed /multiple ethnic groups – other mixed – 0.2%
Asian/Asian British – Indian – 0.38%
Asian/Asian British – Pakistani – 0.25%
Asian/Asian British- Bangladeshi – 0.06%
Asian/Asian British – Chinese – 0.16%
Asian/Asian British – other Asian – 0.24%
Black/African/Caribbean/Black British: African – 0.19%
Black/African/Caribbean/Black British – Caribbean – 0.21%
Black/African/Caribbean/Black British – Other black – 0.05%
Other ethnic group – Arab – 0.04%
Other ethnic group – any other ethnic group – 0.13%
Doncaster:
302,402 population
149,230 male
153,172 female
White: 91.8%
White Irish: 0.39%
White gypsy or Irish traveller: 0.19%
White other: 2.82%
Mixed /multiple ethnic groups – white and black Caribbean – 0.46%
Mixed /multiple ethnic groups – white and black African – 0.15%
Mixed /multiple ethnic groups – white and Asian – 0.29%
Mixed /multiple ethnic groups – other mixed – 0.2%
Asian/Asian British – Indian – 0.6%
Asian/Asian British – Pakistani – 0.9%
Asian/Asian British- Bangladeshi – 0.04%
Asian/Asian British – Chinese – 0.37%
Asian/Asian British – other Asian – 0.58%
Black/African/Caribbean/Black British: African – 0.43%
Black/African/Caribbean/Black British – Caribbean – 0.25%
Black/African/Caribbean/Black British – Other black – 0.08%
Other ethnic group – Arab – 0.07%
Other ethnic group – any other ethnic group – 0.27%
NE Derbyshire:
99,023 total population
48,564 male
50,459 female
White: 96.9%
White Irish: 0.26%
White gypsy or Irish traveller: 0.07%
White other: 0.79%
Mixed /multiple ethnic groups – white and black Caribbean – 0.32%
Mixed /multiple ethnic groups – white and black African – 0.1%
Mixed /multiple ethnic groups – white and Asian – 0.25%
Mixed /multiple ethnic groups – other mixed – 0.11%
Asian/Asian British – Indian – 0.35%
Asian/Asian British – Pakistani – 0.08%
Asian/Asian British- Bangladeshi – 0.03%
Asian/Asian British – Chinese – 0.18%
Asian/Asian British – other Asian – 0.15%
Black/African/Caribbean/Black British: African – 0.15%
Black/African/Caribbean/Black British – Caribbean – 0.06%
Black/African/Caribbean/Black British – Other black – 0.02
Other ethnic group – Arab – 0.04%
Other ethnic group – any other ethnic group – 0.08%
Chesterfield
103,788 total population
50,900 male
52,888 female
White: 94.8%
White Irish: 0.37%
White gypsy or Irish traveller: 0.004%
White other: 1.2%
Mixed /multiple ethnic groups – white and black Caribbean – 0.5%
Mixed /multiple ethnic groups – white and black African – 0.09%
Mixed /multiple ethnic groups – white and Asian – 0.27%
Mixed /multiple ethnic groups – other mixed – 0.17%
Asian/Asian British – Indian – 0.47%
Asian/Asian British – Pakistani – 0.32%
Asian/Asian British- Bangladeshi – 0.13%
Asian/Asian British – Chinese – 0.35%
Asian/Asian British – other Asian – 0.25
Black/African/Caribbean/Black British: African – 0.41%
Black/African/Caribbean/Black British – Caribbean – 0.26%
Black/African/Caribbean/Black British – Other black –0.07%
Other ethnic group – Arab – 0.06%
Other ethnic group – any other ethnic group – 0.08%
Rotherham
257,280 total population
126,247 male
131,033
White: 91.9%
White Irish: 0.3%
White gypsy or Irish traveller: 0.05%
White other: 1.3%
Mixed /multiple ethnic groups – white and black Caribbean – 0.3%
Mixed /multiple ethnic groups – white and black African – 0.11%
Mixed /multiple ethnic groups – white and Asian – 0.33%
Mixed /multiple ethnic groups – other mixed – 0.23%
Asian/Asian British – Indian – 0.37%
Asian/Asian British – Pakistani – 2.96%
Asian/Asian British- Bangladeshi – 0.04%
Asian/Asian British – Chinese – 0.23%
Asian/Asian British – other Asian – 0.5%
Black/African/Caribbean/Black British: African – 0.65%
Black/African/Caribbean/Black British – Caribbean – 0.11%
Black/African/Caribbean/Black British – Other black –0.06%
Other ethnic group – Arab – 0.22%
Other ethnic group – any other ethnic group – 0.28%
Sheffield
552,698 population
272,661 male
280,037 female
White: 80.84%
White Irish: 0.5%
White gypsy or Irish traveller: 0.06%
White other: 2.25%
Mixed /multiple ethnic groups – white and black Caribbean – 0.98%
Mixed /multiple ethnic groups – white and black African – 0.23%
Mixed /multiple ethnic groups – white and Asian – 0.63%
Mixed /multiple ethnic groups – other mixed – 0.55%
Asian/Asian British – Indian – 1.06%
Asian/Asian British – Pakistani – 3.97%
Asian/Asian British- Bangladeshi – 0.6%
Asian/Asian British – Chinese – 1.33%
Asian/Asian British – other Asian – 1.04%
Black/African/Caribbean/Black British: African – 2.0%
Black/African/Caribbean/Black British – Caribbean – 0.99%
Black/African/Caribbean/Black British – Other black – 0.54%
Other ethnic group – Arab – 1.52%
Other ethnic group – any other ethnic group – 0.7%
Wakefield
325,832 total population
159,913 male
165,924 female
White: 92.76%
White Irish – 0.27%
White gypsy or Irish traveller: 0.09%
White other: 2.27%
Mixed /multiple ethnic groups – white and black Caribbean – 0.33%
Mixed /multiple ethnic groups – white and black African – 0.11%
Mixed /multiple ethnic groups – white and Asian – 0.27%
Mixed /multiple ethnic groups – other mixed – 0.17%
Asian/Asian British – Indian – 0.47%
Asian/Asian British – Pakistani – 1.5%
Asian/Asian British- Bangladeshi – 0.009%
Asian/Asian British – Chinese – 0.26%
Asian/Asian British – other Asian – 0.36%
Black/African/Caribbean/Black British: African – 0.6%
Black/African/Caribbean/Black British – Caribbean – 0.1%
Black/African/Caribbean/Black British – Other black –0.07%
Other ethnic group – Arab – 0.11%
Other ethnic group – any other ethnic group – 0.17%
Appendix 3
During the pre-consultation phase we asked people, “How would you want to see/read/hear about the formal consultation?”
Summary of responses:
By email: 42.7% (82 out of 192 responses)
Online (social and digital media): 34.9% (67 out of 192 responses)
Local media (print and broadcast): 12.5 % (24 out of 192 responses)
Face to face meetings and events: 9.9% (19 out of 192 responses)
GB/Pu/16/06/10
Putting Barnsley People First
GOVERNING BODY
9 June 2016
SPECIAL EDUCATION NEEDS UPDATE
1. PURPOSE OF THE REPORT
To inform the Governing Body about how the requirements of The Children’s and Families Act 2014 new 0-25 Special Educational Needs and Disability (SEND) reforms are being met by the CCG with regard to the responsibilities of Health.
2. EXECUTIVE SUMMARY
The paper outlines the reforms and the requirements of CCGs to have a designated role in relation to them. The paper notes the importance of Health Care Professionals being effectively supported to contribute to personalised plans for children and young people to maximise their educational opportunities and quality of life. Key to the effective production of integrated plans with education and social care colleagues is co-production with families, mutual trust of all involved and clinical and system acumen.
3. THE GOVERNING BODY IS ASKED TO:
Note the information provided
Agenda time allocation for report: 10 minutes.
Report of: Brigid Reid
Designation: Chief Nurse
Report Prepared by: Karen O’Brien
Designation: Lead Nurse Children with Complex Health Care & Designated Clinical Officer
1 GB/Pu/16/06/10
1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
1.2 Engagement to meet needs 4.2 Partnership working 5.2 Statutory Duties & Governance 1.2 Links to Objectives
To have the highest quality of governance and processes to x support its business To commission high quality health care that meets the needs x of individuals and groups Wherever it makes safe clinical sense to bring care closer to x home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual x accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist Has the area been considered (yes / no / not relevant)? Financial Implications Ongoing monitoring of Children CHC spend Contracting Implications N/A
Quality Overseen by Chief Nurse Consultation / Engagement DCO liaises with Parent Carer Forum Equality and Diversity EIA N/A
Information Governance Business conducted as per IG policy Environmental Sustainability N/A
Human Resources N/A
2 GB/Pu/16/06/10
2. INTRODUCTION
The Children’s and Families Act 2014 introduced the new 0-25 Special Educational Needs and Disability (SEND) reforms and implementation of these reforms commenced nationally on the 1st September 2014. The reforms have made significant changes to the responsibilities for all agencies involved in the delivery of care for children and young people with special educational needs. This will hopefully allow for greater co-operation between education, health and social care. Under the new Act, all statements of special educational needs and Learning Difficulty Assessments (LDAs) will be replaced, with a single combined Education, Health and Care (EHC) plan by 1st September 2018. The new process will cover children and young people from birth to age of 25, and will include information about health and social care needs as well as special educational needs in one single document.
There is a statutory responsibility for all Clinical Commissioning Groups (CCG) and other health bodies to work collaboratively with their local authorities in jointly commissioning services (Children and Families Act 2014). This will allow for services to cross organisational and inter-agency boundaries, preventing fragmentation of the delivery of care. The CCG have a specific duty to arrange the health provision specified in the EHC plan of a child or young person if this cannot be provided by the currently commissioned universal health services.
While Barnsley local authority leads the local SEND arrangements, Barnsley CCG is a key partner. The CCG therefore needed to ensure that we have a strong working relationship with BMBC in order to provide the basis for joint commissioning of the SEND services to occur. The joint arrangements underpinning the plan must include an agreement between the partners about their respective responsibilities for funding, to ensure the services specified are commissioned promptly. The health care provision specified in an EHC plan must be agreed in time to be included in the draft of the EHC plan that is sent to the child or young person and their parents.
To support these changes the SEND Code of Practice recommends that CCG’s identify a Designated Medical Officer, (DMO) or a Designated Clinical Officer, (DCO) to coordinate and support the implementation of the system. The role is non-statutory but their input into the statutory SEND processes is vital.
As identified to the Governing Body in the April Quarterly update regarding Childrens Services further information can be found on www.gov.uk (search for Health Professional Guide to the Send Code of Practice).
3. OVERVIEW
Mindful of the requirements outlined in section 2 we chose to implement a DCO in order to combine the clear responsibilities and interdependencies between the SEND reforms and Continuing Health Care (CHC). Karen O’Brien was appointed into the role of DCO alongside her half time substantive post as Lead Nurse for Children and Young people with Complex Health Needs and Lead for Children’s CHC. Karen has significant experience of working in a
3 GB/Pu/16/06/10
clinical setting with children and young people with SEND (half time substantive post as Lead Nurse for Neurology at Sheffield Children’s NHS Trust). The clinical and managerial balance of this DCO role has been difficult to separate so careful consideration has been given to both elements.
The role of the DCO is to;
Act as a point of contact for local authorities, schools and colleges when notifying parents and local authorities about children and young people they believe have, or maybe have, SEN or a disability, and when seeking advice on SEN or disabilities. Act as a point of contact for local authorities, schools and colleges seeking health advice. Supporting schools with their duties to pupils with medical conditions. Ensuring that assessments, planning and health support is carried out within CCGs. The DCO would not routinely carry out the assessments themselves but ensure they are done Support the CCG in the transition of young people from children’s to adult services and jointly commission services that will help meet the outcomes in the EHC plan.
In Barnsley the DCO works both strategically and clinically offering a source of knowledge on matters relating to SEND for the CCG, local authorities, healthcare providers, other local organisations and agencies and has worked with the local medical team in developing the health advice request form which is currently being audited for the next 6 months.
The role involves being an active member of the multidisciplinary panel that is led by education. This is a weekly panel which is responsible for developing and agreeing Education, Health and Care (EHC) plans.
Finally, the DCO acts as the lead health contact for young people 19-25 years, in order to assist families, health, education and social care to understand and navigate the complex world of adult health and social care services.
As the pace of EHC plans increases the DCO plans to work with a GP from Membership Council to ensure that although the frequency with which GPs will need to be involved will vary (dependent upon their practice population) they are clearly sighted on the DCO role so that it can best support them as required. The contact details for the post holder are identified in Appendix A
4. RISKS AND IMPLICATIONS TO THE CLINICAL COMMISSIONING GROUP
Without the effective co-ordination, support and advice of the DCO the required benefits of a needs based personalised plan to maximise the ability children with special needs to benefit from their educational opportunities will be at risk. The work undertaken so far by the DCO has shown an effective ability to enable the relevant health practitioners to contribute to the EHC Plan in a cogent and timely manner. Furthermore the role is vital in maintaining positive relationships with children and their families to best personalise Plans that are focused on outcomes that enable young people to be as independent and occupied as
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benefits their quality of life. As previously articulated to the Governing Body (2014) the arrangements of how children’s eligibility for CHC funding is assessed was strengthened with the creation of the Lead Nurse role and this is monitored through the Children’s & Young Peoples Trust (C&YPT) Executive Commissioning Group (ECG). The work of the Lead Nurse in contributing to integrated packages of care via the Children’s Resource Allocation Group has paved the way to better understanding of all partners of when and how needs requiring greater input than universal services can provide. Such an understanding is vital in the partnership working to achieve effective EHC Plans (Blank proforma can be accessed by https://www2.barnsley.gov.uk/media/3829685/ehcp_v1.2.pdf) In light of the increasing activity re EHC Plans and the forthcoming developmental inspections of the locality delivery of them by Ofsted and CQC it is important that all relevant Health Care Practitioners are aware of them and feel supported to contribute as required. The DCO will be prioritising this over the summer.
5. APPENDIX
Appendix A - DCO contact details
6. CONCLUSION
This paper gives an overview of the required contribution of CCGs to enable effective delivery of EHC Plans as required by the SEND reforms of 2014. Further updates will be given as part of the Quarterly Update re Children’s Services that the Governing Body receives. The Trust Executive Group (TEG) of the C&YPT is overseeing the borough’s work and has a strategy and action plan to ensure delivery of this important work keeps pace with the needs of the children and young people of Barnsley.
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APPENDIX A
Karen O’Brien Lead Nurse for Children and Young People with Complex Health Needs Designated Clinical Officer Barnsley Clinical Commissioning Group Hillder House 49-51 Gawber Road Barnsley S75 2PY Tel No: 01226 730000 Mobile No: 07799 037693
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Putting Barnsley People First
GOVERNING BODY
9 JUNE 2016
Quality Highlights Report
1. PURPOSE OF THE REPORT
Provide the June Governing Body with the agreed highlights of the May 2016 Quality & Patient Safety Committee meeting.
2. EXECUTIVE SUMMARY
The information provided in this report is in addition to that already provided within the monthly performance report and the ongoing risk management work through the Assurance Framework and Risk Register. The format agreed highlights quality issues considered at each Quality & Patient Safety Committee which includes key points discussed, relevant actions and a narrative summary.
3. THE GOVERNING BODY IS ASKED TO:
Note the Quality Highlights identified.
Agenda time allocation for report: 10 minutes.
Report of: Brigid Reid
Designation: Chief Nurse
Report Prepared by: Amanda Lindley
Designation: Quality Manager
Quality Highlights Report to June 2016 Governing Body Page 1 of 2
GB/Pu/16/06/11
1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
This report links to risks on the current Assurance Framework as follows:
1.1 If the CCG is unable effectively to manage the competing interests and priorities of our partners and providers, there is a risk that the CCG will fail to work effectively to commission high quality health care.
5.1 If the CCG does not appropriately identify the ability of services commissioned to meet the needs of vulnerable people; AND if the CCG does not ensure our professional advice to direct commissioning of care homes (BMBC) is effectively acted upon there is a risk of failure to deliver our adult safeguarding responsibilities to people in Care Homes.
1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist As this report is Financial Implications for information Contracting Implications only, all areas Quality within the Consultation / Engagement governance Equality and Diversity arrangements Information Governance checklist are not Environmental Sustainability relevant. Human Resources
Quality Highlights Report to June 2016 Governing Body Page 2 of 2
QUALITY HIGHLIGHTS
MONTHLY UPDATE TO THE JUNE 2016 GOVERNING BODY FOLLOWING THE MAY 2016 QUALITY & PATIENT SAFETY COMMITTEE
This paper identifies quality issues that the Quality & Patient Safety Committee judge important for the Governing Body to be sighted on.
Issue Consideration Action
The committee clarified that the key The current risk description issue is the scant or absent information needs to be re-worded to better relating to why changes in medication articulate the risk and the follow D 1 Discharge Letters have been made. Even if the change in on actions identified by – risk 14/15 hospital has been for therapeutic/safety Governing Body to be reasons to not communicate this implemented. creates a patient safety risk.
The Committee discussed the Ending The Chief Nurse agreed to Offender Health Violence Against Women & Girls highlight this at the Quality Services Strategy 2016-2020 Surveillance Group for South and it’s implications. As part of this Yorkshire & Bassetlaw discussion the Offender Health Services were highlighted as an area that could be improved, particularly around data sharing to ensure patients receive safe, effective and quality care on their transition back into the community.
The Committee received and approved Note the approved TOR – see the amended TOR. Governing Body item 15 for a Revised QPSC Terms copy of the TOR. of Reference (TOR)
The Committee has received and noted Note the CCG has responded to Provider Quality both the BHNFT and SWYPFT draft both BHNFT and SWYPFT’s Accounts Quality Account reports. These are an draft Quality Account reports. annual report and the CCG are offered the opportunity to comment and provide feedback. Submissions have been provided to both organisations commending areas of good practice and identifying areas for further improvement.
Governing Body Highlights Report following the May 2016 QPSC Page 1 of 1 GB/Pu/16/06/12
Putting Barnsley People First
GOVERNING BODY
9 June 2016
Social Prescribing – “My Best Life”
1. PURPOSE OF THE REPORT
The purpose of this report is to gain approval to invest and procure a borough wide Social Prescribing liaison service in Barnsley.
2. EXECUTIVE SUMMARY
Around a fifth of GP’s time is spent dealing with patients’ social problems including debt, social isolation, housing, work, relationships and unemployment.
Social prescribing is a mechanism for linking patients with non-medical sources of support within the community.
This paper:
• This is a revised paper as a result of feedback received from the private section of the Governing Body at meetings held on 11 February and 14 April 2016.
• This paper provides an update of the model and includes the recommendations made by the Governing Body and Senior Management Team.
3. THE GOVERNING BODY IS ASKED TO:
Approve to invest and procure a borough wide Social Prescribing liaison service in Barnsley
Agenda time allocation for report: 10 minutes
Report of: Lesley Jane Smith
Designation: Chief Officer
Report Prepared by: Katie Roebuck
Designation: Lead Commissioning &
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Transformation Manager
1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
If the CCG fails to deliver the objective of the Strategic Plan and the Primary Care Strategy to move care out of hospital, due to failure to engage with all providers, lack of capacity within the CCG, or the primary care workforce, there is a risk that care will either: be moved closer to home inappropriately or inconsistently across the district, resulting in an adverse effect on health inequalities in Barnsley, or conversely will not move out of secondary care settings. If the CCG and its partners on the Health & Wellbeing Board do not articulate a clear ‘sense of place’ (strategy for Barnsley) or develop a strong sense of mutual accountability (eg for the Better Care Fund), there is a risk that the Board will not deliver more joined up, higher quality, efficient and effective services for the people of Barnsley which address the priority areas in the JSNA. 1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs X of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual X accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist
Financial Implications Yes
Contracting Implications Yes – procurement process required Quality Yes – no risk
Consultation / Engagement Yes
Equality and Diversity Outstanding
Information Governance Outstanding
Environmental Sustainability No significant impact Human Resources N/A
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2. INTRODUCTION/ BACKGROUND INFORMATION
Social prescribing is a mechanism for linking patients with non-medical sources of support within the community. It provides health care professionals with a non-medical referral option that can operate alongside existing treatments to improve health and wellbeing and enable a more holistic approach.
Social prescribing provides a route to help to ‘de-medicalise’ support and recognises the importance of psychosocial, environmental and economic factors in health and wellbeing and health inequalities
Papers proposing a borough wide social prescribing model have previously been to the Governing Body private session on 11th February and 14th April 2016 and the Senior Management Team on 25th May and 1st June 2016, where discussions took place around the following:
Provide feedback on the proposed model Endorse the direction of travel of the proposed model for a borough wide social prescribing liaison service in Barnsley Note that a stakeholder workshop was to be held on the 16th of February. Agree to the development of an application for additional funding from the national Primary Care Transformation Funding
The business case and service specification were previously provided and approved in principle by Governing Body, subject to recommendations made.
3. DISCUSSION/ISSUES
The service specification has been further developed to include the recommendations previously made by the Governing Body and the Senior Management Team.
The recommendations included the following:
Senior Management Team Recommendations:
• Identified the requirement for expected referral numbers within the specification. Therefore, the level of referrals expected by the CCG has been described in the service specification (600 in year one, rising to 1,800 by year three).
• Requested that an external evaluation is included within the service specification, to inform the evidence base. This has been included.
Governing Body Recommendations:
• The recruitment of advisors and referral routes have been reconsidered in response to the request from Governing Body that the implementation of the Social Prescribing Scheme should be achieved at pace as opposed to the original planned phasing and that a broader range of health and social care professionals should be able to refer into the service from the start.
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The service specification has been changed with: • Removal of the phased implementation. However, as the Provider may be unable to recruit enough high calibre advisors to fill all of the posts in one recruitment round, within the specification the following caveat has been added:
• If the full complement of advisors are not recruited into post at the commencement of the service, a phased implementation of social prescribing will be required, such as phasing from East to West of the Borough. • Referral routes now incorporates the following: • The service provider will develop a system wide referral process for patients with a non-clinical need to be referred from all clinical primary care staff (e.g. GP’s, Practice Nurses, ANP’s and HCA’s), Community and Specialist Nurses, District Nurses, Community Matrons, Mental Health services, Care Navigators, social services, independent living at home service, Be Well Barnsley etc • Provides feedback to referrer in an appropriate manner as agreed between both parties
• It was suggested that an alert about the scheme be included on Practice systems as an option to offer patients. Electronic referrals to the scheme would be preferred. Therefore the following is stated within the specification:
• IT systems will be required to incorporate social prescribing on the referral button of System One and EMIS • Develop an IT system to flag potential patients via a referral code
• It was identified that Practice Champions and a Governing Body clinical Champion may be effective in promoting and success of the scheme. Therefore, this has been included in the service specification and within the HITS element of the practice delivery agreement.
• It was highlighted that the name “Social Prescribing” did not provide a clear understanding for potential participants on what the service provided and could be misconstrued. Therefore, the service will be branded as “My Best Life”, giving positive connotations to potential participants on how the service could improve a participant’s quality of life.
4. IMPLICATIONS
Procurement timelines
The procurement of the service, if approval agreed, will commence in June 2016.
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A three year contract with option to extend by one year plus one year will be offered.
The timeline for this process is as follows:
Prepare tender documents – June 2016 This will include: Development of Specification, Question Set, Pricing Schedule Prepare tender documentation for ITT phase including drafting the evaluation methodology, criteria, scoring and weighting and sharing the proposed ITT for comment
Tender stage – 11/07/2016 – 05/09/2016 This will include: Issue tender to OJEU (30 days) Stakeholder event to provide information on service specification and procurement process to potential providers Desktop evaluation of tenders Presentation/demonstration/Q&A as appropriate Evaluation consensus meeting and decision on provider recommendations
Contract award and implementation – 12/09/2016
Prepare and send Paper to Governing Body Meeting for information and / or approval if contract value exceeds agreed cost envelope
• Final contract signed by both parties – 10/10/16 • Mobilisation & implementation period for the new contract – 17/10/2016 • New service commences – 01/04/2016 • Contract & performance monitoring – 01/04/2016
Funding The investment required£830,000 +/- 10% to deliver the service and a further £50,000 investment to provide an independent evaluation. . The total budget therefore is £981,000 in the first three years.
An application has been made to the Primary Care Infrastructure Fund for the 2016/17 funding.
5. RISKS TO THE CLINICAL COMMISSIONING GROUP
There could be potential staffing risks associated with the aspiration to recruit all the advisors at the same time. There is a possibility for the need to recruit over 2/3 phases if there is a lack of high quality applicants/candidates. This may be influenced by the provider, as staff may already be available.
If there is a delay in recruiting staff, this may impact on the implementation of the model and the provider will need to agree with the commissioner any changes in the time line of implementation.
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The success of this model is highly dependent on the development and maintenance of good relationships between referrers, the liaison service and the community and voluntary sector services that patients will be referred on to. Further engagement work will be undertaken by the CCG with key stakeholders during the development and commissioning of this service to help to develop these relationships. It is proposed that the Provider, once in place, will establish a steering group with the key stakeholders to help to further develop the relationships and provide a route for stakeholder feedback and influence on the development of the service.
The Provider will be expected to monitor the needs identified and the number and type of onward referrals made. It is possible that this may identify gaps in service provision and / or capacity for particular needs. The Stronger Communities Partnership work streams, including the Early Help offer, could provide a route to address identified gaps.
There is a risk that service will not work if there is not a commitment of a minimum of 3 years for this service to embed and become successful. Therefore, it is proposed to offer a 3 year plus 1 plus 1 contract.
6. CONSULTATION
A stakeholder workshop was held on 16th February 2016, which included members from the patient council, practice nurse and the lay representative from the Governing Body. The workshop was attended by approximately 60 people and provided very positive feedback which has been considered and where appropriate included within the service specification.
The service specification and business case took into consideration feedback from the Rotherham and Doncaster services to highlight best practice and identify lessons learnt.
The model has been discussed regularly at the Practice Managers Forum and has been discussed with the Social Prescribing, Urgent Care and Secondary Care representative Governing Body Members.
The Acting Executive Director for Communities at BMBC has been involved in the development of the model to ensure that it links with the work with communities in Barnsley and a Council representative has been invited to be on the procurement panel.
An update is being given to the Provider Forum on 15th June.
7. APPENDICES TO THE REPORT
No appendices
8. CONCLUSION
To conclude, amendments have been made to the service model as per the recommendations and feedback previously received from the private sector of the Governing Body and SMT.
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Governing Body are asked to give final approval for the model and commencement of procurement of the service.
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Putting Barnsley People First
GOVERNING BODY
9 June 2016
CCG COMMITTEES TERMS OF REFERENCE
1. PURPOSE OF THE REPORT
The purpose of this report is to provide the Governing Body with updated Terms of Reference for CCG Committees.
2. EXECUTIVE SUMMARY
The Terms of Reference for CCG Committees are reviewed on an annual basis to ensure that the Terms of Reference:
remain current and fit for purpose accurately reflect the Committee’s duties and responsibilities adhere to any Internal Audit recommendations.
The following terms of reference have been reviewed and recommended by each respective committee to the Governing Body for approval.
Audit Committee – Appendix 1 Finance and Performance Committee – Appendix 2 Quality and Patient Safety Committee – Appendix 3 Equality Steering Group – Appendix 4
The Terms of Reference for the Primary Care Commissioning Committee were approved by the Governing Body in April 2016.
The following Committees will shortly be reviewing their Terms of Reference and will submit them to the August Governing Body for approval:
Patient and Public Engagement Committee Remuneration Committee Clinical Transformation Board
3. THE GOVERNING BODY IS ASKED TO:
Approve the terms of reference for the CCG Committees.
Agenda time allocation for report: 10 minutes.
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Report of: Vicky Peverelle
Designation: Chief of Corporate Affairs
Report Prepared by: Richard Walker
Designation: Head of Assurance
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1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
The terms of reference for CCG Committees links to the risk reference 5.2 on the CCGs Assurance Framework
5.2 If the CCG fails to deliver its statutory duties, due to weaknesses in its corporate governance and control arrangements, it will result in legal, financial, and / or reputational risks to the CCG and its employees.
1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist
Financial Implications Not relevant – report for information Contracting Implications As above
Quality As above
Consultation / Engagement As above
Equality and Diversity As above
Information Governance As above
Environmental Sustainability As above
Human Resources As above
3
Putting Barnsley People First
Audit Committee Terms of Reference
NHS Barnsley Clinical Commissioning Group Audit Committee - Terms of Reference
1. Introduction
1.2 The Clinical Commissioning Group has established a committee reporting to the Governing Body known as the Audit Committee.
1.3 The Committee is established in accordance with Barnsley Clinical Commissioning Group’s Constitution, Standing Orders and Scheme of Delegation.
1.4 These terms of reference set out the membership, remit responsibilities and reporting arrangements of the group and shall have effect as if incorporated into the Clinical Commissioning Group’s constitution. The Committee is a non-executive committee of the Governing Body and has no executive powers other than those specifically delegated in these Terms of Reference.
2. Authority 2.1 The Committee is authorised by the Clinical Commissioning Group to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to cooperate with any request made by the Committee.
2.2 The Committee is authorised by the Clinical Commissioning Group to obtain external legal or other independent professional advice and to secure the attendance of advisers with relevant experience and expertise if it considers this necessary.
2.3 The Committee shall provide assurance and advice to the Governing Body on the proper stewardship of resources and assets, including value for money; financial reporting; the effectiveness of audit arrangements (internal and external); compliance with NHS Protect’s Standards for Commissioners: Fraud, Bribery and Corruption; risk management, and on control and integrated governance arrangements within the Clinical Commissioning Group.
2.4 The Committee has responsibility for recommending approval of the annual financial statements and Annual Governance Statement to the Governing Body.
3. Purpose
3.1 The purpose of the Audit Committee is to assist Barnsley Clinical Commissioning Group to deliver its responsibilities for the conduct of public business, and the stewardship of funds under its control. In particular, the Committee will seek to provide assurance to the Governing Body that an appropriate system of internal control is in place to ensure that:
a) Business is conducted in accordance with the law and proper standards;
b) Public money is safeguarded and properly accounted for;
c) Financial Statements are prepared in a timely fashion, and give a true and fair view of the financial position of Barnsley CCG for the period in question;
d) Affairs are managed to secure economic, efficient and effective use of resources;
e) Reasonable steps are taken to prevent and detect fraud and other irregularities in line with NHS Protect’s Standards for Commissioners: Fraud, Bribery and Corruption. 4. Responsibilities.
4.1 The responsibilities and duties of the Audit Committee can be categorised as follows:
5. Governance, Internal Control and Risk Management
5.1 The Committee shall review the establishment and maintenance of an effective system of governance, internal control and risk management across Barnsley Clinical Commissioning Group for both clinical and non- clinical activities, including partnerships that support the achievement of the organisation’s objectives.
5.2 The Committee will review the adequacy and effectiveness of:
a) all risk and control related disclosure statements, together with any accompanying Head of Internal Audit statement, External Audit opinion or other appropriate independent assurances, prior to endorsement by the Clinical Commissioning Group Governing Body on behalf of the Membership Council;
b) the structures, assurance processes and responsibilities for identifying and managing key risks facing the organisation, indicating the degree of achievement of corporate objectives, as laid down in the Clinical Commissioning Group’s Annual Governance Statement and Assurance Framework;
c) the policies for ensuring that there is compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification;
d) the operational effectiveness of policies and procedures;
e) the policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the Counter Fraud and Security Management Service to ensure compliance with NHS Protect’s Standards for Commissioners: Fraud, Bribery and Corruption.
5.3 In carrying out this work the Committee will primarily utilise the work of Internal Audit, External Audit, Counter Fraud and Security Management Service the Local Counter Fraud Specialist, NHS Protect , and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from managers as appropriate, concentrating on the overarching systems of governance, risk management and internal control, together with indicators of their effectiveness.
5.4 This will be evidenced through the Committee’s use of an effective Risk Assurance Framework to guide its work and that of the audit and assurance functions that report to it.
5.5 To review the CCGs Assurance Framework and Risk Register at each meeting of the Committee in particular:
Assurance Framework Review the risks on the Assurance Framework for which the Committee are responsible Note and approve the risks assigned to the Committee Review the risk assessment scores for risks Identify any new risks that present a gap in control for inclusion on the Assurance Framework Agree actions to reduce impact of extreme and high risks.
Risk Register Review those risks on the Risk Register for which the Committee are responsible for completeness and accuracy Note and approve the risks assigned to the Committee Review the risk assessment scores for risks Identify any new risks for inclusion on the Risk Register Agree actions to reduce impact of extreme and high risks Consider and agreed whether risks are being effectively managed
5.6 The Committee will monitor compliance with the CCG’s Standing Orders and Prime Financial Policies and will receive regular reports of any decisions to suspend standing orders, instances of non-compliance with prime financial policies, changes to banking arrangements, use of single tender waivers, or losses and special payments. 6. Internal Audit
6.1 The Committee shall ensure that there is an effective internal audit function established by management that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Governing body. This will be achieved by:
a) consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal;
b) review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the Assurance Framework.
c) considering the major findings of internal audit work (and management’s response), and ensuring coordination between the internal and external auditors to optimise audit resources;
d) ensuring that the Internal Audit function is adequately resourced and has appropriate standing within the organisation;
e) an annual review of the effectiveness of internal audit.
7. External Audit
7.1 The Committee shall review the work and findings of the External Auditors and consider the implications and management’s responses to their work. This will be achieved by:
a) consideration of the appointment and performance of the External Auditor, as far as the rules governing the appointment permit.
b) discussion and agreement with the External Auditors, before the audit commences, of the nature and scope of the audit as set out in the Annual Audit plan, and ensuring coordination, as appropriate, with other External Auditors in the local health economy.
c) discussion with the External Auditors of their local evaluation of audit risks and assessment of the Clinical Commissioning Group and associated impact on the audit fee;
d) review of all External Audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Governing Body and any work undertaken outside the annual audit plan, together with the appropriateness of the management responses.
8. Financial Reporting
8.1 The Committee shall monitor the integrity of the financial statements of the Clinical Commissioning Group and any formal announcements relating to the Clinical Commissioning Group’s financial performance. 8.2 The Committee should ensure that the systems for financial reporting to the Clinical Commissioning Group Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Governing Body.
8.3 The Group shall review the Clinical Commissioning Group Annual Report before submission to the Clinical Commissioning Group Governing Body and review the Financial Statements, focusing particularly on:
a) the wording in the Annual Governance Statement and other disclosures relevant to the Terms of Reference of the Committee;
b) changes in, and compliance with, accounting policies and practices;
c) major judgemental areas; and significant adjustments resulting from the audit; Unadjusted mis-statements in the financial statements;
d) Letter of representation.
9. Other Assurance Functions 9.1 The Audit Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications to the governance of the organisation.
9.2 These will include, but will not be limited to, any reviews by Department of Health Arm’s Length Bodies or Regulators/Inspectors (e.g. Care Quality Commission, NHS Litigation Authority, etc.), professional bodies with responsibility for the performance of staff or functions (e.g. Medical Royal Colleges, other professional bodies and accreditation bodies, etc.)
9.3 In addition, the Committee will review the work of other Committees within the organisation, whose work can provide relevant assurance to the Audit Group’s own scope of work. This will include Committees that have a remit for clinical governance, finance and performance and commissioning.
10. Counter Fraud
10.1 The Committee shall satisfy itself that the organisation has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. The Committee will seek assurance regarding the organisation’s compliance with NHS Protect’s Standards for Commissioners: Fraud, Bribery and Corruption by means including reports from the Local Counter Fraud Specialist, the CCG’s annual self- assessment (Self Review Tool) submissions to NHS Protect, and from NHS Protect inspection reports.
11. Management
11.1 The Committee shall request and review reports and positive assurances from managers on the overall arrangements for governance, risk management and internal control. 11.2 They may also request specific reports from individual functions within the organisation (e.g. clinical audit) as they may be appropriate to the overall arrangements.
12. Membership
12.1 The membership of the Audit Committee will be:
a) Governance Lay Member – Committee Chair b) PPE Lay Member c) Governing Body Member ( Dr Guntamukkala) d) Practice Manager Governing Body Member (Ms M Hoyle) e) One member of the Membership Council (Dr J Maters)
Plus
a) The Chief Finance Officer will be in attendance only b) The Committee will be supported by the Chief of Corporate Affairs The Chief Officer will attend the Committee at least once a year to c) answer questions in relation to Internal Controls and Assurance.
12.2 The Chair will be
a) Appointed as set out in the Clinical Commissioning Group Constitution for a term of between 2 and 4 years. b) A Lay Member of the Governing Body who has the qualifications, expertise or experience such as to enable them to express informed view about financial management and audit matters
12.3 The following are disqualified from being Members of the Audit Committee
a) The Chair of the Clinical Commissioning Group Governing Body b) The Chief Finance Officer c) All CCG Employees
13. Quorum
13.1 A minimum of 3 members (one of which should be a lay member) will constitute a quorum.
13.2 If the meeting becomes inquorate, the meeting shall either be suspended or decisions adjourned to another date, including consideration of virtual agreement.
13.3 A decision put to a vote at the meeting shall be determined by a majority of the votes of members present. In the case of an equal vote, the Chair of the Committee shall have a second and casting vote. 13.4 In the event of the chair of the audit committee being unable to attend all or part of the meeting, he or she will nominate a replacement from within the membership to deputise for that meeting.
14. Attendance
14.1 The Elected Practice Lead(s) and one member of the Membership Council shall attend meetings of the Audit Committee.
14.2 The Clinical Commissioning Group Chief Finance Officer, or designated representative, shall be required to attend all meetings of the Committee, and the Chief of Corporate Affairs will support the committee.
14.3 Appropriate Internal Audit, and External Audit, and Local Counter Fraud Specialist representatives shall be invited to attend meetings. At least once a year the Committee should meet privately with the External and Internal Auditors.
14.4 The Chief Officer would normally be invited to attend and discuss, at least annually with the committee, the process for assurance that supports the Annual Governance Statement. He or she would also normally attend when the committee considers the draft internal audit plan and the annual accounts.
14.5 Regardless of attendance, external audit, internal audit, local counter fraud and security management providers will have full and unrestricted rights of access to the audit committee.
14.6 Any NHS Manager/CCG Clinical Leads may be invited to attend, particularly when the committee is discussing areas of risk or operation that are the responsibility of that director.
14.7 The chair of the Governing Body will be invited to attend one meeting per year in order to form a view on, and understanding of, the committee’s operations.
14.8 Deputies are not permitted except in exceptional circumstances, and only with the agreement of the Chair.
15. Reporting Arrangements
15.1 The minutes of Audit Committee meetings shall be formally recorded and submitted to the Clinical Commissioning Group Governing Body. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require disclosure to the full Governing Body, or require executive action.
15.2 The Group will report to the Clinical Commissioning Group Governing Body at least annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embedding of risk management in the organisation and the integration of governance arrangements.
15.3 A Committee Annual Report will be produced for submission to the Governing Body.
16. Administration
16.1 The Chief of Corporate Affairs will oversee the management of the Committee supported by the Chief Finance Officer.
16.2 The Chief of Corporate Affairs will be responsible for supporting the Chair in the management of the Committee’s business and for drawing the Committee’s attention to best practice, national guidance and other relevant documents, as appropriate.
17. Frequency
17.1 Meetings shall be held at least four times a year and more frequently if or when the work plan warrants it.
17.2 The External Auditor, or Internal Auditor, or Local Counter Fraud Specialist may request a meeting if they consider that one is necessary.
17.3 The agenda and papers will be made available five working days in advance of the meeting.
18. Conduct of the Committee
18.1 The Committee shall conduct its business in accordance with national guidance, relevant codes of practice including the Nolan Principles and the Clinical Commissioning Group Conflict of Interest Policy.
18.2 The Committee should review at least annually its own performance, membership and terms of reference. Any resulting changes to the terms of reference or membership should be approved by the Governing Body.
19. Review
19.1 These Terms of Reference will be reviewed at least once a year or sooner if required, with recommendations made to the Clinical Commissioning Group Governing Body for approval.
July November 2015
Putting Barnsley People First
Finance and Performance Committee
Terms of Reference
NHS Barnsley Clinical Commissioning Group Finance and Performance Committee
1. Introduction
1.1 The Clinical Commissioning Group has established a committee reporting to the Governing Body known as the Finance and Performance Committee.
1.2 The Committee is established in accordance with Barnsley Clinical Commissioning Group’s Constitution, Standing Orders and Scheme of Delegation.
2. 1. Purpose
The purpose of the Finance and Performance Committee is to:
2.1 establish a performance framework which enables the Clinical Commissioning Group to proactively manage its Financial, Performance and Quality Innovation, Productivity and Prevention agenda.
2.2 provide assurance about delivery and sustained performance in these areas to the Governing Body, by reviewing and approving performance reports and rectification action plans in detail prior to the Governing Body meetings.
2.3 hold to account the Management Team of the Clinical Commissioning Group for delivery in their areas of responsibility.
3. 2. Responsibilities
3.1 The Committee will review and have oversight of finance and performance in relation to the following areas:
a) performance against national and local targets;
b) ‘in year’ financial position. Receiving a detailed report of the financial position and progress towards meeting the targets within the Clinical Commissioning Group financial plans;
c) implementation of the Quality, Innovation, Productivity and Prevention schemes and receive updates on both the financial and activity performance of each scheme;
d) achievement against Clinical Commissioning Group incentive schemes and receive reports of the actual and forecast performance to inform the success of incentive schemes;
e) implementation of investments / transformation schemes and receive updates outlining financial, activity and delivery against key performance indicators for each scheme;
3.2 The committee will also;
a) Receive and review departmental delivery plans for indicators or performance areas by exception.
b) Challenge delivery or rectification plans produced to achieve targets or improve performance.
c) Ensure resolution of key performance issues raised by accountable members of the Management Team.
d) Identify and allocate resources where appropriate to improve performance.
e) The Committee will fulfil the priorities of the Procurement Advisory Group.
f) The Committee will review the CCGs Assurance Framework and Risk Register in accordance with the Integrated Risk Management Framework. In particular:
Assurance Framework
Review the risks on the Assurance Framework for which the Committee are responsible Note and approve the risks assigned to the Committee Review the risk assessment scores for risks Identify any new risks that present a gap in control for inclusion on the Assurance Framework Agree actions to reduce impact of extreme and high risks
Risk Register
Review those risk on the Risk Register for which the Committee are responsible for completeness and accuracy Note and approve the risks assigned to the Committee Review the risk assessment scores for risks Identify any new risks for inclusion on the Risk Register Agree actions to reduce impact of extreme and high risks. Consider and agreed whether risks are being effectively managed
4. Membership
4.1 The membership of the Finance and Performance Committee will be:
a) The Chair of the Governing Body b) One Lay Member, Governance c) A Member of the Membership Council (Vacant) d) The Chief Officer e) The Chief Finance Officer f) The Elected Governing Body member representative Audit Committee g) The Elected Governing Body member representative Finance h) The Elected Governing Body member representative Contracting i) Chief of Corporate Affairs
4.2 Membership will be reviewed and adjusted as necessary to ensure the Committee meets its responsibilities, and it can co-opt expert members as necessary to support its function.
5. Quorum
5.1 A minimum of five members will constitute a quorum, including 1 officer and 1 CCG senior manager.
5.2 A decision put to a vote at the meeting shall be determined by a majority of the votes of members and deputies present. In the case of an equal vote, the Chair of the Committee shall have a second and casting vote.
5.3 Deputies are not permitted except with the agreement of the Chair
6. Reporting Arrangements
6.1 The minutes of the Finance and Performance Committee shall be formally recorded and submitted to the Clinical Commissioning Group Governing Body on a monthly basis.
6.2 The Finance and Performance Committee will produce a monthly report for the Barnsley Clinical Commissioning Group Governing Body in the agreed format.
6.3 A Finance and Performance Committee Annual Report will be produced for submission to the Governing Body.
7. Administration
7.1 The Chief of Corporate Affairs will oversee the management of the Committee supported by the Head of Performance and Planning and the Deputy Chief Finance Officer/Finance.
8. Frequency
8.1 The Finance and Performance Committee will meet at least ten times a year in a published schedule of meetings and extraordinary meetings may be held as required.
8.2 The agenda and papers will be made available five working days in advance of the meeting.
9. Code of Conduct
9.1 The Committee shall conduct its business in accordance with national guidance, relevant codes of practice including the Nolan Principles and the Conflict of Interest policy.
10. Review
10.1 The Committee should review at least annually its own performance, membership and terms of reference. Any resulting changes to the terms of reference or membership should be approved by the Governing Body.
Reviewed by: Finance and Performance Committee on the 4 February 2016
Review date: March 2017
Putting Barnsley People First
Quality and Patient Safety Committee
Terms of Reference
Date- May 2016
Governing Body Approved - TBC
Review – May 2017
NHS Barnsley Clinical Commissioning Group Quality and Patient Safety Committee
1. Introduction
1.1 The Clinical Commissioning Group has established a committee reporting to the Governing Body known as the Quality and Patient Safety Committee.
1.2 The Committee is established in accordance with NHS Barnsley Clinical Commissioning Group’s Constitution, Standing Orders and Scheme of Delegation. 1. 2. 2. Authority
2.1 The Committee is authorised by the Governing Body to establish and maintain effective systems to monitor Quality and Patient Safety for the services the Clinical Commissioning Group commissions.
2.2 The Committee will have other sub-committees or groups reporting to it or informing its discussions. See 4.2 for details, in addition any others as determined by the committee or the governing body.
2.3 The Committee will commission, where appropriate, any reports or surveys it deems necessary to assist in discharging its obligations.
3. Purpose
3.1 The purpose of the Committee is to assure the CCG regarding all elements of quality, patient safety, clinical effectiveness and patient experience of the services commissioned for the people of Barnsley.
3.2 The Committee will:
a) Support the development of the commissioning strategy and monitor its implementation and improvement to ensure that that quality sits at the heart of everything the CCG does. This will provide assurance to the Clinical Commissioning Group that there is an effective and consistent process for commissioning for quality and safety in Barnsley.
b) Gain assurance that commissioned services are being delivered in a high quality, safe and effective manner for people across all its commissioning responsibilities.
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This is includes jointly commissioned services either with other Clinical Commissioning Groups, the Local Authority or other specialised commissioners.
c) Ensure that any concerns about quality are duly considered by the relevant function/committee at BCCG.
d) Advise on and oversee the management of commissioning clinical risk on behalf of the Governing Body via regular review of the QPSC risk register.
e) The committee will obtain and provide to the Governing Body assurance regarding the quality and safety of primary medical care services in Barnsley.
4. Responsibilities
4.1 The duties of the Quality and Patient Safety Committee will be driven by the priorities for NHS Barnsley Clinical Commissioning Group and any identified risks or areas that need quality improvement. The Committee will operate to the brief below which is flexible to new and emerging priorities and risks.
4.2 The Committee will;
a) Receive reports and guidance from regulatory, national and other competent bodies and where applicable ensure action plans are developed to improve performance or adopt best practice in Barnsley.
b) Receive relevant information regarding the management of:
i. Serious Incidents including Never Events ii. Homicide investigations, by exception iii. Infection prevention and control iv. Safeguarding children and adults, including Domestic Violence and Mental Health Reviews v. Medicines Safety
c) Receive reports and action plans in respect of:
i. National Institute of Clinical Excellence (NICE) Technology Appraisals , clinical guidelines and Quality Standards compliance
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ii. Clinical Audit performance iii. Research governance and implementation iv. Agreement of locally determined CQUINS taking into account national CQUINS - v. CQUINS performance – and ongoing monitoring throughout the year. Patient/Public Experience: patient surveys and reports vi. Staff surveys information in relation to quality and patient safety vii. Reports from Care Quality Commission, Monitor and any other viii. relevant regulatory bodies re inspections, guidance and recommendations d) Review the CCG’s Assurance Framework and Risk Register in accordance with the CCG’s Integrated Risk Management Framework.
e) Receive minutes/briefings from the following meetings:
i. Area Prescribing Committee - minutes ii. Primary Care Quality & Cost Effective Prescribing Group-minutes iii. Quality Surveillance Group (QSG )- briefing iv. Barnsley Intelligence Sharing Meetings – briefing v. BHNFT Clinical Quality Board - minutes vi. SWYPFT Clinical Quality Board - minutes vii. Health of Children in Care and Care Leavers Steering Group - minutes viii. Health Protection Board - minutes ix. Care UK Out of Hours Contract Meeting - briefing x. Primary Care Commissioning - briefing
4.3 The Committee will agree a clear escalation process, with the governing body, including appropriate trigger points to enable appropriate engagement of the Clinical Commissioning Group and external bodies on areas of concern.
4.4 The Committee will provide an annual report and highlight’s /escalation report and approved minutes to the Governing Body after each meeting.
4.5 The Committee will also oversee professional issues and responses to whistle blowing linked to quality and patient safety.
4.6 The Committee will identify and determine best performance, quality and value outcomes by assessing clinical effectiveness, cost effectiveness, quality standards and the views of patients and carers in Barnsley.
4
4.7 The Committee will ensure all service development and redesign, evaluation of services and decommissioning of services are subject to a Quality Impact Assessment as part of the implementation process. This will also ensure the proposal is safe for patients.
4.8 The Committee will ensure the implementation of key standards within CCG in relation to Information Governance (including the Information Governance toolkit, data exchange agreements) and ensure effective governance systems are in place for implementing and monitoring these standards.
4.9 The Committee will receive regular patient safety, patient experience and complaints reports to review themes and trends and identify areas for change in practice.
4.10 The Committee will satisfy itself that effective processes are in place within all its commissioned services and the Clinical Commissioning Group for safeguarding children and young people, safeguarding vulnerable adults, managing issues arising from domestic violence, forced marriage and the PREVENT agenda.
4.11 The Committee will also receive and approve clinical policies and clinical pathways for adoption in Barnsley.
5. Membership
5.1 Quality of healthcare services is not the responsibility of any one individual or directorate. To ensure that Barnsley Clinical Commissioning Group functions effectively it is vital to have clinical participation and representatives in all activities, however for this committee it is essential that there is a clinical majority at all times.
5.2 As well as this committee the Clinical Commissioning Group Governing Body will also receive Clinical Advice and input to its decision making from the local Clinical Senate which will be an” independent” but linked clinical body. This group will have representation across the whole range of clinical practice.
5
5.3 The membership of the Quality and Patient Safety Committee will be:
a) Medical Director (the Chair) b) Chief Nurse (Deputy Chair) c) Governing Body Secondary Care Doctor ( Mr M Simms) d) 2 Membership Council Members as a clinical advisors (Dr R Farmer & Dr M Kadarsha) e) Governing Body member (Dr M Smith) f) Governing Body member (Dr S Krishnasamy) g) Head of Medicines Optimisation h) Lay Member for Public and Patient Engagement and Chair of Primary Care Commissioning Committee i) Deputy Chief Nurse / Head of Patient Safety j) Head of Quality for Commissioning Primary Care Medical Services
5.4 Membership will be reviewed regularly as required by committee to enable it to discharge its duty. The committee may co-opt expert members as necessary with the agreement of the Governing Body.
5.5 A decision put to a vote at the meeting shall be determined by a majority of the votes of members and deputies present. In the case of an equal vote, the Chair of the Committee at that meeting shall have a second and casting vote.
6. Attendance
6.1 In exceptional circumstances where committee members cannot attend deputies, at an appropriate level, are welcomed.
7. Quorum
7.1 A minimum of 5 members will constitute a quorum, including at least 3 Clinicians and at least 1 elected member of the Governing Body.
8. Reporting Arrangements
8.1 The minutes of the Quality and Patient Safety Committee shall be formally recorded and submitted to the Clinical Commissioning Group Governing Body after each meeting.
8.2 The Committee will agree upon key issues to be included in a highlight report to the Governing Body after each meeting.
6
8.3 A Quality & Patient Safety Committee Annual Report will be produced for submission to the Governing Body.
8.4 The Committee will provide more detailed reports at agreed intervals to the Clinical Commissioning Group Governing Body and if required to the South Yorkshire and Bassetlaw Area Team.
9. Administration
9.1 The Management of the committee will be overseen by the Chief of Corporate Affairs, managed and supported by the Quality Manager and Quality Team.
10. Frequency
10.1 The Quality and Patient Safety Committee will meet on a 6 weekly basis at least eight times per year. Extraordinary meetings to be held as required, either by circumstances, the Governing Body or the Committee.
11. Conduct of the Committee
11.1 The Committee shall conduct its business in accordance with national guidance, relevant codes of practice including the Nolan Principles and the Conflict of Interest policy.
12. Review
12.1 The Quality & Patient Safety Committee will review its performance, membership and terms of reference at least annually. Any resulting changes to the terms of reference will be presented for approval to the Governing Body.
Last Reviewed: May 2016 Next Review Due: May 2017.
Approved by Governing Body tbc.
7
Putting Barnsley People First
Equality Steering Group
Terms of Reference
NHS Barnsley Clinical Commissioning Group Equality Steering Group Terms of Reference
1. Introduction
1.1 The Clinical Commissioning Group has established a Committee reporting to the Governing Body known as the Equality Steering Group
1.2 The Steering Group is established in accordance with NHS Barnsley Clinical Commissioning Group’s Constitution, Standing Orders and Scheme of Delegation.
2. 1. Authority
2.1 The Steering Group is authorised by the Governing Body to establish and maintain effective systems to manage and oversee the implementation of a strategic vision for equality, diversity and human rights across all healthcare commissioning and contracting decisions in Barnsley.
2.2 The Steering Group will commission, where appropriate, any reports or surveys it deems necessary to assist in discharging its obligations.
3. Purpose
3.1 The purpose of the Steering Group is to ensure that Barnsley CCG meets the General and Specific duties under the Equality Act 2010 across all commissioning decisions, contracting and workforce, and that equality, diversity and human rights is actively promoted, communicated and managed for the workforce of the CCG and the community of Barnsley alongside the continuing work with other partners to contribute to reducing health inequalities across Barnsley.
4. Responsibilities
The Equality Steering Group will:
4.1 Ensure that the CCGs Equality and Diversity and Human Rights Strategy is implemented and revised as required.
4.2 Develop an Equality Action Plan to incrementally improve the CCGs performance against the NHS Equality Delivery System (EDS 2).
4.3 Ensure that the CCG meets and monitors all its statutory requirements, both nationally and locally, relating to equality, diversity and human rights both in commissioning and employment.
4.4 Co-ordinate its work with the Patient and Public Engagement Committee to ensure that the CCG’s patient & public engagement work utilises every opportunity to involve groups across the 9 protected characteristics to maximise the input of these users experiences to inform effective commissioning of services to meet the needs of the whole population we serve.
4.5 Promote and publish Barnsley CCG’s core values and equality and diversity successes and ensure all staff are aware of the achievements and promote ownership of Equality and Diversity.
4.6 Provide quarterly briefings and update reports for the CCG Governing Body.
4.7 To review the CCGs Assurance Framework and Risk Register at each meeting of the Steering Group in particular:
Assurance Framework
Review any risk on the assurance Framework for which the Committee is responsible; Note and approve the risks assigned to the Committee; Review the risk assessment scores for risks; Identify any new risks that present a gap in control for inclusion on the Assurance Framework; Agree actions to reduce impact of extreme and high risks.
Risk Register
Review any risks on the Risk Register for which the Committee is responsible for completeness and accuracy; Note and approve the risks assigned to the Committee; Review the risk assessment scores for risks; Identify any new risks for inclusion on the Risk Register; Agree actions to reduce impact of extreme and high risks; Consider and agree whether risks are being effectively managed.
5. Membership
5.1 The Membership of the Equality Steering Group will be:
a) Chief Nurse (the Chair) b) Lay member for Public and Patient Engagement c) Elected Governing Body Member d) Head of Contractsing Deputy Chief Finance Officer (Contracting) (representing both finance and contracting) e) Membership Council Elected Members x 2 (Dr Saxena and vacant) f) Practice Manager Governing Body Member ( Deputy Chair) g) Head of Assurance (representing Corporate Affairs)
Head of Communications & Engagement
52 In Attendance
a) Head of Communications & Engagement Manager (CSU) b) HR Business Partner c) Equality & Diversity Manager d) Healthwatch Barnsley
5.3 As Required
a) Public Health Representative (Director or Deputy)
5.4 Membership will be reviewed regularly as required by the Group to enable it to discharge its duty. The Committee may co-opt expert members as necessary with the agreement of the Governing Body.
6. Attendance
6 .1 Deputies will not be permitted except in exceptional circumstances and only in agreement with the Chair.
7 Quorum
71 A minimum of five members will constitute a quorum, including at least two members of the Governing Body.
7.2 A decision put to a vote at the meeting shall be determined by a majority of the votes of members and deputies present. In the case of an equal vote, the Chair of the Committee at that meeting shall have a second and casting vote.
8. Reporting Arrangements
8.1 The minutes of the Equality Steering Group will be formally recorded and submitted to the Clinical Commissioning Group Governing Body on a quarterly basis.
9. Administration
9.1 The Management of the Committee will be overseen by the Chief Nurse, supported by the Equality & Diversity Manager and the PA to the Chief Nurse.
10. Frequency
10..1 The Equality Steering Group will meet on a quarterly basis and extraordinary meetings to be held as required, either by circumstances,
the Governing Body or the Committee.
11. Code of Conduct
11.1 The Committee shall conduct its business in accordance with national guidance, relevant Codes of Practice including the Nolan Principles and the Conflict of Interest policy.
12. Review
12.1 The Equality Steering Group will review its performance, membership and Terms of Reference at least annually. Any resulting changes to the Terms of Reference will be presented for approval to the Governing Body.
12.2 The Equality Steering Group will review any risks arising from its business and ensure these are pursued and if necessary escalated to the management via the Standards of Business Conduct, Managing Conflicts of Interest, and the Acceptance of Gifts and Hospitality Policy.’CCG Risk Register.
Approved by Governing Body 9 July 2015
GB/Pu/16/06/14
Putting Barnsley People First
GOVERNING BODY
9 June 2016
RISK AND GOVERNANCE EXCEPTION REPORT
1. PURPOSE OF THE REPORT
To provide the Governing Body with: the Risk and Governance Exception Report a proposal regarding the process for appointing the CCG’s External Auditors from 2017/18.
2. EXECUTIVE SUMMARY
Governing Body Assurance Framework
The Governing Body Assurance Framework (GBAF) facilitates the Governing Body in assuring the delivery of the CCG’s annual strategic objectives.
A Governing Body development Session was held on 28 April to review and refresh the GBAF. The Chief of Corporate Affairs and the Head of Assurance have subsequently re-drafted and updated some of the risks on the GBAF in the light of these discussions, and the changes have been considered by the Management Team.
The updated GBAF 2016/17 is attached for the Governing Body’s consideration and approval (Appendix 1). Text which has been changed or updated is shown in red. Risk references 2.1, 3.1, 3.2, 4.1 and 4.2 are completely new and the Governing Body is asked particularly to consider whether these risks are appropriately described and scored.
There is currently one risk on the GBAF currently rated as red (extreme) which is:
1.1 If the CCG is unable effectively to manage the competing interests and priorities of our partners and providers, there is a risk that the CCG will fail to work effectively to commission high quality health care.
The Governing Body should consider whether all risks continue to be managed and scored appropriately, and that any relevant positive assurances are identified for inclusion on the GBAF.
1 GB/Pu/16/06/14
Corporate Risk Register
The Corporate Risk Register is a mechanism to effectively manage the current risks to the organisation.
Red (extreme) risks This exception report provides the Governing Body with the extreme risks faced by the organisation; that is those risks that impact on the Assurance Framework and which could potentially impact on the achievement of the CCG’s strategic objectives.
There are currently six extreme risks on the CCG’s Risk Register which have been escalated to the Assurance Framework as gaps in assurance against risks on the Assurance Framework. The risks are: Ref 13/3 (rated score 16 ‘extreme) - BHNFT’s under performance against the target that 95% of A&E patients are treated or discharged within 4 hours Ref CCG 14/5b (rated score 20 ‘extreme’) – Contractual and reputational risks relating to Yorkshire Ambulance Service (YAS) under achieving against the Category A response standard of 75% within 8 minutes Ref CCG 14/10 (rated score 16 ‘extreme’) – Risks resulting from the lack of GPs in Barnsley compared with the national average Ref CCG 14/15 (rated score 16 ‘extreme’) – Potential impact on quality & patient safety of incomplete D1 discharge letters Ref CCG 15/07 (rated score 15 ‘extreme’) – Quality & patient safety risks relating to Yorkshire Ambulance Service (YAS) under achieving against the Category A response standard of 75% within 8 minutes Ref CCG 15/14b (rated score 16 ‘extreme’) - In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service (or failure to improve outcomes) there is a risk that there will be a negative impact on primary care workforce and capacity.
The Governing Body should consider whether these risks continue to be managed and scored appropriately.
Risks added or removed since the last meeting
At its meeting in May 2016 the Quality & Patient Safety Committee agreed to remove 2 risks from the risk register on the grounds that they are now fully mitigated. The risks are: Risk ref 13/1 (relating to delivery of HCAI trajectories Risk ref 15/09 (relating to Greenacre School).
Quality & Patient Safety Committee also agreed to include one new risk, Ref 16/04, as follows: “If there is not an adequate response from BHNFT to the areas identified as ‘requiring improvement’ in the CQC report, there is a risk that the Trust does not meet the requirements potentially leading to poor quality or unsafe services for the people of Barnsley.” The Committee agreed this risk should be scored as 8 (‘high’).
2 GB/Pu/16/06/14
Procurement of External Audit Service 2017/18 The Governing Body is aware that following dissolution of the Audit Commission, CCGs are now required to appoint their external auditors commencing from the financial year 2017/18. The procurement process must be completed by 31 December 2016.
In order to comply with guidance Governing Body has previously approved the establishment of a Barnsley CCG Auditor Panel comprising the Lay Member for Governance (chair of the Panel), the Lay Member for Patient and Public Engagement and Primary Care Commissioning (Vice Chair), and the Chief Finance Officer. The Chief of Corporate Affairs and Head of Assurance attend Auditor Panel meetings in an advisory capacity. The Panel’s Terms of Reference were approved by the Governing Body in May 2016. CCG’s across South Yorkshire and Bassetlaw have been exploring the potential for a joint procurement exercise, led by Doncaster CCG. The Auditor panel has received and reviewed a proposal from Doncaster CCG, the key points of which are described below:
Proposal BCCG Auditor Panel view To procure external audit services Supported on the basis that it is likely jointly with other CCGs in SY & to deliver better value for money Bassetlaw
Procure utilising an existing Supported on the basis that this will be framework (Crown Commercial quicker and less costly, and does not Services framework or the East of contravene OJEU rules England CPC framework)
Process to be overseen by a Supported – CCG reps to be the Head Regional Sub group comprising 2 of Assurance and the Head of representatives from each CCG Commissioning (MH, Children, Specialised)
Each CCG to appoint an Evaluation Supported – CCG panel to be the Chief Panel to evaluate bids Finance Officer, Chief of Corporate Affairs, Head of Assurance and the Head of Commissioning (MH, Children, Specialised), with their recommendation to be signed off by the Auditor Panel
One supplier to be appointed across Supported – whilst the CCG might not the sub region based on arithmetic get its first choice supplier the service mean of all CCG panel scores is tightly scoped with minimal local variation, and all suppliers are centrally accredited and operate to the same professional standards
The Governing Body is asked to approve the process outlined above. At the conclusion of the process the Auditor Panel will recommend the supplier to the Governing Body for final approval.
3 GB/Pu/16/06/14
3. THE GOVERNING BODY IS ASKED TO:
Review and approve the refreshed GBAF for 2016/17 Consider and agree whether the red (extreme) risks on the GBAF are appropriately scored and whether there is sufficient assurance that they are being effectively managed as at 9 June 2016 Identify any positive assurances relevant to the risks on the GBAF Review risks rated as extreme on the Risk Register Review the risks escalated from the Risk Register as gaps in control against risks on the Assurance Framework Note the risks removed from and added to the Risk Register by the Quality & Patient Safety Committee Approve the proposal regarding the procurement of the External Audit service from 2017/18.
Agenda time allocation for report: 10 minutes.
Report of: Vicky Peverelle
Designation: Chief of Corporate Affairs
Report Prepared by: Richard Walker
Designation: Head of Assurance
4 GB/Pu/16/06/14
1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
The requirement for the CCG to have an Assurance framework and Risk Register is documented in the Integrated Risk Management Framework 2013/14.
1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist Has the area been considered (yes / no / not relevant)? Financial Implications Not relevant – report for information Contracting Implications As above
Quality As above
Consultation / Engagement As above
Equality and Diversity As above
Information Governance As above
Environmental Sustainability As above
Human Resources As above
5 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 1: To commission high quality health care that meets the needs NHSE Domains: Committee providing assurance QPSC of individuals and groups Better Health Better Care Executive lead(s) BR Sustainability Leadership Clinical / Lay Lead MG What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Improved outcomes for patients. 1.1 If the CCG is unable effectively to manage the competing interests and priorities of our partners and providers, there is a risk Improved performance by providers in delivery of all key performance measures that the CCG will fail to work effectively to commission high quality health care. inc A&E waits, ambulance response times and the quality of D1 discharge letters.
Likelihood Consequence Risk rating Total 20 Date reviewed May-16 Initial 3 5 15 Rationale: Historic poor performance by BHNFT & SWYPFT against some Current 3 5 15 key quality measures means likelihood of failure is possible. Consequence Appetite 3 4 12 0 of failure catastrophic owing to impact on patient care. A M J J A S O N D J F M Approach Treat Key controls to mitigate threat: Sources of assurance Rec'd? Contract monitoring meetings with BHNFT & SWPFT Minutes received and considered by FPC Ongoing Clinical Quality Board bi monthly meetings with BHNFT & SWYPFT Minutes received and considered by QPSC Ongoing CCG represented at South Yorkshire Quality Surveillance Group Updates received and considered by QPSC Ongoing QA of all provider Serious Incident Investigations Monthly assurance to QPSC via Patient Safety Reports Ongoing CQUINs built into contracts & monitored through Quality & Performance Meetings Quality & Performance Group minutes received and considered by QPSC Ongoing Joint commissioning arrangements with BMBC Minutes of Joint Commissioning meetings go to FPC Ongoing NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal letters received and considered by GB. assessment against the 4 domains of assurance at the year end. Real time assurance via Clinically Led Quality Assurance visits to main providers Reports received and considered by QPSC Ongoing CCG share intelligence with Healthwatch on a bi monthly basis Any resulting lines of enquiry are identified through the monthly Quality Metrics Ongoing report to QPSC In addition to the expansion of the alliance contract for RightCare Barnsley the New Models of Care Both report to CTB Ongoing workstream has brought partners together in developing a new vehicle for delivering a seamless and integrated service, initially for respiratory and diabetes. Regular reports on Quality to Governing Body QPSC minutes and Quality Highlights Reports to Gov Body every month; annual Ongoing QPSC report is presented to GB; ad hoc reports to GB on specific issues. Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance YAS is currently under achieving against the Category A response standard of 75% within 8 minutes for Ongoing work with YAS to better understand and mitigate impact of under performance on the quality Barnsley residents, with potential impacts on the quality of care for Barnsley residents (RR 15/07). and safety of care for Barnsley residents, through breach analysis, review of serious incidents etc. Detailed reports have been received and reviewed by the GB. April 2016: New Lead Commissioner arrangements are being developed for the 999 and 111 contracts, and new access targets are being piloted in our region. June 2016 - The Year-end position was not delivered. YAS have been accepted as a national pilot to look at different ways of managing to calls – under a red amber green approach. To get responses better matched to individual’s needs.
Potential for harm to patients if the quality and completeness of medication information on D1 discharge May 2016: A timeline of all discussions and decisions relating to this issue has been prepared, and the letters is not improved. (RR 14/15) issue has been escalated formally to BHNFT's Chief Executive. June 2016 - RR14/15 being revised to reflect persistant gaps in communication re why medications have been changed in hospital and rising concerns re patient safety implications. Agenda item for June CQB.
Failure to deliver 4 hour A&E waits target in 2015/16 (RR 13/3). April 2016: A Sustainable Sytem Delivery Plan is being developed by the SRG and improvement trajectories agreed and submitted to NHS Improvement aiming to recover the position and deliver the standard on a sustained basis by the end of Quarter 1. 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 1: To commission high quality health care that meets the needs NHSE Domains: Committee providing assurance PPE of individuals and groups Better Health Better Care Executive lead(s) VP Sustainability Leadership Clinical / Lay Lead CM What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Commissioning plans clearly reflect the stated needs and preferences of 1.2 If the CCG does not engage effectively with the people of Barnsley there is a risk that it will not fully understand the needs of individuals and groups in the area. individuals and groups in the area, resulting in failure to commission high quality health care that meets their needs.
Risk rating Likelihood Consequence Total Date reviewed May-16 10 Initial 2 3 6 Rationale: Risk judged unlikely to occur due to well established 5 Current 2 3 6 arrangements in place. Consequence of risk occurring is moderate as Appetite 3 4 12 0 patients are affected indirectly. Approach Tolerate A M J J A S O N D J F Key controls to mitigate threat: Sources of assurance Rec'd? Robust management structure (Lay Member, Officer, & CSU leads in place) Monitored through PPE Committee & PPE Operational Delivery Group Ongoing Committee report & business case template prompt consideration of engagement Reports & business cases reviewed by relevant committees of the CCG Ongoing PPE strategy in place (updated Q1 2016) Delivery monitored through PPE Committee & PPE Operational Delivery Group To be kept under review PPE Committee in place with a work plan to ensure delivery of its ToR ToR approved by GB; annual report to GB provides assurance re delivery of ToR Due Mar-17 Commissioning Plan includes a section on engagement and reflects outcomes of engagement activity. Refreshed Strategic Commissioning Plan 2014-19 signed off by GB and Membership Yes Council (May 2014, June 2015). 2016 - updated narrative re 10 'must do's' assured by NHSE. OPEN network established Yes Patient Council now well established Patient Council chaired by Lay Member for PPE, and minutes received and Yes considered by PPE Committee Regular engagement with Barnsley Healthwatch Intelligence Sharing feedback via PPE committee. Healthwatch now attends Equality Ongoing Steering Group and the Primary Care Commissioning Committee. Patient Reference Groups established, PRG DES in place, PPE project work underway. Bi-annual PRG engagement events held to understand and evaluate effectiveness. To be kept under PRG feedback provided to Patient Council. review NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal letters received and considered by GB. assessment against the 4 domains of assurance at the year end. Gaps in control Positive assurances received The results of the 360 Stakeholder Survey (received May 2016) indicate most respondents have confidence in the visibility and capability of the CCG’s leadership including clinical leadership, and feel they have been engaged with appropriately although they would welcome clarity re how their contributions have been taken on board.
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 1: To commission high quality health care that meets the needs NHSE Domains: Committee providing assurance FPC of individuals and groups Better Health Better Care Executive lead(s) LJS Sustainability Leadership Clinical / Lay Lead What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Commissioning Plan includes ambitious but deliverable targets and trajectories. 1.3 If the CCG’s commissioning priorities are not sufficiently ambitious and outcome focused there is a risk that required Clinical Transformation Board ensures monies available for investment are improvements in health care will not be achieved, resulting in the needs of individuals and groups not being met. directed towards priority areas with greatest chance of success, and that commissioning priorities are delivered via the workstreams.
Risk rating Likelihood Consequence Total Date reviewed May-16 20 Initial 3 4 12 Likelihood is possible. Ability of CCG to deliver priorities, and impact on 10 Current 3 4 12 outcomes, will become apparent over the year. Major impact on CCG Appetite 3 4 12 0 credibility and on patients if priorities not delivered. Approach Tolerate A M J J A S O N D J F M Key controls to mitigate threat: Sources of assurance Rec'd? Strategic Commissioning Plan includes ambitious targets and trajectories reflecting the priorities of the Refreshed Strategic Commissioning Plan 2014-19 signed off by Governing Body and Yes Membership, Governing Body, service users, and other stakeholders. The Plan was subject to review & Membership Council and sent out for wider stakeholder consultation (May 2014), and challenge by NHSE at key stages in its development. a further refresh was approved by Governing Body in June 2015 following consultation with Membership Council. Operational planning templates 2016-17 were submitted to NHSE in April 2016. Plan submitted to NHSE - feedback awaited.. Feedback imminent Financial Plan and Commissioning For Value programme supports delivery of CCG ambitions Financial Plan signed off by GB (March 2016). Ongoing monitoring & reporting of To be kept under financial position via FPC to GB. CFV programme reports into F&PC. review Barnsley Integrated transformation Plan supporting delivery of STP locally. Task and finish group reports to SSDG / H&WB, with minutes to Governing Body. In progress
All service transformation activity now under the remit of a single Clinical Transformation Board with strong Transformation projects to be delivered through a series of workstreams, supported To be kept under clinical leadership and membership including representatives from BMBC and provider trusts. by the Commissioning & Transformation Team. Workstreams will take highlights review reports into the Clinical Transformation Board, which will then share minutes and highlights with the Governing Body. NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal letters received and considered by GB. assessment against the 4 domains of assurance at the year end. Regular reports to Governing Body on commissioning priorities Integrated Performance Reports; annual FPC Committee report. Ongoing Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 1: To commission high quality health care that meets the needs NHSE Domains: Committee providing assurance FPC of individuals and groups Better Health Better Care Executive lead(s) VP / HW Sustainability Leadership Clinical / Lay Lead What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Clear annual commissioning intentions are developed from the CCG's Strategic 1.4 If the CCG’s contracting governance arrangements are not effective, there is a risk that the specific contract changes necessary Plan. These commissioning intentions result in specific contract changes which to deliver our annual commissioning intentions will not be delivered, leading to poorer quality care. can be monitored and evaluated in relation to quality outcomes.
Risk rating Likelihood Consequence Total Date reviewed May-16 10 Initial 3 3 9 Rationale: Likelihood and consequence set as possible - historically Current 3 3 9 contracting arrangements have been effective and commissioning Appetite 3 4 12 0 intentions have been clearly articulated and incorporated in contracts. A M J J A S O N D J F M Approach Tolerate Key controls to mitigate threat: Sources of assurance Rec'd? Publication of annual commissioning intentions Commissioning Intentions for 16/17 were agreed by the GB in December 15 and sent Yes to providers for response Contracts in place with all providers, which reflect commissioning intentions Contracting Updates to FPC meetings Ongoing Contract governance arrangements in place with BHNFT & SWYPFT Minutes and Contracting Updates received and considered by FPC Ongoing Clinical Quality Board (previously Quality & Performance Group) meetings with BHNFT & SWYPFT Clinical Quality Board/Quality & performance group minutes received and considered Ongoing by QPSC CQUINs built into contracts & monitored through Clinical Quality Board (previously Quality & Performance) Clinical Quality Board/Quality & performance group minutes received and considered Ongoing meetings, and escalated as necessary to Contract Management Executive Board by QPSC
Wider involvement at CTB from BMBC and other providers insuring system ownership of plans CTB will feed into HWBB reporting system wide delivery and impact Ongoing
Integrated performance reports include provider performance against operational standards and contract IPRs considered at every meeting of FPC and GB Ongoing plans Regular reports to FPC on contracting arrangements Contracting update reports; annual FPC Committee report to GB Ongoing
NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal letters received and considered by GB. assessment against the 4 domains of assurance at the year end. Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance YAS is currently under achieving against the Category A response standard of 75% within 8 minutes for April 2016: New Lead Commissioner arrangements are being developed for the 999 and 111 contracts, Barnsley residents, and targets for handover times and turn around times (RR 14/5b). and new access targets are being piloted in our region. Potential for harm to patients if the quality and completeness of medication information on D1 discharge letters May 2016: A timeline of all discussions and decisions relating to this issue has been prepared, and the is not improved. (RR 14/15) issue has been escalated formally to BHNFT's Chief Executive. Failure to deliver 4 hour A&E waits target in 2015/16 (RR 13/3). April 2016: A Sustainable Sytem Delivery Plan is being developed by the SRG and improvement trajectories agreed and submitted to NHS Improvement aiming to recover the position and deliver the standard on a sustained basis by the end of Quarter 1. 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 2: Wherever it makes safe clinical sense to bring care closer to NHSE Domains: Committee providing assurance FPC home. Better Health Better Care Executive lead(s) VP Sustainability Leadership Clinical / Lay Lead NB, MG What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Drive an integrated out-of-hospital model and move services closer to home in a 2.1 If the CCG fails to work collaboratively with providers there is a risk that services will be moved closer to home inappropriately / way which does not destabilise access to local hospital services. inconsistently OR will not move out of secondary care settings.
Likelihood Consequence Risk rating Total 20 Date reviewed May-16 Initial 3 4 12 Rationale: Likelihood is currently possible - ability of the CCG to deliver Current 3 4 12 the strategy will become apparent through the year. Consequence major Appetite 3 4 12 0 given importance of the out of hospital strategy to delivery of our strategic A M J J A S O N D J F M Approach Tolerate objectives. Key controls to mitigate threat: Sources of assurance Rec'd? CCG's refreshed Strategic Plan places care closer to home at the heart of the strategy and the CCG's Plan approved by GB and Membership Council and delivery is monitored via IPRs to Ongoing investment plan prioritises investments best place to make this happen F&P and GB, and through the work of the CTB in terms of transformation. GP Forward View Primary Care development Workstream priorities developed to progress the GPFV Ongoing (see below) Primary Care Development Workstream Priorities Oversight by F&PC. Priorities for 2016/17 are incorporated in 2016/17 PDA, BQF, To be kept under and HITS review Delegated responsibility for commissioning primary medical services allows greater scope for integrating Delegated responsibilities delivered through Primary Care Commissioning Due Apr-17 primary care with the wider CCG strategy Committee, which reports to GB and is subject to assurance processes from NHS England. Continued funding in Barnsley from PMCF for OOH hubs (£6 per head of pop. 2016/17) will increase access I Heart Barnsley Performance reports provided to F&PC To be kept under to GP services evenings & weekends and potentially impact positively on numbers of unplanned attendances review and admissions to secondary care BCCG along with partners is embracing the opportunities in the FYFV for new, flexible methods of delivering Oversight by the ACO Partnership Board To be kept under healthcare outside hospital eg a local MCP is being established initially for diabetes and respiratory conditions review but with a view to rolling out the model to wider long term condition management
Practice Delivery Agreement (PDA) supports delivery of primary care at scale PDA updated 2016/17 to include HITS and updated BQF Yes Primary Care Development Strategy for Barnsley developed Strategy has been approved by Governing Body Yes
Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance RR 15/14(b): In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in Membership of Children & Young people’s Trust; Oversight through Children & Young People’s Trust service (or failure to improve outcomes) there is a risk that there will be a negative impact on primary care ECG; Promoting dialogue and shared ownership as commissioners with Public Health; Monitoring at workforce and capacity practice level delivery of 0-19 KPIs in relation to practice contracts, utilizing identified escalation routes when core service KPIs are not delivered in real time. The CCG is still in discussions with the Council through our Chair, Chief Officer and Chief Nurse to establish how we can ensure that the service we have will be the best for people of Barnsley. RR 14/10: If the Barnsley area continues to experience a lack of GPs in comparison with the national The priorities for Primary Care continue to support the development of an MDT structure for Practices. average, due to GP retirements, inability to recruit etc there is a risk that: The two main projects focused on this area are the introduction of Clinical Pharmacists with Practice (a) Some practices may not be viable, and the industrialization of HCAs and administration apprentices. (b) Take up of LES / DES or other initiatives could be inconsistent (c) The people of Barnsley will receive poorer quality healthcare services (d) Patients services could be further away from their home. Primary and Community Workforce Shortages to deliver out of hospital strategy SY Workforce Group in place; STP has a workforce chapter developed in collaboration with CCG's, HEE, providers and Universities. 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 2: Wherever it makes safe clinical sense to bring care closer to NHSE Domains: Committee providing assurance FPC home. Better Health Better Care Executive lead(s) VP Sustainability Leadership Clinical / Lay Lead NB, MG What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Drive an integrated out-of-hospital model and move services closer to home in a 2.2 If the CCG fails to deliver the out of hospital strategy, which aims to transform the delivery of care from secondary to primary and way which does not destabilise access to local hospital services. community settings and give better value for the Barnsley £, there is a risk that the CCG will be unable to deliver a comprehensive service within its financial allocation.
Risk rating Likelihood Consequence Total Date reviewed May-16 220 Initial 3 4 12 Rationale: Likelihood is currently possible - ability of the CCG to deliver the Current 3 4 12 strategy will become apparent through the year. Consequence major given Appetite 3 4 12 00 importance of the out of hospital strategy to delivery of our commissioning 12A 12M J J A S O N D J F M Approach Tolerate priorities. Key controls to mitigate threat: Sources of assurance Rec'd? CCG's refreshed Strategic Plan places care closer to home at the heart of the strategy and the CCG's Plan approved by GB and Membership Council and delivery is monitored via IPRs to Ongoing investment plan prioritises investments best place to make this happen F&P and GB, and through the work of the CTB in terms of transformation. GP Forward View Primary Care development Workstream priorities developed to progress the GPFV Ongoing (see below) Primary Care Development Workstream Priorities Oversight by F&PC. Priorities for 2016/17 are incorporated in 2016/17 PDA, BQF, and To be kept under HITS review Delegated responsibility for commissioning primary medical services allows greater scope for integrating Delegated responsibilities delivered through Primary Care Commissioning Committee, Due Apr-17 primary care with the wider CCG strategy which reports to GB and is subject to assurance processes from NHS England.
Continued funding in Barnsley from PMCF for OOH hubs (£6 per head of pop. 2016/17) will increase access to I Heart Barnsley Performance reports provided to F&PC To be kept under GP services evenings & weekends and potentially impact positively on numbers of unplanned attendances and review admissions to secondary care BCCG along with partners is embracing the opportunities in the FYFV for new, flexible methods of delivering Oversight by the ACO Partnership Board To be kept under healthcare outside hospital eg a local MCP is being established initially for diabetes and respiratory conditions review but with a view to rolling out the model to wider long term condition management
Practice Delivery Agreement (PDA) supports delivery of primary care at scale PDA updated 2016/17 to include HITS and updated BQF Yes Primary Care Development Strategy for Barnsley developed Strategy has been approved by Governing Body Yes
Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance RR 15/14(b): In relation to the 0-19 pathway reprocurement by Public Health, if there is any reduction in service Membership of Children & Young people’s Trust; Oversight through Children & Young People’s Trust (or failure to improve outcomes) there is a risk that there will be a negative impact on primary care workforce ECG; Promoting dialogue and shared ownership as commissioners with Public Health; Monitoring at and capacity practice level delivery of 0-19 KPIs in relation to practice contracts, utilizing identified escalation routes when core service KPIs are not delivered in real time. The CCG is still in discussions with the Council through our Chair, Chief Officer and Chief Nurse to establish how we can ensure that the service we have will be the best for people of Barnsley. RR 14/10: If the Barnsley area continues to experience a lack of GPs in comparison with the national average, The priorities for Primary Care continue to support the development of an MDT structure for Practices. due to GP retirements, inability to recruit etc there is a risk that: The two main projects focused on this area are the introduction of Clinical Pharmacists with Practice and (a) Some practices may not be viable, the industrialization of HCAs and administration apprentices. (b) Take up of LES / DES or other initiatives could be inconsistent (c) The people of Barnsley will receive poorer quality healthcare services (d) Patients services could be further away from their home. Primary and Community Workforce Shortages to deliver out of hospital strategy SY Workforce Group in place; STP has a workforce chapter developed in collaboration with CCG's, HEE, providers and Universities.
SCORE: A M J J A S O N D J F M Likelihood 3 3 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 3: To support safe and sustainable local hospital services, NHSE Domains: Committee providing assurance CTB supporting them to transform the way they provide services so that they Better Health are as efficient and effective as possible for the people of Barnsley. Better Care Executive lead(s) LJS Sustainability Leadership Clinical / Lay Lead NB What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Co-production with the hospital 3.1 If partners do not achieve a culture of trust and a shared vision for the delivery of services in Barnsley there is a risk that the Shared culture of trusted partnership across the system (BHNFT, CCG, BHF, system will be unable effectively to implement the new models of care and new ways of working necessary to ensure safe and SWYPFT, BMBC) sustainable local hospital services are maintained. Manage potential misalignment of organisational requirements (eg CCG QUIPP vs BHNFT control total delivery) Primary Care leadership and capacity to bring hospital services into community settings Clinical Transformation Board identifies ways to manage demand Risk rating Likelihood Consequence Total Date reviewed May-16 20 Initial 3 4 12 Rationale: Likelihood is currently possible - ability of the CCG & wider Current 3 4 12 system to deliver new models etc will become apparent through the year. Appetite 3 4 12 0 Consequence major given importance of new models & new ways of A M J J A S O N D J F M Approach Tolerate working to delivery of our commissioning priorities. Key controls to mitigate threat: Sources of assurance Rec'd? Sustainability and Transformation Plan (STP) will set out how the local system & the SY&B footprint will The STP will be formally assessed by NHSE following submission in June 2016. Due post Jun-16 holistically deliver the triple aim – better health, transformed quality of care delivery and sustainable finances. The plan will cover the period between October 2016 and March 2021. To deliver the regional STP, a regional STP Task and Finish Group is meeting on a fortnightly basis with Outcomes will inform the STP which is subject to NHSE assurance (see above) Due post Jun-16 regional events planned to include partners from across the region. Barnsley Integrated Transformation Plan to be taken forward by a sub group of SSDG working across the Task and finish group reports to SSDG / H&WB, with minutes to Governing Body. In progress. system, which will dovetail with both the development of the regional STP and the Health and Wellbeing Strategy refresh. Multispecialty Community Provider (MCP) model for diabetes and respiratory services with providers to be The MCP Implementation Group is continuing to develop the plans for the delivery In progress. implemented in 2016/17. of integrated care pathways for respiratory and diabetes within 2016/17.
Accountable Care Organisation (ACO) model to be developed in Barnsley with a view to becoming The CCG's Chair, CO, and MD are all on the ACPB, and minutes of the ACPB will In progress. operational from April 2017 - dedicated Programme Management Office and Accountable Care Partnership be taken to the CCG GB. Board in place to oversee this work. NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 required, informed by performance indicators and a wide range of other sources of insight, leading to a letters received and considered by GB. formal assessment against the 4 domains of assurance at the year end. All service transformation activity is under the remit of a single Clinical Transformation Board with strong Transformation projects to be delivered through a series of workstreams, To be kept clinical leadership and membership including representatives from BMBC and provider trusts. supported by the Commissioning & Transformation Team. Workstreams will take under review highlights reports into the Clinical Transformation Board, which will then share minutes and highlights with the Governing Body. Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 3: To support safe and sustainable local hospital services, NHSE Domains: Committee providing assurance FPC supporting them to transform the way they provide services so that they Better Health are as efficient and effective as possible for the people of Barnsley. Better Care Executive lead(s) LJS Sustainability Leadership Clinical / Lay Lead NB What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective STP workstreams manage sustainability across a wider footprint. 3.2 There is a risk to the financial sustainability of BHNFT in its current form if the Trust is unable successfully to balance its elective and non-elective activity, which could put pressure on the CCG to manage public expectations re sustaining a local hospital.
Risk rating Likelihood Consequence Total Date reviewed May-16 1020 Initial 3 3 9 Rationale: Rationale: Likelihood is currently possible - BHNFT's ability to Current 3 3 9 balance elective & non elective activity will become apparent through the Appetite 3 4 12 0 year. Consequence moderate as it could lead to local media coverage and a long-term reduction in public confidence. Approach Tolerate A M J J A S O N D J F M Key controls to mitigate threat: Sources of assurance Rec'd? Sustainability and Transformation Plan (STP) will set out how the local system & the SY&B footprint will The STP will be formally assessed by NHSE following submission in June 2016. Due post Jun-16 holistically deliver the triple aim – better health, transformed quality of care delivery and sustainable finances. The plan will cover the period between October 2016 and March 2021. To deliver the regional STP, a regional STP Task and Finish Group is meeting on a fortnightly basis with Outcomes will inform the STP which is subject to NHSE assurance (see above) Due post Jun-16 regional events planned to include partners from across the region.
Barnsley Integrated Transformation Plan to be taken forward by a sub group of SSDG working across the Task and finish group reports to SSDG / H&WB, with minutes to Governing Body. In progress. system, which will dovetail with both the development of the regional STP and the Health and Wellbeing Strategy refresh. NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal letters received and considered by GB. assessment against the 4 domains of assurance at the year end.
Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 4: To develop services through real partnerships with mutual NHSE Domains: Committee providing assurance FPC accountability and strong governance that improve health and health Better Health care and effectively use the Barnsley £. Better Care Executive lead(s) LJS Sustainability Leadership Clinical / Lay Lead NB What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Development and delivery of a Sustainability & Transformation Plan across the 4.1 If partners locally and sub regionally do not engage constructively together, due to a lack of a shared vision and a focus on local and sub-regional footprint. organisational self interest, there is a risk that the STP and Barnsley Integrated Transformation Plan will not be delivered This will require a shared vision with and full engagement from all partner resulting in poorer care and less effective use of the Barnsley £. organisations and a commitment to work towards shared goals over and above organisational self interest. Should be underpinned by public engagement. Risk rating Likelihood Consequence Total Date reviewed May-16 20 Initial 3 4 12 Rationale: Likelihood is possible as clear arrangements and timeframes Current 3 4 12 are in place for the production of the STP and BITP. Consequence is Appetite 3 4 12 0 major as non delivery represents a significant risk to the delivery of CCG A M J J A S O N D J F M Approach Tolerate and system wide objectives. Key controls to mitigate threat: Sources of assurance Rec'd? Sustainability and Transformation Plan (STP) will set out how the local system & the SY&B footprint will The STP will be formally assessed by NHSE following submission in June 2016. Due post Jun-16 holistically deliver the triple aim – better health, transformed quality of care delivery and sustainable finances. The plan will cover the period between October 2016 and March 2021. To deliver the regional STP, a regional STP Task and Finish Group is meeting on a fortnightly basis with Outcomes will inform the STP which is subject to NHSE assurance (see above) Due post Jun-16 regional events planned to include partners from across the region. Barnsley Integrated Transformation Plan to be taken forward by a sub group of SSDG working across the Task and finish group reports to SSDG / H&WB, with minutes to Governing Body. In progress. system, which will dovetail with both the development of the regional STP and the Health and Wellbeing Strategy refresh. NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 required, informed by performance indicators and a wide range of other sources of insight, leading to a letters received and considered by GB. formal assessment against the 4 domains of assurance at the year end.
Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 4: To develop services through real partnerships with mutual NHSE Domains: Committee providing assurance FPC accountability and strong governance that improve health and health care Better Health and effectively use the Barnsley £. Better Care Executive lead(s) LJS Sustainability Leadership Clinical / Lay Lead NB What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Develop an Accountable Care Organisation capable of function effectively and in 4.2 if the CCG with its partners locally is unable to develop an effective Accountable Care Organisation model in Barnsley, due to an compliance with relevant laws and regulations wef 1.4.2017 inability to overcome organisational, cultural, and legal and other barriers, there is a risk that we will collectively fail to develop services through real partnerships underpinned by strong governance.
Likelihood Consequence Risk rating Total 20 Date reviewed May-16 Initial 3 4 12 Rationale: Likelihood is possible as the CCG already has in place Current 3 4 12 arrangemets to deliver the ACO. Consequence is major given the Appetite 3 4 12 0 significance of the ACO to the delivery of the CCG's priorities. A M J J A S O N D J F M Approach Tolerate Key controls to mitigate threat: Sources of assurance Rec'd? Multispecialty Community Provider (MCP) model for diabetes and respiratory services with providers to be The MCP Implementation Group is continuing to develop the plans for the delivery of In progress. implemented in 2016/17. integrated care pathways for respiratory and diabetes within 2016/17.
Accountable Care Organisation (ACO) model to be developed in Barnsley with a view to becoming operational The CCG's Chair, CO, and MD are all on the ACPB, and minutes of the ACPB will be In progress. from April 2017 - dedicated Programme Management Office and Accountable Care Partnership Board in place taken to the CCG GB. to oversee this work. NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance letters Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal received and considered by GB. assessment against the 4 domains of assurance at the year end.
Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 5: To have the highest quality of governance and processes to NHSE Domains: Committee providing assurance QPSC support our business. Better Health Better Care Executive lead(s) BR Sustainability Leadership Clinical / Lay Lead What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Services commissioned safeguard vulnerable clients. Partnership responsibility for 5.1 If the CCG does not appropriately identify the ability of services commissioned to meet the needs of vulnerable people; AND if safeguarding in care homes is delivered. the CCG does not ensure our professional advice to direct commissioning of care homes (BMBC) is effectively acted upon there is a risk of failure to deliver our adult safeguarding responsibilities to people in Care Homes.
Risk rating Likelihood Consequence Total Date reviewed May-16 20 Initial 3 4 12 Rationale: Likelihood is 'possible ' due to concerns relating to a care 10 Current 3 4 12 home within Barnsley. Consequence scored as major due to impact on Appetite 3 4 12 0 patient care should risk crystallise. Approach Treat A M J J A S O N D J F M Key controls to mitigate threat: Sources of assurance Rec'd? Safeguarding vulnerable clients policy Patient Safety reports to QPSC include Safeguarding issues Ongoing Specialist Safeguarding Nurses & Designated Doctor employed by CCG Patient Safety reports to QPSC include Safeguarding issues Ongoing Quality Schedules in contracts with providers Monitored via contract monitoring arrangements Ongoing Membership of Barnsley wide Safeguarding Boards Reports & feedback from Safeguarding Board to QPSC Ongoing Incident Reporting arrangements & serious case reviews - (NOTE Serious Incident Reporting Guidance for Patient Safety reports to QPSC include Safeguarding issues Ongoing Care Homes was approved by QPSC in September 2014)
Care Homes Service Spec includes clear PIs Contract Monitoring, & QPSC Patient Safety reports Ongoing CHC team does health, safety, & wellbeing checks on CHC patients Reported back via QPSC Ongoing CCG Infection Control team does unannounced visits to Care Homes Reported back via QPSC Ongoing CQC inspects and certifies all Care Homes against national standards Reported back via QPSC Ongoing
Work of Barnsley Safeguarding Children Board re Child Sexual Exploitation Regular reports on CSE to GB Ongoing
NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal letters received and considered by GB. assessment against the 4 domains of assurance at the year end. Gaps in control Positive assurances received Named GP currently vacant - out to advert again with revised job description.
Gaps in assurance Actions being taken to address gaps in control / assurance 02/06/2016 NHS Barnsley CCG Governing Body Assurance Framework 2016-17
Objective 5: To have the highest quality of governance and processes to NHSE Domains: Committee providing assurance AC support our business. Better Health Better Care Executive lead(s) All Sustainability Leadership Clinical / Lay Lead What are the key enablers / deliverables to support this objective? Principal threat(s) to delivery of the objective Delivery of all the CCG's statutory responsibilities: deliver statutory financial duties 5.2 If the CCG fails to deliver its statutory duties, due to weaknesses in its corporate governance and control arrangements, it will & VFM; Improve quality of primary & secondary services; Involve patients and result in legal, financial, and / or reputational risks to the CCG and its employees. public; Promote Innovation; Promote education, research, and training; Meet requirements of the Equality Act; meet good governance standard; comply with statutory conflicts of interest guidance; maintain IG Toolkit compliance.
Risk rating Likelihood Consequence Total Date reviewed May-16 10 Initial 2 4 8 Rationale: Likelihood is 'unlikely' as arrangements now well established. Current 2 4 8 Consequence is major due to significant financial & reputational impact of Appetite 3 4 12 0 failure. A M J J A S O N D J F M Approach Tolerate Key controls to mitigate threat: Sources of assurance Rec'd? Constitution, Corporate Manual, Prime Financial Policies, and suite of corporate policies Audit Committee provides oversight, supported by internal & external audit reports & Yes opinions, LCFS work etc Governing Body & Committee Structure underpinned by clear terms of ref and work plans GB members sit on Committees. All Committee minutes taken to GB and significant Yes issues are escalated. Committees produce annual reports for the GB. Management Structure - responsibilities clearly allocated to teams and individuals Management action monitored by regular formal and informal management team Ongoing meetings Risk management framework (GBAF and RR) provides assurance that risks have been identified and are being GBAF and Risk register updated monthly and considered at all Committees and Ongoing managed (GBAF refreshed May 2016) meetings of the GB Budgetary control, contract monitoring & QIPP monitoring arrangements. HFMA finance training for all staff. Financial Plan signed off by GB (Mar-16). Monthly finance report to FPC and GB; In progress - AR Reporting template amended to ensure finance team reviews and sign off of all Committee reports & business internal & external audit reviews and opinions; GB formally adopt annual report & & Accts to be cases with financial implications. accounts. adopted Jun-16 Performance monitoring arrangements Integrated Performance Reports to FPC provides assurance across all NHS Ongoing Constitution pledges. Summary reports to GB. All service transformation activity now under the remit of a single Clinical Transformation Board with strong Transformation projects to be delivered through a series of workstreams, supported Ongoing clinical leadership and membership including representatives from BMBC and provider trusts. Terms of Ref and by the Service Development Team. Workstreams will take highlights reports into the reporting arrangements have been considered and approved by the GB in April / May 2015. Clinical Transformation Board, which will then share minutes and highlights with the Governing Body. Equality Strategy; Equality Action Plan; E&D CSU Lead; E&D training provided to all staff; EQIA policy in place Progress monitored by Equality Steering Group. Minutes to GB every month, plus Ongoing and EQIAs attached to GB papers where appropriate; Staff survey results considered & acted upon; Links with Annual Report prepared annually. PPE committee clarified; HR policies approved & embedded. Statutory & Mandatory training programme in place for all staff, inc GB members, as well as OD Plan, IPR CSU L&D team provides dashboard which is considered by management team on a Ongoing reviews, development sessions for Governing Body inc conflicts of interest, risk management & assurance etc regular basis.
Information Governance strategy & policies in place, SIRO / Caldicott Guardian identified, training provided for IG Toolkit compliance (minimum Level 2) & delivery of Improvement Plan monitored Currently all staff, information asset register in place, committee report & business case template prompts consideration via IG Group reporting to QPSC. compliant - to be of IG issues. updated by 31.3.17 Health & Safety Group established to oversee compliance with statutory Fire & Health & Safety requirements Annual Report & update reports taken to Audit Committee Ongoing
NHSE Improvement & Assessment Framework - continuous risk-based process, with meetings as required, Feedback and action planning following assurance meetings; NHSE assurance letters Due Apr-17 informed by performance indicators and a wide range of other sources of insight, leading to a formal received and considered by GB. assessment against the 4 domains of assurance at the year end. Gaps in control Positive assurances received
Gaps in assurance Actions being taken to address gaps in control / assurance Risk Register Escalation to GB Assurance Framework
RISK REGISTER – GB June 2016 Likelihood Consequence Scoring Description Current Review Domains Risk No’s 1. Adverse publicity/ reputation Almost Certain 5 Catastrophic 5 Red Extreme Risk (15-25) 6 Monthly 2. Business Objectives/ Projects Likely 4 Major 4 Amber High Risk (8- 12) 26 3 mthly 3. Finance including claims Possible 3 Moderate 3 Yellow Moderate Risk (4 -6) 12 6 mthly 4. Human Resources/ Organisational Development/ Staffing/ Unlikely 2 Minor 2 Green Low Risk (1-3) 2 Yearly Competence Rare 1 Negligible 1 5. Impact on the safety of patients, staff or public Total = Likelihood x Consequence (phys/psych) 6. Quality/ Complaints/ Audit The initial risk rating is what the risk would score if no mitigation was in place. The residual/current risk score 7. Service/Business Interruption/ Environmental Impact is the likelihood/consequence (impact) of the risk sits when mitigation plans are in place 8. Statutory Duties/ Inspections
Initial Risk Residual
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Consequence Consequence CCG 5,6 If improvement in 3 4 12 YAS management invited to VP Risk 5 4 20 04/16 April 05/16 14/5b Yorkshire Ambulance a ‘confirm and challenge’ Assessment The Year-end Service (YAS) meeting. (Finance & position was not performance Performance delivered. YAS against the Category Progress will be monitored Committee) have been A response standard ( through the CCG’s Integrated accepted as a 75% within 8 minutes Performance Report national pilot to for Barnsley residents) look at different is not secured and The CCG will work through ways of managing sustained, there is a lead commissioner should to calls – under a risk that performance not be red amber green the reputation of the maintained approach. To get CCG with its responses better stakeholders could matched to be damaged. individual’s needs.
March 2016 March and year to date below required standard 1
Initial Risk Residual
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Consequence Consequence the CCG continues to work with YAS and the Lead Commissioner to improve performance.
February 2016 February and year to date performance remains below the 75% target with February position being for red 1 calls 66.67% and red 2 53.85%. Year to date for red 1 calls 70.01% and red 2 70.42%.
CCG 1,3, If the system fails to 4 5 20 Health Community whole VP Risk 4 4 16 04/16 April 2016 05/16 13/3 5,6, sustain the system wide response lead by Assessment Performance 8 improvement in the CCG Health Community (Finance & against the four BHNFT’s whole system wide response Performance hour 95% performance against lead by the CCG Committee) standard remains the target that 95% below the of A&E patients are Jointly developed action plan requirement. The treated or discharged will include actions from IST improvement within 4 hours there visit the CCG’s Commissioning trajectory agreed is a risk that the Plan and BHNFT work on is to meet 93% for 2
Initial Risk Residual
Score Risk Score
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Consequence Consequence Trusts Monitor transformation April, 94% for Governance Risk May and 95% by Rating will be Urgent Care Working group June and affected, and also oversight sustained that the CCG will fail thereafter. A clear to deliver the NHS Daily Reporting plan is being constitution and a developed to pre-requisite of the Winter Planning manage inflow Quality Premium. arrangements through flow and outflow to the A and E Director of Operations role at department. BHNFT from April 2014 March 2016 SRG 4 Hour System Wide Performance plan in place and being against the four implemented to increase hour 95% capacity and resilience standard remains across the health and care below the system. requirement with March IHEART Barnsley established performance at and operational offering out 88.12%, Quarter of hours GP appointments on 4 Performance at evenings and Saturdays 92.48% - an improvement trajectory has been agreed with NHSE to secure the 95% target consistently from Q4 onwards. The Sustainable 3
Initial Risk Residual
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Consequence Consequence delivery plan for the UEC system is being developed through SRG.
February 2016 Performance against the four hour 95% standard remains below the requirement With February to date position at 88.31% Quarter 4 at 88.74% Year to date at 93.01% SRG have requested a rectification plan to recover the position sustainable by the end of Quarter 1.
15/14( 4 In relation to the 0-19 4 4 16 As for risk 15/14(a) MG Governing 4 4 16 05/16 May 2016 06/16 b) pathway Body BMBC, SWYPFT reprocurement by Monitoring at practice level (Primary and the CCG are Public Health, if there delivery of 0-19 KPIs in Care continuing to is any reduction in relation to practice contracts, Commissioni discuss the 4
Initial Risk Residual
Score Risk Score
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Consequence Consequence service (or failure to utilizing identified escalation ng optimum solutions improve outcomes) routes when core service Committee) to deliver high there is a risk that KPIs are not delivered in real quality services there will be a time. for this patient negative impact on group. primary care workforce and February 2016 capacity. The CCG is still in discussions with the Council through our Chair, Chief Officer and Chief Nurse to establish how we can ensure that the service we have will be the best for people of Barnsley.
December 2015/ January 2016 The CCG is still in discussions with the Council through our Chair, Chief Officer and Chief Nurse to establish how we can ensure that the service we have will be the best for people of 5
Initial Risk Residual
Score Risk Score
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Lead Owner Source of Ref Risk Description Mitigation/Treatment
of the risk Risk
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Consequence Consequence Barnsley.
14/15 1, If the quality and 4 4 16 The results of the audit have MG Risk 4 4 16 04/16 April 2016 05/16 5, 6 completeness of D1 been shared with BHNFT and Assessment & Jan 2016 repeat medication raised with the Trust’s (Quality audit of audit reported to information on medical director. &Patient discharge April APC shows discharge is not Safety letters slight improved there is a The BHNFT Medical Committee) deterioration in risk that patients may Director is now leading on the accuracy – not be prescribed the development of a BHNFT escalated to correct ongoing Action Plan to address the Governing Body medication by D1 medicines issues raised CCG Medical primary care and which will, when Director to write to following hospital completed, be received by GPs seeking their discharge thereby the Area Prescribing vigilance whilst increasing the risk of Committee. organizational harm remediation of Work to streamline the this significant (Jan 15 - An audit of information required to patient safety risk 355 D1 discharge ensure effective and timely is secured letters from BHNFT completion for all discharged undertaken by the patients is being progressed March 2016 – medicines between BHNFT’s Clinical BHNFT Medical management team Director for General and Director confirms identified that in 55% Specialist Medicine, the that 77% of non- of cases the TTO CCG’s Clinical Lead for the elective discharge section had not been BHNFT Contract, and summaries are completed or was members of the Medicines completed and incorrect). Optimisation team. sent out to GP’s within 24 hours. In Work is undertaken in addition, 95% of primary care to reconcile pre- non-elective and post-hospitalisation patients have 6
Initial Risk Residual
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Consequence Consequence medication. medicines reconciliation D1 completion included completed within within the BHNFT contract for 24 hours of 2015/16 with financial admission. penalties if not met. BHNFT is determined to A follow up audit will be secure continuous undertaken in due course. improvement in this regard.
February 2016 No further work has been progressed against the September 2015 action plan. Outstanding actions are now reported as awaiting implementation of the new electronic discharge system. Planned medicine audits and re- audits have been deferred until the Lorenzo system has been introduced, still being reported as 7
Initial Risk Residual
Score Risk Score
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Consequence Consequence planned for Spring 2016, but no definite implementation date has been given.
CCG 2, If the Barnsley area 3 3 9 NHS England’s Primary Care MG Governing 4 4 16 05/16 May 2016 06/16 14/10 5, 6 continues to Strategy includes a section Body The CCG has experience a lack of on workforce planning (Clinical approved the GPs in comparison Transformati recruitment of 15 with the national The CCG’s Primary Care on Board) clinical average, due to GP Development Programme pharmacists to retirements, inability has a workforce workstream. help take some of to recruit etc there the pressure of is a risk that: Links have been developed primary care. (a) Some practices with the Medical School to may not be enhance attractiveness of March 2016 viable, Barnsley to students Two Barnsley (b) Take up of LES practices (one / DES or other The CCG continues to invest single handed initiatives could in primary care capacity. and one medium be inconsistent The PDA enables practices to sized) have (c) The people of invest in the sustainability of recently handed Barnsley will their workforce. The innovation in their contracts. receive poorer Fund saw £0.25m invested in The Clinical quality developing new, more efficient Transformation healthcare and flexible ways of working. Board agreed to services The successful PMCF has change the risk (d) Patients enabled additional capacity to score to 4 x 4. services could be made available outside be further away normal hours via the I heart February 2016 8
Initial Risk Residual
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of the risk Risk
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assessment
Consequence Consequence from their Barnsley Hubs. The CCG is Two Barnsley home. also creating 4 GP fellowships practices (one in partnership with SWYPFT. single handed and one medium sized) have recently handed in their contracts. The Clinical Transformation Board agreed to change the risk score to 4 x 4.
December 2015 The priorities for Primary Care continue to support the development of an MDT structure for Practices. The two main projects focused on this area are the introduction of Clinical Pharmacists with Practice and the industrialization of HCAs and administration apprentices. It is anticipated that 9
Initial Risk Residual
Score Risk Score
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of the risk Risk
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Date Risk Risk Date
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Consequence Consequence both project will be live by 31st March 2016.
CCG 1,5, If improvement in 4 5 20 Regular meetings between BR Risk 3 5 15 04/16 April 16 05/16 15/07 6 Yorkshire Ambulance CCG and YAS senior Assessment No significant Service (YAS) management to assess (Quality & change – risk to performance against actual and potential harm in Patient be reviewed after the Category A relation to delayed response Safety May Q&PS paper. response standard times and understand YAS Committee) (75% within 8 minutes actions to mitigate the risk of March 2016 – for Barnsley residents) harm. As at 21 March is not secured and Red 1 sustained, there is a Meeting of CCG Governing performance for risk that the quality Body and YAS Executive the month was and safety of care for Team 26 March 2015 to above the 75% some patients could discuss ways of achieving standard at be adversely affected. sustainable improvements in 77.42% however performance and safety of Red 2 remains the service. Further meeting below at 64.87% planned. and year to date performance for CCG action plan in place Red 1 and 2 was covering safety, performance, below the and sustainability. standard at 70.45% and Regular consideration of YAS 69.97% incident reporting by QPSC respectively. A and GB to understand the paper to go to frequency and severity of April QPSC to incidents associated with review this risk ambulance response. and consider other quality 10
Initial Risk Residual
Score Risk Score
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Lead Owner Source of Ref Risk Description Mitigation/Treatment
of the risk Risk
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Date Risk Risk Date
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Assessed
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Consequence Consequence indicators which recognise there are many stages between a patients call for help and safe arrival in hospital.
February 2016 999 performance for both Red 1 and Red 2 KPI remains challenged. The Regional 999 Contracting Board and the Regional 999 Clinical Quality Review Group are combined and are addressing the issues.
January 2016 Performance remains challenged Q3 not met.
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GB/Pu/16/06/15
Putting Barnsley People First
GOVERNING BODY
9 June 2016
Integrated Performance Report
1. PURPOSE OF THE REPORT
1.1 To provide the Governing Body with: The headline Performance Dashboard including performance against key performance indicators, along with an update on key performance issues by exception. An overview of the key risks or challenges in achieving performance indicators along with any actions being taken to improve performance. An update on workforce information and performance.
2. EXECUTIVE SUMMARY
2.1 The Governing Body Integrated Performance Report aims to provide an overview of the performance of NHS Barnsley Clinical Commissioning Group (BCCG) up to the end of April 2016.
2.2 The performance report attached at Appendix 1 provides a high level dashboard and an exception report which covers the NHS constitution standards, quality indicators, key performance indicators linked to programme board performance and financial performance. The report would also usually highlight the financial performance of the CCG, however, for April the finance report has been provided as a separate paper covering the 2016/17 budgets.
2.3 The Finance and Performance Committee have received a more detailed report containing all indicators monitored by the CCG to enable them to maintain an oversight of performance and provide assurance to the Governing Body.
2.4 There are a number of performance measures which are currently rated at ‘Red’ or ‘Amber’ for the month of April 2016. Where these are new ratings or where new data has become available since the last report and performance continues to be a concern, a narrative is provided in the performance report attached at appendix 1. A number of the measures which are currently flagged red are annual targets and therefore no narrative is included.
2.5 Key issues which are identified within the report are :
The 4 hour standard for patients waiting in A&E was not achieved in March (86.94%) at a commissioner level taking year to date performance to 92.09%. At Barnsley Hospital 86.54% of patients were seen within 4 hours in March. Performance improved in April in line with the agreed improvement trajectory with 93.01% of patients seen within 4 hours.
1 (Red)
The proportion of people waiting 6 weeks or less from referral to first IAPT treatment appointment improved slightly in April but remains significantly below the target. (Red) The percentage of people waiting more than 6 weeks for diagnostic tests was above the 1% threshold in April. (Red) The percentage of patients referred with breast symptoms (Cancer) seen within 2 weeks of referral was below the 93% target in March. (Amber) The percentage of patients seen within 31 days for subsequent surgery treatment (Cancer) was slightly below the 94% target in March. (Amber) Ambulance handover times over 30 minutes were above targe expectations in April, however there was a significant reduction from the number reported in March. Crew clear delays were also above the target in March. (Red)
2.6 The Barnsley CCG Workforce information for April 2016 shows that:
The number of employees in the CCG workforce in April was 105 (87.61 full time equivalents). The sickness rate for April was 2.35% and was therefore below the 2.5% target.
3. THE GOVERNING BODY IS ASKED TO:
Note the contents of the report including the 2015/16 performance to date.
Agenda time allocation for report: 15 minutes.
Report of: Vicky Peverelle
Designation: Chief of Corporate Affairs
Report Prepared by: Jamie Wike
Designation: Head of Planning & Performance
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1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
This report provides assurance to the Committee against risks 1.1, 1.3, 1.4, 3.1 and 4.1 of the Governing Body Assurance Framework.
Performance reporting is a key tool in providing assurance that both the risks currently identified within the Assurance Framework are being addressed and that any emerging performance risks are escalated as appropriate.
1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist Has the area been considered Financial Implications Yes Contracting Implications Yes Quality Yes Consultation / Engagement N/A Equality and Diversity N/A Information Governance N/A Environmental Sustainability N/A Human Resources N/A
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2. INTRODUCTION/ BACKGROUND INFORMATION
2.1 This monthly integrated performance report consists of a progress update against key performance indicators.
2.2 The headline performance report (attached at Appendix 1) covers the NHS constitution standards, quality indicators, key performance indicators linked to programme board performance, workforce indicators and financial performance. The report contains, by exception, a narrative on any key performance issues escalated by Finance and Performance Committee along with details of any actions being taken to address under performance.
2.3 Work is planned to review the content and format of the Integrated Performance Report to ensure it remains fit for purpose and reflects national and local priorities and also to identify improvements for inclusion in future months which will be presented to the committee for agreement as the changes are proposed.
3. DISCUSSION/ISSUES
3.1 Performance Report – Progress against Key Performance Indicators by Exception
3.2 There are a large number of performance indicators which are monitored by the CCG to provide assurance and measure performance in delivering improved outcomes. These are reviewed on a monthly basis by the Finance and Performance Committee with key indicators reported on a monthly basis to Governing Body.
3.3 Due to the commencement of a new call coding pilot for Ambulance Services in April 2016 there is no information available at this point against which to assess YAS in delivering the NHS constitution measures for ambulance response times. YAS are one of two ambulance services taking part in the new call coding pilot for ambulance response times. In addition to the pilot, the changes to commissioning arrangements for Ambulance Services agreed at the Governing Body in May 2016 are also likely to have an impact on how the performance and quality of the ambulance service are reported. Work will take place with the lead commissioner to ensure appropriate local governance and monitoring arrangements are in place.
3.4 The key issues identified for consideration by the Governing Body are:
The 4 hour standard for patients waiting in A&E was not achieved in March (86.94%) at a commissioner level taking year to date performance to 92.09%. At Barnsley Hospital 86.54% of patients were seen within 4 hours in March. Performance improved in April in line with the agreed improvement trajectory with 93.01% of patients seen within 4 hours. (Red)
The proportion of people waiting 6 weeks or less from referral to first IAPT treatment appointment has again improved from 60.05% in March to 62.66%% in April. This does however remain significantly below the 75% target. (Red)
4 The percentage of people waiting more than 6 weeks for diagnostic tests was above the 1% threshold in April with 3.72% (96 patients) waiting more than 6 weeks. This was an increase from March when 2.41% waited more than 6 weeks. Of the 96 patients, 74 were at BHNFT with the biggest proportion waiting for MRI.
The percentage of patients referred with breast symptoms (Cancer) seen within 2 weeks of referral was below the 93% target in March at 88.46%. 15 out of 130 patients referred waited more than 2 weeks due to patient choice and outpatient capacity. (Amber)
The percentage of patients seen within 31 days for subsequent surgery treatment (Cancer) was slightly below the 94% target in March at 93.75%. 1 out of 16 patients were not seen within 31 days. (Amber)
Ambulance handover times over 30 minutes were below targeted expectations in April (75), however there was a significant reduction from the number reported in March (200). Crew clear delays were also above the target with 10 breaches recorded in April, a slight reduction from 11 in March. (Red)
4. IMPLICATIONS
4.1 Any implications of current levels of performance are included within the commentary in section 3.
5. RISKS TO THE CLINICAL COMMISSIONING GROUP
5.1 Risks have been identified within the content of the report above.
6. CONSULTATION
6.1 All relevant functions and departments within the Clinical Commissioning Group are engaged in the development of the integrated performance report and all relevant documents or approaches have been provided to Governing Body, Management Team, the Audit Committee or Programme Boards prior to this paper.
7. APPENDICES TO THE REPORT
Performance Section Appendix 1 – Barnsley CCG (InPhase) Monthly Performance Report to April 2016
8. CONCLUSION
8.1 The Governing Body is asked to note the contents of the report including the 2016/17 Performance to date.
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NHS Barnsley Clinical Commissioning Group
Performance Report
CCGs are accountable to their local populations and to NHS England for planning and delivering comprehensive and high quality care that meets the needs of their local community.
We have created within InPhase the tools that you need to ensure that your activities and operations are compliant with the targets set within the CCG Assurance Framework.
1
Governing Body Dashboard 2015/16
Performance
Actual Actual Period End Outcomes Target Period YTD Date Potential Years of Life Lost (PYLL) from causes considered amendable to 2,333.00 2,332.70 2,332.70 December -14 healthcare, per 100,000 Improved Access to Psychological Services -IAPT: People entering treatment 1.25 % 1.45 % 1.45 % April -16 against level of need Improved Access to Psychological Services -IAPT: People who complete 50.00 % 50.98 % 50.98 % April -16 '?' = Awaiting Data treatment, moving to recovery Estimated diagnosis rate for people with dementia 73.07 % 69.63 % 69.63 % March -16 Unplanned hospitalisation for chronic ambulatory care sensitive conditions 1,235.50 1,222.30 1,222.30 September -15 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 343.90 350.00 350.00 September -15 Emergency admissions for acute conditions that should not usually require 1,675.30 1,657.50 1,657.50 September -15 hospital admission
Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) 607.00 556.40 1,135.50 September -15 The proportion of older people (65+)still at home 91 days after discharge into 85.00 % 80.40 % 80.40 % March -15 rehabilitation % Patient experience of primary care - GP Services 84.93 % 83.96 % 83.96 % September -15 Quality % Patient experience of primary care - GP Out of Hours services 66.96 % 63.52 % 63.52 % September -15 Actual Actual Period Outcomes Target % 4 hour A&E waiting times - seen within 4 hours - CCG (Monthly) 95.00 % 86.94 % 92.09 % March -16 Period YTD End Date % Patients on incomplete non -emergency pathways waiting no more than 18 March 92.00 % 94.28 % 94.28 % April -16 Patient experience of hospital care 77.30 76.30 76.30 weeks (Commissioner) 2015 Number of 52 week Referral to Treatment Pathways Incomplete (Commissioner) 0 0 0 April -16 Incidence of healthcare associated infection (HCAI) - % Patients waiting for diagnostic test waiting > than 6 wks from referral 0 0 0 April 2016 1.00 % 3.72 % 3.72 % April -16 MRSA (Commissioner) (Commissioner) Incidence of healthcare associated infection (HCAI) - 0 0 0 April 2016 Cancer - % Patients seen within 2wks referred urgently by a GP 93.00 % 93.72 % 95.93 % March -16 MRSA (Provider) - BHFT
Cancer - % Patients referred with breast symptoms seen within 2 wks of referral 93.00 % 88.46 % 92.54 % March -16 Incidence of healthcare associated infection (HCAI) - 3 2 2 April 2016 Cancer - % Patients seen within 31 days from referral to treatment 96.00 % 98.33 % 97.79 % March -16 C.Diff (Commissioner) Incidence of healthcare associated infection (HCAI) - Cancer - % Patients seen within 31 days for subsequent treatment (Surgery) 94.00 % 93.75 % 94.90 % March -16 1 0 0 April 2016 Cancer - % Patients seen within 31 days for subsequent treatment (Drugs) 98.00 % 100.00 % 99.71 % March -16 C.Diff (Provider) - BHFT Number of mixed sex accomodation breaches Cancer - % Patients seen within 31 days for subsequent treatment (Radiotherapy) 94.00 % 97.30 % 99.51 % March -16 0 0 0 April 2016 Cancer - % Patients seen within 62 days of referral from GP 85.00 % 85.42 % 83.41 % March -16 (Commissioner) Cancer - % Patients seen from referral within 62 days (Screening Service: Breast, 90.00 % 100.00 % 97.85 % March -16 Bowel & Cervical) Cancer - % Patients being seen within 62 days (ref. Consultant) 85.00 % 90.00 % 83.46 % March -16 CatA (Red 1) 8 min response time (Yorkshire Ambulance Service - YAS) 75.00 % 68.50 % 70.93 % March -16 CatA (Red 2) 8 min response time (Yorkshire Ambulance Service - YAS) 75.00 % 69.50 % 71.38 % March -16 CatA 19min response time (Yorkshire Ambulance Service - YAS) 95.00 % 94.86 % 94.86 % March -16 Resources Proportion of people on Care Programme Approach (CPA) who were followed Actual Actual Period 100.00 % 95.24 % 95.24 % March -16 Outcomes Target upwithin 7 days of discharge Period YTD End Date Urgent operations cancelled for a second time 0 0 0 February -16 March Underlying Recurrent Surplus (FORECAST) 2.01% 1.13 % 1.13 % Ambulance handover delays of over 30 mins 0 75 75 April -16 2016 Ambulance handover delays of over 1 hour 0 8 8 April -16 March Reduction in the proportion of broad spectrum antibiotics as a total of all antibiotics Surplus - full year forecast £8,280,000 £8,280,000 £8,280,000 11.84 8.71 8.49 September -14 2016 in 14/15 Quality, Innovation, Productivity and Prevention (QIPP) - Plans being Plans being March £4,491,104 Satisfaction with accessing primary care 72.4 % 69.2 % 69.2 % December -15 year to date delivery developed developed 2016 Satisfaction with the quality of consultation at the GP practice 437.30 436.10 436.10 December -14 March Running Costs (FORECAST) £5,896,000 £5,896,000 £5,896,000 Satisfaction with the overall care received at the surgery 85.2 % 83.4 % 83.4 % December -15 2016 Number of patients admitted to hospital for non -elective reasons discharged at March 23.13 % 23.42 % 22.31 % January -16 BCCG Headcount 108 114 108 weekends/bank holiday 2016
Trolley waits in A&E -zero waits from decision to admit to admissions over 12 March 0 0 0 February -16 BCCG Monthly sickness rate 2.5% 1.18 % 3.32 % hours - BHNFT (Month) 2016 Improvement in health related quality of life for people with a long term mental 0.53 0.43 0.43 March -16 health condition Proportion of people waiting 18 weeks or less from referral to entering a course of 95.00 % 98.43 % 98.43 % April -16 IAPT treatment Proportion of people waiting 6 weeks or less from referral to entering a course of 75.00 % 62.66 % 62.66 % April -16 IAPT treatment Cancelled operations rebooked within 28 days - BHFT 0 0 0 March -16
2
Key Performance Indicators by Exception Performance Indicator Target Actual RAG Period Performance Period Direction % 4 hour A&E waiting times - seen within 4 Barnsley CCGs position for February 16 is under target at 86.94%. YTD the position is 95.00 % 86.94 % 31/03/2016 hours - CCG (Monthly) 92.09%. Performance for BHFT is currently at 91.12% as at 19th April 2016 YTD. In March, 15 out of 16 patients we seen with 31 days for surgery treatment, therefore the small Cancer - % Patients seen within 31 days for 94.00 % 93.75 % numbers show an underperformance. The one breach was due to patient choice. Quarter 4's 31/03/2016 subsequent treatment (Surgery) performance was 93.75% against the national standard of 94%. CatA (Red 1) 8 min response time YAS Performance for Red 1 remains under the national standard of 75%, with performance at 75.00 % 68.50 % 31/03/2016 (Yorkshire Ambulance Service - YAS) 68.50% in March. CatA (Red 2) 8 min response time Performance for Red 2 Calls in Barnsley has shown a slight drop, reporting 66.9% in March, with a 75.00 % 66.92 % 31/03/2016 (Barnsley) YTD position of 69.9%. CatA (Red 2) 8 min response time YAS Performance for Red 2 remains under the national standard of 75%, with performance at 75.00 % 69.50 % 31/03/2016 (Yorkshire Ambulance Service - YAS) 69.50% in March. The latest data of 69.63% as at March 2016 shows a slight increase from February performance of Estimated diagnosis rate for people with 73.07 % 69.63 % 66.45%, but is still under the Target of 73.03%. This data is monitored closely by the CCGs 31/03/2016 dementia Dementia Lead, who receives regular monthly reports directly from NHSE The underperformance in this measure is linked to issues identified with demand for initial Proportion of people waiting 6 weeks or appointments within the service. less from referral to entering a course of IAPT 75.00 % 62.66 % 30/04/2016 treatment Work is ongoing with the IAPT support team to review the IAPT services and support improvement in activity.
3 Other Key Performance Indicators by Exception (not included on dashboard) Performa ... Indicator Target Actual RAG Period Performance Period Direction
The percentage of patients waiting more than 6 weeks from referral for diagnostic tests in April, continues to exceed the 1% threshold, with 96 patients (2.41%) waiting longer than 6 weeks.
The majority of the delays were at: BHNFT of which there were 74 over 6 weeks. Of these 30 were for MRI, 17 for Gastroscopy, 12 for Colonoscopy, 9 for Cardiology - echocardiography, 3 for Computed Tomography and 3 for Flexi sigmoidoscopy.
% Patients waiting for diagnostic test At Sheffield Teachings Hospitals there were 14 delays, of which 8 patients were waiting for waiting > than 6 wks from referral 1.00 % 3.72 % 30/04/2016 Colonoscopy, 4 for Gastroscopy, and 2 for Flexi sigmoidoscopy. (Commissioner) Other breaches were seen at Doncaster & Bassetlaw Hospitals NHS Foundation Trust (3 in Magnetic Resonance Imaging, 1 in Cystoscopy), Leeds Teaching Hospitals trust (2 in Gastroscopy), Sheffield Children's Hospital (1 in Audiology), The Rotherham NHS Foundation Trust (1 in Respiratory physiology - sleep studies).
Performance against the diagnostics target will continue to be monitored through contract monitoring.
Ambulance handovers for BCCG, have decreased in April to 75 delays, with the number of delays going from 200 in March 2016. Ambulance handover delays of over 30 0 75 30/04/2016 mins There was zero delays over 120 minutes.
There is a financial penalty for the Ambulance handover measure that has been applied since April
2014. In March, 115 out of 130 patients were seen within 2 weeks with breast symptom. These 14 Cancer - % Patients referred with breast breaches therefore caused this indicator to underperform. 11 breaches were due to patient choice, 4 93.00 % 88.46 % 31/03/2016 symptoms seen within 2 wks of referral were due to outpatient capacity inadequate. Quarter 4's performance was 89.44% against the national standard of 93%. In March, 15 out of 16 patients we seen with 31 days for surgery treatment, therefore the small Cancer - % Patients seen within 31 days for 94.00 % 93.75 % numbers show an underperformance. The one breach was due to patient choice. Quarter 4's 31/03/2016 subsequent treatment (Surgery) performance was 93.75% against the national standard of 94%.
The number of Crew Clear delays has increased slightly with the over 30 minutes reporting 11 Crew Clear delays of over 30 mins 0 9 cases for April, compared to the 10 cases in March against a target of zero. 30/04/2016
There were no patients waiting over 60 minutes.
4 GB/Pu/16/06/16
Putting Barnsley People First
GOVERNING BODY
9 June 2016
Budgets 2016/17
1. PURPOSE OF THE REPORT
The Governing Body approved the updated 2016/17 financial plan in April, noting that the £7.5 million efficiency target may change as contracts are finalised with all providers. The plan has subsequently been translated into detailed budgets for 2016/17, which are set out in this report.
2. EXECUTIVE SUMMARY
Appendix A provides a movement statement, showing a summary of the changes from the financial plan approved by Governing Body in April to the current position. The changes have arisen following the conclusion of contract negotiations and a detailed review of Programme and Running Costs budgets.
Appendix B provides the current detailed budget position and also includes details of the executive and clinical leads. Budget meetings with executive and clinical leads have been arranged throughout 2016/17 to ensure effective financial management of CCG resource.
This budget plans for the delivery of the £8.28 million surplus required by NHS England (NHSE), but is predicated on delivery of an efficiency programme of £7.1 million.
The Finance and Performance Committee considered a more detailed paper at the meeting on 2 June and recommended the budgets to Governing Body, for approval.
3. THE GOVERNING BODY IS ASKED TO:
note the contents of the report note the requirement to deliver the efficiency programme in order that the CCG achieves an £8.28m surplus as required by NHS England, and delivers all other planning requirements approve the budgets, following the recommendation of the Finance and Performance Committee.
Agenda time allocation for report: 10 minutes.
1 Report of: Heather Wells
Designation: Chief Finance Officer
Report Prepared by: Roxanna Naylor
Designation: Head of Financial Management and Contracting
2
1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
5.2 If the CCG fails to deliver its statutory duties, due to weaknesses in its corporate governance and control arrangements, it will result in legal, financial, and / or reputational risks to the CCG and its employees. 1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist
Financial Implications Yes Contracting Implications Yes Quality Yes Consultation / Engagement Not relevant Equality and Diversity EIA not undertaken Information Governance Yes
Environmental Sustainability No Human Resources Not relevant
3
2. INTRODUCTION/ BACKGROUND INFORMATION
Appendix A provides a movement statement, showing a summary of the changes from the financial plan approved by Governing Body in April to the current position. The changes have arisen following the conclusion of contract negotiations and a detailed review of Programme and Running Costs budgets. Appendix B provides the current detailed budget position and also includes details of the executive and clinical leads. Budget meetings with executive and clinical leads have been arranged throughout 2016/17 to ensure effective financial management of CCG resource. This budget plans for the delivery of the £8.28 million surplus required by NHS England (NHSE), but is predicated on delivery of an efficiency programme of £7.1 million. This is a revised position from the £7.5m previously reported, following the conclusion of contract negotiations and a detailed review of budgets that has been undertaken. The Finance and Performance Committee considered a more detailed paper at the meeting on 2 June and recommended the budgets to Governing Body, for approval.
3. DISCUSSIONS / ISSUES
Budgets 2016/17 Update
A review of all budgets has been undertaken in order that the budgets for 2016/17 reflect agreed contract positions, actual contributions to services and investments agreed by Governing Body and Management Team.
Appendix A provides a summarised movement statement from the financial plan approved by Governing Body in April to the detailed budget position in Appendix B.
Appendix A considers three categories of movement : adjustments following the conclusion of contract negotiations technical adjustments which arise only as a change in the category of expenditure. An example of this would be moving emerging risk reserves to programme services where investments have now been confirmed. No change in the value has occurred QIPP adjustments are the result of the detailed budget review that has been undertaken. The net effect of these changes has contributed £0.4 million to the previously reported efficiency target, reducing this from £7.5 million to £7.1 million. Budgetary Control and Management
Responsibilities and Approval Limits
All responsibilities relating to decisions to commit and approve expenditure are contained within the Organisational Scheme of Delegation and Prime Financial Policies (PFPs). The responsibility for ensuring effective management of budgets identified within this paper lies with the executive lead, clinical lead
4 and budget manager.
However, it is important to note that PFPs state that approval for committing to new expenditure requires :
Management Team up to £100k Governing Body greater than £100k.
Budget Management Meetings
The Finance and Contracting team has arranged budget management meetings with relevant officers and staff throughout 2016/17 to ensure effective financial management of CCG resource.
4. IMPLICATIONS
The CCG has proposed budgets which plan to achieve the minimum required surplus of £8.28m, this is predicated on the successful delivery of a significant efficiency programme.
5. RISKS TO THE CLINICAL COMMISSIONING GROUP
Achievement of the efficiency savings programme and potential financial risks will be reported through the Integrated Performance Report which is a standing agenda item on the Governing Body agenda.
6. CONSULTATION
The detailed budgets have been developed following the conclusion of contract negotiations and investments agreed by the Governing Body and Management Team.
7. APPENDICES TO THE REPORT
Appendix A – Movements from Financial Plan Submission Appendix B – Detailed Programme and Running Costs Budget 2016/17.
8. CONCLUSION
THE GOVERNING BODY IS ASKED TO:
note the contents of the report note the requirement to deliver the efficiency programme in order that the CCG achieves an £8.28m surplus as required by NHS England, and delivers all other planning requirements approve the budgets, following the recommendation of the Finance and Performance Committee.
5 Movement from Financial Plan Submission Summary 2016/17
2016/17 -Plan Submission - April Movements 2016/17 - Revised Budget Position 2016
Adjustments following Technical adjustments - conclusion of contract amendment to category of QIPP negotiations expenditure
Non- Non- FORECAST PLAN POSITION Recurrent Total Recurrent Non-recurrent Recurrent Non-recurrent Recurrent Non-recurrent Recurrent Total recurrent recurrent
£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s
ALLOCATIONS Recurrent allocation for CCG Commissioned Services 367,042 - 367,042 ------367,042 - 367,042 Recurrent allocation for Primary Delegated Co-Commissioning 34,600 - 34,600 ------34,600 - 34,600 Recurrent Running Costs Allocation 5,492 - 5,492 ------5,492 - 5,492 Return of surplus - 8,280 8,280 ------8,280 8,280 Other Non-Recurrent Allocations ------SUB-TOTAL ALLOCATIONS 407,134 8,280 415,414 ------407,134 8,280 415,414 EXPENDITURE PROGRAMME Acute Services 199,920 - 199,920 (1,700) 1,700 170 - - - 198,390 1,700 200,090 Mental Health Services 33,136 - 33,136 (516) 516 - - - - 32,620 516 33,136 Community Healthcare Services 36,467 - 36,467 (163) 145 121 18 - - 36,425 163 36,588 Continuing Healthcare 15,721 1,007 16,728 38 (38) (55) - - - 15,704 969 16,673 Primary Care Services 59,563 - 59,563 20 - 80 - (239) - 59,424 - 59,424 Primary Care Delegated (Co-Commissioning) 34,599 (346) 34,253 - (346) 692 - - 34,253 346 34,599 GPIT 869 - 869 ------869 - 869 Property Services 661 - 661 ------661 - 661 Voluntary Sector 1,680 - 1,680 (2) - - - - - 1,678 - 1,678 Social Care 10,081 - 10,081 184 (68) (28) (226) 10,237 (294) 9,943 Other Programme Services 8,924 (3,117) 5,807 982 772 9,906 (2,345) 7,561 Sub-Total Programme Expenditure before reserves and contingency 401,622 (2,456) 399,166 (2,323) 2,323 1,136 1,414 (267) (226) 400,168 1,055 401,223 PROGRAMME RESERVES Overseas Visitors - 434 434 ------434 434 1% Non-Recurrent System Financial Balance Headroom - 4,017 4,017 - - (346) - - - 3,671 3,671 Seasonal Resilience Reserve 1,926 - 1,926 - - - (715) - - 1,926 (715) 1,211 Emerging Risk Reserve 1,635 - 1,635 - - (1,316) - - - 319 - 319 Recurrent Emerging Risk Reserve bfwd ------Unidentified Efficiency Savings Requirement Reserve (7,171) (347) (7,518) - - (95) 267 226 (6,999) (121) (7,120) Recurrent Efficiency Savings Requirement bfwd ------Better Care Fund Reserve (95) - (95) - 95 - - - - Recurrent Brought Forward Emerging risks ------Sub-Total Programme Reserves (3,705) 4,104 399 - - (1,316) (1,061) 267 226 (4,754) 3,269 (1,485) TOTAL PROGRAMME EXPENDITURE 397,917 1,648 399,565 (2,323) 2,323 (180) 353 - - 395,414 4,324 399,738 Running Costs 5,492 - 5,492 5,492 - 5,492 Contingency - Primary Care - - - Contingency - 2,077 2,077 - - - (173) - - 1,904 1,904 TOTAL CCG EXPENDITURE 403,409 3,725 407,134 (2,323) 2,323 (180) 180 - - 400,906 6,228 407,134 SURPLUS / (-) DEFICIT 3,725 4,555 8,280 6,228 2,052 8,280 Recurrent Non Recurrent Total Budget TOTAL ALLOCATIONS 407,134,004 8,280,000 415,414,004
PROGRAMME EXPENDITURE ACUTE SERVICES Barnsley NHS Foundation Trust 129,639,752 1,700,000 131,339,752 Sheffield Teaching Hospital NHS Foundation Trust 25,918,871 0 25,918,871 Doncaster and Bassetlaw Hospitals NHS Foundation Trust 6,853,768 0 6,853,768 Mid Yorkshire NHS Trust 2,519,230 0 2,519,230 The Rotherham Foundation Trust 11,716,208 0 11,716,208 Sheffield Children's Hospital NHS Foundation Trust 2,157,772 0 2,157,772 Leeds Teaching Hospital NHS Trust 904,480 0 904,480 YAS Risk 254,348 0 254,348 Ophthalmology - New Service Feb/Mar 1,386,504 0 1,386,504 SCH - SARCS 10,202 0 10,202 RDASH - MH Bed 184,000 0 184,000 Contract Risk 1,418,527 0 1,418,527 Yorkshire Ambulance Services - E&U 7,479,553 0 7,479,553 Yorkshire Ambulance Services - PTS 1,548,331 0 1,548,331 Acute Contracts - Other Providers 3,801,214 0 3,801,214 Acute Contracts - Non Contract Activity 2,597,279 0 2,597,279 TOTAL ACUTE SERVICES 198,390,040 1,700,000 200,090,040 MENTAL HEALTH SERVICES Sheffield Health and Social Care NHS Foundation Trust 88,010 0 88,010 South West Yorkshire Partnerships NHS Foundation Trust 30,391,416 514,516 30,905,932 Rotherham, Doncaster and South Humber NHS Foundation Trust 799,794 0 799,794 BMBC Mental Health Service 304,010 0 304,010 MH Liaison 140,000 0 140,000 Future in Mind 567,000 0 567,000 Mental Health - NCA's 330,017 0 330,017 TOTAL MENTAL HEALTH SERVICES 32,620,247 514,516 33,134,763 COMMUNITY HEALTH SERVICES Rotherham, Doncaster and South Humber NHS Foundation Trust 48,905 0 48,905 The Rotherham Foundation Trust 501,185 0 501,185 South West Yorkshire Partnerships Foundation Trust 35,809,738 162,809 35,972,547 Sheffield Health and Social Care NHS Foundation Trust 65,228 0 65,228 TOTAL COMMUNITY HEALTH SERVICES - NHS 36,425,056 162,809 36,587,865 TOTAL CONTINUING HEALTHCARE & FUNDED NURSING CARE 15,703,972 969,783 16,673,755 PRIMARY CARE CO-COMMISSIONING DELEGATED BUDGETS 34,254,000 346,000 34,600,000 TOTAL GP PRESCRIBING 52,838,879 0 52,838,879 TOTAL ENHANCED SERVICES - PRIMARY CARE 388,291 0 388,291 TOTAL OUT OF HOURS 1,927,308 0 1,927,308 Total GP IT 869,056 0 869,056 Total Primary Care PDA 4,191,665 0 4,191,665 TOTAL OTHER PRIMARY CARE SERVICES 5,140,721 0 5,140,721 TOTAL PRIMARY CARE 94,549,199 346,000 94,895,199 TOTAL OTHER COMMUNITY SERVICES 10,270,492 (327,000) 9,943,492 SUB TOTAL VOLUNTARY SECTOR GRANTS/SERVICES 1,677,553 0 1,677,553 TOTAL BARNSLEY CHILDRENS AND YOUNG PEOPLE TRUST 4,552,300 0 4,552,300 TOTAL BARNSLEY SUBSTANCE MISUSE SERVICES 500,000 (500,000) 0 TOTAL OTHER INVESTMENTS/CONTRACTS 3,528,345 (1,845,771) 1,682,574 TOTAL CORPORATE COSTS - PROGRAMME 1,986,659 0 1,986,659
RESERVES TOTAL OVERSEAS VISITORS 434,000 0 434,000 TOTAL 1% NON RECURRENT RESERVE 0 3,671,000 3,671,000 TOTAL SEASONAL RESILIENCE RESERVE 1,925,983 (714,958) 1,211,025 TOTAL EMERGING RISK RESERVE 318,754 0 318,754 TOTAL 0.5% CONTINGENCY 1,904,000 0 1,904,000 TOTAL QIPP RESERVE (6,999,226) (121,750) (7,120,976) TOTAL CCG RESERVES - PROGRAMME (2,416,489) 2,834,292 417,803
TOTAL PROGRAMME EXPENDITURE 397,787,375 3,854,629 401,642,004
RUNNING COSTS TOTAL CHIEF OFFICER 589,742 (19,498) 570,244 TOTAL JOINT COMMISSIONING UNIT 373,848 (17,512) 356,336 TOTAL CONTRACTING 311,190 (28,610) 282,580 TOTAL CORPORATE GOVERNANCE AND ADMIN 520,781 (28,972) 491,809 TOTAL ADMIN 578,070 0 578,070 TOTAL FINANCE 945,510 (1,249) 944,261 TOTAL MEDICAL DIRECTORATE 101,537 0 101,537 TOTAL CHIEF NURSE DIRECTORATE 559,283 (11,943) 547,340 TOTAL COMMISSIONING AND TRANSFORMATION 488,433 (12,238) 476,195 TOTAL PRIMARY CARE DIRECTORATE 156,991 0 156,991 TOTAL COMMUNICATIONS AND ENGAGEMENT 150,082 (10,309) 139,773 TOTAL SHARED SERVICES 543,000 0 543,000 TOTAL RUNNING COST RESERVES 173,533 130,331 303,864 TOTAL RUNNING COSTS EXPENDITURE 5,492,000 0 5,492,000 GB/Pu/16/06/17
Putting Barnsley People First
Minutes of the Meeting of the Barnsley Clinical Commissioning Group AUDIT COMMITTEE held on Thursday 23 May 2016 at 1200 pm in the Boardroom Hillder House, 49/51 Gawber Road, Barnsley S75 2PY
PRESENT:
Ms A Arnold Acting Audit Committee Chair Ms M Hoyle Practice Manager, Governing Body Member Mr C R Millington Lay Member for Patient and Public Engagement
IN ATTENDANCE:
Mr J Lander Head of Finance Ms K Morgan Governing Body Secretary Mr J Prentice KPMG Director Mr G Shead Assistant Client Manager, 360 Assurance Ms L Wild KPMG Manager Mr R Walker Head of Assurance Ms H Wells Chief Finance Officer
APOLOGIES
Ms L Hawkes Deputy Director, 360 Assurance Dr M Guntamukkala Governing Body Member Ms C Croft Counter Fraud Specialist Dr J Maters Membership Council Mrs V Peverelle Chief of Corporate Affairs
Agenda Note Action Deadline Item
AC 16/43 QUORACY
The Acting Committee Chair declared that the meeting was not quorate. However, with regard to the CCG’s Annual Report, Governance Statement and final Accounts the Committee’s role was not to approve but make a recommendation to the Governing Body. On this basis the Committee would consider these documents and make an appropriate recommendation to the Governing Body.
AC 16/44 DECLARATIONS OF INTEREST, SPONSORSHIP, GIFTS AND HOSPITALITY
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Agenda Note Action Deadline Item
The Audit Committee noted the Declaration of Interests report. No further declarations of interest were received.
AC 16/45 MINUTES OF THE PREVIOUS MEETING HELD ON 31 March 2016
The Minutes of the meeting held on 31 March 2016 were verified as a correct record of the proceedings subject to the following amendment:
Minute reference AC 16/41 41.2 – Page 55 Section 4.9.4
Typographical error - Years to read 2015/16 and 2016/17
Minute reference AC 16/41 41.7 – Management Representation Letter
Second sentence to read: At this stage no key points had been identified for inclusion in the Management Representation Letter.
AC 16/46 MATTERS ARISING
The Committee considered the Matters Arising Report and the following main points were noted:
Minute reference AC 15/148 Specification of Map of CCG KPI and related Assurance Flows
It was agreed that this action would remain on the Matters Arising Report for consideration mid-year by the new Audit Committee Chair and Audit Committee.
Minute reference AC 15/162 Internal Audit Progress Report
CSU Transition – coordination of assurance reporting
The Head of Assurance advised that a Memorandum of Understanding was in place for in house services which included the provision of assurance reports.
The Audit Committee deemed that the actions relating to;
Page 2 of 8
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Agenda Note Action Deadline Item
Updating the Audit Committee about CSU transition and Communication of CSU transition arrangements to practices were complete
Actions Complete
The Audit Committee agreed that the following actions were complete:
Minute reference AC 16/25 - New Declarations Minute reference AC 16/27 – Circulation of Fraudulent Times to Practices Minute reference AC 16/28 – Amendment of 2016/27 work plan to reflect all joint working Minute reference AC16/33 – Accounting Policies.
The Audit Committee noted the Matters Arising.
AC 16/47 NHS BARNSLEY CCG ANNUAL REPORT AND ACCOUNTS 2015/16
The Audit Committee considered the Annual Report, Governance Statement and Final Accounts together with the log of amendments resulting from the detailed review of the draft Annual Report and Accounts at the meeting on 28 April 2016.
47.1 CCG Annual Report
The Committee proposed the following minor amendments to the Annual Report:
Page 11
Third paragraph - replace wording from timelier appointments to more timely appointments.
Sixth paragraph first sentence to read ‘This year, the CCG has also launched a new computer system whereby, with patients’ permission’ etc.
Page 13
Mental Health Waiting Times - capital letter for March
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Agenda Note Action Deadline Item
Page 16 Section 2.2.2.2 South West Yorkshire Partnership NHS Foundation Trust
Second paragraph first two sentences to read:
Performance of mental health services has generally been good. Access to psychiatric liaison services is in place to ensure early support with patients attending the acute trust.
47.2 Governance Statement
The Committee proposed the following minor amendment to the Accountability Report:
Page 52
Third paragraph – delete random rogue ‘s’
It was noted that two SARs from NHS Business Services Authority regarding Prescription Services and from HSCIC regarding GP Payments Services are still outstanding.
The Audit Committee agreed that the Governance Statement could be further amended should the reports be received before the Governing Body meeting. A verbal update will be provided to the Governing Body and any late amendments will be tabled for its approval
47.3 Draft Final Accounts
The Committee reviewed the draft final accounts together with tabled papers of late amendments and proposed the following additional amendments.
Page 12
Note 2 Other Operating Revenue – last sentence to read: ‘These recharges are recorded as revenue within Recoveries in respect of employee benefits and other revenue respectively’.
Page 16
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Agenda Note Action Deadline Item
Note 4.5 Pension costs sub section a) Accounting valuation - third sentence inclusion of the word ’at’ between as and 31 March 2016.
Page 25
To format font size consistently.
Page 31
Final paragraph first sentence to read - ‘The Better Care Fund arrangement contains an element of funding relating to achievement of reducing non elective admissions.
47.4 Head of Internal Audit Opinion & Annual Report
The Committee noted the 2015/16 Final Head of Internal Audit Opinion and Annual Report which provided significant assurance that there was a generally sound system of internal control within the CCG. This report had been reviewed in detail at the previous Committee meeting.
47.5 Annual Report Local Counter Fraud Specialist
The Committee received and noted the Counter Fraud, Bribery and Corruption Annual Report 2015/16. This report had been reviewed in detail at the previous Committee meeting
47.6 Annual Governance Report from External Auditors KMPG (ISA 260)
The KPMG Manager presented the Summary of External Audit Findings 2015/16 to the Audit Committee.
KPMG intended to issue an unqualified audit opinion on the accounts and Value for Money if the Governing Body adopt them on 26 May 2016 and receipt of the signed accounts and Management Representation Letter.
Status of Audit – Outstanding work
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Agenda Note Action Deadline Item
The KPMG Manager reported that :
Receipt of the bank verification letter for the cash balance remained outstanding, however this was not a major issue and could be agreed to an electronic bank statement.
Two other areas remain to be completed; Checking of consistency between the final updated accounts and the consolidation schedules, Final audit review and closedown processes, which would take place over the next few days.
The outstanding Service Auditors Report (SAR) would be added to the items of LW outstanding work.
Audit Fee
The proposed fee for the audit was £57,050 (plus VAT) The fee was £800 above that highlighted within the audit plan agreed by the Audit Committee in March 2016. This was due to additional audit resource required as a result of working papers provided for the audit not being in line with agreed expectations.
The Chief Finance Officer advised that the loss of two experiences staff members from the Finance/Accounts Team had been taken into account, which had necessitated and additional interim support for the team. Looking ahead the year-end timetable was to be reviewed and refined to ensure all required information was available at the specified time for year-end audits in future years. Additional training, supervision and support would also be provided to staff.
Value for Money
The Committee noted that the sustainability of the local health economy would impact more in future years.
Audit Differences
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Agenda Note Action Deadline Item
It was noted that there would be no unadjusted or adjusted audit differences. A number of presentational / disclosure issues were identified during the course of the audit, all have been amended and there is no impact on the overall achievement of targets by the CCG. .
General
The KPMG Manager commented that the Finance Team had been most helpful throughout the audit. The Chief Finance Officer indicated that lessons had been learned from the audit process and incorporated into a revised year end timetable which would be shared with the KPMG Manager.
The Audit Committee recognised that despite losing two key members of staff there had been a strong team effort in producing the year end accounts.
The Committee expressed their appreciation to the Finance Team for delivering the accounts and to 360 Assurance and KPMG for their support.
47.7 Management Representation Letter
The Committee received the Management Representation Letter. The letter reflected the national template and no additional disclosures specific to Barnsley CCG were proposed or required.
47.8 Third party Assurances including YHCS Service Auditor Report
The Audit Committee noted the summary of third party assurance received.
The Audit Committee:
Reviewed the amended Annual Report and Accounts 2015/16 Received the final Head of Internal Audit Opinion
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Agenda Note Action Deadline Item
Received the final Annual Report of the Local Counter Fraud Specialist Received and considered the ISA260 External Auditor’s Report Reviewed the Management Representation Letter Received the summary of Third Party Assurances.
Recommendation
On the basis of the above recommended to the Governing Body that it approves the Annual Report and Accounts 2015/16, subject to final wording around third party assurance.
Agreed Actions
To update ISA 260 and Management Representation letter relating to third party assurance if required.
The Governance Statement to be further amended should the outstanding SARs reports be received before the Governing Body meeting. To provide a verbal update to the Governing Body and table any late amendments for approval
To convey the appreciation of Audit Committee to the Finance Team for their excellent work in delivering the accounts to timescale.
AC 16/48 EXTERNAL AUDITORS KPMG ANNUAL AUDIT FEE LETTER 2016/17
The Committee noted the planned audit fee for 2016/17 and redistribution of Audit Commission surplus to audited bodies.
AC 16/49 DATE AND TIME OF NEXT MEETING
The next meeting of the Audit Committee will be held on Thursday 30 June 2016 at 3.00 pm in the Boardroom, Hillder House, 49/51 Gawber Road, Barnsley, S75 2PY.
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Putting Barnsley People First
Minutes of the Meeting of the NHS Barnsley Clinical Commissioning Group FINANCE & PERFORMANCE COMMITTEE held on Thursday 5 May 2016 at 10.30am in the Boardroom, Hillder House, 49 – 51 Gawber Road, Barnsley S75 2PY.
PRESENT: Dr Nick Balac (Chairman) - Chairman of Barnsley CCG Ms Lesley Smith - Chief Officer Dr Madhavi Guntamukkala - Elected Member Governing Body Dr John Harban - Elected Member Governing Body Dr Nick Luscombe - Elected Member Governing Body Dr Andrew Mills - Membership Council Member Mrs Vicky Peverelle - Chief of Corporate Affairs Miss Heather Wells - Chief Finance Officer
IN ATTENDANCE: Miss Leanne Burgin - PA to Chief Finance Officer Mr Patrick Otway - Head of Commissioning (MH, Children & Specialised)
APOLOGIES: Mr Jamie Wike - Head of Planning & Performance
Agenda Note Action Deadline Item FPC16/75 QUORACY
The meeting was declared quorate.
FPC16/76 DECLARATIONS OF INTEREST RELEVANT TO THE AGENDA
There were no declarations of interest raised relevant to the agenda.
Dr Andrew Mills indicated that he was a GP Partner at Ashville Medical Centre and this needed adding to the declarations of interest register. LB/AS
FPC16/77 MINUTES OF THE PREVIOUS MEETING
The minutes of the meeting held on the 7 April 2016 were agreed as a true record of proceedings.
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FPC16/78 MATTERS ARISING REPORT
Members worked through the Matters Arising Report and the following updates were given:
FPC16/71 Minutes of the Children’s Executive Commissioning Board 22 February 2016
The Head of Commissioning (MH, Children’s & Specialised) attended the meeting to update members on the waiting times and inappropriate referrals. It was noted that the waiting times which were previously at 18 weeks were now at 5 weeks by the end of March. Inappropriate referrals were still around 29-30% and over 50% of referrals were from GP’s. A presentation will be made at a future BEST meeting, to address referral issues.
FPC16/72 Minutes of the Adult Joint Commissioning Group 22 February 2016
The Head of Commissioning (MH, Children’s & Specialised informed members that the ECLO Report was tabled at the Adult Joint Commissioning Group. The report was discussed by Management Team; it had been agreed that the ECLO post be extended, until the newly procured ophthalmology service was in place.
FPC16/48 Integrated Performance Report – Cancer
The Chief of Corporate Affairs provided an update to members in relation to patients being referred with breast symptoms seen within 2 weeks of referral target being below target. It was noted that BHNFT had managed to secure extra clinics and also recruit a radiologist which should begin to address the issues and raise the targets over the next few months. It was expected that these plans be in place from July onwards.
FPC16/25 2016/17 Initial 5 Year Plan
The Chief of Corporate Affairs reported that she had received the primary care transformation fund bids and would pick any issues up with James Barker at their planned meeting on Friday 6 May.
The Chair reported he had received feedback that the I Heart Barnsley Service had been releasing pressure on A&E services. It was noted that a piece of work was awaited from the GP Federation about the flows from which practices into I Heart Barnsley.
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FPC16/49 Assurance Framework
The Chief Officer reported that she had considered whether it was appropriate to add the Sustainability & Transformation Plan to the Assurance Framework as requested at a previous meeting. However, in her view the production of a plan did not pose a risk to the organisation. Risks may arise subsequently, once the plans move to the implementation stage.
FPC16/79 UPDATE ON RECENT PUBLISHED AND EXPECTED GUIDANCE
There were no updates on recent published and expected guidance since the previous Committee meeting.
FPC16/80 UPDATE ON CONTRACTING CYCLE
The Chief Finance Officer presented the report to the Committee giving an update on contract negotiations for 2016/17. The verbal update included outstanding key issues and ongoing discussions with providers.
Dr J Harban queried data around the first to follow up ratios for month 12 and whether this had been received. The Chief Finance Officer reported that data was not yet available but it would be reviewed once received. It was also reported that during the course of negotiation meetings the Medical Director at BHNFT had proposed a clinical working group to review outpatient arrangements but had not yet set up a meeting. The Chief Finance Officer agreed to ask the HW Contracting Team to follow this up.
The Finance and Performance Committee thanked the Finance and Contracting Team for the work done throughout the contracting cycle.
The Committee noted the report and its contents.
FCP16/81 BARNSLEY HOSPICE OUTCOME MEASURES
Dr J Harban presented a report to the Committee setting out the outcome measures to be included within the Grant agreement for Barnsley Hospice 2016/17. It was noted that the Hospice had agreed to continue to fund 2 Community Nursing Specialist Posts at BHNFT.
Dr J Harban welcomed comments from the Finance and Performance Committee in relation to the outcome measures and whether there was anything else members
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GB/Pu/16/06/18 would like to see going forward. The Committee felt that performance data and preferred place of death and the End of Life KPIs would be something that the Hospice could measure. The Committee felt that the measures were a good start from which to build in future.
It was agreed to share this paper at the Governing Body Private Session on the 12 May to give the opportunity for further clinical input on areas for future development. JH
FPC16/82 INTEGRATED PERFORMANCE REPORT
Finance
The Chief Finance Officer briefed members on the current financial position as outlined in the report and reported that the CCG’s draft accounts for year ended 31 March 2016 had now been completed and submitted for audit. It was reported that the CCG achieved delivery of a £8,280,000 surplus as forecast and in line with NHS England’s expectations together with achieving all other financial duties and targets. Subject to audit the CCG had met all of its key financial duties as outlined in the report.
It was reported that Auditors were currently on site and would be reporting their audit findings to the Audit Committee meeting on 23 May.
Performance
The Chief of Corporate Affairs updated the Committee on Performance Issues and the key issues identified from the report were A&E 4 hour waits target not achieved and year to date performance as at the end of March was 92.24% (red). YAS performance for year to date on Red 1 calls were at 70.87% which remains below target so has not achieved. It was noted that ongoing work around RAG rating calls and allowing handlers more time to assess the best care was being looked at as part of a pilot. The Committee felt that if a call was made from a GP that the normal script from the handlers could be shortened and the VP Chief of Corporate Affairs agreed to feed this back.
All other performance data was noted within the report. The Committee noted the report and its contents.
FPC16/83 ASSURANCE FRAMEWORK
The Chief of Corporate Affairs presented the Assurance Framework to the Committee. It was reported that the Governing Body had, had a Development Session to look at
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GB/Pu/16/06/18 the Assurance Framework and the Chief of Corporate Affairs agreed to update the documentation following that session with the Head of Assurance. VP/RW
It was noted that there were currently 2 risks on the Assurance Framework which were highlighted within the report. The Committee received and noted the report.
FPC16/84 RISK REGISTER
The Chief of Corporate Affairs presented the Risk Register to the Committee which currently showed two risks, these were around the A&E 4 hour target and YAS performance against the Category A calls. It was noted that all other risks had been updated within the register. The Committee received the report.
FPC16/85 CLINICAL TRANSFORMATION BOARD SUMMARY REPORT
The Chair presented the report from the Clinical Transformation Board which outlined the status of the Clinical Transformation Board projects and the ongoing recruitment process within the Commissioning and Transformation Team.
The Committee received the report and noted the contents.
The Chief Officer questioned whether the Committee should receive reporting on the Commissioning for Value workstreams, to monitor progress made and see performance against plans.
It was anticipated that this would become an appendix to the Integrated Performance Report and was felt that this information would be more appropriate within this Committee, rather than the CTB Dashboard.
The Chief Officer felt that the Finance and Performance Committee agenda could be refreshed to focus on the Commissioning for Value workstreams with progress and a deep dive on one workstream each month. The Chief of Corporate Affairs agreed to raise this with the Head of Planning and Performance and the Head of Commissioning and Transformation. VP
FPC16/86 MINUTES OF THE SWYPFT CONTRACT MANAGEMENT BOARD
No minutes available.
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GB/Pu/16/06/18 FPC16/87 MINUTES OF THE BHNFT CONTRACT MANAGEMENT BOARD
No minutes available.
FPC16/88 MINUTES OF THE CHILDREN’S EXECUTIVE COMMISSIONING GROUP HELD ON 4 APRIL 2016
The minutes of the Children’s Executive Commissioning Group held on the 4 April were received and noted by the Committee.
The Head of Commissioning (MH, Children’s & Specialised) attended the meeting to take any questions in relation to the minutes. It was reported that all funds had been utilised in year. Dr J Harban raised the issue of School Nurses still not being able to refer into CAMHS and coming to the GP which in fact they can refer and asked that a communication be sent out in relation to this. The Head of Commissioning (MH, Children’s & Specialist) agreed to raise this issue. It was noted that the 0-19 programme had now been taken in PO house by the Council.
FPC16/89 MINUTES OF THE ADULT JOINT COMMISSIONING GROUP HELD ON 4 APRIL 2016
The notes of the Adult Joint Commissioning Group held on the 4 April were received and noted by the Committee.
The Head of Commissioning (MH, Children’s & Specialised) attended the meeting to take any questions in relation to the minutes and provided a brief update.
FPC16/90 ANY OTHER BUSINESS
There was no other business for discussion.
FPC16/91 DATE AND TIME OF NEXT MEETING
The next meeting of the Finance and Performance Committee will be held at 10.30am on Thursday 2 June 2016 in the Boardroom at Hillder House.
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Putting Barnsley People First
Minutes of the NHS Barnsley Clinical Commissioning Group QUALITY & PATIENT SAFETY COMMITTEE Thursday 31 March 2016, 13:00 Room 3, Hillder House
PRESENT:
Dr Mehrban Ghani (Chair) - Medical Director Mike Simms - Secondary Care Doctor Brigid Reid - Chief Nurse & Caldicott Guardian Martine Tune - Deputy Chief Nurse/Head of Patient Safety Dr Sudhagar Krishnasamy - Governing Body Member Dr Mark Smith - Practice Member Rep Contracting Lead from the Governing Body Dr Mohammed Kadarsha - Membership Council Member as Clinical Advisor
IN ATTENDANCE:
Amanda Lindley (minutes) - Quality Manager - APOLOGIES:
Gillian Pepper - Designated Nurse, Safeguarding Adults & Patient Experience Dr Rob Farmer - Membership Council Member Chris Lawson - Head of Medicines Optimisation Chris Millington - Lay Member for Public and Patient Engagement Richard Walker - Head of Assurance Karen Martin - Head of Quality Primary Care Commissioning
Agenda Note Action Deadline Item
QPSC APOLOGIES & QUORATE 31/03/01 Apologies were noted. The meeting was quorate. One amendment was agreed to the agenda; Defer item 11 – QPSC Terms of Reference, as the committee self-assessment survey results will shortly be available and can be reflected in the review of the TOR.
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QPSC DECLARATIONS OF INTEREST RELEVANT TO 31/03/02 THE AGENDA
The declaration of interest paper was considered. It was confirmed as correct with no additions or changes to be made.
QPSC PATIENT STORY 31/03/03 The story of John a 69 year old gentleman with a learning difficulty, obsessive compulsive disorder and recent dementia diagnosis who has received 24 hour care all his life was discussed. His care staff had identified he was having a problem with his bowels. John lacked capacity to make a decision about treatment and options and so a best interest meeting was held with all relevant parties.
A procedure under anaesthetic was required and so plans were made to ensure the visit to hospital was smooth and individualised to John. The anaesthetist visited John at home, his favourite carer accompanied him on the day of the procedure and John went directly into theatre. He went from recovery straight to home and carers were briefed and contact numbers given. John’s family felt this was great team work and John was shown compassion and dignity.
The committee were assured this was based on an actual Barnsley patient’s positive experience and that reasonable adjustments and personalised care is achievable. Key factors that led to the success of this patient’s journey were; people listened, the family were very involved and the carer was not only known to John but was knowledgeable about his care. The Chief Nurse reflected that there had been instances in previous roles she had held outwith Barnsley where she would consider the case as a safeguarding issue if staff had no interest or knowledge regarding the patient they were there to escort and support.
QPSC MINUTES OF THE PREVIOUS MEETING - 25/02/16 31/03/04 The minutes of the previous meeting were received by the Committee. Amendments were requested to: Page 4, item 21/01/08 Medical Interoperability Gateway (MIG), text to clarify the Deputy Chief Nurse is not the lead, but feeding back to the Head of Commissioning Partnership and
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Integration. Page 5, Primary Care Commissioning item, text to change from alternatively to ‘in addition’. AL 08/04/16 Page 10, Risk Register. The Chair queried why the CQC requires improvement rating of BHNFT had not been added to the risk register. The Chair confirmed in relation to primary care services that ‘required improvement’ practices have been added to the Primary Care Commissioning Committee risk register. Discussion ensued about the risk threshold to the delivery of CCG objectives. In conclusion it was agreed by the Committee to add the risk, the wording of the risk would be circulated to committee members and the scoring will be agreed at the next meeting. MT/RW 29/04/16
QPSC MATTERS ARISING REPORT 31/03/05 17/12/05c – NHSE VTE letter Ensure the NHSE letter is shared at the next available BHNFT VTE meeting, 6 April. The Chair is not able to attend the next meeting and feels the letter needs explanation as well as sharing, also for BHNFT to provide an update as to how this guidance is implemented. The Chair therefore asked MG 12/05/16 that this item remains open.
17/12/08 - CCG Individual Funding Request (IFR) Policy The Deputy Chief Nurse confirmed she is meeting the IFR manager on the 5 April 2016. MT 12/05/16
21/01/08 – Medical Interoperability Gateway(MIG) It was agreed to ascertain the latest sign up figures re MIG. If the figure is less than 30 practices then the Committee agreed to include this as a red item on the Governing Body Highlight Report. It was agreed to AL 08/04/16 write to all practices who have signed up to congratulate them and also write to the ones who have not yet signed up to ascertain the reasons. The committee require assurance that practices who have not signed up to the MIG have made a risk based MT 12/05/16 decision and can identify controls to mitigate the risks of not signing up.
25/02/13 Minutes of the APC Further clarity was requested regarding the action on biosimilar and branded generics, particularly in CL 12/05/16
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relation to the ‘contractual implications’.
QUALITY AND GOVERNANCE
QPSC QUALITY METRICS REPORT (STANDING ITEM) 31/03/06 The Deputy Chief Nurse presented the report, the focus was Patient Experience.
BHNFT It was highlighted that the BHNFT Friends and Family Test (FFT) data for A & E had improved and the data for Maternity was very positive and above the national average. In line with national data the two most common themes identified in complaints was care and treatment issues and communication. BHNFT were commended for their attempts to gain feedback and the Chief Nurse identified they have been nominated for an award re their Friends and Family Tests and they are keen to do more.
SWYPFT The positive FFT data for SWYPFT was noted. Although the response numbers are small. Further discussion will be held with SWYPFT to develop quality reports to include a greater level of detail.
The Deputy Chief Nurse reflected with the committee whether they are satisfied with the Patient Experience information reported by our providers. It was agreed that existing tools are limited largely to FFT but that providers are getting better at reporting patient experience data and that we need further assurance that they are using it to improve services. It was felt some of this good work was occurring but was not pro-actively shared with the CCG. In respect of vulnerable clients, it was confirmed this was identified via the Safeguarding Adults Board. It was agreed that further work to progress the patient experience via the CQB meeting’s agenda is required to ensure there is local action to improve services.
Serious Incidents The committee confirmed it is helpful to include the BHNFT and SWYPFT lessons learned documents re SI’s and so this will continue. The Chief Nurse confirmed the 1 historical SI from April 2013 – March 2015 for the CCG was being progressed.
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Staffing The Chief Nurse shared feedback re recent CQC visit to SWYPFT. No significant concerns identified in the verbal feedback from CQC (it was stated this should be taken with caution and await the full CQC final report of the visit). SWYPFT had described as having only one surprise from the CQC visit and this was not related to a care area based in Barnsley. However CQC were ‘pursuing’ the staffing in the acute Mental Health wards.
Primary Care The spreadsheet of the primary care CQC visits and ratings was welcomed by the committee, the overall good practice ‘green’ areas was highlighted. It was noted the dates on the spreadsheet were the date of the report not the visit.
BHNFT HSMR The performance was noted. The Chair confirmed whilst a number improvements had been introduced such as the Septic Bundles, HSMR remains an area for the committee to be sighted on. (see item 14 for further detail on HSMR & mortality).
QPSC SAFEGUARDING VULNERABLE CLIENTS CCG 31/03/07 POLICY
The Deputy Chief Nurse presented the paper and confirmed there were minimal changes which were colour highlighted. The minor amendments have been included to reflect the Care Act 2015.
The committee approved the policy.
QPSC RISK REGISTER & ASSURANCE FRAMEWORK 31/03/08 The Chair presented the risk register.
Risk 14/15 D1 Discharge letter – the update for March 2016 was noted. The effective communication to GP’s (D1 completeness) was not felt to be answered in the March update. The Chair agreed to await the outcome of the CCG audit of the BHNFT action plan in April/May 2016.
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Risk 15/07 YAS – the update was noted.
The Deputy Chief Nurse will refresh the MT 12/05/16 previous YAS Governing Body paper with a focus on safety and quality rather than performance and present this at a future QPSC meeting.
The Assurance Framework was noted and this has been updated to reflect the Clinical Quality Board meetings.
QPSC MAZARS SOUTHERN HEALTH REPORT 31/03/09 The Deputy Chief Nurse presented an overview of the report. Whilst the report focused on a mental health/learning disability provider the findings and recommendations have wider relevance to health and social care re investigation of expected and unexpected deaths and learning from deaths and resultant service change.
There was a general discussion in respect of some of the recommendations and some of the current CCG practice and existing practice by the providers. For example: CCG Serious Incident review groups approach to quality of reports rather than solely complying with the 60 day timescale BHNFT Mortality review group in place BHNFT Deputy Medical Director reviews on Mondays all deaths that have occurred at the trust over the weekend. SI’s are then declared as relevant. Primary care recording significant events BHNFT training on ‘human factors’
The Committee requested further time to fully consider the 9 recommendations for commissioners and the Deputy Chief Nurse will bring back the paper All 15/04/16 and collated responses to the next meeting.
QPSC QUALITY SURVEILLANCE GROUP – 16 Mar 2016 31/03/10 The Chief Nurse provided a verbal update. Intelligence continues to be provided to the group. Work is ongoing to improve the analytical approach, consistency and thresholds of the
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Agenda Note Action Deadline Item
data across the QSG membership.
YAS – CQC Action Plan – was discussed; the lead for this is the Sheffield CCG Chief Nurse. A mock inspection for YAS has been suggested.
QPSC QPSC REVISED TERMS OF REFERENCE 31/03/11 Item deferred to the next meeting as the committee member self-assessment survey outcome report is awaited and will be utilised in the review of the TOR. As of 29/03/16 nine QPSC members had completed the survey, a reminder was given for any outstanding to complete.
QPSC CCG QUALITY ASSURANCE VISITS 31/03/12 QA TOR It was noted that the revised QA visit TOR were agreed at the BHNFT Clinical Quality Board meeting of 09/03/16. They will be tabled at the SWYPFT CQB meeting on the 06/04/16.
Future Visits The Chief Nurse confirmed she had verbally agreed with Chief Nurse, BHNFT to carry out an unannounced early evening visit. Further details will be circulated in the CCG to the AL 12/05/16 visiting team.
QPSC INFORMATION GOVERNANCE TOOLKIT UPDATE 31/03/13 The committee received and noted the report.
The proposed changes to the CCG’s IG policies were approved.
COMMITTEE REPORTS AND MINUTES GENERAL
QPSC CLINICAL QUALITY BOARDS 31/03/14 The adopted minutes of the BHNFT 07/01/16 CQB meeting were noted.
The Chief Nurse verbally confirmed the key areas from the BHNFT 09/03/16 CQB meeting:
HSMR, there is evolving thinking about the
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value of this data in relation to measuring quality. The Deputy Chief Nurse updated that she had attended a Mortality master class with Professor Mohammed, who is an academic leading work on Mortality for Yorkshire & Humber Academic health Science Network. Current measurement methods such as HSMR and SHIMI are being questioned in respect of the link to quality of care and that it leads to false thinking. He has offered to attend MT 12/05/16 Barnsley and it was agreed a joint meeting between the CCG and BHNFT including non- executive directors and Governing Body members would be of value. The Deputy Chief Nurse also raised re a recent MT 12/05/16 self-assessment tool that has been sent by NHSE to providers. It was agreed to request to see this and the results. Quality Assurance TOR agreed. CQC Action Plan discussed. Seven day services were discussed. The 16/17 focus will be on the 4 outcomes highlighted by NHSE. Fall’s work – BHNFT are reporting a positive impact, and whilst they are not reporting a decrease in falls there has been a reduction in harm. The CCG will continue to monitor this area via CQB.
QPSC MINUTES OF THE 17/02/16 AREA PRESCRIBING 31/03/15 COMMITTEE The minutes were received and noted by the committee.
QPSC MINUTES OF THE 19/02/16 HEALTH OF 31/03/16 CHILDREN IN CARE AND CARE LEAVERS STEERING GROUP The minutes were received and noted.
The Chief Nurse confirmed re Child ‘N’ the serious case review is due to be published by 01/04/16. Good practice has been commended.
The de-commissioning of the Family Nurse Partnership team was discussed. This process and caseloads will be risk managed over the next 6 months. The Chair confirmed the funding for the first year was within the 0-19 years’ service, but after 1
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year the CCG has not been informed what will happen to that funding. QPSC UNADOPTED MINUTES OF THE 25/01/16 HEALTH 31/03/17 PROTECTION BOARD The minutes were received and noted.
It was confirmed the TB issue is now resolved and the contract sorted. A letter will be going out to GP practices. MT 12/05/16
The Deputy Chief Nurse is now the TB lead.
QPSC ANY OTHER BUSINESS 31/03/18 No items were raised.
QPSC ISSUES FOR ESCALATION TO THE GOVERNING 31/03/19 BODY/ HIGHLIGHT REPORT
It was agreed to highlight four areas; 1. MIG if less than 30 practices signed up-red 2. Quality Assurance TOR approved - green 3. Information Governance toolkit approved - green 4. Mazars Southern Health Report Update - amber
QPSC DATE AND TIME OF NEXT MEETING 31/03/20 The date of the next meeting : 19 May 2016, 13:00-15:00.
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Putting Barnsley People First
Minutes of a Meeting of the NHS Barnsley Clinical Commissioning Group
EQUALITY STEERING GROUP held on Thursday 18 February 2pm to 4pm
Boardroom at Hillder House, Barnsley
PRESENT: Brigid Reid - Chief Nurse, Barnsley CCG (Chair)
Carolyn Ellis - Healthwatch Barnsley
Marie Hoyle - The Practice Manager Member (Deputy Chair)
Chris Millington - Governing Body Lay Member for Public & Patient Engagement, Barnsley CCG Dr Saxena - Membership Council Member
Peter Smith - HR Business Partner , Barnsley, Sheffield & Rotherham CCGs Kirsty Waknell - Head of Communications and Engagement, Barnsley CCG Richard Walker - Head of Assurance, Barnsley CCG
IN ATTENDANCE Carol Williams - Executive PA to Brigid Reid, Chief Nurse (Minute Taker)
APOLOGIES: Elaine Barnes - Equality & Diversity Manager, Barnsley, Sheffield & Rotherham CCGs Dr Lawrence King - Governing Body Member, Barnsley CCG
Carrianne Stones - Healthwatch Manager, Healthwatch Barnsley.
Agenda Note Action Deadline Item ESG WELCOME/APOLOGIES/QUORACY/ 16/02/01 DECLARATIONS OF INTEREST
Apologies received as above and the meeting was declared Quorate.
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Agenda Note Action Deadline Item The Chair informed the Committee that the Equality & Diversity Manager had been on sickness absence leave since late November 2015. The Chair had discussed with Sheffield and Rotherham CCGs, who share the service, how best to support the Equality & Diversity Manager in returning to work. The Chair asked that the Equality & Diversity Manager be informed that she had been missed. As a result of the absence and lack of capacity some of the actions from the October 2015 were outstanding.
The Chair invited declarations of interest relevant to the agenda, none were declared.
ESG SUMMARY OF OCTOBER 2015 SURVEY 16/02/02 ASSESSING OUR EFFECTIVENESS AS A COMMITTEE & EXAMPLES OF PERSONAL EXPERIENCE OF POSITIVE ENACTMENT OF REINFORCING GOOD BEHAVIOUR AND CHALLENGING POOR BEHAVIOUR
The Chair asked members reflect on the questions asked at the October 2015 meeting and to speak up if they felt actions during the meeting were not clearly articulated and to suggest an alternative summary if required.
Committee members shared personal examples of good and poor behaviour as follows:
Following the Investing in Excellence training The Chair added ‘Sharing the Good News’ as a standing agenda item to the Quality Team meetings. The Head of Communications & Engagement had felt comfortable in challenging a colleague when they had made inappropriate comments The HR Manager was confident in feeding back to the member of staff involved that their behaviour had not been acceptable. The Head of Contracting stated that in daily team meetings poor behaviour was identified and challenged and staff were encouraged to own their mistakes and identify how they could have dealt with them differently.
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Agenda Note Action Deadline Item The Practice Managers Member had identified that when reception staff in General Practice were dealing with patients who did not have English as their first language, there could be a tendency to speak slowly and loudly which could be perceived as patronising. The First Port of Call training had given her the opportunity to remind staff that having empathy with a patient was a more effective way to communicate. The Practice Manager Member agreed to share this learning with other Practice Managers.
The Chair stated that the Governing Body had agreed the roll out of the First Port of Call training and agreed to share the video link with Committee members, asking that this was not shared wider with practice staff.
The Chair stated that we would repeat this exercise CW 6.5.16 again at future meetings.
ESG MINUTES FROM THE PREVIOUS MEETING HELD 16/02/03 ON 29 OCTOBER 2015
The minutes of the previous meeting held on 29 October 2015 were agreed as an accurate record.
ESG MATTERS ARISING REPORT FROM 16 JULY 2015 16/02/04 MEETING
ESG 15/01/05 British Sign Language (BSL) Interpreting Contract SWYPFT had provided guidelines for booking an interpreter but these were incomplete and had not been approved.
The Equality and Diversity Manager is to liaise with SWYPFT to confirm the process for accessing EB 6.5.16 interpreters. Outstanding due to sickness absence and lack of capacity.
The Chair confirmed through the SWYPFT Clinical Quality Board meeting that we wanted access to the posters and telephone numbers.
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Agenda Note Action Deadline Item The Committee agreed that guidance was needed for when it was not possible to book an interpreter, for example Google Translate was an excellent alternative that could be highlighted to practices.
Action outstanding due to sickness absence and lack EB 6.5.16 of capacity.
In the absence of the Equality & Diversity Manger the Practice Manager Member and Head of Quality Primary Care had made good progress with the implementation of the Accessible Information Standards within Primary Care.
The Practice Manager Member stated that PRIMIS had agreed to capture communication needs across all systems and she will liaise with BHNFT as to how they flag patient needs. Next steps was to develop MH 31.3.16 and present a business case to the Management Team for translating software and assisted hearing kit to be available in practices.
MATTERS ARISING REPORT FROM 29 OCTOBER 2015 MEETING
ESG 15/10/02 Lesbian, Gay, Bi-Sexual, Transgender (LGBT) Video The Chair thanked the Deputy Chair who has attended the BEST event in January 2016 on her behalf to share the LGBT video and to answer any questions raised.
The Chair to work with Healthwatch to explore ‘mystery shopper’ approach with GPs to check if we BR/CS 6.5.16 are getting it right/wrong. Outstanding.
The Committee member from Healthwatch stated that they had asked the CCG to participate in ‘Enter & View’ training to be run in April 2016 and for a LGBT Champion to be involved. The Chair noted that this was different to the mystery shopper approach and would discuss this outside of the meeting.
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Agenda Note Action Deadline Item The HR Business Partner to present an employee story at the next meeting with relevance to the LGBT PS 6.5.16 agenda item. Outstanding.
ESG 15/10/05 Joint Strategic Needs Assessment (JSNA) & Equality Updates The Committee agreed that targeting health inequalities needs targeted effort. RightCare Atlas shows 156 indicators in relation to health outcomes. The Chair stated that the Community Nursing Review highlighted different areas of Barnsley borough had different health needs which we should have at the core of our principles but would need different approaches.
Discussions took place about how to avoid DNAs and Committee members noted that texts sent by GPs did not allow a response of Yes or No for attendance. The Practice Manager Member stated that the system used to send texts did not allow for responses and that a manual workaround was not practical.
The Chair stated that the CAHM service in SWYPFT had engaged a company to allow responses to text BR 6.5.16 messages and she would obtain details of this.
The Practice Manager Member to contact Jamie Wike to check if other areas who have less DNA’s that we could learn from and anything they may be doing MH 6.5.16 differently that works.
ESG 15/10/07 Risk Register & Assurance Framework The Committee asked that the audit of Equality Impact Assessments which had been undertaken approximately 6 months ago was to be repeated in order to further assure members and mitigate EB 6.5.16 associated risks. Noted as outstanding due to sickness absence and lack of capacity.
ESG 15/10/09 Behaviour Champions Give a title to the role, refine the job description and plan training for post holders in conjunction with Learning and development. On hold until all staff BR/EB 6.5.16 have completed Investing in Excellence training.
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Agenda Note Action Deadline Item The First Port of Call training to be included in the induction of Health Care Assistants within General BR 6.5.16 Practices.
ESG 15/10/10 British Sign Language (BSL) Interpreting Contract The Contract Manager confirmed that the SWYPFT KPIs for BSL had been circulated and agreed, though noted that further work was needed to understand what was happening in relation to SWYPFT interpreters. The Chair stated that the Chief of Corporate Affairs in Doncaster CCG shared that they AC 6.5.16 have had positive experience of using the local college for the Deaf in terms of a good supply of interpreters.
The Contract Manager to speak to Jayne Sivakumar to inform discussions for the Management Team as AC 29.2.16 we need to understand how the contract through SWYPFT supports Primary Care.
The Chair indicated that there had been a communication to the CCG’s Commissioning & Service Transformation Team from the charity Health BR 20.2.16 Deafinitions which she would forward the Contract Manager and the Head of Communications and Engagement.
ESG 15/10/13 Mutual Patient & Public Engagement Involvement It was noted that Health Deafinitions had expressed their interest in co-production of any future BSL videos. The Chair stated that the April Governing Body would be held at Health Deafinitions offices in Goldthorpe. The Head of Communications and Engagement reminded the Committee that this was just one provider of many possible providers and due consideration should be given to this.
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Agenda Note Action Deadline Item The Chair stated that although she had received some expressions of concerns that the video for the Mental Health Strategy had terminology that did not translate well with BSL, at the Clinical Transformation Board, the Lay Member for Patient and Public Engagement commended the work for the way in which consultation for Mental Health strategy had been extensive. The Chair noted that this was a good example of delays to allow for a better process which had resulted in a better outcome.
ESG EQUALITY STEERING GROUP ANNUAL REPORT 16/02/05 The Chair thanked the Head of Communications and Engagement for compiling the Equality Steering Group Annual Report in the absence of the Equality and Diversity Manager. Committee members were asked to review and feedback on the draft report.
Amendments to be made as follows: Attendance to be updated to include February 2016 meeting Note that non-attendance of the Practice Manager Member and the Lay Member for Public & Patient Engagement at 1 meeting was because they had to attend another committee meeting to ensure 29.2.16 that it was quorate KW All actions Note the non-attendance of the Equality & completed Diversity Manager at 1 meeting was due to sickness absence Note not quorate for 16 April 2015 meeting but some members met to follow up on Matters Arising, Equality Objectives Action Plan and to update the Workplan for 2015-16
Committee members were asked to feedback on achievements to the Head of Communications and Engagement by 1 March 2016. ALL 1.3.16
It was noted that staff training figures showed a drop from last year and this could be due to lack of face to face contact and new members of staff not having had the opportunity to undertake this.
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Agenda Note Action Deadline Item The Head of Assurance stated that as at the end of January 2016 staff training figures are 92%. The KW 8.3.16 Head of Communications and Engagement to obtain the very latest figures for the final report.
The Chair to review final report by 8.3.16 BR 8.3.16
Following approval of amendments/additions by The Chair the Annual Report will be submitted to the Audit KW 23.3.16 Committee on 31 March 2016 and subsequently the Completed Governing Body on 14 April 2016.
ESG PUBLIC SECTOR DUTIES 16/02/06 EDS2 Self-Assessment Report The Chair thanked the Head of Assurance and the Minute Taker for their commitment and contribution to the completion and publication of the report ‘How we meet our Public Sector Equality Duties’ which was published on Barnsley CCGs website on 27 January 2016.
The Chair also thanked other Committee members who had contributed to the report and Doncaster CCG who had shared the format of their report which formed the basis of Barnsley CCGs report.
The Committee were asked to review the RAG rated section which had been agreed with the Head of Assurance prior to publication.
The next step was to populate the evidence to support the EDS2 Self-Assessment and to share this with the Committee for proofing and validation in the CW 30.04.16 May 2016 meeting.
Committee members noted statistics in Appendix 2 which showed a that Barnsley CCG staff was predominantly a white, female, middle aged workforce which was not as diverse as other CCGs but reflected the local population.
The Practice Manager Member expressed concerns that 66% of staff had preferred not to state if they had a disability.
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Agenda Note Action Deadline Item The HR Manager stated that this data was collected at the point of employment and that the results of the recent staff survey showed only 10% of staff preferred not to state if they had a disability. It was also noted that 18% of applicants preferred not to state their sexual orientation.
Committee members commented that applicants may be fearful of divulging information that may be perceived as a barrier to employment and to consider using the term ‘additional needs’ instead of disability.
The HR Manager to review the application form and to consider more appropriate phrasing within the PS 6.5.16 outline of new job roles advertised on the NHS Jobs website as the application form cannot be changed, this being standard for all NHS organisations.
The Chair asked Committee members to review an ALL 6.5.16 application form on NHS Jobs to further understand what may dissuade people from declaring disability or sexual orientation.
The HR Manager to share what information is sent to PS 30.4.16 applicants. Committee members to share their thoughts and propose actions at next meeting, particularly around what applicants have to declare.
Equality Objectives Action Plan 2014/16 The Chair stated that in seeking assistance from Doncaster CCG she noted that they had focussed on only 2 main objectives in their action plan. In reviewing our action plan she noted that some of our objectives were embedded into the way that we work and the focus for 2016/18 should be on key priorities but still ensuring all responsibilities of the EDS2 were fulfilled. Committee members were encouraged to look at Doncaster CCGs Action Plan which is published on their website http://www.doncasterccg.nhs.uk/wp- content/uploads/2015/07/Equality-Diversity-Strategy- v1.0-December-2014.pdf
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Agenda Note Action Deadline Item Evidence to be updated on the Action Plan 2014/16 as follows:
Remove all reference to CSU as employees are now part of the CCG. A1 – add Contract Manager to the Lead A3 – add evidence from October 2015 meeting re JSNA data A4 – add Governing Body minutes relating to GP Survey data which will inform Commissioning in Primary Care B2 – BR, KW & CS meet regularly which inputs into quality and contract issues. Add minutes from Intelligence Sharing meeting and the Dementia Friendly communications pledge C1 – in16/18 Behaviour Champions work will build on Investing in Excellence training. Add minutes from this meeting as evidence. C2 – introduction of ‘Lunch with Lesley’ to allow staff members to get to know the Chief Officer and each other better. D1 – Check date when Annual Report needs to be submitted to the Governing Body.
Equality Objectives Action Plan 2016/18 The Committee to review ideas for key priorities for 2016/18 from the list below and add to this as they see fit: o Implementation of Accessible Information Standards o Health Inequalities & JSNA o Dementia Friendly o Build on Behaviour Champions o Interpretation Services o LGBT Community
Committee members to feedback to the minute taker ALL 15.3.16 by 15 March 2016. Feedback will be shared with the Public & Patient Engagement Committee.
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Agenda Note Action Deadline Item ESG FEEDBACKFROM THE BRITISH SIGN LANGUAGE 16/02/07 (BSL) HEALTH DAY REPORT & INITIAL RESPONSE The Head of Communications & Engagement gave a brief background of the BSL Health Day for the benefit of new members.
Healthwatch were responsible for the initial report and work continues, for example the findings of the Barnsley Hospital CQC report found there were issues around access to BSL interpreters which Healthwatch will take up with BHNFT. The Chair would be presenting detailed analysis at the Quality & Patient Safety Committee which will then be presented to the Barnsley Hospital Clinical Quality Board. Actions will be proposed at the next Committee meeting.
The Healthwatch representative stated the on the 5 March 2016 an event for Social Care Aids Equipment and Adaptations will be held. They noted that at a recent Commissioning Intentions event held at The Core there no attendees from the deaf community despite this being promoted via patient reference groups. The Head of Communications & Engagement to look into why this happened. KW 6.5.16
The Head of Communications and Engagement stated that there is an engagement team in the local authority and she had recently been exploring how they can work together on joint commissioned services and develop stronger ties. The Head of Communications and Engagement also stated that the CCG currently does not have direct access into the equality networks as we don’t contribute to this financially to this contract. However the developing joint-working, with the local authority in the area of engagement, will seek to address this.
Initially contractual and financial relationships will be explored and then wider opportunities will be considered with other partners.
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Agenda Note Action Deadline Item ESG MUTUAL PATIENT & PUBLIC INVOLVEMENT 16/02/08 The Healthwatch representative stated that an event had been held for refugees and asylum seekers to understand barriers to accessing Primary Care and other care available in the borough. In addition Healthwatch would be undertaking a fact finding exercise with the public in the Goldthorpe to understand reasons behind the ‘massive’ DNA issue as there is a disconnect with reports of a appointments not being attended and lack of appointments in Primary Care. Healthwatch will work with the CCG around demand management and will include DNA rates as part of this work.
The Practice Manager Member stated that she had attended the Student Council at Greenacre School in February 2016.
This was a very interesting and enjoyable visit and questions raised by students were about emotional wellbeing and who to ask re physical changes the students were experiencing. Students were not aware of Spectrum sexual health services at The Gateway – The Chair has emailed Greenacre School Nurse to ensure details of this service was communicated to students.
The Chair stated that schools were an excellent way to share information about services with students and this was a focus of Children & Young People Trust Executive Group and schools were critical for the Future in Mind local transformation plans.
ESG BEHAVIOUR CHAMPIONS 16/02/09 The Chair stated that the work centred on Behaviour Champions was on hold due to sickness absence and that this would be a resumed following the Investing in Excellence training which all staff would have undertaken by the 1st of April 2016.
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Agenda Note Action Deadline Item ESG HR POLICIES REVIEW 16/02/10 As part of the ongoing process of reviewing and updating HR policies the Head of Assurance and the HR Manger had reviewed the following policies:
Long Service Awards Working Time Regulations Alcohol and Substance Misuse Organisational Change
Minor changes had been made in all policies with the main changes in the Alcohol and Substance Misuse Policy. /section 1.4 to 1.6 of this policy had been removed from the policy as this related to smoking breaks and the Committee agreed that it was inappropriate to condone this.
The Committee agreed the Head of Assurance should make the minor changes made. RW 29.2.16
The Communications and Engagement Manager to highlight policy changes in Friday Roundup and to KW 31.3.16 ensure these are easily accessible on the internet.
ESG RISK REGISTER & ASSURANCE FRAMEWORK 16/02/11 The Head of Assurance reported one risk on the Risk Register associated with the Committee which had been added in January 2015.
The Committee agreed that with the addition of the Public Sector Duties report added to the CCG website in January 2016 further mitigated the risk and agreed with the rating of the risk.
ESG TERMS OF REFERENCE 16/02/12 The Committee were asked to review the terms of reference and the following comment were made:
Section 5 – Membership should have CSU removed from job titles as staff now embedded with the CCG.
The Chair stated that some CCGs had incorporated
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Agenda Note Action Deadline Item the Equality Steering group as part of the Public and Patient Engagement Committee supported by an Equality & Diversity working group. The Chair asked Committee members to consider this for Barnsley CCG and any views to be presented to the Chair for her to take to the next Public and Patient Engagement Committee meeting which will be held ALL 20.3.16 on 24 March 2016.
Following this the terms of reference will be revised in the meeting to be held on 6 May 2016.
ESG WORKPLAN/AGENDA TIMETABLE 16/02/13 The Chair and the minute taker to refresh the work BR/ 6.5.16 plan and agenda timetable. CW
The Chair stated that Values & Behaviours work links to work on Behaviour Champions and the NHS Jobs application process and recruitment training recently undertaken by staff. The Minute Taker to check with the HR Manager who attended the recruitment training and Values and CW 6.5.16 Behaviours to be included on the next agenda. ESG ANY OTHER BUSINESS 16/02/14 The Communications and Engagement Manager updated the Committee about ‘Browse Aloud’ which is a website tool that allows different accessibility on the website e.g. people could hear what is on screen, puts text into a plain English format. A business case for 2 years funding is being developed.
The Contract Manager stated that providers had ‘Freedom To Speak Up Champions’. The Contract Manager to share details of this with the Deputy Chief AC 29.2.16 Nurse to consider if this would then be shared at the Quality & Patient Safety Committee.
ESG ASSESS OUR EFFECTIVENESS AS A 16/02/15 COMMITTEE As part of assessing our effectiveness as a committee, each members was asked to reflect on the questions below which related to the February
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Agenda Note Action Deadline Item 2016 meeting and an anonymised questionnaire was used to gain responses as follows:
Q1 We have been focussed on agenda items in this meeting 25 % agreed 75% strongly agreed
Q2 I have felt comfortable to contribute to the meeting 50% agreed 50% strongly agreed
Q3 The actions agreed during the meeting have been clearly articulated 67% agreed 33% strongly agreed
Q4 In missing the patient story today we have lost an opportunity to affect the ethos of the meeting 14.25% strongly disagreed 43% disagreed 14.25% neither agreed nor disagreed 14.25% agreed
N.B. One Committee member had to leave the meeting just before the end as they had to attend another meeting. The results for Q1, Q2 & Q3 was from 8 responders and Q4 was from 7 responders.
One responder commented that they felt positive actions had worked well though not all Committee members had contributed so questioned if the expectation had been clearly articulated.
ESG DATE AND TIME OF NEXT MEETING 16/02/16 Thursday 12 May 2016 3pm – 5pm Hillder House Boardroom
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GOVERNING BODY
09 June 2016
Primary Care Commissioning Committee Assurance Report
1. PURPOSE OF THE REPORT
Provide the Governing Body with the highlights of the May Private Primary Care Commissioning Committee meeting.
2. EXECUTIVE SUMMARY
Doctors, Dentists, Pay Review Body (DDrB) Update
The Committee were presented with the latest position on the DDrB uplift which had increased the General Medical Services (GMS) global sum to £80.59. A review of all Personal Medical Services (PMS) practices based on April 2015 list sizes indicated that 9 PMS practices were below the GMS global sum the Committee therefore agreed to uplift these practices in accordance with the equalisation agenda ( all GP Practices to be at an equitable price per patient by 2021). A summary of the current position per practice as at 01 April 2016 is attached at Appendix 1.
3. THE GOVERNING BODY IS ASKED TO:
Note the report
Agenda time allocation for report: 5 minutes
Report of: Chris Millington
Designation: Chair of the Primary Care Commissioning Committee
Report Prepared by: Lynne Richards
Designation: Governance, Assurance and Engagement Facilitator
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1. SUPPORTING INFORMATION
1.1 Links to the Assurance Framework
The report is particularly relevant to risks 1.2, 1.4, 2.1 and 5.2
1.2 Links to Objectives
To have the highest quality of governance and processes to support its business To commission high quality health care that meets the needs of individuals and groups Wherever it makes safe clinical sense to bring care closer to home To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.
1.3 Governance Arrangements Checklist As this report is Financial Implications for information Contracting Implications only, all areas Quality within the Consultation / Engagement governance Equality and Diversity arrangements Information Governance checklist are not Environmental Sustainability relevant. Human Resources
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Weighted price per Barnsley Practice - Price per weighted patient as at 1 April 2016 Type Practice Code patient £ PMS C85001 83.49 £85.00 PMS C85003 80.09 PMS C85004 84.44 PMS C85006 80.09 £84.00 PMS C85007 80.08 PMS C85008 80.08 PMS C85009 84.58 £83.00 PMS C85010 80.10 PMS C85014 80.70 PMS C85015 84.43 £82.00 PMS C85016 80.08 PMS C85026 83.85 PMS C85028 84.73 £81.00 PMS C85033 80.10 PMS C85619 80.09 PMS C85622 80.09 £80.00 PMS C85623 84.30 Weighted price per patient £ GMS C85005 80.59 GMS C85013 80.59 £79.00 GMS C85017 80.59 GMS C85018 80.59 £78.00 GMS C85019 80.59 GMS C85020 80.59 GMS C85022 80.59 £77.00 GMS C85023 80.59 GMS C85024 80.59 GMS C85030 80.59 £76.00 GMS C85614 80.59 GMS C85617 80.59 GMS C85624 80.59 £75.00 GMS C85628 80.59
GMS Y00411 80.59
Y00411 Y04809 Y05248 Y05363 Y05364
C85003 C85004 C85006 C85007 C85008 C85009 C85010 C85014 C85015 C85016 C85026 C85028 C85033 C85619 C85622 C85623 C85005 C85013 C85017 C85018 C85019 C85020 C85022 C85023 C85024 C85030 C85614 C85617 C85624 C85628 APMS Y04809 83.84 C85001 APMS Y05248 83.84 APMS Y05363 83.84 APMS Y05364 83.84