CCG Headquarters 4th Floor 1 Guildhall Square (Civic Offices) Portsmouth PO1 2GJ
Governing Board Meeting in Public
A meeting will be held via Microsoft Teams (streamed online) from 2.00pm – 5.00pm on Wednesday 19 May 2021
AGENDA
Subject Lead Attachment
14:00 1. Apologies for Absence and Welcome E Fellows Verbal
Apologies received from Dr Nick Moore
14:10 2. Register and Declarations of Interest E Fellows Attached
To receive and note the register of interests of Committee members and any updates on the interests of members.
To review the agenda of this meeting and confirm any potential or perceived conflicts of interest.
14:15 3. Minutes and Actions of Previous Meeting held on 17 E Fellows Attached March 2021
a. To approve the minutes of the previous Public Governing Board meeting. b. To note progress against agreed actions.
14:30 4. Health and Care Portsmouth Covid-19 H Atkinson Verbal
To receive an update on the vaccination programme and prevalence of Covid-19 in the City.
14:45 5. CCG Executive Report J York Attached
To receive an update report on the activity of the CCG.
15:00 6. System Updates M MacIsaac/ D Williams/ Updates on: J York a. Hampshire & IOW Integrated Care System Verbal b. Portsmouth & South East Hampshire Integrated Care Verbal Partnership c. Health and Care Portsmouth Verbal
15:20 7. Finance & Performance Reports M Spandley/ J York To receive and review the following reports: a. Finance Report Attached b. Performance Report Attached c. 2021/22 Financial Planning Update Attached d. Draft Delivery Plan 2021/22 Attached
Subject Lead Attachment
15:45 8. Quality and Safeguarding Report K Atkinson Attached
To receive the report.
16:00 9. Governance Matters E Fellows
a. Governing Board Work Programme Attached To approve the work programme for 2021/22.
b. Committee Reports Cover Sheet Attached To approve the revised cover sheet for all CCG Committees.
16:10 10. Minutes from Other Meetings E Fellows Attached
To note the minutes from the following meetings:
Primary Care Commissioning Committee Audit Committee
16:15 11. Date and Time of Next Meeting in Public E Fellows
The next Governing Board meeting to be held in public will take place on Wednesday 21 July 2021 at 2.00pm – 5.00pm and will be streamed online via Microsoft Teams.
16:20 Meeting Close
Distribution:
Members
Dr Elizabeth Fellows - Chair of Governing Board/Clinical Executive (GP) Maggie MacIsaac - Accountable Officer
Helen Atkinson - Director of Public Health, Portsmouth City Council Karen Atkinson - Registered Nurse Dr Linda Collie - Clinical Lead/Clinical Executive (GP) Margaret Geary - Lay Member Alison Jeffery - Director of Children’s Services, Portsmouth City Council Dr Carsten Lesshafft - Clinical Executive (GP) Graham Love - Lay Member Dr Nick Moore - Clinical Executive (GP) Jackie Powell - Lay Member David Scarborough - Practice Manager Representative Andy Silvester - Lay Member Dr Simon Simonian - Clinical Executive (GP) Michelle Spandley - Chief Finance Officer Dr Tahwinder Upile - Secondary Care Specialist Doctor David Williams - Chief Executive, Portsmouth City Council Jo York - Managing Director
In Attendance
Jayne Collis - Business Development Manager Justina Jeffs - Head of Governance
GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 2
Title Register and Declarations of Interest
In order to meet its statutory duty, the CCG has revised processes for managing conflicts of interests to reflect national guidance published by NHS England throughout 2016/17.
Purpose of Paper • The Committee Register of Interest holds information on the Committees, its members and regular attendees. • Members are also required to declare any conflicts of interest against agenda items for each meeting. These conflicts are recorded as per the guidance.
The Board are requested to: Recommendations/ • note the Register of Interests and Actions requested • declare any actual, possible or perceived conflicts against the agenda items of the meeting.
Engagement Activities – Not applicable Clinical, Stakeholder and
Public/Patient
Item previously Governing Board, Audit Committee considered at
Potential Conflicts of Interests for Board None Members
Author Justina Jeffs, Head of Governance
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 11 May 2021
NHS Portsmouth Clinical Commissioning Group Register of Interests - Governing Board/Committee Members
Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of business) Is the interest From To Committee Body, Member direct or practice, Employee or indirect? other
Audit Audit
Interests
Committee Committee
Quality and
Primary Care
Safeguarding
Non-Financial
Remuneration
Commissioning
Governing Board
Financial Interests
Executive Committee
Professional Interests
Non-Financial Personal Nicola Andrews Quality Improvement Nil P Manager Helen Atkinson Governing Board Phyllis Tuckwell Hospice P Direct Trustee Nov-20 Current Manage in line with CCG policy P P Member Helen Atkinson Governing Board Portsmouth City Council P Direct Director of Public Health Jan-20 Current Manage in line with CCG policy P P Member Karen Atkinson Registered Nurse Southern Health NHS Foundation P Indirect Niece works at Matron for 2016 Current Declare conflict where appropriate in P P P Representative on Trust MH Services discussions relating to mental health Governing Board services Karen Atkinson Registered Nurse Compass Independent Fostering P Direct Foster Carer 2018 Current Declare conflict where appropriate P P P Representative on Agency Governing Board Karen Atkinson Registered Nurse Nursing and Midwifery Council P Direct Registered Nurse 2018 Current Manage in line with CCG policy P P P Representative on Governing Board Roger Batterbury Chair, Healthwatch, Healthwatch Portsmouth P Direct Chair 2013 Current Manage in line with CCG policy Attendee Portsmouth Roger Batterbury Chair, Healthwatch, Rebound Carers Group P Direct Volunteer Director/Trustee 2014 Current Would step aside should a grant be Attendee Portsmouth discussed. Roger Batterbury Chair, Healthwatch, Solent NHS Trust P Direct Bank SIRI Investigator 2016 Current Should any discussion relate to this Attendee Portsmouth role I would declare my role Roger Batterbury Chair, Healthwatch, East Shore Partnership P Direct Vice Chair Patient 2015 Current Manage in line with CCG policy. Attendee Portsmouth Participation Group Roger Batterbury Chair, Healthwatch, Nursing and Midwifery Council P Direct Registered Mental Health 1991 Current Would declare my membership if Attendee Portsmouth Nurse - RMN relevant Roger Batterbury Chair, Healthwatch, Practice Plus Group Surgical Centre, P Direct Chair Urgent Treatment 2018 Current Manage in line with CCG policy. Attendee Portsmouth St Mary's Portsmouth (St Mary's Centre Patient Participation Community Health Campus site) Group Nicola Burnett Deputy Chief Finance Healthcare Financial Management P Direct Member 2016 Current Manage in line with CCG policy. Attendee Attendee P Officer Association Nicola Burnett Deputy Chief Finance Association of Certified Chartered P Direct Fellow Member 2008 Current Manage in line with CCG policy. Attendee Attendee P Officer Accountants Dr Linda Collie Chief Clinical East Shore Partnership P Direct Partner Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader June 2017 Dr Linda Collie Chief Clinical Portsmouth Primary Care Alliance Ltd P Direct Practice is a Member Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader (PPCA) June 2017 Dr Linda Collie Chief Clinical Portsmouth Primary Care Alliance Ltd P Direct Sessional GP Work Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader (PPCA) June 2017 Dr Linda Collie Chief Clinical National response South Central P Direct Sessional GP Work as 111 02/04/2020 Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader Ambulance Service COVID CAS Clinician June 2017 Mark Compton Director of Nil P P Transformation Simon Cooper Director Medicines Nil P P Optimisation and Primary Care Michael Drake Director of Planning and Portsmouth Hospitals University NHS P Indirect Wife works in Human 1999 Current Manage in line with CCG policy P Performance Trust Resources Department Jason Eastman Associate Director of Nil P P IM&T Dr Elizabeth Fellows Chair/Clinical Executive East Shore Partnership P Direct Partner 01.04.16 Current Manage in line with CCG policy Chair P Dr Elizabeth Fellows Chair/Clinical Executive Portsmouth Primary Care Alliance Ltd P Direct Practice is a Member Current Manage in line with CCG policy Chair P (PPCA)
1 of 5 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of business) Is the interest From To Committee Body, Member direct or practice, Employee or indirect? other
Audit Audit
Interests
Committee Committee
Quality and
Primary Care
Safeguarding
Non-Financial
Remuneration
Commissioning
Governing Board
Financial Interests
Executive Committee
Professional Interests
Non-Financial Personal Dr Elizabeth Fellows Chair of Governing Circle Health P Direct Shareholder Current Manage in line with CCG policy Chair P Board/Clinical Executive
Dr Elizabeth Fellows Chair of Governing NHS Portsmouth Clinical P Direct Designated Doctor for 01/07/2019 Current Manage in line with CCG policy Chair P Board/Clinical Executive Commissioning Group Looked After Children
Margaret Geary Lay Member Age UK Portsmouth P Direct Chair of the Board of Sep-13 Current Will declare an interest when/if the P Interim Chair Chair Trustees business discussed at any of the CCG committees I am participate in involves reference to AgeUK Portsmouth. Margaret Geary Lay Member EC Roberts Centre - A local children P Direct Trustee on the Board Sep-13 Current Will declare and interest if the CCG P Interim Chair Chair and families charity business discussed involves reference to EC Roberts Centre. Margaret Geary Lay Member Action Hampshire - a voluntary sector P Direct Vice Chair on the Board of Oct-13 Current Will declare an interest in the CCG P Interim Chair Chair infrastructure organisation in Trustees business discussed if it refers to the Hampshire involvement of Action Hampshire. Margaret Geary Lay Member Association of Directors of Adult Social P Direct Associate Member Jul-13 Current Will declare an interest if I ever P Interim Chair Chair Services (ADASS) undertake work for ADASS that relates to the business of the CCG Meyrick Grundy Clinical Quality Manager Nil P
Jo Hanswenzl NHS England & NHS Nil Attendee Improvement Christine Horan Primary Care Nil Attendee Improvement Manager Katie Hovenden Clinical Associate Portsmouth Hospitals University NHS P Indirect Sister is Senior Orthopaedic Current Manage in line with CCG policy P P Trust Secretary Katie Hovenden Clinical Associate General Pharmaceutical Council P Direct Registered Current Manage in line with CCG policy P P Katie Hovenden Clinical Associate NHS Solent P Direct Redeployed to work in Feb-21 Current Manage in line with CCG policy P P Covid Vaccination Centre Alison Jeffery Governing Board Nil P Member Justina Jeffs Head of Governance Nil P Attendee Attendee Attendee Attendee Attendee P Rochelle Kneller HR Provider Nil Attendee Dr Carsten Lesshafft Clinical Executive Trafalgar Medical Group P Direct Salaried GP Jun-19 Current Manage in line with CCG policy P Dr Carsten Lesshafft Clinical Executive NHS Portsmouth Clinical P Indirect In a relationship with a Feb-17 Current Manage in line with CCG policy P Commissioning Group Commissioning Manager Dr Carsten Lesshafft Clinical Executive British Medical Association P Direct Member 1995 Current Manage in line with CCG policy P Dr Carsten Lesshafft Clinical Executive Fine-Line Medical Aesthetic P Direct Sole Trader 2000 Current Manage in line with CCG policy P Treatments Dr Carsten Lesshafft Clinical Executive NHS England/Wessex P Direct GP Appraiser Jun-19 Current Manage in line with CCG policy P Graham Love Lay Member Western Sussex Hospitals NHS P Direct Head of Employee Dec-17 Present Manage in line with CCG policy P Chair P Foundation Trust Relations Graham Love Lay Member Chartered Institute of Personnel and P Direct Member Jun-05 Present Manage in line with CCG policy P Chair P Development Sylvia Macey Primary Care Estates Kings Training Solutions P Indirect Husband owns Kings 11/09/2019 Current Manage in line with CCG policy. P Programme Manager Training Solutions which Exclusion from involvement in related delivers First Aid and commissioning of decision making. Resuscitation Training to GP and Dental Practices in Hampshire Steve McInnes Head of Primary Care Nil P Commissioning Dr Nicholas Moore Clinical Executive Derby Road Group Practice P Direct Salaried GP Aug-19 Current Manage in line with CCG policy P P
2 of 5 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of business) Is the interest From To Committee Body, Member direct or practice, Employee or indirect? other
Audit Audit
Interests
Committee Committee
Quality and
Primary Care
Safeguarding
Non-Financial
Remuneration
Commissioning
Governing Board
Financial Interests
Executive Committee
Professional Interests
Non-Financial Personal Dr Nicholas Moore Clinical Executive Health Education England, Wessex P Direct GP Trainer Jan-12 Current Manage in line with CCG policy P P Dr Nicholas Moore Clinical Executive Wessex GP Appraisal Service P Direct GP Appraiser Jul-19 Current Manage in line with CCG policy P P Dr Nicholas Moore Clinical Executive Craneswater Group Practice P Direct GP Partner Nov-11 30/06/2019 Manage in line with CCG policy P P Julia O'Mara Practice Nurse Advisor J2S Limited P Direct Director in Nurse training 2011 Current Will always declare this interest if P company providing training involved in discussions regarding the locally provision of nurse education and will not participate in decision making regarding the award of any funding.
Stephen Orobio Clinical Quality Manager Enthuse Care P Indirect Spouse is an employee Jun-20 Current No action required Attendee
Anna Plumbly Quality Improvement Nil P Officer Jackie Powell Lay Member Solent NHS Trust P Direct Associate Hospital Manager 2013 Present Declare conflict where appropriate in P P P P discussions relating to Solent and Mental Health Services Jackie Powell Lay Member Southern NHS Foundation Trust P Direct Mental Health Act Manager 2013 Present Declare conflict where appropriate in P P P P discussions relating to Mental Health Services Jackie Powell Lay Member Off The Record - a Young Persons P Direct Director 2013 Present Declare conflict where appropriate in P P P P Support and Counselling Service discussions regarding mental health and wellbeing of young peoples' services Jackie Powell Lay Member Off The Record - a Young Persons P Direct Counsellor 2013 Present Declare conflict where appropriate in P P P P Support and Counselling Service discussions regarding mental health and wellbeing of young peoples' services Jackie Powell Lay Member You Trust P Direct Counsellor Jan-18 Present Declare conflict where appropriate in P P P P discussions regarding mental health and wellbeing of young peoples' services Jackie Powell Lay Member Relate - Young Persons Counsellor P Direct Counsellor Oct-17 Present Declare conflict where appropriate in P P P P discussions regarding mental health and wellbeing of young peoples' services Innes Richens Chief of Health & Care Portsmouth City Council P Direct CCG role is dual role with Apr-16 Mar-21 CCG/City Council joint risk mitigation Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Portsmouth Portsmouth City Council agreement is in place for this role that includes statutory responsibility for Adult Social Care Innes Richens Chief of Health & Care Portsmouth City Council P Indirect Father in Law is a service Apr-16 Mar-21 Manage in line with CCG policy Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Portsmouth provider within the City Council commissioned Shared Lives scheme Innes Richens Chief of Health & Care Portsmouth City Council P Direct Non-voting member of the Sep-19 Mar-21 Manage in line with CCG policy. Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Portsmouth Board for The HIVE, a not- Where any decisions relating to The for-profit company HIVE are required, consider delivering services in exclusion from the discussion and Portsmouth exclude from the decision. Innes Richens Chief of Health & Care Portsmouth City Council P Indirect Husband is a self-employed Apr-16 Mar-21 Manage in line with CCG policy Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Left 31/03/21 Portsmouth IT and software developer working across the south coast, including supporting the community and voluntary sector in Portsmouth.
3 of 5 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of business) Is the interest From To Committee Body, Member direct or practice, Employee or indirect? other
Audit Audit
Interests
Committee Committee
Quality and
Primary Care
Safeguarding
Non-Financial
Remuneration
Commissioning
Governing Board
Financial Interests
Executive Committee
Professional Interests
Non-Financial Personal Terri Russell Deputy Director Nil Left Left (Primary Care) 30/9/20 30/9/20 Tracy Sanders Managing Director Sandpiper Associates P Direct Director 14.12.16 Current Approval provided via T&Cs of Left 28/02/21 Left 28/02/21 Left 28/02/21 employment to undertaken work for other NHS organisations. Little activity undertaken by company at present but when identified will consider any mitigating actions required if necessary. Tracy Sanders Managing Director University of Portsmouth P Indirect Husband is Lecturer 14.12.16 Current Unlikely to present a conflict but to Left 28/02/21 Left 28/02/21 Left 28/02/21 remain alert when CCG dealing with the University. Tracy Sanders Managing Director Chartered Institute of Management P Direct Associate Member 14.12.16 Current Unlikely to present a conflict but to Left 28/02/21 Left 28/02/21 Left 28/02/21 Accountants and a Chartered Global remain alert should the CCG ever be Management Accountant dealing with the CIMA/CGMA. Tracy Sanders Managing Director Sandpiper Associates P Indirect Husband is a Director of 14.12.16 Current Any conflicts when identified will be Left 28/02/21 Left 28/02/21 Left 28/02/21 Sandpiper Associates declared in line with CCG policy Tracy Sanders Managing Director Portsmouth Music Hub Board P Direct Parent Representative 21.10.20 Current Any conflicts when identified will be Left 28/02/21 Left 28/02/21 Left 28/02/21 declared in line with CCG policy David Scarborough Practice Manager NHS Portsmouth Clinical P Indirect Wife is Deputy Director of 01.04.18 Current Manage in line with CCG policy P P Representative on Commissioning Group Quality and Safeguarding Governing Board David Scarborough Practice Manager Trafalgar Medical Group P Direct Business Manager 01.04.18 Current Manage in line with CCG policy P P Representative on Governing Board David Scarborough Practice Manager Portsmouth South Coast Primary Care P Direct Business Lead 01.07.19 Current Manage in line with CCG policy P P Representative on Network Governing Board Tina Scarborough Deputy Director Quality NHS Portsmouth Clinical P Indirect Husband is Practice Apr-18 Current Manage in line with CCG policy. P P and Safeguarding Commissioning Group Management Lead Tina Scarborough Deputy Director Quality Portsmouth South Coast Primary Care P Indirect Husband is Business Lead Jul-19 Current Manage in line with CCG policy. P P and Safeguarding Network for Portsmouth South Coast Primary Care Network Tina Scarborough Deputy Director Quality Trafalgar Medical Group P Indirect Husband is Business Apr-16 Current Manage in line with CCG policy. P P and Safeguarding Manager for Trafalgar Group Practice Sarah Shore Head of Safeguarding Nil P Clare Sieber Medical Director, Nil P Wessex LMC Andrew Silvester Lay Member Portsmouth Civil Service Sports P Direct Chair and some CCG staff 2016 Current Manage in line with CCG policy P P Chair P Council are CSSC members Andrew Silvester Lay Member Portsmouth Hospitals University NHS P Indirect Spouse is an employee 2016 Current Manage in line with CCG policy P P Chair P Trust Andrew Silvester Lay Member Portsmouth City Council P Direct Chair of Portsmouth Event 2016 Current Manage in line with CCG policy P P Chair P Safety Advisory Group (PESAG) Andrew Silvester Lay Member Office of the Police and Crime P Direct Independent Custody Visitor 2016 Current Manage in line with CCG policy P P Chair P Commissioner (OPCC) Simon Simonian Clinical Executive Simonian Medical Limited P Direct Director 2014 Current Manage in line with CCG policy P Simon Simonian Clinical Executive Winbell Limited P Direct Helps father with business Current Manage in line with CCG policy P Simon Simonian Clinical Executive Lola Alvarez Psychotherapist P Direct Clinical Trustee Current Manage in line with CCG policy P Simon Simonian Clinical Executive Portsmouth Primary Care Alliance Ltd P Direct Sessional GP Work Current Manage in line with CCG policy P (PPCA) Simon Simonian Clinical Executive Derby Road Surgery P Direct Locum Mar-21 Mar-21 Manage in line with CCG policy P
4 of 5 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of business) Is the interest From To Committee Body, Member direct or practice, Employee or indirect? other
Audit Audit
Interests
Committee Committee
Quality and
Primary Care
Safeguarding
Non-Financial
Remuneration
Commissioning
Governing Board
Financial Interests
Executive Committee
Professional Interests
Non-Financial Personal Michelle Spandley Chief Finance Officer Chartered Institute of Management P Direct Member 22.12.16 Current Manage in line with CCG policy P Attendee Attendee P P Accountants (CIMA) and Chartered Global Management Accountants (CGMA) designation. Michelle Spandley Chief Finance Officer Healthcare Financial Management P Direct Member 22.12.16 Current Manage in line with CCG policy P Attendee Attendee P P Association Michelle Spandley Chief Finance Officer NHS Portsmouth Clinical P Indirect Daughter is employed in the Current Daughter does not report directly to P Attendee Attendee P P Commissioning Group Finance Department Michelle. There are systems in place to ensure that segregation of duties is addressed. Rebecca Spandley Finance Manager NHS Portsmouth Clinical P Indirect Mother is Chief Finance Current Rebecca and Michelle do not discuss P Commissioning Group Officer for the CCG CCG business outside of the workplace. There are systems in place to ensure that segregation of duties is addressed. Rebecca Spandley Finance Manager Chartered Institute of Management P Direct Member Current Manage in line with CCG policy P Accountants Tahwinder Upile Secondary Care University Hospitals Southampton NHS P P Direct Consultant Aug-07 Current Manage in line with CCG policy P P Specialist Doctor on Foundation Trust & Hampshire Governing Board Hospitals NHS Foundation Trust
Tahwinder Upile Secondary Care Concordia/Omnes Healthcare P P Direct Clinical Supervisor Jan-17 Current Manage in line with CCG policy P P Specialist Doctor on Governing Board Tahwinder Upile Secondary Care Harley Street LMA Group P P Direct Consultant Aug-12 Current Manage in line with CCG policy P P Specialist Doctor on Governing Board Tahwinder Upile Secondary Care Kent Surrey Sussex Deanery P P Direct Secondary and Primary Current Manage in line with CCG policy P P Specialist Doctor on Care Physician Governing Board David Williams Governing Board Portsmouth City Council P Direct Chief Executive 2007 Current None P Member David Williams Governing Board Gosport Borough Council P Direct Chief Executive 2016 Current None P Member David Williams Governing Board Solent NHS Trust P Direct Appointed Governor 2010 Current None P Member David Williams Governing Board UTC Portsmouth P Direct Member 2014 Current None P Member David Williams Governing Board Portsmouth Harbour Marine CIC P Direct Director 2020 Current None P Member Jo York Deputy Chief Officer Nil P P Health and Care Portsmouth
STAFF LIST Marcel Britton Executive Assistant Nil Minutes Jayne Collis Business Development Solent NHS Trust P Indirect Sister in Law works at Jun-20 Current Manage in line with CCG policy Minutes Manager Solent NHS Trust Victoria Sexton Business Development Nil Minutes Minutes Manager Lisa Stray Business Assistant Nil Minutes
5 of 5
GOVERNING BOARD MEETING
Date of Meeting 19 May 2021 Agenda Item No 3a
Title Minutes of Previous Meeting
Purpose of Paper To agree the minutes of the Governing Board Meeting held on Wednesday 17 March 2021.
Recommendations/ Approve Actions requested
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at
Potential Conflicts of Interests for Board N/A Members
Author Jayne Collis, Business Development Manager
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 11 May 2021
DRAFT
Minutes of the NHS Portsmouth Clinical Commissioning Group Governing Board Meeting held on Wednesday 17 March 2021 at 1.00pm via Microsoft Teams (streamed online)
Summary of Actions Governing Board Meeting held on Wednesday 17 March 2021
Agenda Action Who By Item 7c Performance - National cancer targets information to be M Spandley May 21 updated for next report. 7c Performance – Provide information on rates of referral M Spandley May 21 compared to pre-pandemic regarding cancer targets. 7d Planning Approach – Business cases to be reviewed at M Spandley May 21 April Governing Board Development session and reported back to next meeting. 8 Quality and Safeguarding Update - Safeguarding – Check K Atkinson May 21 if independent author has been allocated for thematic review on homelessness deaths. 8 Quality and Safeguarding Update - Practice Plus Group - K Atkinson May 21 Check if there has been a change in the DoS for Portsmouth UTC regarding treatment of under 2s. 8 Quality and Safeguarding Update - CAMHS - Provide A Jeffery/ May 21 feedback on take-up of digital service. K Atkinson
Present:
Andy Silvester - Lay Member (Chair)
Helen Atkinson - Director of Public Health, Portsmouth City Council Karen Atkinson - Registered Nurse Dr Linda Collie - Chief Clinical Officer and Clinical Leader (GP) Margaret Geary - Lay Member Alison Jeffery - Director of Children’s Services, Portsmouth City Council Dr Carsten Lesshafft - Clinical Executive (GP) Graham Love - Lay Member Jackie Powell - Lay Member David Scarborough - Practice Manager Representative Dr Simon Simonian - Clinical Executive (GP) Michelle Spandley - Chief Finance Officer David Williams - Chief Executive, Portsmouth City Council (left at 3pm)
In Attendance:
Jayne Collis - Business Development Manager Justina Jeffs - Head of Governance Jo York - Deputy Chief of Health and Care Portsmouth (for Innes Richens)
Apologies:
Dr Elizabeth Fellows - Chair of Governing Board/Clinical Executive (GP) Dr Nick Moore - Clinical Executive (GP) Innes Richens - Chief of Health and Care Portsmouth 1
Dr Tahwinder Upile - Secondary Care Specialist Doctor
1. Apologies and Welcome
Apologies received from Dr Elizabeth Fellows, Dr Nick Moore, Innes Richens and Dr Tahwinder Upile.
Andy Silvester, chairing the meeting in Dr Elizabeth Fellows absence, welcomed everyone to the meeting via Microsoft Teams. He noted that the Governing Board were meeting virtually in response to the limitations placed on governance by the Covid-19 pandemic. Members of the public had been invited to view the meeting via a link available from the CCG website. The meeting was also being recorded so that in the event of a failure of technology it would continue and then be uploaded to the CCG website.
2. Register and Declarations of Interest
The Register and Declaration of Interest was presented.
The Governing Board noted the Register and Declarations of Interest.
3. Minutes and Actions of Previous Meeting held on Wednesday 20 January 2021
3a. The minutes of the Governing Board meeting held on Wednesday 20 January 2021 were presented for approval. The following amendments were agreed:
Page 5, 7th paragraph, “Alison Jeffery said she would like thank..” to be amended to “Alison Jeffery said she would like to thank..”.
Page 7, Item 6a, last paragraph, “a no deal” to be removed from first sentence.
The Governing Board approved the minutes of the meeting held on Wednesday 20 January 2021 subject to the amendments noted above.
3b. The Summary of Actions from the Governing Board meeting held on Wednesday 20 January 2021 were presented for information.
The Governing Board noted the Summary of Actions from the Governing Board meeting held on Wednesday 20 January 2021.
4. Chief Clinical Officer’s Report
Dr Linda Collie presented the Chief Clinical Officer’s Report and highlighted the following:
Quality and Safeguarding Committee Update - Proposal for Transformation of the HIOW Safeguarding Function
The Quality and Safeguarding Committee reviewed a paper which provided an outline of the progress of the Hampshire and Isle of Wight ICS/CCG safeguarding transformation project to date. The next steps were detailed and it is proposed that the complete transformation programme can be delivered by the end of June 2021.
Primary Care Commissioning Committee
At its January 2021 meeting, the Primary Care Commissioning Committee received a positive report from Internal Audit and the two recommendations from the report have
2
been actioned. The Committee also welcomed an important report that reviewed GP Surgery websites which was presented by Healthwatch.
NHS Portsmouth CCG Remuneration Committee
The Remuneration Committee met in January 2021 and recommendations were made for extensions to the tenure of Dr Elizabeth Fellows and David Scarborough as elected posts, those recommendations are being checked with member practices. The Committee also supported a recommendation for a disability awareness session to be held for Governing Board members at one of its forthcoming development sessions.
Integration and Innovation: working together to improve health and social care for all
On 11 February 2021 the Government published a White Paper outlining proposals it plans to take forward to Parliament to become law as a Health and Care Bill. The White Paper was discussed with CCG staff at a recent Team Briefing and further information was provided to staff via the CCGs intranet.
SHIP Priorities Committee Update
The following policies were produced following the November 2020 meeting of the SHIP Priorities Committee and were reviewed and recommended for approval by the Clinical Advisory Group in December 2020:
Policy Statement 22 Carpel Tunnel Syndrome Policy Statement 23 Nasal Surgery for nasal blockage and/or deformity Policy Statement 36 Tonsillectomy (adults and children) Policy Statement 60 Interventions for Spinal Pain Policy Statement 66 Treatment of lower urinary tract symptoms (LUTS) as a result of Benign Prostatic Hyperplasia (BPH)
The Governing Board agreed to approve the policies as detailed.
Governance Review
The Governance Review which was jointly commissioned between the CCG and NHS England is reaching its conclusion. A draft report has been produced and will be discussed with Governing Board members and those involved in order to determine actions required. It was proposed that the Audit Committee, as senior scrutiny committee of the CCG, were delegated to oversee the action plan and report progress to the Governing Board.
The Governing Board were asked and agreed to support the delegation of oversight of the CCG action plan to the Audit Committee.
Margaret Geary asked about the proposal for transformation of the HIOW safeguarding function and if there had been a consultation regarding the timeline. Karen Atkinson said that the paper would be presented to the Safeguarding Adults Board in Portsmouth and the Childrens Safeguarding Board and expressed concern regarding the short timeframe.
Jackie Powell asked about transformation of the HIOW safeguarding function and whether the structure was available which aligned the designated professional roles and the named GP roles for primary care. Karen Atkinson explained that the paper was not specific regarding the number of roles but anticipated that there would be a number of roles however there was some concern on how these would be recruited to and what the impact
3
would be for Portsmouth. Dr Linda Collie commented that traditionally roles have been difficult to fill so consideration on sustainability for these roles is vital.
The Governing Board accepted the Chief Clinical Officer’s Report.
5. Health & Care Portsmouth Covid-19 Update
Helen Atkinson presented the Covid-19 Intelligence Summary which provided an update on the rates of infection for Portsmouth and the surrounding areas etc. She noted that the summary is published on the Portsmouth City Council website weekly on a Friday.
An overview of the current situation in Portsmouth:
- Continue to see a reduction in the infection rate across Portsmouth and the Hampshire and Isle of Wight region and nationally. - 13,985 total cases since the beginning of the pandemic. - There were 129 new cases in the last 7 days. - Slight increase in rate per 100,000 in the last 7 days than previous week which could be due to a small change or outbreak in a school or care home. - Now in the first step of the Government road map of coming out of lockdown and we may start to see a slight increase in the rate of infection as we move forward. - Nationally the predominant variant is still the UK variant with 96.9% of cases in Portsmouth being the UK variant. There are a few cases nationally of the South African variant. - The current vaccines being used in the UK were effective for all variants. - The weekly rates of Covid-19 by age bands were falling in all age groups. - Are seeing slightly higher infection rates across young adults and working age adults. - Reduction in pressure across Portsmouth Hospitals University Trust although still reasonably high numbers of patients with Covid-19 in the hospital. - There have been 3 deaths in the last 7 days with 356 deaths in total. - Good vaccine uptake rates across Portsmouth.
Dr Linda Collie asked if, with the return to schools, there was a good uptake of the lateral flow testing of pupils. Helen Atkinson confirmed that this was the case and that these tests had identified a small number of covid-positive individuals. Alison Jeffery commented that schools have been very pleased with the high level of engagement from parents and pupils. The Governing Board formally thanked local schools, colleges and universities for their support and work in getting pupils back to school.
Andy Silvester thanked Helen Atkinson for the update.
6. Health and Care Portsmouth – Strategic Development
David Williams noted that the original agenda had referred to a document which had been a draft and had been removed from the agenda. He provided a verbal update on partnership working across Health and Care Portsmouth, Portsmouth and South East Hampshire ICP (Integrated Care Partnership) and the ICS (Integrated Care System). Health and Care Portsmouth had been reviewing our current operating model to ensure that it meets the needs now, and in the future, as outlined in the White Paper. The review included; identifying and determining the CCG’s aspirations and building on the existing partnership arrangements across the whole system. The work highlighted the CCG’s commitment to, and strong position for, broader integration across health and social care. This work will continue and the Governing Board would be updated.
Karen Atkinson asked when the document would be finalised. David Williams said that a revised draft would be out shortly.
4
David Scarborough stressed the need for continued commissioning support along with clarity on structures to support the understanding of Primary Care. David Williams commented “place”, as described in the White Paper still required defining and highlighted the importance of primary care within that definition. There was some strong primary care work undertaken throughout the Covid-19 Pandemic which needs to be continued and strengthened. The structure within primary care should provide support in representing Portsmouth across the wider system.
David Scarborough asked if there would be an initial transitional structure from the CCG and Portsmouth City Council ie. where Directors will sit. David Williams explained that they are in the process of developing this, taking into consideration the changes already determined i.e. the joint Accountable Officer role between Portsmouth and Hampshire and IOW CCGs.
Jackie Powell said that she fully endorsed what David had said and that it is really important to keep our staff and public informed and engaged and on board.
Margaret Geary asked about the relationship between the ICS and ICP and Portsmouth CCG. David Williams said that this was part of conversations currently taking place.
Andy Silvester thanked David Williams for the update.
7. Finance & Performance
7a. Finance Report
Michelle Spandley presented the Month 10 finance report noting which reported the CCG was on track to achieve a £3.3m surplus position and confirmed that at Month 11 the CCG remained on track. The CCG had received the retrospective top-up monies for the hospital discharge programme and were in receipt of 80% funding for months 11 and 12 and we continued to work with closely with Portsmouth City Council as it affected our expenditure profiles. The finance team have worked to improve payment processes and manage our cash position and levels.
Graham Love asked about the underspend in mental health commissioning. Michelle Spandley explained that it was partly related to the hospital discharge as some patients had gone through the hospital discharge programme process. There was a need to understand patient flows. The hospital discharge programme will stop on 31 March 2021 with a 6 week lag which needed to be considered.
Following a question from Alison Jeffery, Michelle Spandley confirmed that investments were included in a later agenda item.
The Governing Board accepted the contents of the report.
7c. Performance Report
Michelle Spandley presented the Performance Report dated 17 March 2021. The report provided a high level view of CCG performance against key constitutional targets and other commissioning standards. She noted the impact of the pandemic across several national standards and operating plan commitments as listed on the front sheet. At the last Governing Board meeting Jackie Powell asked about the 111 service and a reduction in calls, which was a comparison of month on month. This indicated how difficult it was for the service to predict activity and therefore levels of service to deal with demand.
111 First expansion – we are ensuring all response times are appropriate.
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National cancer targets – compared to national means are doing well in our areas. This will be updated at the next meeting. Action: M Spandley
Jackie Powell asked about Referral to Treatment (RTT) waiting times and how we could get back on track. Michelle Spandley explained that elective activity was increasing where possible. An update is still awaited regarding national money being put aside for RTT recovery.
Jo York commented that significant work was undertaken during wave one of the pandemic regarding recovery plans. These were impacted by the second wave over the winter period. Recovery plans were being co-ordinated across Hampshire and the Isle of Wight. Jo York highlighted the pressure put on the workforce since the start of the pandemic and also highlighted the change in circumstances during the second wave as services were already treating covid-positive patients which required reflecting in the plans. Further consideration was required for the best use of the voluntary and independent sector along with any alternatives available.
Graham Love asked for further information on the rates of referral for cancer compared to pre-pandemic rates. Michelle Spandley agreed to provide an update at the next meeting. Action: M Spandley
Dr Linda Collie commented that work was underway to review waiting times.
The Governing Board accepted the contents of the Performance Report.
7b. Financial Framework 2021/22 7d. Planning Approach
Michelle Spandley presented the Financial Framework for 2021/22 and the Planning Approach paper explaining that they dovetail together. Further guidance was awaited and, at the time of writing the reports, the expectation was that the current financial regime would continue for the first three months of the 2021/22 financial year – with the exception of the Hospital Discharge Programme as discussed under a previous agenda item. Further guidance was expected regarding mental health and additional elective funding.
The papers provided included timelines. Teams were working up business cases including an ICP business case for discharge to assess services, 111 First and the Transforming Urgent and Elective Care (TrUE) programme.
Michelle Spandley highlighted the difference in the forecasted spend against allocation, indicating the need for £8m efficiency savings, which was expected.
Dr Carsten Lesshafft asked about the £8m efficiencies, whether this would hinder our recovery, and how we could recoup this alongside delivering our recovery plan without any additional spending – particularly against activity not delivered which had already been paid for. Michelle Spandley explained that efficiency savings formed part of the financial framework and were achieved through new initiatives and improvements in existing programmes, services and schemes.
Dr Linda Collie asked whether the Governing Board may need to consider going “at risk” against some of the proposed work/business cases. Michelle Spandley explained that if this was the case, the CCG and Governing Board needed to be clear that it was the right decision to make.
David Williams expressed frustration and concern over impact of any the delay on the residents of Portsmouth and asked if there was a route by which this could be raised. 6
Michelle Spandley explained that this is something that we could go “at risk” on because we have been waiting a long time for guidance and we would not normally be in this position however we understand why it has happened.
Alison Jeffery said that she endorsed what David Williams had said and specifically in the context of the proposals for childrens community nursing which is for all of Hampshire and the Isle of Wight and is a piece of system design.
Michelle Spandley explained that the current situation was unusual but highlighted that the Governing Board could make the decision to go “at risk” against some of these areas of work however, some specific pieces of work also required the agreement and were interdependent with those of South Eastern Hampshire and further afield.
Jackie Powell asked what the next steps would be for the two projects that were previously discussed at the Governing Board meeting. Michelle Spandley explained that if the Governing Board decided to go at risk with them then these would be started with finances kept as tight as possible. Members agreed to review a number of business cases and the proposed priorities at their development session in April to ensure that there was enough time for discussion.
Alison Jeffery commented that it was important that schemes were looked at using a common framework. Action: M Spandley
The Governing Board noted the content of the update for the Financial Framework 2021/22.
The Governing Board noted the progress to date and agreed the approach pending further national guidance in relation to the Planning Approach.
8. Quality and Safeguarding Report
Karen Atkinson presented the Quality and Safeguarding update for February 2021 noting that that the report was not in usual format due to reduced capacity in the team. She explained that the Quality and Safeguarding Committee had met and reported the following:
Portsmouth Hospitals University Trust - Still under pressure with risks needing review: - Delays in assessment and treatment for planned care - Emergency Department and Urgent Care Pathway – it is hoped 111 First will have a positive impact - Safeguarding – it is hoped this can be removed - Governance - There may be an emerging risk relating to a number of serious incidents within maternity services that the quality team are reviewing to ascertain if there is a risk. There is some level of reassurance because they are starting an operational maternity surveillance group in April which will start to pull things together more systematically and there is a new Director and Deputy Director of maternity starting at Portsmouth Hospitals University Trust.
Solent - Noted there is increased demand around children and families which the quality team acknowledge however we are aware that there is increased investment for CAMHS liaison services from winter pressure monies and investment to support the
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neurodiversity waiting list and we are hoping this will start to have an impact on demand. The quality team will continue to review.
SCAS - Continue to meet fortnightly with the CCG and have moved down to REAP level 1 which is a steady state so looking positive.
PPCA - Increased risk - During December 51 patients admitted to oximetry @ home service. During January 138 patients admitted to service.
Care Homes - 4 with Covid-19 outbreaks, 3 of those coming to end of the outbreak. - Risk of losing their access to NHS mail if they do not complete IG toolkit. We need to look at ways we can support them so they can retain NHS mail.
Safeguarding - Vacant post now recruited to. - Just starting Harmful Practice Strategic Group.
Graham Love asked about the allocation of an independent author for the thematic review on homelessness deaths. Karen Atkinson agreed to check if this was an issue and report back. Action: K Atkinson
Dr Simon Simonian asked if there had been a change in the DoS for the Portsmouth Urgent Treatment Centre regarding treatment of children under 2 years old. Karen Atkinson agreed to check and report back. Action: K Atkinson
Jackie Powell said she completely endorsed any support we are able to provide to Care Home in order to complete the Information Governance toolkit.
Jackie Powell asked about the increase in demand on Child and Adolescent Mental Health Service (CAMHS) and how the digital offer was going and if there had been any feedback. Alison Jeffery commented that she had seen some figures recently that the uptake had been good as an underlying preventative measure and agreed to provide an update at the next meeting. The increase in demand for CAMHS has been national. Action: A Jeffery/K Atkinson
The Governing Board noted the contents of the report.
9. Emergency Preparedness Resilience and Response (EPRR) Annual Report 2020/21
David Williams presented the Emergency Planning Resilience and Response (EPRR) annual report which detailed how EPRR corporate responsibilities are met and provided assurance that they comply with relevant legislation and guidance. He noted the huge effort that had gone into the Covid-19 response and how the team had still managed to undertake a number of communication exercises despite this. Early learning and lessons are detailed in section 10.
He noted that Sara Tiller held the role of Accountable Emergency Officer for Fareham and Gosport and South Eastern Hampshire CCGs and Portsmouth CCG.
Dr Linda Collie commented that it was a very good report and asked what the arrangements would be moving forward from 1 April 2022 as the new merged Hampshire, Southampton and Isle of Wight CCG comes online. David Williams highlighted the need to 8
work with colleagues and engage with the ICS and the CCG for the transitional period in order to determine effective solutions. Andy Silvester commented that he understood there is a piece of work being undertaken to ensure CCGs across Hampshire and the Isle of Wight are integrated with the LRF (Local Resilience Forum) and ensure the connection is maintained.
Andy Silvester said that he would like to echo David Williams comments that it was a very good report and the amount of effort and hard work that everyone has put in during the pandemic was terrific and it was a good example of an interoperability and multi-agency approach in dealing with a significant national and localised issue and was carried out very well.
The Governing Board noted the report and the recommendations/actions highlighted on the front sheet.
10. Full Register of Interest for All Staff
The full register of interest for all staff was presented.
The Governing Board reviewed and noted the register.
11. Minutes for Noting
The minutes of the following meetings were presented for noting.
- Minutes of the Primary Care Commissioning Committee meeting held on 26 November 2020. - Minutes of Health and Wellbeing Board meeting held on 25 November 2020.
The Governing Board accepted the minutes.
9. Meeting Close and Date and Time of Next Meeting in Public
Before closing the meeting Andy Silvester took the opportunity, on behalf of the Governing Board, to thank Innes Richens, Chief of Health and Care Portsmouth, for all that he had done for the both the CCG and Portsmouth City Council. He had wholeheartedly supported both organisations and had worked hard to ensure the best possible services for the people of Portsmouth.
The next Governing Board meeting will take place on Wednesday 18 May 2021 at 2.00pm and will be streamed online.
Jayne Collis 1 April 2021
Governing Board - Attendance Log
Member Name May 20 Jul 20 Sep 20 Nov 20 Jan 21 Mar 21 Helen Atkinson Karen Atkinson Dr Linda Collie Dr Elizabeth Fellows A Margaret Geary A Alison Jeffery A A Dr Carsten Lesshafft
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Member Name May 20 Jul 20 Sep 20 Nov 20 Jan 21 Mar 21 Graham Love Dr Nick Moore A Jackie Powell Innes Richens A A David Scarborough A Andy Silvester Dr Simon Simonian Michelle Spandley Dr Tahwinder Upile A A David Williams A A
Key: - Present A - Absent
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GOVERNING BOARD MEETING
Date of Meeting 19 May 2021 Agenda Item No 3b
Title Summary of Actions
Purpose of Paper To note the Summary of Actions from the Governing Board Meeting held on Wednesday 17 March 2021.
Recommendations/ Approve Actions requested
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at
Potential Conflicts of Interests for Board N/A Members
Author Jayne Collis, Business Development Manager
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 11 May 2021
Summary of Actions from Governing Board Meeting held on Wednesday 17 March 2021
Agenda Action Who By Update on Action (March 2021) Item 7c Performance Report - National cancer targets M Spandley May 21 National cancer target achievement will be information to be updated for next report. included in future reports to provide additional context. 7c Performance Report - Provide information on rates of M Spandley May 21 Rates of referrals have been lower by referral compared to pre-pandemic regarding cancer approximately 10% (please see attached targets. for further detail). It should be noted that PHU have been providing capacity to see cancer patients throughout the pandemic, whilst dealing with an unprecedented number of Covid-19 patients within ITU and across the wards. 7d Planning Approach - Business cases to be reviewed M Spandley May 21 A summary of the financial framework and at April Governing Board Development session and investment cases were reviewed and reported back to next meeting. approved at the April Governing Board Development Session. 8 Quality and Safeguarding Update - Safeguarding – K Atkinson May 21 An independent author has been allocated Check if independent author has been allocated for and the review has commenced. thematic review on homelessness deaths. 8 Quality and Safeguarding Update - Practice Plus K Atkinson May 21 There has been no change to the DoS for Group - Check if there has been a change in the DoS Portsmouth. PPG do not see children for Portsmouth UTC regarding treatment of under 2s under 1 years.
8 Quality and Safeguarding Update - CAMHS - A Jeffery/K May 21 For Quarter 4 there were a total of 426 new Provide feedback on take-up of digital service. Atkinson registrations. There was 1,671 logins; 63 chats undertaken by 45 service users and 687 messages from 179 service users. For Quarter 4 feedback showed that 100% of users would recommend the service.
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Supplementary Cancer information
Further analysis of the cancer referrals comparing 2020/21 and 201920 data shows the following: On average, 77 fewer 2 Week Cancer referrals per month were made during 2020/21 (YTD - January) compared with 2019/20. An average of 12 fewer referrals per month were made for 31 Day Wait referrals during 2020/21 (YTD - January) compared with 2019/20. On average, 3 more referrals per month were made for 62 Day Wait referrals during 2020/21 (YTD - January) compared with the previous year. The charts below illustrate the monthly referrals and performance trends.
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3
February 2021 Performance
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GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 5
Title CCG Executive Report
This paper provides an update to the Governing Board on key decisions, actions and matters of information from the CCG’s Executive.
Purpose of Paper
Recommendations/ The Governing Board is requested to accept this report. Actions requested
Engagement Activities – Clinical, Stakeholder and Not applicable Public/Patient
Item previously Not applicable considered at
Potential Conflicts of Interests for Board None Members
Author Senior Management Team
Sponsoring member Jo York, Managing Director
Date of Paper 11 May 2021
CCG EXECUTIVE REPORT
1 Introduction
This report provides updates to the Governing Board on matters of business undertaken and information on behalf of the CCG’s Executive.
2 Quality and Safeguarding Committee Update
The Quality and Safeguarding Committee met in March and April 2021 and, in addition to reviewing the quality exceptions and risks relating to commissioned services, the Committee were presented with the following for discussion;
HIOW Harm Review Process ~ As a result of the Covid-19 pandemic, there has been an increase in patients experiencing longer waits on the referral to treatment (RTT) pathway. In a number of the cases these delays are likely to be as a result of services being paused or reduced and some as a result of some patients adhering to national guidance on self- isolating/shielding. There will however, be cases where there are opportunities for local learning and it is important that these are not missed.
The document sets out the agreed process, which has been built on existing processes, including incident reporting, to support a consistent assessment and review of harm in acute providers across the Hampshire and Isle of Wight Integrated Care System (ICS).
The harm review tool has been developed so that providers can either upload it to their Patient Administration System (PAS) or equivalent system, or, complete it in paper format.
COVID-19 vaccination programme ~ Quality Assurance Framework: COVID-19 vaccination sites: The purpose of this framework is to provide organisations delivering COVID-19 vaccine services with a quality assurance tool aligned to the operating frameworks and standard operating procedures underpinning the delivery models for Hospital Hubs, Local Vaccination Services and Vaccination Centres
It is proposed that the tool is used to ensure services have ongoing robust assurance in place, to demonstrate compliance with the legal frameworks for COVID-19 vaccine delivery and to ensure the standards expected for a healthcare setting are met. It will also help identify any areas of risk and show the corrective actions taken in response.
The tool can be used as a self-assessment or by those responsible for reviewing the quality of healthcare in the locality.
3 Audit Committee
The Audit Committee met on 10 March 2021 where the following items were discussed: Establishment of a sub-group to assess the GBAF and Corporate risk registers in order to discuss with risk owners the way forward.
Page 1 Welcomed the 'The Mental Health Investment Standard Compliance Statement' from the external auditor who stated -"In all material respects, your Mental Health Investment Standard Compliance Statement for 2019/20 has been properly prepared, in all material respects, in accordance with the Criteria set out in line with the requirements of the Guidance". The result was formally published in April 2021. The Internal auditors Interim Head of Internal Audit Opinion was assessed as; Substantial. Assurance can be given that there is a sound system of internal control which is designed to meet the organisation’s objectives and that controls are being consistently applied in all the areas reviewed. Local Counter Fraud Services stated Portsmouth CCG had met and enacted the new guidance. Finance - M10, identified the CCG were on track to deliver its targets despite an 'unusual' financial year. Information Governance - Mandatory Training had reached the mandated 95% target, with those required to complete being reminded of the closing date of 31 March 21. PWC Interviews – The Chief Finance Officer and Head of Governance were reviewing the response from the interviews with PwC. The draft report will be provided to, and discussed by the Governing Board. It was anticipated that the Audit Committee would oversee the actions arising from the report.
4 Primary Care Commissioning Committee
At its meeting on 25th March the Primary Care Commissioning Committee received an update about the work undertaken since the decision made at the Part 11 meeting on 28 January 2021 not to re-procure the Additional Primary Medical Services contract currently held by the Guildhall Walk practice. In January 2021 the number of patients registered at the practice was 8,438. Every effort is being made to achieve a smooth transfer to practices identified as being close to Guildhall Walk and to ensure the continuing care of the patients Letters explaining the position to patients are being sent and they will be invited to engage in meetings to raise any concerns.
The Committee ratified the 2021-2022 Primary Care Quality and Innovation (CQUIN) scheme. This builds on previous schemes. It involves funding practices to achieve improved outcomes for patients in 5 main areas of work. These are:- - Engagement in wider Commissioning issues within the CCG, - Use of Technology - Quality Improvement - Efficient and Effective Use of Resources - Patient Education and Community Engagement.
In principle agreement was also given to proposals for Locally Commissioned Services. The proposals include support for Safeguarding work, new primary care links for unaccompanied minors seeking asylum, work aimed at better addressing deprivation and inequalities issues and a new homeless outreach service.
Approval was given to renaming the University practice which is moving to the City Centre. The new name will be UniCity Medical Centre.
5 Clinical Advisory Group (CAG) Update
Page 2 The Group did not meet in February but the following items were discussed at its more recent meetings.
At the March meeting there was a group discussion led by a psychiatrist from Surrey and Borders who provide the service for patients with ADHD regarding the current waiting times for assessments. These have increased significantly due to the improved access patients now have for this service.
It was agreed that a more detailed proposal will come back to a future meeting regarding how to reduce the waiting list in the short term. It was also agreed in principle that new shared care arrangements will be developed for GPs to manage some patients who have historically all been looked after by the specialist provider thereby reducing their caseload for follow up and making the service more sustainable for the longer term.
Any business case or funding proposals will follow the CCGs governance processes for approval.
The Group also met in May 2021. At this meeting a feedback was sought for a pathway for following up coil fits which are done during a caesarean section. It was agreed that as these have a high complication rate, this would be developed between secondary care and Solent NHS Trust’s specialist clinic rather than involving primary care.
6 SHIP Priorities Committee and Evidence Based Interventions (EBI)
The SHIP Priorities Committee is continuing to review the second tranche of national Evidence Based Intervention policies (EBI2) and aligning the local policies if necessary.
Three polices were produced following the March meeting of the SHIP Priorities Committee and these were reviewed by the Clinical Advisory Group in May 2021 who have recommended approval.
Policy 26 Treatment of Hydrocele This is an update of a policy first published in 2017. A review of the recent literature failed to identify any new evidence or guidance and the policy therefore remains unchanged with surgical treatment being limited to when there is significant discomfort which prevents voiding, sexual function, mobility, or dressing.
Policy 50 Primary joint replacement for hip and knee osteoarthritis This policy was updated to include a statement about supporting the EBI2 guidance in relation to imaging for the diagnosis of hip and knee osteoarthritis. The EBI2 guidance emphasises that If imaging is needed, conventional (plain) radiography should be used before other modalities As thresholds for surgery were not reviewed the policy date remains the same.
Policy 67 Shoulder Radiology: Scans for Shoulder Pain and Guided Injections This is a new policy and the EBI2 wording has been adopted. As for hip and knee arthritis, this policy emphasises the first line of radiological investigation should be a plain x-ray. On the basis of lack of evidence the policy states that guided subacromial injections for the routine management of patients with subacromial pain are an intervention not normally funded.
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7 Mental Health Investment Standard 19/20
The CCG published its statement of compliance against the Mental Health Investment standard as follows
“NHS Portsmouth CCG considers that it has complied with the requirements of the Mental Health Investment Standard for 2019/20. The 2019/20 target spend was £39,103,000 and actual spend was £39,891,000.”
8 Review of Governance Arrangements/Operating Model
The Governing Board met for a development session in April 2021 where the recommendations from a recent review of governance arrangements, undertaken by PwC, were discussed and actions developed. Following this meeting, the management response and actions were drafted for inclusion in the final report. These actions will be overseen by the Audit Committee.
Alongside finalising the Governance report the CCG has been seeking legal advice on our proposed operating model which will be shared with stakeholders on completion
9 Local elections
Local elections were held on Thursday 6 May 2021, which will result in the CCG working with new counsellors over the coming months. Further information will be provided to the Governing Board once portfolios are announced.
10 Integrated Care System
We are continuing to work with other organisations across Hampshire and the Isle of Wight on the guidance issued regarding the development of the Integrated Care System. It is anticipated that further guidance will be published which will help to shape this work.
11 Conclusion
The Governing Board is asked to accept this report.
Updated: 11 May 2021
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GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 7a
Title M12 Finance Report
To inform the Governing Board of the 2020/21 Year end financial Purpose of Paper position of the CCG (subject to Audit).
The Board is requested to accept the report and note: The change in target from £3.3m surplus to break-even as the CCG agreed to changes in allocation to support HIOW ICS in
achieving improved financial outcome. Recommendations/ Actions requested The CCG achieved a small in year surplus (subject to Audit).
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at
Potential Conflicts of Interests for Board N/A Members
Author Rebecca Spandley
Sponsoring member Michelle Spandley
Date of Paper 6 May 2021
Finance Report
March 2021 - Month 12 Draft figures subject to audit
Prepared 26th April 2021
ImprovingImproving health health services… services...services… Finance Dashboard
Indicator Target Actual
In year position - Year to date (variance) -£0.05 -£0.04 (Including redistribution of ICS allocations) In year position - Forecast (variance) -£0.05 -£0.04 (Including redistribution of ICS allocations) Cumulative position - Year to date (variance) -£7.33 -£7.32 (Including redistribution of ICS allocations) Cumulative position - Forecast (variance) -£7.33 -£7.32 (Including redistribution of ICS allocations)
Efficiencies - Year to date £2.16 £2.16
Efficiencies - Full year forecast £2.16 £2.16
Running costs - Year to date (variance) £0.00 -£0.00
Running costs - Forecast (variance) £0.00 -£0.00 BPPC performance - invoices paid within Better Payment Practice Code 95% 100% - Value (Full year) BPPC performance - invoices paid within Better Payment Practice Code 95% 99% - Volume (Full year) Cash Utilisation - percentage of drawdown remaining at month end <= 1.25% 0.48% (£M) £0.311m £0.119m 0% Debtors - percentage over 90 days (£) < 10% £0.000m 35% Creditors - percentage over 90 days (£) < 10% £0.613m
March 2021 - Month 12 Improving health services… Finance Summary
Key Headlines
• NHS Portsmouth CCG has achieved its financial objective for 2020/21 through the delivery of an in-year surplus of £0.041m, against a target surplus of £0.049m. The cumulative surplus at the end of 2020/21 is £7.323m.
• As anticipated and agreed at CCG, Hampshire & Isle of Wight Integrated Care System (HIOW ICS) and NHS England regional level, allocation adjustments were transacted in Month 12 to redistribute Growth and COVID-19 allocations across the HIOW ICS. This adjustment resulted in an agreed reduction to NHS Portsmouth CCG’s planned in-year surplus, from £3.349m to £0.049m.
• Total expenditure relating to COVID-19 was £8.9m in 2020/21. £7.9m of this expenditure related to the Hospital Discharge Programme.
• The year-end cash target has been achieved, with a final cash balance of £0.119m.
• As at 31st March, there were no outstanding aged Debtors over the age of 90 days, and the aged Creditors balance has reduced from Month 11 through resolution of outstanding queries. During this financial year the CCG has consistently performed well in paying providers promptly, to support provider sustainability.
March 2021 - Month 12 Improving health services… Summary Financial Performance
Annual MONTH 12 - March 21 Forecast To Month 12 Budget YTD Budget YTD Actual YTD Variance Outturn Variance £'m £'m £'m £'m £'m £'m Acute Commissioning 153.3 153.3 154.3 1.0 154.3 1.0 Mental Health Commissioning 44.8 44.8 44.4 -0.4 44.4 -0.4 Community Services Commissioning 37.6 37.6 38.3 0.8 38.3 0.8 Primary Care Commissioning 73.4 73.4 72.0 -1.4 72.0 -1.4 Continuing Care 26.2 26.2 27.6 1.4 27.6 1.4 Other Commissioning 9.5 9.5 8.2 -1.3 8.2 -1.3 Running Costs 4.4 4.4 4.3 -0.0 4.3 -0.0 Reserves & Contingencies 0.0 0.0 0.0 -0.0 0.0 -0.0 In-year surplus 3.3 3.3 0.0 -3.3 0.0 -3.3 In Year Reporting 352.4 352.4 349.1 -3.3 349.1 -3.3
Redistribution of ICS allocations -3.3 -3.3 0.0 3.3 0.0 3.3
Revised In Year Reporting 349.1 349.1 349.1 -0.0 349.1 -0.0
To reflect our control total reported position (including central allocations adjustments):
In Year Reporting 349.1 349.1 349.1 -0.0 349.1 -0.0 Cumulative Surplus 7.3 7.3 0.0 -7.3 0.0 -7.3 Cumulative Surplus 356.4 356.4 349.1 -7.3 349.1 -7.3
Please note regarding variances – Negative represents a favourable variance, Positive represents an adverse variance
March 2021 - Month 12 Improving health services… Detailed Financial Performance
Annual MONTH 12 - March 21 Forecast To Month 12 Budget YTD Budget YTD Actual YTD Variance Forecast Variance £'m £'m £'m £'m £'m £'m Portsmouth Hospitals NHS Trust 134.0 134.0 134.0 -0.0 134.0 -0.0 University Hospital Southampton FT 3.8 3.8 3.8 -0.0 3.8 -0.0 Western Sussex Hospitals FT 0.6 0.6 0.6 0.0 0.6 0.0 Hampshire Hospitals NHS FT 0.1 0.1 0.1 0.0 0.1 0.0 Acute Commissioning Salisbury HealthCare NHS FT 0.1 0.1 0.1 0.0 0.1 0.0 South Central Ambulance FT 10.7 10.7 10.7 0.0 10.7 0.0 Clinical Assessment and TCs 2.1 2.1 2.1 0.0 2.1 0.0 NCAs / OATs 0.0 0.0 0.2 0.1 0.2 0.1 Other Acute Commissioning 1.9 1.9 2.8 0.9 2.8 0.9 Solent NHS Trust (MH) 30.2 30.2 30.2 0.0 30.2 0.0 Mental Health Commissioning Southern Healthcare FT (MH) 1.2 1.2 1.2 0.0 1.2 0.0 Other Mental Health Commissioning 13.4 13.4 13.0 -0.4 13.0 -0.4 Solent NHS Trust (Community) 32.9 32.9 32.9 0.0 32.9 0.0 Southern Healthcare FT (Community) 0.7 0.7 0.7 0.0 0.7 0.0 Joint Equipment Store 1.2 1.2 1.2 0.0 1.2 0.0 Community Health Wheelchair Service 1.0 1.0 1.0 0.0 1.0 0.0 Commissioning Hospices 0.2 0.2 0.2 -0.0 0.2 -0.0 CCN Consumables 0.0 0.0 0.0 0.0 0.0 0.0 Other Community Commissioning 1.5 1.5 2.2 0.8 2.2 0.8 Practice Primary Care Prescribing 35.1 35.1 34.5 -0.7 34.5 -0.7 Local Commissioned Services 6.6 6.6 6.3 -0.2 6.3 -0.2 Primary Care Commissioning Delegated Commissioning 29.5 29.5 29.1 -0.4 29.1 -0.4 Primary Care Transformation 2.1 2.1 2.0 -0.1 2.0 -0.1 Adult Continuing Care 22.5 22.5 24.3 1.7 24.3 1.7 Continuing Care CHC Children 1.1 1.1 1.1 -0.0 1.1 -0.0 Funded Nursing Care 2.6 2.6 2.3 -0.3 2.3 -0.3 Recharges NHS Property Services Ltd 0.9 0.9 1.0 0.0 1.0 0.0 Childrens ECRs and S56/S257 0.6 0.6 0.5 -0.1 0.5 -0.1 IVF / IFR 0.0 0.0 0.2 0.2 0.2 0.2 Other Commissioning BCF 7.7 7.7 8.2 0.4 8.2 0.4 111 Service 0.3 0.3 0.3 0.0 0.3 0.0 Other Commissioning -0.0 -0.0 -1.9 -1.9 -1.9 -1.9 HQ / Directorates, Agency & Assurance 2.9 2.9 2.9 0.0 2.9 0.0 Running Costs CSU Charges 1.2 1.2 1.2 -0.0 1.2 -0.0 Estate Management 0.3 0.3 0.3 -0.0 0.3 -0.0 Centrally Managed Commissioning Reserve 0.0 0.0 0.0 -0.0 0.0 -0.0 Programmes In-year Surplus 3.3 3.3 0.0 -3.3 0.0 -3.3 In Year Reporting 352.4 352.4 349.1 -3.3 349.1 -3.3
Redistribution of ICS allocations -3.3 -3.3 0.0 3.3 0.0 3.3
Revised In Year Reporting 349.1 349.1 349.1 -0.0 349.1 -0.0
To reflect our control total reported position (including central allocations adjustments):
In Year Reporting 349.1 349.1 349.1 -0.0 349.1 -0.0 Cumulative Surplus 7.3 7.3 0.0 -7.3 0.0 -7.3 356.4 356.4 349.1 -7.3 349.1 -7.3
Please note regarding variances – Negative represents a favourable variance, Positive represents an adverse variance
March 2021 - Month 12 Improving health services… Glossary of Terms
Acronym Acronym Description ACS Accountable Care System AMH Adult Mental Health BCF Better Care Fund BPPC Better Payment Practice Code CCG Clinical Commissioning Group CHC Continuing Healthcare CSU Commissioning Support Unit CYP Children and Young People ECR Extra Contractual Referral EOL End of Life FNC Funded Nursing Care FT Foundation Trust HQ Headquarters IAPT Improved Access to Psychological Therapies ICP Integrated Care Provider ICS Integrated Care System IFR Individual Funding Request IVF In Vitro Fertilisation KPI Key Performance Indicator LDS Local Delivery System MH Mental Health MHIS Mental Health Investment Standard NCA Non-Contracted Activity NHSPS NHS Property Services NR Non-Recurrent OOH Out of Hours OPMH Older People's Mental Health PD Physical Disability PSEH Portsmouth and South Eastern Hampshire QIPP Quality, Innovation, Productivity & Prevention TC Treatment Centre WLI Waiting List Initiative YTD Year to date
March 2021 - Month 12 Improving health services…
GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 7b
Title Performance Report
The Performance Report provides the Governing Board with a high- level view of CCG performance against key constitutional targets and other standards that define an effective commissioner.
The Board is asked to note the impact of the pandemic across several national standards and operating plan commitments including; 111 Call Answer Performance. Purpose of Paper Cancer ‘62-day first treatment’ target. RTT Waiting Times. Diagnostics Waiting Times Standard. Dementia Diagnosis. In addition, there has been one incident of MRSA reported for February 2021.
Recommendations/ The Board is asked to accept the contents of the Performance Report. Actions requested
Engagement Activities – Clinical, Stakeholder and Not Applicable Public/Patient
Item previously Not Applicable considered at
Potential Conflicts of Interests for Committee Not Applicable Members
Bernie Allen Author Deputy Director of Planning and Analytics
Michelle Spandley Sponsoring member Chief Finance Officer
Date of Paper 6 May 2021
NHS Portsmouth CCG Governing Board Meeting 19 May 2021
Performance Report
Report Contents
1. Performance Summary ...... 3 2. Performance Exceptions ...... 4 Unscheduled Care ...... 4 Scheduled Care...... 5 Methicillin-resistant Staphylococcus aureus (MRSA) ...... 7 Mental Health ...... 7 3. Recommendations/ Actions requested ...... 8
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1. Performance Summary The table below details the CCG’s performance in the last three months in relation to NHS Constitution standards and other key performance indicators. NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Dec-20 Jan-21 Feb-21 Perf Dir National Ave Q3 2020/21 Q4 2020/21 2020/21 Trend 111 Calls answered within 60 seconds SCAS M 95.0% 65.2% 66.4% 81.4% 69.8%. 70.9% 73.4% 76.5% Category 1 - 7 minutes mean response time SCAS M 00:07:00 00:06:37 00:06:37 00:05:48 00:06:51 Category 1 - 15 minutes 90th percentile response time SCAS M 00:15:00 00:12:16 00:12:08 00:10:38 00:12:06 Category 2 - 18 minutes mean response time SCAS M 00:18:00 00:19:02 00:23:12 00:12:29 00:18:19 Category 2 - 40 minutes 90th percentile response time SCAS M 00:40:00 00:37:47 00:48:55 00:23:30 00:36:04 Category 3 - 120 minutes 90th percentile response time SCAS M 02:00:00 02:23:34 03:16:11 01:18:50 01:43:22 Category 4 - 180 minutes 90th percentile response time SCAS M 03:00:00 03:09:56 03:41:25 01:45:24 02:28:21 Trolley Waits in A&E - Total (>12 Hours) PHT M 0 Reporting suspended due to the pandemic 0 0 0 Cancer: 2 Week Wait CCG M 93.0% 96.9% 94.3% 97.6% 90.3% 96.1% 94.3% 96.4% Cancer: 2 Week Wait (Breast Symptoms) CCG M 93.0% 97.0% 97.0% 98.8% 71.4% 97.1% 97.0% 100.1% Cancer: 31 Day Wait for First Treatment CCG M 96.0% 100.0% 100.0% 98.4% 94.7% 98.8% 100.0% 99.3% Cancer: 31 Day Subsequent Surgery CCG M 94.0% 100.0% 90.9% 100.0% 87.5% 95.3% 90.9% 97.2% Cancer: 31 Day Subsequent Anti Cancer Drug Regimen CCG M 98.0% 100.0% 100.0% 100.0% 99.1% 100.0% 100.0% 100.0% Cancer: 31 Day Subsequent Radiotherapy CCG M 94.0% 96.4% 100.0% 100.0% 98.1% 98.9% 100.0% 97.4% Cancer: 62 Day Wait for First Treatment CCG M 85.0% 91.9% 90.3% 66.7% 69.8% 88.7% 90.3% 86.60% Cancer: 62 Day Wait for First Treatment Screening Referral CCG M 90.0% 100.0% 100.0% 100.0% 72.1% 83.3% 100.0% 86.7% RTT: Incomplete Waiting List Size CCG M 12,969 13,467 13,355 13,414 RTT: Incomplete Performance CCG M 92.0% 69.7% 66.7% 64.3% 64.5% 64.1% 65.5% 60.06% RTT: Patients waiting more than 52 Weeks CCG M 0 280 563 883 684 1446 2,885 Diagnostic Test Waiting Times CCG M 99.0% 84.5% 78.8% 87.7% 71.5% 84.3% 78.8% 75.0% Audiology: Incomplete Waiting List Performance CCG M 92.0% Reporting suspended due to the pandemic - #N/A #N/A #N/A Incidents of C.Diff CCG M 28 2 2 2 3 4 9 Incidents of MRSA CCG M 0 0 0 1 0 1 2 Mixed Sex Accommodation Breaches CCG M 0 Reporting suspended due to the pandemic - #N/A 0 #N/A Dementia Diagnosis Rate CCG M 66.7% 64.0% 62.8% 62.8% 66.6% 64.2% 62.8% 64.6% IAPT: People entering treatment CCG M 5.50% 5.4% 5.50% #N/A 6.7% #N/A 4.7% IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 53.8% 61.0% #N/A 57.1% #N/A 57.9% IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 90.0% 88.1% #N/A 104.6% #N/A 94.9% IAPT: First Appointment Within 18 Weeks of Referral CCG M 95.0% 95.9% 100.0% #N/A 105.6% #N/A 104.4% Early Intervention in Psychosis - Started Treatment CCG M 60.0% #N/A #N/A #N/A - #N/A #N/A #N/A Out of Area Placements for Mental Health Active at Period End CCG M 0 0 0 0 0 0 5 Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/, NHS Digital https://digital.nhs.uk/search/document-type/publication/publicationStatus/true?area=data&sort=date, GOV.uk https://www.gov.uk/government/statistics
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2. Performance Exceptions This report provides an update on performance in line with standards outlined in the 2020/21 operating plan and where applicable trajectories agreed as part of the Hampshire and Isle of Wight Restoration and Recovery plan as part of phase 3 of the NHS response to Covid-19, (https://www.england.nhs.uk/coronavirus/publication/third- phase-response/).
Although the CCG is working with partners to ensure the delivery of the operating plan and the Phase 3 Restoration and Recovery plan, it should be noted that the agreed trajectories did not anticipate another peak in the number of cases of Covid-19. Consequently, delivery of both the national targets and locally agreed trajectories is challenging.
Unscheduled Care South Central Ambulance Service (SCAS) 111 Calls Answered within 60 Seconds SCAS recorded 74.9% of 111 calls answered within 60 seconds in March 2021 compared to the national standard of 95%. The national average for March was 78.2%.
The underperformance in March was contributed by the Trust being required to provide national contingency, supporting 42 requests for assistance from other locations in the month.
Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
Resumption of the national performance standard has been suspended until after quarter 2 2021. However, the following actions continue to be taken by the Trust to improve performance: Further recruitment to fill vacancies with additional training for new recruits to improve efficiency. Active management of staff sickness. Implementation of a planning tool to improve rota fit.
SCAS 999 Ambulance Response Times (ARP) All the national ambulance response time standards were met by SCAS in March 2021. The Trust has been operating business as usual since the beginning of March 2021 with additional support the Trust received from the military and fire services as part of the response to the pandemic stopping at the end of February 2021.
SCAS has attributed the improved performance to increased capacity as result of fewer staff being off sick and a reduction in Covid-19 related demands. Organisation Frequency Target Jan-21 Feb-21 Mar-21 Category 1 - 7 minutes mean response time SCAS M 00:07:00 00:06:37 00:05:48 00:06:00 Category 1 - 15 minutes 90th percentile response time SCAS M 00:15:00 00:12:08 00:10:38 00:10:58 Category 2 - 18 minutes mean response time SCAS M 00:18:00 00:23:12 00:12:29 00:12:50 Category 2 - 40 minutes 90th percentile response time SCAS M 00:40:00 00:48:55 00:23:30 00:23:35 Category 3 - 120 minutes 90th percentile response time SCAS M 02:00:00 03:16:11 01:18:50 01:42:10 Category 4 - 180 minutes 90th percentile response time SCAS M 03:00:00 03:41:25 01:45:24 01:39:27 Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
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Scheduled Care Cancer Standards NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Dec-20 Jan-21 Feb-21 Cancer: 2 Week Wait CCG M 93.0% 96.9% 94.3% 97.6% Cancer: 2 Week Wait (Breast Symptoms) CCG M 93.0% 97.0% 97.0% 98.8% Cancer: 31 Day Wait for First Treatment CCG M 96.0% 100.0% 100.0% 98.4% Cancer: 31 Day Subsequent Surgery CCG M 94.0% 100.0% 90.9% 100.0% Cancer: 31 Day Subsequent Anti Cancer Drug Regimen CCG M 98.0% 100.0% 100.0% 100.0% Cancer: 31 Day Subsequent Radiotherapy CCG M 94.0% 96.4% 100.0% 100.0% Cancer: 62 Day Wait for First Treatment CCG M 85.0% 91.9% 90.3% 66.7% Cancer: 62 Day Wait for First Treatment Screening Referral CCG M 90.0% 100.0% 100.0% 100.0% Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
The CCG met 7 out of the 8 national cancer standards in February 2021, failing the ‘62-day first treatment’ target with a performance of 66.7% against the national target of 85%. The CCG’s performance in February fell below the national average (69.8%) for the first time in 2020/21.
A total of 30 Portsmouth CCG patients received their first cancer treatment in February 2021 of whom 20 were treated within the 62 day waiting time standard. All 30 patients were seen at Portsmouth Hospitals University NHS Trust (PHU).
As the main provider of the CCGs cancer care, PHU met 7 of the 8 national cancer targets in February 2021: failing the ‘62-day first treatment’ with performance of 74.1% against the national standard of 85%. In all, the Trust treated a total of 121 patients of whom 31 were not treated within the waiting time standard.
The table below shows PHU’s activity level in relation to the trajectory agreed as part of the Phase 3 Restoration and Recovery plan as at the end of February 2021. Cancer Trajectory Actual Variance % Variance Urgent Cancer Referrals - Two Week Wait All Cancers 1,965 1,447 -518 -26% Cancer Treatment Volumes - 31 Day Wait 1st Treatment All Cancers 284 251 -33 -12% Cancer 62 Day PTL - The number of cancer 62 day pathways 53 57 4 8% Source:https://insights-secure.scwcsu.nhs.uk/SitePages/default.aspx#/home
PHU conducts weekly cancer performance meetings to reviews all patients on the 62 day cancer PTL. The Trust is working on a recovery trajectory which has been incorporated within activity plans submitted as part of the 2021/22 planning returns.
Referral to Treatment (RTT) Incomplete Waiting List Size NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Dec-20 Jan-21 Feb-21 RTT: Incomplete Waiting List Size CCG M 12,969 13,467 13,355 13,414 RTT: Incomplete Performance CCG M 92.0% 69.7% 66.7% 64.3% RTT: Patients waiting more than 52 Weeks CCG M 0 280 563 883 Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
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In February 2021, the CCG waiting list grew to 13,414 patients from 13,355 patients in January 2021. Additionally, the number of patients who waited more than 52 weeks also increased from 563 in January to 883 in February. Provisional data for March 2021 places the CCG’s waiting list at 13,689 patients of whom 1,029 had waited more than 52 weeks.
PHU’s performance continues to impact the CCG’s position. There were 35,964 patients were waiting to be seen by the Trust at the end of February 2021, compared to the Restoration and Recovery plan trajectory of 35,499. The number of patients who had waited more than 52 weeks at the end of February 2021 was 2,686 compared to a planned trajectory of 1,963.
The table below shows a breakdown of patients who were waiting longer than 52 weeks to be seen at PHU broken down by the referring CCG in February 2021.
Commissioner > 52 Weeks NHS Portsmouth CCG 773 NHS Fareham & Gosport CCG 666 NHS South Eastern Hampshire CCG 599 Other CCGs Combined 648 Total 2,686 Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
The Tables below show how PHU’s performance in relation to restoration and recovery plan for waiting list size and number of patients waiting longer than 52 weeks compared with other local providers. WL Size Trajectory WL Size Actual % Variance Hampshire Hospitals NHS Foundation Trust 41,541 41,588 0% University Hospital Southampton NHS Foundation Trust 39,794 36,554 -8% Portsmouth Hospitals University NHS Trust 35,499 35,964 1%
>52 Trajectory >52 Actual % Variance University Hospital Southampton NHS Foundation Trust 2,355 3,331 41% Hampshire Hospitals NHS Foundation Trust 1,600 3,282 105% Portsmouth Hospitals University NHS Trust 1,963 2,686 37% Source:https://insights-secure.scwcsu.nhs.uk/SitePages/default.aspx#/home
PHU continues to take the following actions to manage waiting times: Actively managing capacity to ensure that cancer and urgent patients are treated as planned and where possible minimise the impact on 52-week waiters. Constantly reviewing the use of Independent Sector (IS) theatre and bed capacity where clinically appropriate. Providing non-face-to-face outpatient service where clinically appropriate.
Diagnostics Waiting Times 88.7% of the CCG’s patients requiring any one of the 15 key diagnostic tests in February 2021 were seen within the 6 weeks. Although the CCG missed the national target of 99%, it performed better than the national average of 71.5%.
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NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Dec-20 Jan-21 Feb-21 Diagnostic Test Waiting Times CCG M 99.0% 84.5% 78.8% 87.7% Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/ Again, the CCG’s performance is mostly impacted by the performance of PHU who recorded completion of 81.6% of diagnostics within 6 weeks.
Whilst this did not meet the national target of 99%, performance continues to be above the national average, which for February 2021 was 71.5%. Provisional data for March 2021 places the CCG’s performance at 87.3%.
The table below details PHU’s performance against the agreed Recovery and Restoration trajectories for February 2021. Overall, the Trust achieved the total diagnostics activity planned for February 2021 but performed fewer diagnostics in MRI, CT, and Flexible Sigmoidoscopy. Diagnostics Trajectory Actual Variance % Variance Diagnostics Activity - Total 11,940 11,952 13 0.1% Diagnostics Activity - Magnetic Resonance Imaging 2,587 2,510 -77 -3.0% Diagnostics Activity - Computed Tomography 4,564 4,198 -366 -8.0% Diagnostics Activity - Non-Obstetric Ultrasound 4,001 4,296 295 7.4% Diagnostics Activity - Colonoscopy 110 183 73 66.4% Diagnostics Activity - Flexible Sigmoidoscopy 350 172 -178 -50.9% Diagnostics Activity - Gastroscopy 329 593 264 80.2% Source:https://insights-secure.scwcsu.nhs.uk/SitePages/default.aspx#/home
The Trust continues to the following action to manage the position: Ongoing fortnightly meeting to review ultrasound capacity across the system to balance the waiting list. Increasing capacity in endoscopy as result of insourcing.
Methicillin-resistant Staphylococcus aureus (MRSA) One incident of MRSA has been reported in February 2021. The incident involved a 78-year-old male admitted to PHU’s emergency department on 6 February 2021 with an initial diagnosis of sepsis and acute kidney injury. After testing, the patient was found to be MRSA positive on 9 February 2021. Root cause analysis of the incident has been conducted and the CCG’s quality team is working with PHU to ensure that lessons learnt are fully implemented.
Mental Health Improving Access to Psychological Therapies (IAPT) – People Entering Treatment Updated performance data relating to February 2021 will not be available until 14 May 2021, with the previous report confirming the CCG met all the IAPT standards in January 2021. NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Dec-20 Jan-21 Feb-21 IAPT: People entering treatment CCG M 5.50% 5.4% 5.50% #N/A IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 53.8% 61.0% #N/A IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 90.0% 88.1% #N/A IAPT: First Appointment Within 18 Weeks of Referral CCG M 95.0% 95.9% 100.0% #N/A Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
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Dementia Diagnosis 63.8% of the CCG’s prevalent population were diagnosed with dementia at the end of March 2021 against a target of 66.7%. The underperformance continues to be attributed to the reduction in the number of face-to-face contacts because of the pandemic which has reduced the number of opportunistic assessments and diagnoses. The national average is 66.6%. NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Jan-21 Feb-21 Mar-21 Dementia Diagnosis Rate CCG M 66.7% 62.8% 62.8% 63.8% Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
3. Recommendations/ Actions requested The Governing Board is asked to accept the contents of this Performance Report.
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GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 7c
Title 2021/22 Financial Planning Update
To update the board on the 21/22 financial planning. Purpose of Paper
The Board is requested to accept the report and note:
The CCGs commitment to deliver a surplus of £1.7m in H1.
The investments identified within the plans Recommendations/ Actions requested The CCGs commitment to achieving the MHIS in 21/22
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously April Governing Board Development Session considered at
Potential Conflicts of Interests for Board N/A Members
Author Nicola Burnett
Sponsoring member Michelle Spandley
Date of Paper 6 May 2021
Planning/Budget Setting 21/22
Prepared 19th April 2021 Updated 7th May 2021
ImprovingImproving health health services… services...services… Context
• Following publication of 2021/22 priorities and operational planning guidance 25th March 2021 the CCG has been working alongside colleagues across the ICS to develop plans to cover April to September (H1).
• A key risk to delivery of the financial plan is the uncertainty around the receipt of funding against the Hospital Discharge Programme.
• In addition Mental Health plans covering the whole year demonstrating the delivery of Long Term Plan objectives and the Mental Health Investment Standard were required.
• Initial draft plans were submitted 6th May delivering a breakeven position across the ICS and delivery against Mental Health investment expectations
Improving health services… 21/22 Planning Update
• For the first half of 21/22 many of the changes to the financial framework implemented in 20/21 in response to the COVID-19 pandemic will remain in place with the following key changes:
–Block Payments from 20/21 will be uplifted by 0.5% and will no longer be paid a month in advance
–Independent Sector contracts will be paid and managed locally
–ICS partners will collectively need to deliver a system efficiency target
–Hospital Discharge scheme 2 will cease for patients discharged after 31st March 2021. Scheme 3 details TBC
• M1-6 Allocations have been confirmed for NHS Portsmouth CCG as follows with a requirement to generate a surplus of £1,674k : HALF 1 TOTAL Allocation £000s CCG block allocation 152,308 Less System Efficiency -134 System Covid allocation 1,204 CCG primary care allocation 17,342 CCG running cost allocation 2,062 CCG allocation for acute services - Independent sector/commercial Sector 4,275 Total CCG allocations 177,057 Improving health services… 21/22 Plan
The M1-6 plan has been constructed to achieve the MHIS, create a 0.5% contingency reserve and applies growth at agreed ICS values across key lines of expenditure
Allocation £000s CCG block allocation 152,308 Less System Efficiency -134 System Covid allocation 1,204 CCG primary care allocation 17,342 CCG running cost allocation 2,062 CCG allocation for acute services - Independent sector/commercial Sector 4,275 Core CCG allocations 177,057 CCG SDF Allocation 1,894 Total CCG Allocation 178,951 Expenditure £000s Acute Services -79,720 Mental Health Services -23,190 Community Services -17,959 CHC -8,420 Primary care services (excluding prescribing) -5,192 Primary care prescribing -15,785 Primary care co-commissioning -17,401 Other programme services -11,424 Running Costs -2,008 System Contingency -762 Total CCG Expenditure -181,862 Less national COVID funding 4,585 Net CCG Expenditure -177,277 CCG Surplus 1,674 Improving health services… 21/22 Mental Health
•The CCG is required to commit a minimum investment of 3.75% or £1.6m into Mental Health services in 21/22 to meet the Mental Health Investment Standard (MHIS)
•Current plans meet the standard through the application of 0.5% growth funding applied across NHS contracts, the creation of a 1.27% pay uplift reserve in addition to agreed service development investments.
•National Service Review (SR) and Service Development Funding (SDF) has also been allocated to the CCG to enable the required service transformations and developments.
Value (£000's)
20/21 MHIS Outturn 42,794 SDF & SR 21/22 Value (£000's) Portsmouth CCG HIOW ICS Growth (0.5%) 95 SDF: Adult Mental Health Community (AMH Community) 0 3,290 SDF: Adult Mental Health Crisis (AMH Crisis) 0 852 Pay Reserve (1.27%) 362 SDF: 18-25 young adults (18-25) 77 0 SDF: CYP community and crisis 259 0 CAMHS Eating Disorders 209 SDF: MHST 19/20 sites wave 1&2 (MHST19/20) 736 0 SDF: MHST 20/21 sites wave 3&4 (MHST20/21) 255 0 CAMHS Neuro-Diversity investment 160 SDF: Rough Sleeping 19/20 and 20/21 Sites 299 0 SR: Children & Young People's Eating Disorders (CYPED) 46 0 Perinatal Service 88 SR: CYP community and crisis 174 0 SR: Discharge 336 0 Adult MH Liaison 344
CCG Total MHIS Plan 21/22 2,182 4,142 Paediatric Psychiatric Liaison 81
21/22 Positive Minds Business Case Investment 267
CCG Total MHIS Plan 21/22 44,400 Improving health services… Minimum Requirement 44,399 21/22 Planned Investments
In preparing the NHS Portsmouth CCG financial plan for 21/22 the following investments have been taken into account through the core allocation.
Programme: Scheme Portsmouth CCG £000s
Community Discharge to Assess Business Case (net investment requires resource recycle) 1,000
ICP Integrated Urgent Care Business Case (net investment requires resource recycle) 0
ICS Integrated Urgent Care Business Case 130
CICN Business Case 198
Long Covid Service continuation 400
Mental Health CAMHS Eating Disorders (FYE of 20/21 variation) 209
CAMHS Neuro-Diversity (FYE of 20/21 variation) 160
Paediatric Psychiatric Liaison (FYE of 20/21 variation) 81
Perinatal Service Investment 88
21/22 Positive Minds Business Case Investment (approved via GB) 267
Adult MH Liaison (Business Case approved in principle via Unified Exec) 344
Improving health services… 21/22 SDF Investment
SDF has been allocated across individual CCGs and the ICS for investment in 21/22:
Programme: Scheme System Allocation - Footprint Portsmouth CCG H, S & IOW CCG HIOW ICS Total £000s £000s £000s £000s Primary Care Workforce: Training Hubs STP Allocation 186 186 Primary Care Networks - development and support systems STP Allocation 454 454 Practice resilience programme - local STP Allocation 131 131 Online consultation software systems (local) STP Allocation 246 246 GP IT Infrastructure and Resilience (revenue) - central and systems CCG Allocation 26 176 202 Improving Access CCG Allocation 703 1,328 2,031 Primary Care - Covid Support STP Allocation 3,728 3,728 Mental Health SDF: CYP community and crisis CCG Allocation 130 781 911 SDF: 18-25 young adults (18-25) CCG Allocation 39 233 272 SDF: MHST 19/20 sites wave 1&2 (MHST19/20) CCG Allocation 368 368 736 SDF: MHST 20/21 sites wave 3&4 (MHST20/21) CCG Allocation 128 511 639 SDF: Perinatal - Maternal Mental Health Services (MMHS) CCG Allocation 288 288 SDF: Adult Mental Health Crisis (AMH Crisis) CCG Allocation 426 426 SDF: Adult Mental Health Community (AMH Community) CCG Allocation 1,645 1,645 SDF: Suicide Prevention CCG Allocation 178 178 SDF: Rough Sleeping 19/20 and 20/21 Sites CCG Allocation 150 150 COVID: Mental health support for staff hubs CCG Allocation 503 503 SR: Children & Young People's Eating Disorders (CYPED) CCG Allocation 23 140 163 SR: CYP community and crisis CCG Allocation 87 525 612 SR: Discharge CCG Allocation 168 1,015 1,183 Cancer Planning Guidance Delivery (including Cancer Alliance Core Funding) Cancer Alliance 1,837 1,837 Rapid Diagnostic Centres Cancer Alliance 1,571 1,571 Targeted Lung Health Checks Cancer Alliance 551 551 Cytpsponge Cancer Alliance 104 104 System leadership / preparation funding STP Allocation 119 119 Additional Community Services allocation STP Allocation 4,284 4,284 Diabetes Programme Transformation Fund CCG Allocation 219 219 LD & Autism Community investment/reduce admissions TCP Allocation 455 455 CeTR review TCP Allocation 31 31 Learning Disabilities Mortality Review Programme (LeDeR) TCP Allocation 36 36 WS1 - Local transformation & LTP - Local Maternity Systems (LMS) - capacity funding LMS Funding 75 75 WS1 - Local transformation & LTP - Local Maternity Systems (LMS) - implementation funding LMS Funding 101 101 LMS funding for continuity of carer and equity LMS Funding 105 105 LTP - SBL Pre-term Birth CCG Allocation 18 136 154 Personalised Care Personalised Care Implementation (ICSs/STPs) CCG Allocation 100 100 Alcohol Care Teams CCG Allocation 129 129 Emergency & Elective Care 111First STP Allocation 352 352 System Transformation ICS Implementation STP Allocation 150 150 CCG Allocation 314 314 Outpatients Outpatient Video Consultation Software Improving health services…
GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 7d
NHS Portsmouth CCG Draft Delivery Plan Title 2021/22
The Draft Delivery Plan 2021/22 sets out the Portsmouth CCG priorities for the year ahead as part of its commitment to supporting people to live healthy, safe and independent lives by offering health and social care services that are joined up and provided in the right place, at the right time.
The plan is set within the context of new partnership working arrangements across the local health system and the challenge of responding to pressures arising as a direct consequence of the Purpose of Paper pandemic. As such the plan sets how Portsmouth CCG will meet the national mandate to: Protect the most vulnerable from COVID-19; Restore NHS services inclusively; Accelerate preventative programmes which proactively engage those at risk of poor health outcomes; Collaborate locally in planning and delivering action; and Continue to achieve financial balance.
Recommendations/ The Board is asked to endorse the approach outlined in the Draft Actions requested Delivery Plan 2021/22.
Engagement Activities – Clinical, Stakeholder and Not Applicable Public/Patient
Item previously Not Applicable considered at
Potential Conflicts of Interests for Committee Not Applicable Members
Bernie Allen Author Deputy Director of Planning and Analytics
Michelle Spandley Sponsoring member Chief Finance Officer
Date of Paper 6 May 2021
NHS Portsmouth CCG Delivery Plan 2021/22
Improving health & care services…1 Contents
Page No.
Introduction 3
National Priorities (2021/22 Operating Guidance) 4
Health and Care Portsmouth Priorities 2021/22 5
Portsmouth and South East Hampshire Integrated Care Partnership (PSEH ICP) Priorities 6
Delivery of Priorities 7
Portsmouth CCG: Finance, Activity and Performance 30
Potential Risks associated with Delivery of Priorities 38
Appendices (including glossary) 40
2 Introduction
This plan sets out the Portsmouth CCG priorities for the year ahead as part of its commitment to support people to live healthy, safe and independent lives by offering health and social care services that are joined up and provided in the right place, at the right time.
The plan is set within the context of new partnership working arrangements across the local health system and the challenge of responding to pressures arising as a direct consequence of the pandemic.
The governments’ mandate to the NHS dictates the national priorities for health and care which are translated by NHS England & Improvement into the planning guidance (which are summarised on slide 4). The CCG applies the national ask in a way that meets the aspirations and requirements of it’s local population in Portsmouth (as set out on slide 5).
The CCG will deliver its priorities through its placed based partnership with Portsmouth City Council (Health and Care Portsmouth, HCP), within the Portsmouth and South East Hampshire Integrated Care Partnership (PSEH) and as a key partner in the Hampshire and Isle of Wight Integrated Care System (HIOW ICS), and in a manner that meets the HCP vision whilst demonstrating the CCG complies with system oversight framework requirements.
Our partners include Hampshire, Southampton and Isle of Wight CCG, Portsmouth Hospitals University NHS Trust, Solent NHS Trust, Southern NHS Foundation Trust, South Central Ambulance Services Trust, Portsmouth Primary Care Alliance (PPCA), Portsmouth City Council, voluntary and community sector partners including HIVE Portsmouth and independent and private sector providers.
The CCG has played an active role in co-producing collaborative plans with all its stakeholders to ensure health and care services are joined up across all tiers of the system, and from slide 28 onwards sets out in more detail how it works collaboratively across different systems and with its partners to deliver on these priorities.
3 National Priorities (2021/22 Operating Plan Guidance)
The 2021/22 priorities and operational planning guidance sets the priorities for the year ahead, against a backdrop of the challenge to restore services, meet new care demands and reduce the care back logs that are a direct consequence of the pandemic, whilst supporting staff recovery and taking further steps to address inequalities in access, experience and outcomes. Tackling health inequalities to prevent and manage ill health Restore NHS services inclusively in groups that experience poorer outcomes Mitigate against digital exclusion Ensure datasets are complete & timely Accelerate preventative programmes that engage those at greatest risk of poor health outcomes Strengthen leadership and accountability
A. Supporting the health and wellbeing of staff and taking A1 Looking after our people & helping them recover action on recruitment and retention A2 Belonging in the NHS & addressing inequalities A3 Embed new ways of working & delivering care A4 Grow for the future
B. Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19
C. Building on what we have learned during the pandemic to C1 Maximise elective activity, taking full opportunities to transform service delivery transform the delivery of services, accelerate the restoration C2 Restore full operation of cancer services of elective and cancer care and manage the increasing C3 Expand & improve mental health services & services for people with a LD or autism demand on mental health services C4 Deliver improvements in maternity care, including responding to the recommendations of the Ockenden review
D. Expanding primary care capacity to improve access, local D1 Restoring & increasing access to primary care services health outcomes and address health inequalities D2 Implementing population health management & personalised care approaches to improve health outcomes & address health inequalities
E. Transforming community and urgent and emergency care E1 Transforming community services & improve discharge to prevent inappropriate attendance at emergency E2 Ensuring the use of NHS111 as the primary route to access urgent care & the timely admission of patients departments (ED), improve timely admission to hospital for to hospital who require it from emergency departments ED patients and reduce length of stay
F. Working collaboratively across systems to deliver on F1 Effective collaboration & partnership working across systems these priorities. F2 Develop local priorities that reflect local circumstances & health inequalities F3 Develop the underpinning digital & data capability to support population-based approaches F4 Develop ICSs as organisations to meet the expectations set out in Integrating Care F5 Implement ICS level financial arrangements
4 Health and Care Portsmouth Priorities 2021/22
In 2020 the Health & Care Portsmouth partnership refreshed its commitments and blueprint for the future of health & care, initially drawing together existing plans for children, adults and public health. The 9 commitments are included at appendix 1 for reference.
This work has continued in response to the NHS Mandate and National Planning guidance as the Health & Care Portsmouth partnership continues to align its work and to establish a single strategic planning & commissioning leadership for health & care in Portsmouth. It supports the delivery of the broader Portsmouth Health & Wellbeing Strategy and further drives the integration between Portsmouth Clinical Commissioning Group and Portsmouth City Council.
The revised plans set out 3 year priorities for Adults, Children & Families and Public Health which are underpinned by core strategies, summarised in the diagram below, the detail of which can be found at appendix 2. Common to priorities in the national guidance are actions that address inequalities in access, experience and outcomes.
in addition there are 7 principles or enablers that are progressed within each of these three areas: Contracting approach; Workforce Development; Maximising use of SystmOne (single care record); Co-production approach; Improving use of Business Intelligence to inform decision making; Safeguarding and liberty protections; developing a smart accommodation strategy to minimise void space.
When taken together, this collection of plans describe the full range of health & care intentions for the city,
This delivery plan sets out where the CCG contributes to the one year Health & Care Portsmouth priorities for 2021/22 to deliver better health for the whole population, better quality care for all patients, and financially sustainable services for the taxpayer.
5 Portsmouth and South East Hampshire Integrated Care Partnership (PSEH ICP) Priorities As a local system, the Portsmouth and South East Hampshire Integrated Care Partnership (PSEH ICP) comes together where it makes sense to do so and adds value. Portsmouth CCG and Portsmouth City Council join colleagues from Hampshire, Southampton and Isle of Wight CCG who are predominantly focussed on the areas previously served by Fareham, Gosport and South East Hampshire CCGs as well as providers, PCNs, Hampshire County Council and the Voluntary Sector.
Members of PSEH ICP have produced an operating plan that sets out what they will collaborate on to deliver the national priorities of restoring services, meeting the new care demands and reducing the care back logs in a manner that ensures equity of access and outcomes. The key components of this operating plan are summarised here: Managing fall-out from pandemic Embedding and continuing to build Refresh and refocus on long-term objectives (restoration and recovery) on improvements made
• Increase in mental health demand • D2A and Home First • More people treated closer to home (low level and complex; adult and • 111 first and total triage model in • Improved access to community mental health support, including child) primary care crisis response (adults and children) - parity with physical • Long elective waits • Mental health access health • Preparedness for future waves • Vaccination programme • Place-based service integration via PCNs – health and social • Deteriorating physical health (LTC • Mainstream digitally enabled care care, primary and community care, physical and mental health management etc) (primary care, outpatients, • Giving people more control over their own health • Screening and Cancer referrals telehealth) (personalised care, prevention, self-care) (impact of delayed access) • COVID surge planning and • No wrong door approach to accessing support • Imms programmes catch-up provision of care in community • Reducing pressure on emergency hospital services • Primary and community services • Care Homes • Targeted support for highest risk groups restoration • Make sure everyone gets the best start in life • Staff recovery • Supporting people to age well • Inequalities - Disproportionate • Increased focus on population health – predictive prevention impact on specific groups (BAME and targeted intervention (inequalities focus) and bottom 20% deprivation)
In order to meet this ask, PSEH has established three transformation programmes to drive, enable, support, be accountable for and deliver the priorities over the next 6 months Managing Flow, Place Based Care, Healthy Communities which can be found at appendix 2.
This delivery plan identifies where the PSEH Transformation Programme contributes to Portsmouth CCGs delivery of the national priorities.
6 Delivery of priorIties
Page No.
Tackling health inequalities to prevent and manage ill health in groups that 8 experience poorer outcomes Supporting the health and wellbeing of staff and taking action on recruitment and retention 12
Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19 15
Building on what we have learned during the pandemic to transform the delivery of services, accelerate the 18 restoration of elective and cancer care and manage the increasing demand on mental health services, restore maternity Expanding primary care capacity to improve access, local health outcomes and address health inequalities 21
Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency 24 departments (ED), improve timely admission to hospital for ED patients and reduce length of stay Working collaboratively across systems to deliver on these priorities 26
7 Tackling health inequalities to prevent and manage ill health in groups that experience poorer outcomes National Health Inequalities and Improving Outcomes Locally there are 6 priorities for Public Health: • Reduce the harm caused by substance misuse including alcohol misuse Restore NHS Ensure Accelerate Mitigate Strengthen Collaborate locally • Reduce the prevalence of smoking, including services datasets are preventative against leadership in planning and smoking in pregnancy, across the city working inclusively digital complete programmes delivering action and with partners to ensure sustained system wide exclusion and timely that engage accountability to address health those at inequalities action greatest risk • Reduce unwanted pregnancies by increasing of poor access to Long-Acting Reversible Contraception health (LARC) in general practice, maternity and outcomes abortion pathways, and strengthening LARC pathways with vulnerable groups National Prevention & Pathways Priorities • Promote positive mental wellbeing across Portsmouth and reduce suicide and self-harm in the city by delivering the actions within Screening Diabetes CVD Obesity Stroke Cardiac Respiratory Portsmouth’s Suicide Prevention Plan (2018-21) and the STP Suicide Prevention Plan (2019-20) • Reduce the harms from physical inactivity and poor diet HCP Public Health Priorities • Work with Council partners to address the health impacts of the built environment
Address health inequalities Work with Council partners to Continue to lead the response Strengthen the intelligence with targeted attention on improve the wider Action to prevent ill-health by targeting the most to the COVID-19 pandemic function for the Council and those that have the greatest determinants of health by focusing on public health vulnerable in our population forms a central Portsmouth Health and Care need and are more likely to improving educational advice to the council, partners Partnership experience serious attainment, employment component of the PSEH Healthy Communities and our residents consequences of COVID opportunities programme: chaired by Portsmouth CCG MD Jo York, the programme is closely aligned to the HCP work to ensure the CCG will meet all the NHS HCP Prevention & Pathway Priorities priorities on addressing health inequalities.
The Portsmouth CCG Executive lead for tackling physical impacts of substance access to suicide and health Inequalities is Helen Atkinson FFPH, smoking inactivity & built misuse LARC self-harm Director of Public Health, Portsmouth City Council, poor diet environment who also represents the CCG on the ICS Prevention Board. 8
Tackling health inequalities to prevent and manage ill health in groups that experience poorer outcomes Priority Area Tier of Milestone to be achieved NHS England planning Operating & Framework delivery priorities Reduce the harm PCN As a result of additional funding for homeless drug & alcohol treatment service from now until March Accelerate caused by HCP 2022 we will increase our engagement and support to meet complex needs. preventative substance misuse programmes that including alcohol This will include psychological and mental health support for those with co-occurring conditions engage those at misuse including inpatient detox and residential rehabilitation. greatest risk of poor health We will continue to support primary care to embed brief intervention within PCNs building on insights outcomes work undertaken previously
Reduce the PCN Our focus will be to work with providers on cessation efforts with those groups most in need SMI / Accelerate prevalence of HCP deprivation / BAME / D&A services: this will include enabling acute trusts to embed Smokefree preventative smoking, including PSEH policies across all hospital sites and embed cessation pathways. programmes that smoking in ICS engage those at pregnancy, across We will implement the smoke free maternity pathway to enable pregnant women who smoke, and greatest risk of the city working with their families to access stop smoking support and quit smoking. poor health partners to ensure outcomes sustained system wide action Reduce unwanted PCN We will work with partners across the City to maximse access points to address inequalities: general Accelerate pregnancies by HCP practice, maternity and abortion pathways, and strengthening LARC pathways with vulnerable groups preventative increasing access to programmes that Long-Acting engage those at Reversible greatest risk of Contraception poor health (LARC) outcomes
9 Tackling health inequalities to prevent and manage ill health in groups that experience poorer outcomes Priority Area Tier of Milestone to be achieved NHS England planning Operating & Framework delivery priorities Promote positive mental PCN We will introduce a real time surveillance system to monitor suspected suicides and mobilise timely Accelerate wellbeing across HCP post-intervention responses from agencies. preventative Portsmouth and reduce PSEH programmes suicide and self-harm in ICS We will develop and deliver comprehensive training (covering mental health, suicide prevention, that engage the city by delivering the debt and anxiety) targeting workforces in contact with higher risk cohorts. those at actions within greatest risk of Portsmouth’s Suicide We will continue to develop and deliver innovative projects across community and voluntary sector poor health Prevention Plan (2018- to support their engagement with seldom heard groups. outcomes 21)) We will develop the People with Lived Experience Bureau.
We will increase awareness of and improve pathways for self-harm with support for parents/carers We will develop the Suicide Bereavement Service with single point of access for people bereaved by suicide.
We will develop and implement a GP Suicide Prevention & Support training package. Reduce the harms from PCN Using the additional funding Portsmouth City Council has been awarded for weight management Accelerate physical inactivity and HCP services from, we will deliver: preventative poor diet PSEH • Tier 2 behavioural weight management services provision for adults; and programmes ICS • Behavioural (tier 2) weight management services for children and their families including that engage extended brief interventions. those at greatest risk of The system will work with Energise Me to implement the Hampshire & IOW physical activity poor health strategy with a specific focus on targeting health inequalities and provide weight management outcomes support to people on elective pathways.
We will work to ensure al maternity services deliver accredited evidence based infant feeding programme.
We will work with council colleagues to increase the utilisation of outdoor space for health/exercise reasons.
10 Tackling health inequalities to prevent and manage ill health in groups that experience poorer outcomes Priority Area Tier of Milestone to be achieved NHS England planning Operating & Framework delivery priorities Work with Council PCN We will continue to work on transforming public transport (modal shift, accessibility, addressing Accelerate partners to address the HCP inequality and social isolation). preventative health impacts of the programmes built environment We will include health at all stages of the planning process and regeneration projects. that engage those at We will develop working links between the air quality agenda, clinical practice, skills and greatest risk of knowledge. poor health outcomes We will encourage PHU to see itself as an ‘Anchor Institution’ and reduce its carbon footprint and its impact on poor air quality in the city. Continue to lead the PCN We will continue to provide the data and intelligence to inform and support Covid-19 response and Restore NHS response to the COVID- HCP recovery. services 19 pandemic focusing inclusively on public health advice Through the Modelling and Intelligence Cell we will provide the information required to ensure an to the council, partners intelligence-led approach to Covid-19 including modelling future course of the pandemic. Ensure datasets and our residents are complete & We will continue to source, collate, interpret and present data on all relevant aspects of Covid-19 timely including testing, vaccination and contact tracing. Address health PCN We will finalise the new Health and Wellbeing Strategy for the city, which will be underpinned by a Restore NHS inequalities with HCP robust Joint Strategic Needs Assessment (JSNA) including the Strategic Assessment for Crime, services targeted attention on ASB, Re-offending and Substance Misuse. inclusively those that have the greatest need and are We will re start of NHS Health Checks programme by focusing on inequalities through Primary Care Ensure datasets more likely to targeting patients who are most at risk of CVD are complete & experience serious timely consequences of The Portsmouth Wellbeing Service will be supporting patients referred from primary and secondary COVID-19 care, as well as self-referral. Screening for 4 risk factors (smoking, BMI, physical activity, alcohol), Strengthen mental wellbeing and activation levels. leadership and accountability
11 Supporting the health and wellbeing of staff and taking action on recruitment and retention
Our staff who make up Health and Care Portsmouth are our greatest asset and the CCG Executive endeavours to take an inclusive approach in engaging and involving them, recognising that it is only through them that we will achieve our vision and strategic objectives.
National Workforce Priorities: health and wellbeing of staff & recruitment We are committed to attracting and & retention retaining the best possible talent in the form of staff who are committed to delivering our priorities whilst adhering to Belonging in the Looking after our Embed new ways of NHS and the values of the organisation, we aim to people and helping working and Grow for the future addressing going beyond the ‘must do’s’ of an them to recover delivering care inequalities employer and applying sound organisational practices to ensure staff are supported at work. We recognise this will be a year of change for our staff so we will HCP Priorities and Actions: health and wellbeing of staff & recruitment & ensure effective communication with staff retention so they are informed.
The Portsmouth HR Framework sets out Workforce our commitments and responsibilities and Continuing to development: Supporting PCN will be republished in July 2021.Managing give staff better Continue to leadership to make full use Expanding EAP control and development, Director, Jo York is the executive workforce implement of their & encouraging visibility of their restorative actions from Additional Roles lead with support from Graham Love (lay access working patterns organisations WRES & WDES Reimbursement member and chair of the Remuneration (flexible working and high quality Scheme funding etc.) professional Committee training http://intranet.portsmouthccg.nhs.uk/document/policies- procedures/hr/371-hr-framework-2019/file https://portsmouthccg.portcreative.co.uk/about-portsmouth- ccg/equality-and-diversity-annual-report-2020/#action-plan-2021
12 Supporting the health and wellbeing of staff and taking action on recruitment and retention Priority Area Tier of Milestone to be achieved NHS England plannin Operating g & Framework delivery priorities Expanding EAP & HCP We will be formalising health and wellbeing conversations. Looking after encouraging access our people & We will expand the Employee Assistance Programme and Occupational health service available to helping them staff, and engage with low usage groups to develop access to programmes that meet their needs. recover
We will continue to deliver training to managers on supporting mental health in the workplace.
We will deliver further webinars for staff on taking control of their mental health, managing anxiety and dealing with uncertainty.
We will increase the promotion of wellbeing support available including use of Corporate wellbeing updates; Wellbeing champions; Wellbeing campaigns and activities; intranet pages, such as mental
We will explore participation in the National NHS Staff surveys: including the new quarterly staff survey to track people’s morale in the first quarter of 2021/22. Continue to implement HCP We will Implement actions identified in baseline WDES reporting. Belonging in actions from WRES & the NHS & WDES We will conduct self-assessment against the Goals and Objectives of EDS2 by locality. addressing inequalities We will use feedback from staff experience to inform the EDS2.
We will consult and engagement with patients, the public, statutory and voluntary community sector partners and staff to: i) Assess achievement against the Goals and Objectives of EDS2, WDES and WRES; and ii) Develop equality objectives.
We will progress actions to understand our gender pay gap and develop ethnicity reporting
13 Supporting the health and wellbeing of staff and taking action on recruitment and retention Priority Area Tier of Milestone to be achieved NHS England planning Operating & Framework delivery priorities Continuing to give staff PCN We will continue to encourage and monitor the update of flexible working policies. Embed new better control and HCP ways of visibility of their working We will ensure staff are taking annual leave and make sure staff in frontline roles were allowed to working & patterns (flexible carry over extra leave. delivering care working etc.) We will embed wellbeing action plans as part of 1-2-1s and return to work meetings. Workforce development: PCN We will continue the development and delivery of high quality professional training across the health Grow for the leadership development, HCP and care disciplines (including support to teachers, social workers, care staff) as identified within future restorative organisations the plans for Adults, Children & Families and Public Health. and high quality professional training We will deliver he Manager Essentials programme supplemented with coaching and mentoring
We will create career paths within directorates including support for apprenticeships in all parts of the organisation and fully exploiting the apprenticeship levy where possible.
Supporting PCN to PCN We are continuing to support ongoing PCN recruitment to additional roles in order to maximise Embed new make full use of their HCP funding. ways of Additional Roles working & Reimbursement We will review and redefine the neighbourhood model programme within P3, based on the delivering care Scheme funding one team approach across primary, community health and social care. Grow for the future
14 Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19
National COVID Priorities: vaccination programme and HCP is addressing delivery of the vaccination programme meeting the needs of COVID-19 patients and meeting the needs of patients with Covid as part of its Vulnerable People and Long-Term Conditions Strategy, Surge Physical which includes the following objectives: Delivery of capacity: Post COVID Application critical care • Providing ongoing support to those people classified as vaccination home Assessment of infection capacity and programme oximetry, clinics control clinically vulnerable including those from BAME workforce virtual wards communities • Proactive delivery of flu vaccination programme to meet targets HCP COVID Priorities: vaccination programme and meeting • Local Delivery of Covid vaccination programme the needs of COVID-19 patients Many of these objectives are delivered via the PSEH ICP Increased care Place Based Care transformation programme, where HCP Delivery of Surge capacity: Post COVID home support collaborates on: vaccination home oximetry, Assessment on infection programme virtual wards clinics • Delivery first and second vaccinations to Cohort 10 and control above; • Developing and delivering action plan for patients experiencing in inequalities in the vaccination PSEH COVID Priorities: vaccination programme and programme; meeting the needs of COVID-19 patients • Planning and participating in COVID revaccination, flu and children’s vaccination programmes; • Supporting referrals to current long CV19 clinics at Delivery of vaccination Surge capacity: home Post COVID QAH. programme oximetry, virtual wards Assessment clinics • Supporting PCNs to utilise the ARRS initiative in order to address long CV19 presentations (physical and MH) presentations
At a system level Solent NHS trust has been commissioned to be the lead provider to develop and deliver a paediatric long covid service deploying community based multi disciplinary teams across HSIOW & Portsmouth. 15
Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19 Priority Area Tier of Milestone to be achieved NHS England planning Operating & delivery Framework priorities Delivery of vaccination PCN We will complete COVID vaccination of all adults and plan for revaccination from Autumn, including Delivering the programme HCP children’s programme if agreed. NHS COVID PSEH vaccination ICS We will monitor uptake of COVID testing and vaccination by ethnicity and geographic deprivation to programme address any disparities with additional resource and targeting.
We will ensure existing programme's that prevent ill health are targeted at those in COVID vulnerable groups to improve resilience to future waves of COVID or other novel infections.
We will establish the Local Testing and Contact Tracing Service as business as usual. Provision of surge PCN We will review the service provision for CO@H: creating a road map for a BAU model for the next Meeting the capacity: home HCP 6 months alongside national predictions with flexibility built in to respond to future needs. needs of oximetry, virtual wards PSEH patients with ICS We will continue the discussions to develop the plans for Virtual Wards as a framework for care COVID-19 delivery both locally and system wide, and will continue in our participation of evaluation projects, run by UCL and Wessex.
We will continue to expand our support for carers to reduce risk of package breakdown in light of learning from Covid19 as well as the outcome of our review of respite services. Increased care home HCP We will continue to provide effective infection prevention and control processes across the care Meeting the support sector to reduce risk and spread of infection, including establishment of designated C19 positive needs of site provision. patients with COVID-19 We will ensure we have appropriate operational and financial support package in place to maintain care sector resilience through the winter.
We will continue to manage and reduce outbreaks in care homes reduces mortality, long term health care damage, pressure on the acute sector.
We will support continuity of placement for better resident experience.
16 Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19 Priority Area Tier of Milestone to be achieved NHS England planning Operating & delivery Framework priorities
Post COVID PCN Currently there are long CV19 clinics at PHU. However it is recognised that there will be an impact Meeting the Assessment clinics HCP of physical and MH presentations at Primary Care. PCNs are currently being supported to utilise needs of PSEH the ARRS initiative in order to diversify their clinical response facilities and widen their service patients with ICS base. COVID-19
CV19 triggered and LTCs Respiratory is being mooted as the first test of this model in adaptation. Once the framework of this test, inclusive of measures, milestones and final evaluation is complete the project can be considered for other diagnostic groups.
We will develop further Long COVID model to meet expected increases in demand (including Paediatrics model) and linking into PCNs.
We will review learning from pre Covid LTC hub project and relaunch a programme to deliver a new care model aligned to PCNs.
We will continue with pathway specific projects for diabetes, heart failure and respiratory including review of specialist community services and provision of same day emergency care (SDEC) solutions.
17 Transform the delivery of services, accelerate the restoration of elective and cancer care, manage the increasing demand on mental health services and improvements to maternity care
Recovery of elective services: National Planned Care Priorities: elective, cancer, mental Predominantly delivered through the ICS and via the PSEH health, maternity Partnership, where HCP collaborates to deliver services in line with the footprint for Portsmouth Hospitals University NHS Trust as Increase Maximise Fully restore capacity & Improve part of the Managing Flow workstream. Maximise elective cancer quality in Maternity diagnostics activity activity Mental Services Cancer: Health The national directive is that systems develop plans drawing on advice and analysis from the local Cancer Alliance. The CCG is leading on a local lung cancer screening pilot in collaboration with HCP Planned Care Priorities: elective, cancer, mental Wessex Cancer Alliance and PHU. health, maternity Mental Health: The CCG is an integral part of the Mental Health Board. Local Delivery of projects include the delivery of Positive Minds /Harbour pilot Support Lung improved primary Cancer Strengthening Combined project with Solent. maternity care to screening Primary and Council / care engage in pilot Community CCG Children & Families Mental through the use of A&G (includes strategy for Health PSEH Joint The Portsmouth Children’s Trust partnership is co-ordinating and new targeted children and services Maternity priorities for Children and Family under 6 key strategies intended referral diagnostic families provision Partnership to improve: education outcomes; early help & safe guarding; pathways capacity) Group physical health; social, emotional and mental health; outcomes for PSEH Planned Care Priorities: elective, cancer, mental children in care and care leavers; outcomes for children with Special Educational Needs and Disabilities. health, maternity Maternity: Provide Enable recovery of Increase Delivery of children and Local priorities are delivered by the LMS and overseen by the ICS. cancer and capacity & improved young Priorities for 2021/22 are: Giving people more control over their elective services quality in maternity care people with own health (personalised care, prevention, self-care); addressing and reduce Mental through the PSEH best start in backlog Health Joint Maternity inequalities – impact on access, outcomes and experience; and life Partnership Group Enhanced Safety in Maternity Units (continuing to work towards the recommendations set out in Better Births) 18
Transform the delivery of services, accelerate the restoration of elective and cancer care, manage the increasing demand on mental health services and improvements to maternity care
Priority Area Tier of Milestone to be achieved NHS England planning Operating & Framework delivery priorities Delivery and PSEH We will reduce backlog in elective care through development of co-ordination hubs with system Maximise restoration of ICS partners and better use of independent sector capacity. elective activity, sustainable model of taking full elective, diagnostics We will increase rapid access to consultant opinion for adults and children through expansion of opportunities to and cancer services advice and guidance. transform service delivery We will Increase access to diagnostics through expansion of straight to test pathways and development of Community Diagnostic Hub, working with system partners . Lung Cancer PCN We will deliver the Portsmouth lung cancer screening pilot in conjunction with the Wessex Cancer Restore full screening pilot HCP Alliance, Portsmouth PCNs, PHU and Practice Plus. operation of (includes targeted cancer services diagnostic capacity) We will also use the pilot to promote early bowel screening.
We will review lessons learned from the pilot. and consider how to roll out / secure long term funding. Strengthening PCN We will review and strengthen role of Positive Minds as ‘gateway’ to MH services for primary care. Expand & Primary and HCP improve mental Community (within We will use the PCN DES new MH roles as part of an agreed primary and community pathway. health services & Mental Health HIOW services for framework) services provision for We will deliver a vision and action plan for MH assessment services aligned with CMHF people with a LD Adults ensuring 'no wrong front door' when accessing mental health support and seamless transitions or autism between services based / dependent on need.
We will develop community based alternatives to admission as part of integrated intermediate care offer and ensuring least restrictive and local placements as early as possible
We will continue to support Dementia Friendly City Community Rehabilitation.
19 Transform the delivery of services, accelerate the restoration of elective and cancer care, manage the increasing demand on mental health services and improvements to maternity care
Priority Tier of Milestone to be achieved NHS England Area planning Operating & Framework delivery priorities Improve HCP We will secure strong early attachment in the first 1000 days of life by: Mitigate Social, Remodelling peri-natal mental health support. against digital Emotional Improving ante-natal identification of factors leading to poor attachment. exclusion and Reviewing capacity of Post-Natal Depression support. Mental We will develop high quality advice, guidance and self-help by: Accelerate Health – Through the consultation planned with Parent Board to explore how we could empower parents and carers to preventative Children support their children's wellbeing. programmes & We will improve early help and develop digital solutions by: that engage Families Commissioning Think Ninja for Pandemic related MH support. those at Commissioning Digital Platform for children and young people up to age 18. greatest risk of Promoting the take up of Digital Platform with key services. poor health We will Improve wellbeing and resilience in education by: outcomes Completing MHST demand and capacity modelling - preparing for third team. Recruiting the additional Behaviour Specialists and Digital Communication role in the MHST's. Strengthen Continuing to roll out training and support as part of the Wellbeing for Education Return (post lockdown). leadership and Developing a set of practical resources that can be used in school for pupils, parents and staff. accountability We will improve mental health support for LAC and care leavers by: Reviewing DQ process and embedding of SDQ in care planning. Expand & Reviewing trauma informed training programme. improve Reviewing MH support offer for Children placed out of City. mental health We will improve the support for specific groups of vulnerable children and young people by: services & Reviewing the Conduct Disorder deep dive recommendations. services for Reviewing how we address the emotional health needs of children and young people who identify as LGBTQ +. people with a Identifying what needs to be done to improve access to, experience of and outcomes from mental health services LD or autism for Black, Asian and minority ethnic communities in Portsmouth.
20 Transform the delivery of services, accelerate the restoration of elective and cancer care, manage the increasing demand on mental health services and improvements to maternity care
Priority Tier of Milestone to be achieved NHS England Area planning Operating & Framework delivery priorities Improve HCP We will develop CAMHS services to meet demand by: Expand & Social, Reviewing the CAMHS LD offer with the ambition that this offer is available across all mainstream schools. improve Emotional Expanding the CAMHS Eating Disorder offer to deliver evidence based Eating Disorder service Expand the mental health and CAMHS Eating Disorder offer to deliver evidence based Eating Disorder service. services & Mental We will work to prevent suicide and its impact on children, young people and families by services for Health – Working with schools and schools services to strengthen the offer of complex suicide-specific bereavement people with a Children support for children & young people. LD or autism & Families Delivery PCN We will deliver the action plan that implements outstanding Ockenden recommendations with assurance via Deliver of HCP PSEH Joint Maternity Partnership Group. improvements improved PSEH in maternity maternity Working as part of Local Maternity System, we will progress recommendations set out in Better Births (2016). care, including care responding to We will work with all maternity services to deliver accredited evidence based infant feeding programme (ICS). the recommendati We will ensure every woman is offered a Personalised Care and Support plan by March 2022. ons of the Ockenden review
21 Expanding primary care capacity to improve access, local health outcomes and address health inequalities National Primary Care Priorities Strengthening primary and community care services forms one of the HCP priorities for adult Restoring & Improve health outcomes Increase actions to increasing access address health health and care with the vision that primary and to primary care inequalities community care form the foundation of health services Population health Personalised health and care services on the basis that primary care management care is the populations preferred point of care co- ordination. Principles include ensuring • Primary care is accessible, in person and HCP Primary Care Priorities virtually, and enables access to the broader health & care system and community resources where these are part of the Primary care services restoration Improve health outcomes Address health individual’s care. Primary health & care is inequalities based on inter-disciplinary teams, including Ensuring a safe the person and their family, who work and sustained Population collaboratively towards common goals. Optimising use health Increase transition in of digital See Tackling • Health & care staff are trained to work Primary Care, management: provision of approaches to Health together, encouraged to develop a team spirit maintaining locality preventative triage and Inequalities virtual triage, demonstrator support options and continuously improve their skills and the assessment section self- sites to help people quality of the services they deliver. management manage their own health and and Many of the primary care objectives are delivered strengthening wellbeing MDT working via the PSEH Partnership, where HCP collaborate on primary care and population under PSEH Primary Care Priorities the Place-Based Care Transformation programme, with health outcomes being Improve health outcomes Increase action address health inequalities addressed in the Healthy Communities Restoring & increasing programme. access to primary care Population Establish There is a new HIOW Population Health services health Accelerating Provide a Manage place based PSEH Digital Management Service with two Primary Care management: the roll out of disparities in Personal framework for Inclusion Networks in our geography chosen as the locality access to Network demonstrator health reducing services Population Health Management Demonstrators sites budgets health linked to inequalities sites: Island City PCN and Brunel PCN. ethnicity and deprivation 22 Expanding primary care capacity to improve access, local health outcomes and address health inequalities Priority Area Tier of Milestone to be achieved NHS England planning Operating & delivery Framework priorities Improve population PCN We will participate in HIOW Population Health Management programme as demonstrator site for Implementing health management HCP South East at both place and PCN levels: supporting Island City PCN and Brunel PCN who are population (PHM) approach PSEH Population Health Management Demonstrators. health ICS management & We will use real time data to segment and risk stratify at risk groups including those with complex personalised needs and where health inequalities have been further exposed by Covid. This will include elective care long waiters, access to vaccination and uptake of screening. approaches to improve health outcomes & address health inequalities
Increase provision of PCN We will develop and implement sustainable operating model for Community Helpdesk from April 2021. Implementing preventative support HCP population options to help We will ensuring ongoing delivery and evaluation of the community catalyst/capacity. health people manage their management & own health and We will support the smooth implementation and embedding of the new social prescribing model personalised wellbeing established in April 2021. to ensure integration and closer collaboration with additional planned care investment within PCN’s for care coordinators and health and wellbeing coaches. approaches to improve health We will develop clearer pathways and support between sectors to facilitate greater awareness of and outcomes & appropriate response to mental health issues within the community, facilitating additional early address health intervention through the ongoing work of the Mental Health Alliance. inequalities
We will enable ongoing partnership working with BBI to increase whole system awareness, recognition, and response to reducing social isolation as a pivotal factor in improving health and wellbeing. Project scoping is underway.
We will recognise the role of locality teams as a legacy from Covid-19 with volunteers helping people within their neighbourhood and as a vehicle for engagement and coproduction.
23 Expanding primary care capacity to improve access, local health outcomes and address health inequalities Priority Area Tier of Milestone to be achieved NHS England planning Operating & delivery Framework priorities Prevention and effective PCN We will review learning from pre Covid LTC hub project and relaunch a programme to deliver a Implementing management of long HCP new care model aligned to PCNs. population term conditions (LTC) health management & personalised care approaches to improve health outcomes & address health inequalities
Ensuring a safe and PCN We will support all general practices in maintaining virtual triage and offering both face-to-face a Restoring & sustained transition in HCP and digital appointments where clinically appropriate. increasing Primary Care, access to maintaining virtual We will continue to strengthen MDT working through continued development inter-disciplinary primary care triage, self-management teams. services and strengthening MDT working Primary care network PCN We will support ongoing PCN recruitment to additional roles. Restoring & (PCN) development and HCP We will complete the strategic plan for supporting primary care resilience and sustainability. increasing integrated locality teams We will review and redefine the neighbourhood model programme within P3, based on the access to one team approach across primary, community health and social care. primary care services Making every contact PCN We are continuing to develop closer working arrangements with public health and housing Develop local count HCP colleagues as part of the H&C Portsmouth operating model. priorities that reflect local We are supporting the refreshing of the City Health and Well Being Strategy and aligning circumstances priorities within the adults plan. & health inequalities We complete analysis of demand in conjunction with public health through the helpdesk CRM to ensure pathways and commissioning strategy align with needs. 24 Transforming community and urgent and emergency care
National Community, Urgent & Emergency Care Priorities The Secondary, Acute and Specialist Care Strategy forms part of the Health & Care Portsmouth’s Adults Plan, with the aim of Ensuring the use of Transforming community Timely admission to designing and delivering hospital and NHS111 as the primary services & improve hospital if required specialist care that has the whole person in discharge route to access urgent care mind, respecting people’s preferences and integrating physical, emotional, mental and social health. HCP Community, Urgent & Emergency Care Priorities Many of the of the emergency care objectives are delivered via the PSEH Partnership, where HCP collaborate on Support to Long Term urgent care under the Managing Flow Development Developing Strengthening Condition Transformation programme to mobilise the of the market rehab and Personalised the role of Pathways to to increase reablement Integrated Urgent Care model (further care planning the VCS in minimise care and strategies to developing NHS 111 service as primary service emergency support support maximise delivery attendances urgent care access route, including access options across independence to paediatrics and into UTCs and SDEC the City and admissions services) and supporting more people to be cared for safely at home.
PSEH Community, Urgent & Emergency Care Priorities
Ensuring the use of Transforming community Timely admission to NHS111 as the primary services & improve hospital if required discharge route to access urgent care
25 Transforming community and urgent and emergency care
Priority Area Tier of Milestone to be achieved NHS England planning Operating & Framework delivery priorities Development of the PCN We will implement the findings of the domiciliary care intervention review. Transforming market to increase HCP community care and support We are continuing to explore and develop opportunities to increase use of assisted technology to services & options across the City support domiciliary care packages. improve discharge Personalised care PCN We will review ECR processes with a view to align with integrated CHC governance arrangements Transforming planning support HCP with a new processes and delivery model being fully operational from April 2021. community PSEH services & We will continue with ongoing work to increase use of future and advanced care planning, improve including sharing of information and templates, ongoing training and monitoring and evaluation being discharge key work stream elements. Strengthening the PCN We complete the strategic partnership MOA with the HIVE. Transforming role of the VCS in HCP community service delivery We will continue to involve HIVE Portsmouth within PPP and the Strategic Partnership Group to services & ensure VCS contribution to new models of care on a whole system basis. improve discharge We will review of existing VCS commissioning and contracting arrangements from April 2021to promote co-production of services with end users. Developing rehab PCN We will support the continued restoration of community specialist services, implementing patient Transforming and reablement HCP initiated follow-ups where appropriate. community strategies to PSEH We will complete the review of sensory services intervention. services & maximise We will review respite services for people with LD. improve independence discharge Support to Long Term PCN We will review of Portsmouth CAS model and capacity to effectively deliver NHS 111 first, ensure Ensuring the Condition Pathways to HCP there is a shared business continuity plan across PSEH. use of minimise emergency PSEH NHS111 as attendances and We will continue with ongoing pathway specific projects for diabetes, heart failure and respiratory the primary admissions including review of specialist community services and provision of same day emergency care route to (SDEC) solutions. access urgent care We will support the reduction in conveyances to acute hospital as part of ICP admission avoidance and frailty work programmes. 26 Working collaboratively across systems to deliver on these priorities
As HIOW ICS we believe we are well placed to deliver the ambitions of the recently published white paper. Place based partnership working around local authority boundaries, as well as around acute hospital footprints is well established and at the heart of the HIOW long term planning.
With an appropriately broad vision of health and wellbeing, a commitment to reducing health inequalities, and a skilled and sensitive operation of local determination in accordance with the principles of subsidiarity, it will be possible to balance wider system requirements with the needs of the local population. This is informed by our experiences of working within the ICP and the ICS and the benefits this can bring.
Significant work has started to develop around the subsidiarity model, with consideration of the “footprints” at which we will be working and the further development of placed based partnership arrangements in line with the White Paper.
In November 2020 Portsmouth CCG made a decision to remain as a statutory organisation, but has changed its constitution to move to a shared Accountable Officer with Hampshire Southampton and Isle of Wight CCG and the ICS. Portsmouth CCG Board has authorised the Chief Executive of the council, to be the Executive lead for Health and Care Portsmouth with delegated responsibility to lead a shared executive team, and a remit to continue to secure deeper integration of council and health services across the wider health and care system, whilst supporting the Accountable Officer in her leadership of the developing ICS.
27 Working collaboratively across systems to deliver on these priorities. The council’s Chief Executive is authorised to act on behalf of the CCG to develop the best arrangements for delivering this. This includes the remit to form an embedded executive team comprising of the statutory council functions of the Director of Adult Social Services, Director of Children’s Services, Director of Public Health, and Clinical Leader (NHS post), Director of Health and Care Portsmouth (NHS post) and Director of Finance (NHS post),
The Portsmouth Health and Wellbeing Board continues to be a statutory requirement, with a role to take an overview of local services. The board has oversight of all commissioning that are the responsibilities of the CCG and council (in relation to its health and care functions across children’s, adults and public health functions).
The CCG Quality and Safeguarding Committee (QSC) assures the Governing Board that the services the CCG commissions on behalf of the people of Portsmouth are safe, of high quality and that any quality concerns and risks are monitored and managed effectively. The QSC reviews quality exceptions, risks relating to commissioned services (including GP practices), directing and mandating the Quality and Safeguarding team to undertake further actions to ensure required improvements are made, risks are mitigated and progress is evidenced. The committee ensures exceptions and risks are formally escalated to the Governing Board where it deems necessary. Additionally the committee receives annual updates on children and adults continuing healthcare, Transforming Care, Mental Capacity Act and Prevent agendas.
28 Working collaboratively across systems to deliver on these priorities. The city also has a thriving provider alliance arrangement through the Portsmouth Provider Partnership(P3) which has been, and continues to be an important vehicle to improve provision of community care within Portsmouth, and transformational activities have progressed well since the establishment of the partnership. The Portsmouth Provider Partnership Programme (P3 Programme) will be a key building block in the foundation of the HIOW Integrated Care System (ICS) and the Portsmouth & South East Hants Integrated Care Partnership (ICP).
Working as active partner of the PSEH Strategic leadership team to progress and deliver shared priorities based on current work programme and achievements in line with agreed timeframes and in line with national guidance, in the PSEH system we will come together where it makes sense to do so PSEH and adds value, to deliver the agreed set of priorities Programme that will improve health and care for our local Group population.
PSEH has established three transformation Managing Place-Based Healthy programmes to drive, enable, support, be accountable Flow Care Communities for and deliver the priorities over the next 6 months to ensure we can restore and recover, whilst transforming •Managing •Managing •Keeping the way we provide services, accelerate delivery and acute need? ongoing need? people well? start to look ahead to achieving the Long Term Plan commitments.
29 Portsmouth CCG: Workforce, Finance, Activity and Performance
Workforce information is being collated and submitted at an ICS level with the CCG awaiting a copy of the draft submission being made on its behalf
30 Portsmouth CCG: Workforce, Finance, Activity and Performance
The ICS is planning to deliver a breakeven position across Value (£m) H1 2021/22 with deficits across Isle of Wight and Solent NHS Trusts being offset by surpluses delivered across HDP excluded from Organisation Surplus / (Deficit) position Portsmouth and HSIOW CCGs
In the absence of operational guidance around scheme 3 Solent (1.5) 1.0 of the Hospital Discharge Programme (HDP) the costs have been excluded from the CCG plan with the IOW (3.0) 1.4 expectation of national funding to cover. Failure to receive full funding poses a significant financial risk. UHS 0.0 0.0
PHU (0.0) 0.0 The CCG plan included SDF funding of £1.9m to deliver national objectives as well as £0.8m anticipated Elective HHFT (0.0) 0.0 Recovery Fund income linked to planned Independent Sector activity levels. Southern 0.0 3.2 Successful delivery of the plan relies on stringent control SCAS (0.0) 0.0 over prescribing growth and the cost of continuing Provider Total (4.6) 5.6 healthcare costs across the system.
HSIOW 2.9 28.2
Portsmouth 1.7 3.1 CCG Total 4.6 31.2 Total 0.0 36.8
31 Portsmouth CCG: Workforce, Finance, Activity and Performance
The CCG is required to commit a minimum investment of 3.75% or £1.6m into Mental Health services in 2021/22 to meet the Mental Health Investment Standard (MHIS)
Current plans meet the standard through the application of 0.5% growth funding applied across NHS contracts, the creation of a 1.27% pay uplift reserve in addition to agreed service development investments.
National Service Review (SR) and Service Development Funding (SDF) has also been allocated to the CCG to enable the required service transformations and developments. Value (£000's) SDF & SR 21/22 Value (£000's) Portsmouth 20/21 MHIS Outturn 42,794 HIOW ICS CCG Growth (0.5%) 95 SDF: Adult Mental Health Community (AMH Community) 0 3,290 Pay Reserve (1.27%) 362 SDF: Adult Mental Health Crisis (AMH Crisis) 0 852
CAMHS Eating Disorders 209 SDF: 18-25 young adults (18-25) 77 0 SDF: CYP community and crisis 259 0 CAMHS Neuro-Diversity investment 160 SDF: MHST 19/20 sites wave 1&2 (MHST19/20) 736 0 Perinatal Service 88 SDF: MHST 20/21 sites wave 3&4 (MHST20/21) 255 0
Adult MH Liaison 344 SDF: Rough Sleeping 19/20 and 20/21 Sites 299 0 SR: Children & Young People's Eating Disorders Paediatric Psychiatric Liaison 81 (CYPED) 46 0
21/22 Positive Minds Business Case Investment 267 SR: CYP community and crisis 174 0 SR: Discharge 336 0 CCG Total MHIS Plan 21/22 44,400
Minimum Requirement 44,399 CCG Total MHIS Plan 21/22 2,182 4,142
32 Portsmouth CCG: Workforce, Finance, Activity and Performance
Elective Activity: PHU have committed to deliver the required levels of activity for April - September. Productivity constraints, the ongoing challenges in re-establishing affected services and workforce recovery have all been taken into account and the requirements of achieving 70% of 2019/20 activity levels in April, 75% for May, 80% for June and 85% from July to September 2021 will be met. This will be for elective activity (ordinary and day case), including cancer; outpatient procedures; and outpatient attendances.
Cancer: It is intended that the cancer standards are maintained with the exception of April. Planned achievement for the remainder of the year is expected to achieve noting the risks associated with potential demand fluctuations / increases stretching limited capacity
Non-Elective: Planned NEL demand for 21/22 is in line with 2019/20 actuals as per the planning guidance. This will need to be managed through system working to ensure no growth above this level to maintain flow. COVID has been set to 5% of NEL 1+ Day LOS again based on planning guidance, currently this does not align to PSEH ICS modelled COVID scenarios.
2021/22 Activity: Portsmouth Hospitals University NHS Trust Timeline Metric Total Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 E.M.8 Consultant-led first outpatient attendances (Specific acute) 157,382 24,975 23,747 27,479 27,464 26,237 27,480 E.M.9 Consultant-led follow-up outpatient attendances (Specific acute) 181,231 28,763 27,325 31,644 31,650 30,207 31,642 E.M.10a Elective day case spells 30,369 4,686 4,765 5,507 5,356 4,648 5,407 E.M.10b Elective ordinary spells 4,412 557 743 848 800 651 813 E.M.11c Non-elective spells with a length of stay of zero days 13,570 2,178 2,270 2,277 2,258 2,298 2,289 E.M.11b Non-elective spells with a length of stay of 1 or more days 21,287 3,339 3,639 3,590 3,561 3,623 3,535
E.B.30 Urgent Cancer Referrals 12,953 2,307 2,097 1,975 2,351 2,130 2,093 E.B.31 Cancer treatment volumes 1,838 307 294 288 353 272 324
33 Portsmouth CCG: Workforce, Finance, Activity and Performance
Diagnostic Activity: Recovery plans in place to restore the 6-week standard, which are being reviewed alongside the elective recovery plans (associated risk with the increase in elective activity) Delivering a level of diagnostic activity that supports elective recovery and looking to maximise the use of Community Diagnostic Hubs
2021/22 Activity: Portsmouth Hospitals University NHS Trust Timeline Metric Total Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 E.B.26a Diagnostic Tests - Magnetic Resonance Imaging 14,247 2,379 2,468 2,409 2,497 2,115 2,379 E.B.26b Diagnostic Tests - Computed Tomography 25,998 4,293 4,472 4,386 4,544 4,012 4,291 E.B.26c Diagnostic Tests - Non-Obstetric Ultrasound 24,200 3,996 4,163 4,083 4,230 3,734 3,994 E.B.26d Diagnostic Tests - Colonoscopy 1,332 220 229 225 233 205 220 E.B.26e Diagnostic Tests - Flexi Sigmoidoscopy 1,097 181 189 185 192 169 181 E.B.26f Diagnostic Tests - Gastroscopy 3,476 574 598 586 608 536 574 E.B.26g Diagnostic Tests - Cardiology - Echocardiography 6,530 1,078 1,123 1,102 1,141 1,008 1,078
34 Portsmouth CCG: Workforce, Finance, Activity and Performance
The CCG activity plan is derived from agreed provider plans, including primary targets that make progress against the expectation that more general practice appointments will be available by 2024.
The summary of Portsmouth CCG activity shown below:
2021/22 Activity: CCG level metrics Timeline Metric Total Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 E.M.8 Consultant-led first outpatient attendances (Specific acute) 44,558 7,133 6,803 7,769 7,828 7,352 7,673 E.M.9 Consultant-led follow-up outpatient attendances (Specific acute) 47,990 7,598 7,367 8,461 8,283 7,913 8,368 E.M.10a Elective day case spells 7,608 1,164 1,190 1,415 1,373 1,120 1,346 E.M.10b Elective ordinary spells 308 41 50 61 59 45 52 E.M.11c Non-elective spells with a length of stay of zero days 334 54 57 55 54 56 58 E.M.11b Non-elective spells with a length of stay of 1 or more days 7,133 1,120 1,241 1,158 1,168 1,196 1,250 E.B.30 Urgent Cancer Referrals 4,802 769 816 759 883 814 761 E.B.31 Cancer treatment volumes 519 81 87 88 94 80 89 E.D.19 Appointments in General Practice 510,341 85,293 89,883 81,645 90,274 77,664 85,582 2021/22 Activity: CCG level metrics Timeline Metric Total Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 E.B.26a Diagnostic Tests - Magnetic Resonance Imaging 5,535 912 967 855 1,007 885 909 E.B.26b Diagnostic Tests - Computed Tomography 8,684 1,443 1,485 1,418 1,540 1,347 1,451 E.B.26c Diagnostic Tests - Non-Obstetric Ultrasound 10,374 1,774 1,869 1,775 1,899 1,453 1,604 E.B.26d Diagnostic Tests - Colonoscopy 857 139 143 149 138 128 160 E.B.26e Diagnostic Tests - Flexi Sigmoidoscopy 419 73 85 71 69 57 64 E.B.26f Diagnostic Tests - Gastroscopy 1,929 322 329 319 338 298 323 E.B.26g Diagnostic Tests - Cardiology - Echocardiography 2,346 386 417 374 439 360 370
35 Portsmouth CCG: Workforce, Finance, Activity and Performance
Performance targets have been set in line with the national expectations including: • Agreements with SCAS & PHU to maximise the utilisation of direct referral from NHS 111 to other hospital services (including SDEC and specialty hot clinics) and implement referral pathways from NHS 111 to urgent community and mental health services; • Agreement with community providers to minimise the reliance on inpatient care for both adults and children with a learning disability, autism or both • Agreement with GPs to increase the number of annual health checks for people with a learning disability • Agreement with PCC and community providers to accelerate the delivery of personal health budgets, social prescribing referrals and personalised care and support plans • Agreement with PCC to continue delivery of the 2-hour crisis community health response at home providing consistent cover (8am-8pm, seven days a week) by April 2022
2021/22 Performance: CCG level metrics
Timeline Metric Total Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Urgent Cancer Referrals: Numbers of patients seen in a first outpatient E.B.30 4,802 769 816 759 883 814 761 appointment following urgent referrals Cancer treatment volumes: Number of patients receiving first definitive treatment E.B.31 519 81 87 88 94 80 89 following a diagnosis (decision to treat) within 31 days, for all cancers Appointments in General Practice: Planned number of General Practice E.D.19 510,341 85,293 89,883 81,645 90,274 77,664 85,582 appointments NHS 111 Referrals to SDEC (as an alternative to ED): % of calls where an E.M.28 11% 11% 11% 11% 11% 11% 11% SDEC service was an option for referral Numerator 130 15 15 14 26 25 35
Denominator 1,170 136 131 127 231 229 316
36 Portsmouth CCG: Workforce, Finance, Activity and Performance
Timeline Metric Total Q1 Q2 Q3 Q4
E.K.1 Reliance on inpatient care for people with a learning disability and/or autism: The number of adults aged 18 and over from the CCG who are autistic, have a E.K.1a learning disability or both and who are in inpatient care for a mental disorder and 2 2 2 2 whose bed is commissioned by a CCG The number of adults aged 18 or over from the CCG who are autistic, have a E.K.1b learning disability or both and who are in inpatient care for a mental disorder and 2 2 2 2 whose bed is commissioned by NHS England or via a Provider Collaborative The number of children aged under 18 years from the CCG who are autistic, have a learning disability or both and are in inpatient care for the treatment of a E.K.1c 0 0 0 0 mental disorder and whose bed is commissioned by NHS England or via a Provider Collaborative.
AHCs delivered by GPs for patients on the Learning Disability Register: The E.K.3 number of people on GP Learning Disability Registers who will receive an Annual 70% 5% 7% 18% 40% Health Check during the quarter
Numerator 807 58 80 208 461
Denominator 1,153 1,153 1,153 1,153 1,153 Personal Health Budget: Number of personal health budgets that have been in E.N.1 646 106 141 183 216 place, at any point during the financial year to date Social Prescribing Referral: Total number of social prescribing referrals in year E.N.2C 2,604 413 651 651 889 into social prescribing link workers Personalised Care and Support Planning: Total number of active (new and E.N.3 2,269 354 590 604 722 reviewed) PCSPs that have been in place in the financial year to date 2 hour urgent community response: number of 2 hour crisis response first care E.T.1a 1,120 280 280 280 280 contacts delivered within reporting quarter
37 Potential risks associated with delivery of priorities
Risk Area Risks
New ways of • The direction of travel regarding the future of ICS’ may create uncertainty within Portsmouth CCG and working & Health & Care Portsmouth creating distraction from the delivery of priorities particularly if leading to higher uncertainty about turnover of staff being there is not a critical mass of staff to undertake the work. the future • New ways of working and changed inter-organisational relationships may contribute to a slower pace of delivery as new arrangements take time to embed. These risks will be managed through staff engagement and communication. Patient • Long term impact of reduced screening leads to late diagnosis. experience & • Increased waiting times for elective treatment could contribute to worsening outcomes for patients. declining clinical • Exacerbation of conditions could contribute to additional pressures within primary and community services. outcomes • A lack of evidence to understand the long-term service needs of patient needs arising from long-COVID. These risks will be managed through the CCG Quality and Safeguarding Committee (QSC), and mitigated by close management of waiting lists across the system, clinical review of long waiting patients and collaborative working with providers to ensure the appropriate use of all available capacity. • Digital inequalities increase as we become virtual in our approach. This risk will be mitigated by the establishment of a the PSEH Digital Inclusion Network. Delivery • External pressure to increase throughput may create tensions across the system that filters down into patient and staff experience. • Further spikes in COVID infections will impact on urgent care services and may reduce capacity for elective care services. These risks will be managed by the continuation of close system working and the local resilience forums. Successful delivery of the vaccine programme is dependent on surety of supply. This risk will be managed nationally.
38 Potential risks associated with delivery of priorities
Risk Area Risks
Digital & Data • Failure to maximise benefits of SystmOne (single care record) reduces opportunities for closer working across the city and further afield • Reliance on HIOW delivering the Population Health Management tool may mean HCP priorities or timelines not achieved • Investment requirements potentially exceed funding • Increasing expectations around the use of business intelligence to inform decision making exceeds capacity and capability of systems and staff These risks will be managed through the PSEH IM&T service and the HIOW PHM Cell. Workforce • Staff recruitment and retention particularly in terms of ensuring sustainable teams in primary care and the CCG. • Staff continue to recover from effects the pandemic (physical and mental) requiring additional support to minimise absence and turnover. These risks will be mitigated by the actions described in on slides 12-14. Finance • Transformational change may not release the resource required for reinvestment into the system making them unaffordable. • Lack of clarity from the government on funding streams in advance of committing expenditure to discharge and restoration & recovery programmes may create unintended cost pressures. • Inability to deliver activity due to physical, financial (revenue and capital) or staffing constraints may result in penalties being applied to contingent funding streams. • Financial pressures across the ICS may require local investment plans to be delayed or revised to deliver a balanced ICS position. These risks will be mitigated by the continuation of strong fiscal management which has enabled the CCG to deliver its financial plans and through close system working spearheaded by the Directors of Finance
39 Appendices
Page No.
Appendix 1: Health and Care Portsmouth Commitments 41
Appendix 2: Health and Care Portsmouth Strategic Priorities 43
Appendix 3: Portsmouth and South East Hampshire Integrated Care Partnership Transformation Programme 51
Appendix 4: Hampshire and Isle of Wight ICS priorities 55
Appendix 5: Glossary 56
40 Appendix 1: Health and Care Portsmouth Commitments
41 Health and Care Portsmouth Commitments
The 9 commitments of the Health and Care blue print are: 1. We work continuously to improve the quality of health & care in Portsmouth, for all individuals and communities, visibly demonstrating how the diversity of local communities is reflected in the work. 2. We build our health and care service on the foundation of primary and community care, recognising that people have consistently told us they value primary care as generalists and their preferred point of care co-ordination; we continue to improve access to primary care services when people require it on an urgent basis. 3. We underpin this with a programme of work that supports the individual to maintain good health and prevent ill health. We strengthen the support for local peoples’ health and care from both statutory and community organisations so that people become more resilient and know how to access community services when needed. 4. We bring together important functions that allow our organisations to deliver more effective community based front-line services and preventative strategies; this includes functions such as HR, Estates, IT and other technical support services. 5. We are committed to having a well led, well organised, highly professional and engaged workforce that uses data well to inform services and care and continuously learns from frontline practice. 6. We establish a new constitutional way of working to enable statutory functions of public bodies in the City to act as one and to improve local people’s involvement and influence in health & care in the city. This includes establishing a single commissioning function at the level of the current Health & Wellbeing Board with delegated authority for the totality of health (NHS) and social care budgets. 7. We establish improved and integrated ways of delivering health and care services for the City. This will be achieved through a range of ways including the formal integration of some services. For local people this will mean they do not have to experience multiple assessments, will be offered choices about how they are treated, be offered opportunities to explain what is most important to them and be referred more straightforwardly to the services they need. 8. We simplify the current configuration of urgent, emergency and out of hours services, making what is offered out of hours and weekends consistent with the service offered in-hours on weekdays so that people have clear choices regardless of the day or time 9. We focus on building capacity and resources at a local level and in communities in the City to enable them to commission and deliver services at a locality level within a framework set by the city-wide Health & Wellbeing Board.
42 Appendix 2: Health and Care Portsmouth Strategic Priorities
43 Health and Care Portsmouth Strategic Priorities
Public Health
Reduce unwanted Promote positive pregnancies by mental wellbeing increasing access across Portsmouth Reduce the to Long-Acting and reduce suicide prevalence of Reversible and self-harm in Reduce the harm smoking, including Work with Council Contraception the city by Reduce the harms caused by smoking in partners to address (LARC) in general delivering the from physical substance misuse pregnancy, across the health impacts practice, maternity actions within inactivity and poor including alcohol the city working of the built and abortion Portsmouth’s diet misuse with partners to environment pathways, and Suicide Prevention ensure sustained strengthening Plan (2018-21) and system wide action LARC pathways the STP Suicide with vulnerable Prevention Plan groups (2019-20)
Work with Council partners to improve the wider Address health inequalities Continue to lead the determinants of health by with targeted attention on Strengthen the intelligence response to the COVID-19 improving educational those that have the greatest function for the Council and pandemic focusing on public attainment, employment need and are more likely to Portsmouth Health and health advice to the council, opportunities, housing, experience serious Care Partnership partners and our residents. transport, planning and the consequences of COVID-19 built and natural environment
44 Health and Care Portsmouth Strategic Priorities
Children & Families
Improve education outcomes
Recruit and Inclusion – retain COVID-19 Enabling Digital Literacy and secure Promoting teachers – School learning – language – Ensuring good child Improving more Ensuring we schools – attendance Sufficient children with Access to Developing Ensuring high quality mental results at all have – Reducing school SND to digital key skills for schools are safeguardin wellbeing Key Stages sufficient school places attend learning for learning in safe places g of children through teaching absence mainstream all children all children capacity and for children schools schools quality and staff
Improve early help and safeguarding
Joint Delivering a Ensuring that Using our Meeting children’s Tackling Reducing high quality children Reducing Ensuring high data to child and and adult’s criminal the Solent experiencing youth crime quality front- identify risk family services and sexual prevalence Reducing NHS/City harm are and anti- line and harm need at working to exploitation and impact neglect Council identified and social safeguarding and an early keep of of domestic early help appropriately behaviour practice respond point families adolescents abuse service referred accordingly safe
45 Health and Care Portsmouth Strategic Priorities
Children & Families
Physical Health
Ensuring effective care Reducing across Reduce sexually Improving local primary, acute childhood Increase Reducing transmitted Promoting Deliver the uptake of and obesity & later physical harmful use of diseases and breastfeeding Better Births immunisations community poor health activity substances teenage & vaccinations health services outcomes conceptions across long- term condition pathways
Social, Emotional Mental Health
Other vulnerable Reducing Enabling all Making groups of Achieving Enabling New ways of Mental CAMHS professional On-line schools children – Whole- secure children to identifying health waiting Care for s to work support for positive including system carer-child care for their and support for times and children confidently children and spaces for young working to attachments own responding our children further experiencing with young children’s carers, prevent in the first emotional to neuro- in care and improving loss emotional people mental young suicide 1000 days health diversity care leavers offenders treatment distress health outcomes and self- harmers
46 Health and Care Portsmouth Strategic Priorities
Children & Families
Looked After Children and Care Leavers
Ensuring right Enabling Improving level and quality of Co-located children to Provide progress, Physical and foster care and multi-agency develop and High quality children with attainment mental health Transform residential care sustain child-level and inclusion – including care leavers and multi- placements stability and disciplinary positive family plans continuity of in education, regular health offer including working and friend care employment checks accommodation relationships and training for care leavers
Special Educational Needs and Disabilities
Inclusive Inclusion of schools for children with Autism and Developing Comprehensive Working with children with SEMH needs – Achieving the neurodiversity – front-line and alignment families and SEND and with a focus on Preparing for autism-friendly practice with commissioning young people to reducing reducing Adulthood services and children with of SEND co-design demand for out exclusions and outcomes improving SEND and their services support of city demand for support families placements alternative provision
The Portsmouth Excellent Workforce: Performance and Community A 'deal' with Model of Family leadership development, Quality capacity building: parents: a social Practice: restorative restorative organisations and Management: using enabling the contract with and relational high quality professional data well and community and the families and co- Practice which is development - training and learning from front- voluntary sector to production trauma-informed coaching line practice meet need and whole-family
47 Health and Care Portsmouth Priorities 2021/22
Adults
Personalisation of care and support Improving health and well-being and strengthening our communities
Development of the Increase provision of market to increase Strengthening the role preventative support Improve population Personalised care of VCS in service care and support health management options to help people options across the planning support: E- delivery: Strategic manage their own Making every contact (PHM) approach City: Domiciliary care; care planning; partnership with the health and wellbeing count: closer working (HIOW procurement assisted technology; Improved HIVE & Review of Community with public health and of a PHM tool to Day services management of ECR existing development and housing teams support risk developments; processes, commissioned capacity building, stratification) Increase supported services Strategic review of living opportunities social prescribing
48 Health and Care Portsmouth Strategic Priorities
Adults
Strengthening primary and community care services Supporting vulnerable people through the prevention and management of long-term conditions
Provision of Ongoing Provision of support to support to those support to people with a people people in care learning Review of classified as homes and Prevention and disability in line Primary care Integrated health and care clinically within the wider effective with the network (PCN) intermediate bed based vulnerable care sector: management of Transforming development care to reduce Support for services to including those Effective long term Care agenda: and integrated hospital carers: understand from BAME infection conditions: Identification of locality teams: admissions: Reducing number and communities: prevention and Long term people on GP Primary care Strengthening breakdown of type of Proactive control; Care conditions hub registers and resilience and admission support community delivery of flu sector development & annual health development of avoidance and packages due beds required vaccination resilience; Pathway checks new roles & home first to carer stress eg step-up /D2A programme to Enhanced care specific completed; neighbourhood approach (role /rehab and re- meet targets & home service developments Review of model of PRRT /CIS); ablement Local Delivery implementation; eg respiratory respite services; of Covid Reduced Pathway review vaccination conveyance to of ADHD and programme acute hospital autism pathways
49 Health and Care Portsmouth Strategic Priorities
Adults
Improving access to acute /secondary or specialist services Improving access to mental health services at all stages of the pathway;
Transforming urgent and elective care (TrUE) services in Delivery of the NHS 111 First community and Same programme Improving Day Dementia delivery: Increase well-being, well-being Timely access Emergency pathway: Simplify and Care resilience of access to through to secondary Delivery and strengthening increase solutions: specialist community increased care Crisis service restoration of support for resilience of Strengthen services: support, access to provision: response: ED sustainable carers; community provision of Review of primary MH community Increase redirection & model of integration based urgent CAS as specialist services, based therapeutic section 136 elective and with physical care services gateway to palliative care secondary support: activity for place of cancer health as an primary and services & care and Strengthening those on safety services services, alternative to community critical care planned and role of CMHT delirium ED; services to review crisis services Positive caseload pathway Strengthen reduce Minds out of conveyance; hospital, Frailty hub community developments based elective and diagnostic services
50 Appendix 3: Portsmouth and South East Hampshire Integrated Care Partnership Transformation Programme
51 PSEH ICP OPERATING PLAN 2021/22: Managing Flow
Enable recovery of cancer and elective services and reduce Manage expected increases in mental health Improve end to end urgent care flow and ensure people are backlog demand treated in the right place and without delay
In 2021/22, we will:
• Reduce backlog in elective care through development of • Continue to expand transform community mental • Continue to mobilise our Integrated Urgent Care model to further co-ordination hubs with system partners and better use of health offer in line with national framework and develop NHS 111 service as primary urgent care access route, independent sector capacity . delivery of mental health investment standards including access to paediatrics and into UTCs and SDEC • Give patients more control over their care through focusing on services expansion of patient-initiated follow-ups including roll-out • Review of crisis pathway with focus on developing • Improve referral pathways from NHS 111 to urgent, community of My Medical Records. integrated delivery model across PSEH and mental health services • Increase rapid access to consultant opinion for adults and • Recruit and development mental health practitioner • Complete transition of our Minor Injury Units to Urgent Treatment children through expansion of advice and guidance roles in each PCN as part of wider delivery team Centres in Gosport and Petersfield • Increase access to diagnostics through expansion of • Review and embed new ways of accessing • Adopt a consistent and expanded model of SDEC provision, straight to test pathways and development of Community services and support, building on lessons from including acute frailty services Diagnostic Hub, working with system partners COVID response • Ensure sufficient capacity to capacity to support enhanced • Work with Wessex Cancer Alliance to resume screening • Ensure IAPT capacity is available to meet local management of complex respiratory illness (including COVID) programme activity levels and streamline process for need,, including additional impact of long COVID • Deliver Medical Village to allow management of SDEC, Acute surveillance screening working with independent sector • Mobilise increase CAMHS capacity in Eating Medicine and Medical Short Stay within one single location to • Improve access to endoscopy across all providers Disorders, core CAMHS and community mental support faster and more effective management of medical • Target work to address inequalities in access, outcomes health crisis offer patients and experience for key groups ( bottom 20% IMD and • Mobilise Close to Home teams as part of Provider • Deliver MOFD programme to ensure discharge delays are ethnic minorities) Collaborative for Tier 4 pathways (CYP) minimised, fully implement Criteria to Reside and improve 7 day • Fully implement CAMHS liaison service at QAH flow • Ensure preparedness for future COVID waves and winter planning across all partners
What difference will this make in PSEH?
• Elective activity will be restored to 2019/20 levels with • More capacity to meet increased levels of demand • More people will receive advice and support at home/ in corresponding reduction in waiting lists for mental health support in adults and children community Fewer clinically unwarranted urgent care attendances • Fewer people waiting longer than 62 days for cancer • Improved access and reduced waits to access (ED, SCAS and UTCs) through increased use of CAS and treatment (equivalent to Feb 20 levels) community mental health support, including crisis referrals to SDEC services • More people will be treated without onward referral response (adults and children) • 70% of referrals to ED via NHS 111 receive booked time slots • Shortfall in number of first treatments will be addressed • Fewer people waiting for specialist CAMHS teams • Fewer delays for patients attending ED (consistent reduction in through increased level of referral and treatment by Mar 22 • Increased numbers of children supported by ambulance handover delays, time from referral to speciality) • Faster Diagnosis standards will be met from Q3 Mental Health Support Teams in schools across • Reduction in ALOS with focus on 14 and 21 day plus LOS PSEH • Fewer delays for patients on discharge (MOFD 50; BDL <150) • More people with SMI receiving health checks
Link to NHS England Operating Framework priorities
C1 Accelerate restoration of elective activity C3 Manage increasing demand on mental health services E2 Ensure use of NHS 111 as primary route into all urgent care C2 Restore full operation of cancer services services E2 Timely admission of patients who require it from ED departments
52 PSEH ICP OPERATING PLAN 2021/22: Place Based Care
Continue to support people with (or at risk Deliver greater join-up of primary Improve proactive management of health and care to Support more people to be cared for of) COVID in the community and community care prevent crisis safely at home
In 2021/22, we will:
• Complete COVID vaccination of all adults • Progress PCN development and • Further develop Integrated Care Teams to provide • Further develop and socialise Urgent and plan for revaccination from Autumn, drive stronger integration with proactive and personalised care to vulnerable Community Response model to including children’s programme if agreed community based services to patients and those with complex need provide 7 day 8-8 delivery by Apr • Maximise uptake in flu vaccination for improve access and resilience • Extend/Adapt Virtual Ward model to support other 2022 target groups and look for opportunities to • Return practice appointments to LTCs with initial focus on respiratory • Optimise links between UCR and join up flu/COVID vax programmes to pre-pandemic levels and review • Fully implement Enhanced Care Home Teams and other urgent care services, including increase reach total triage model in primary care; enhance specialist community nursing to improve SCAS • Take targeted actions to address • Improve support for General LTC management • Enhance referrals to Reablement inequalities in vaccine access/uptake for Practices resilience (including • Use population health management tools to risk Care and other community services key groups PCN at scale working , join up with stratify and identify patients to benefit from tailored to support patients recovery post • Extend Oximetry at Home and COVID other services and workforce support intermediate care virtual ward models to manage ongoing wellbeing) • Tackle backlog of LTC management reviews, • Further develop 7 day Home First demand as required • Improve care home resilience screening and routine vaccinations, including response to enable more patients to • Further develop Long COVID model to • Roll-out digital maternity notes targeted work with families who have not attended be discharged safely to home meet expected increases in demand across primary care, health visiting for primary vaccinations • Optimise capacity in home (P1) and (including Paediatrics model) and linking and wider LMS • Ensure GP Learning Disability registers are up to bed based care (P2/P3) to enable into PCNs • Work with VCSE services to target date and increase delivery of annual health checks, increased ‘Home First’ response and • Expand general practice capacity to CYP mental health issues (post- including 14-25 year olds more flexible, efficient bed-based support the ongoing C19 response, COVID) • Improve service for people with LD in line with HIOW model tackles the backlog of care and delivery • Engage with HIOW strategy for TCP programme • Embed ‘Discharge to Assess’ of the vaccination programme primary care based CYP primary • Reduce backlog and improve support post diagnostic principles across all pathways • Implement mutual aid/surge capacity care champions support in Autism Diagnostic Service • Implement Community Services plans across bed-based and home-based • Implement 100% of actions LeDeR reviews Dataset (CSDS) care to aid management of future COVID waves
What difference will this make in PSEH?
• Increased proportion of population • Restored access to primary care • Increased uptake of annual health checks for • Increased numbers of people in crisis vaccinated leading to fewer avoidable with balance of virtual/F2F digital people with LD/Autism and improved access to supported at home (preventing hospitalisation (targeting inequalities) access support admission and delivery of 2h /2d • More people with COVID are supported • Reduction in backlog of care and • Improved support for people with LTC and/or response standard) to be managed at home with access to improved service resilience frailty, including management of backlog leading • Increased number of patients appropriate recovery support • More joined up care (fewer hand- to improved independence and fewer avoidable discharged safely to home (reducing offs) hospitalisations reliance on beds) • Reduction in ALOS and bed days lost
Link to NHS England Operating Framework priorities
B Deliver the NHS vaccination programme D1 Restore and increase access to C3 Expand and improve services for people with E1 Transform community services and B Continue to meet needs of patients with C-19 primary care services LD/autism improve discharge
53 PSEH ICP OPERATING PLAN 2021/22: Healthy Communities
Provide children and young people with best start in life Take action to prevent ill-health, targeting the most vulnerable in Take action to address inequalities in access, our population outcomes and experience
In 2021/22, we will:
• Deliver an action plan to implement outstanding • Participate in HIOW Population Health Management programme • Provide a framework for reducing health inequalities Ockenden recommendations with assurance via PSEH as demonstrator site for South East at both place and PCN in districts, boroughs, Portsmouth City, Primary Care Joint Maternity Partnership Group levels Networks and Neighbourhoods • Progress recommendations set out in Better Births • Use real time data to segment and risk stratify at risk groups • Take action to restore NHS Services inclusively and (2016) working as part of Local Maternity System including those with complex needs and where health manage disparities in access to services linked to • Review paediatric services in acute setting to identify inequalities have been further exposed by Covid. This will ethnicity and deprivation (elective recovery) opportunities for improvement and meet local needs include elective long waiters, access to vaccination and uptake • Establish PSEH Digital Inclusion Network to drive • Review the allergy pathway in order to improve of screening action to mitigate against digital exclusion as a result experience and support more children to be managed • Address priority areas of smoking cessation, Diabetes of upscaling of digital health and care services. safely in a community setting prevention, CVD prevention and weight management • Ensure health inequalities dataset is complete and • Review the dietetics pathway in order to improve • Accelerate existing core elements of the NHSE Personalised timely, including data collection on protected experience and support more children to be managed Care model including Personal Health budgets, social characteristics, health inequalities and mandatory safely in a community setting prescribing referrals and personalised care and support plans. ethnicity recording in primary care • Review common respiratory illness pathway in order to This will include targeted work with people with LD and mental • Accelerate prevention including culturally competent improve experience and reduce the number of children health issues, maternity and primary care intervention vaccination uptake approach, management of LTCs, accessing acute services as a result of weak • Continue to grow PSEH social prescribing network and Annual Health Checks (LD/SMI)and maternity community symptom management community of practice to support more targeted delivery to key continuity of care • Review CCN provision across PSEH to ensure it can population groups • Strengthen leadership and accountability for health meets local need and is in line with national • Expand PCN additional roles with social prescribers working as inequalities by ensuring Executive Board level leads recommendations part of a team alongside care navigators and health and in place and access to training by the Health Equity • Further develop psychiatric liaison service and align wellbeing coaches Partnership Programme with HIOW priority for 'all age' pathways • Accelerating the roll out of Personal health budgets via wheelchair services, those with learning disabilities, those accessing mental health services and those receiving end of life care
What difference will this make in PSEH?
• Every women will be offered Personalised Care and • Increase numbers of personal health budgets, social • Restore NHS services inclusively Support plan by March 2022 prescribing referrals and personalised care and support plans • Mitigate against digital exclusion • Increased access to perinatal mental health services • Increase the number of personalised care interventions • Ensure datasets are complete and timely • More children supported in the community supported by Primary Care Network new workforce roles • Accelerate prevention programmes targeted at high • Delivery of more targeted work with highest risk groups to risk tackle inequalities in outcomes, experience and access • Strengthen leadership and accountability
Link to NHS England Operating Framework priorities
C4 Deliver improvements in maternity care (Ockenden D2 Implement population health management and personalised care D2 Actions to address health inequalities (5 priority review) approaches actions)
54 Appendix 4: Hampshire and Isle of Wight ICS priorities
55 Appendix 5: Glossary
56 Glossary
Term Definition or Explanation
A&E Accident and Emergency Department, often referred to now as the Emergency Department or ED A&E Four Hour A nationally set target requiring 95% patients attending an A&E department to be seen, treated, admitted or discharged in under four hours. Target STP Sustainable Transformation Partnership– a group of NHS care provider organisations and commissioners working together to provide care to local people over a particular geographical area – in our case Portsmouth, South Eastern Hampshire and Fareham/Gosport. BCF Better Care Fund Better Local Care The name given to the programme of work in our CCG area to develop new models of care, under our MCP vanguard programme, particularly in bringing primary and community care to work more closely together.
BAME Black and Asian minority ethnic CAMHS Child and adolescent mental health services CCG Clinical Commissioning Group CEV Clinically extremely vulnerable. A list of groups identified as being most vulnerable to COVID-19 can be found here. CHC NHS continuing healthcare COPD Chronic obstructive pulmonary disease CQC Care Quality Commission CQUIN Commissioning for Quality and Innovation Payment – allows commissioners to reward excellence, by linking a proportion healthcare providers' income to the achievement of local quality improvement goals.
CSU Commissioning Support Unit ED Emergency Department (see A&E above) E&D Equality and diversity EIA Equality Impact Assessment EPRR Emergency Preparedness, Resilience and Response – how we plan to respond to major incidents or intense pressure on services Equality delivery Linked to the Public Sector Equality Duty, this is a tool that helps local NHS organisations review and improve their performance for people system with characteristics protected by the Equality Act 2010.
57 Glossary
Term Definition or Explanation
FFT Friends and family test FT Foundation Trust FTE Full time equivalent (for staff purposes) – sometimes referred to as Whole Time Equivalent (WTE) FYFV (also 5YFV) NHS Five Year Forward View document Governing All CCGs are required to have a Governing Body and locally we refer to ours as a Governing Board. Board/Governing Body GBAF Governing Body Assurance Framework GMS General medical services (contract) GP General Practitioner HASC/HOSP Local authority monitoring and scrutiny bodies – the Hampshire Health and Adult Social Care Select Committee and the Portsmouth Health Overview and Scrutiny Panel. Health and Care The name given to the programme of work in Portsmouth to develop new models of care, particularly in bringing primary and community Portsmouth/HCP care to work more closely together. Health and A forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and Wellbeing Board reduce health inequalities.
HCAI/CDIFF Health Care Acquired Infection (one such example is CDIFF or clostridium difficile) HIVE Portsmouth A strategic partnership in Portsmouth consisting of a representative group of the voluntary and community sector, NHS Portsmouth Clinical Commissioning Group and Portsmouth City Council. They connect people and organisations to share, support and learn with the objective of building a happier, healthier and more connected city. ICP Integrated Care Partnership - a partnership for Portsmouth and South East Hampshire which includes all NHS providers (including primary care) delivering health services for people for the area. Local authorities are also involved. ICS Integrated care systems (ICSs) have evolved from STPs and take the lead in planning and commissioning care for their populations and providing system leadership. They bring together NHS providers and commissioners and local authorities to work in partnership in improving health and care in their area. Portsmouth CCG is part of the Hampshire and Isle of Wight ICS IG Information Governance
58 Glossary
Term Definition or Explanation
MDT Multi-disciplinary team. A group of different health and care professionals who work with care homes to support their residents. MIU Minor injuries unit NHSE NHS England NHS Five Year The NHS Five Year Forward View, published in October 2014, sets out a vision for the future of the NHS. It articulates why change is Forward View needed, and how we can achieve it, defining the actions required at local and national level to support delivery. NHS Long Term Successor publication to the NHS Five Year Forward View published in January 2019 by NHS England. More information is available here. Plan NHS South, The body that provides a range of support services to CCGs in the Hampshire area, including Portsmouth Central and West Commissioning Support Unit (CSU) OOH Out of hours PACS/Primary Multispecialty community providers (MCPs) and integrated primary and acute care systems (PACSs) are both population-based new care and Acute Care models that aim to improve the physical, mental and social health and wellbeing of their local population. Both are based around the System general practice registered list, and apply a new model of enhanced primary and community care. PAM Patient activation measure PAS Patient administration system PCC Portsmouth City Council PCN Primary care network (see NHS Long Term Plan Jan 2019) PDP Personal development plan PFI Private finance initiative PHE Public Health England PHU Portsmouth Hospitals University NHS Trust – provider of acute health services locally PMS Personal medical services
59 Glossary
Term Definition or Explanation
Portsmouth A formal body representing the interests of GP practices in the city Primary Care Alliance/PPCA PPE/PPI Patient and public engagement/involvement Public Sector The duty came into force in April 2011 and covers age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or Equality Duty belief and sexual orientation. In summary, those subject to the general equality duty must have due regard to the need to: - Eliminate unlawful discrimination, harassment and victimisation - Advance equality of opportunity between different groups - Foster good relations between different groups
QIPP The Quality, Innovation, Productivity and Prevention (QIPP) programme drives forward quality improvements in NHS care, at the same time as ensuring efficiency savings. QOF Quality and outcomes framework RAG Red, amber, green assessment rating RTT Referral to treatment – a nationally set target. The Referral to Treatment (RTT) operational standards are that 90 per cent of admitted and 95 percent of non-admitted patients should start consultant-led treatment within 18 weeks of referral SCAS South Central Ambulance Service Section 75 An agreement made under section 75 of National Health Services Act 2006 between a local authority and an NHS body in England. Section agreement 75 agreements can include arrangements for pooling resources and delegating certain NHS and local authority health-related functions to the other partner(s) if it would lead to an improvement in the way those functions are exercised. SIRI Serious incident requiring investigation SLA Service level agreement STP footprint See above. The ‘footprint’ reference denotes the geographical area covered by each separate STP. SystmOne The shared patient record system used in the city TARGET Local training sessions for GPs. Vanguard/MCP The CCG was selected as one of 14 national MCP Vanguard sites (see Better Local Care) to be at the forefront of work to deliver new models of care Vanguard that met with the aspirations set out in the NHS Five Year Forward View. WGA Whole Government Accounts
60
GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 8
Title Quality & Safeguarding Report
This report provides an update to the Governing Board on the quality & safeguarding exceptions relating to the services that the CCG commission.
It highlights the actions to ensure services for the people of Purpose of Paper Portsmouth are safe, of high quality and that there is effective monitoring and management of any quality concerns and risks
It was reviewed in detail at Quality and Safety Committee on 21st April 2021.
Recommendations/ Actions The Governing Board is asked to note the content of the report. requested
Engagement Activities – Clinical, Stakeholder and Not Applicable. Public/Patient
Item previously considered Quality and Safeguarding Committee (QSC) at
Potential Conflicts of None Interests for Board
Members
Author Tina Scarborough
Sponsoring member Karen Atkinson
Date of Paper April 2021
Quality & Safeguarding Report
April 2021
This monthly report updates the Quality and Safeguarding Committee (QSC) on the work carried out by the Quality and Safeguarding Team. Through review and discussion at the QSC meeting the report supports the Committee in meeting its terms of reference, primarily, to assure the Governing Board that the services the CCG commissions on behalf of the people of Portsmouth are safe, of high quality and that any quality concerns and risks are monitored and managed effectively.
The membership will review quality exceptions, risks relating to commissioned services (including GP Practices), directing and mandating the Quality and Safeguarding team to undertake further actions to ensure required improvements are made, risks are mitigated and progress is evidenced. The committee will ensure exceptions and risks are formally escalated to the Governing Board where it deems necessary.
Contents
1 Current Risks ...... 2 2. Residential, Nursing & Domiciliary Care: ...... 8 3. Safeguarding ...... 9 4. Providers: ...... 10 4(a) Portsmouth Hospitals University Trust ...... 10 4(b) Solent NHS Trust ...... 12 4(c) SCAS 111, 999 & NEPTS ...... 13 4(d) Portsmouth Primary Care Alliance (PPCA) ...... 14 4(e) Practice Plus Group (PPG) ...... 15 4(f) AJM Healthcare – Wheelchair Services ...... 16 4(g) Rowans Hospice: ...... 17 4(h) Spire Healthcare Limited: ...... 18
1
Page 7 1. Current Risks
Risk Ref PHT.29 Date Opened Aug 2017 Risk 1: PHU: Delays in assessment and treatment for Scoring Impact Likelihood Score planned care REPORTING April 2021 LAST UPDATED Mar 2021 Original 3 Moderate 5 Certain 15 MONTH RISK ADMINISTERED Simon Freathy, SEHCCG Current 4 Major 4 Almost Certain 16 BY DESCRIPTION OF RISK If delays, exacerbated by Covid 19, continue in assessment and treatment then care may fall short of constitutional and best practice standards resulting in patients potentially suffering harm/deterioration in their clinical condition. There may also be a negative impact on patient experience and an increased risk of need for unscheduled care. KEY CONTROLS/GAPS IN CONTROLS • PSEH ICP restoration and recovery programme in place with system partners Restoration and Recovery Principles- • Recovery programme will be intelligence driven – with access to update shared system data • Embed the culture of working as a single clinically driven ICP team; behaving like a single system with effective leadership, blurred boundaries between providers with commissioner support; ensuring the ICP shares risk, resource and governance • Total triage approach for all services adopted to ensure ‘right service right time’; using technology to facilitate digital/ call first approach where appropriate • Embedding senior clinical decision makers at the front of every pathway with ready access to real time discussions with colleagues, access to relevant services/diagnostics across different organisations to get the patient to the right place first time. • Increase direct communication between primary and secondary care to facilitate conversations, breakdown barriers and support new clinical pathways. • Alignment to a single cause, and the use of a single message such as ‘protect your NHS’ banner for defining the new normal as part of recovery programme • Maintain full system view of all available capacity; ensuring that we use this effectively to get the patient to the right place at the right time ASSURANCE/GAPS IN ASSURANCE • Planned restoration levels of acute activity in place to improve access, address long waiting patients and target shortfall in capacity • Prioritisation and risk stratification to assess elective need. Clinical Prioritisation panels commenced. • Improvements in access to diagnostics in line with restoration plans Ensure seasonal (winter) plans are developed across PSEH to mitigate additional pressures and ensure patient safety and care is maintained. Gaps in Assurance • No systematic trust process for reviewing harm in all specialities or clinical oversight of waiting lists • Vacancies in all specialities with recruitment challenges affecting wait times
2
ACTIONS • Theatre capacity will return to 224 sessions per week from the 5th of October, 10 of these sessions will be undertaken in the IS. PHU will also be undertaking 3 additional all day operating sessions on Saturdays from week commencing the 14th of September. • Increasing Ophthalmology activity at Care UK, and expanding Endoscopy activity across both independent sites. • Working directly with system partners, to ensure we have GP clinical leads fully engaged in the validation work being undertaking and that system partners are updated on the action being undertaking jointly, to deliver the recovery phase of the elective programme. LATEST NOTE • Strong delivery of the national cancer standards continues. 9/9 standards achieved for Dec. 8/9 Standards are currently achieving for Jan. 62 days remains a challenge. • Referrals showing -31% than the same period last year with variation by tumour site. The current referral gap in referrals received between Jan 2019 to Jan 2021 is -2080 with Skin Contributing for 50% of this gap. Ongoing work to validate data set and to identify any gap in diagnosis. • Number of patients waiting for treatment reduced to 35,858 (35,984 last month) with continued focus on treating urgent and cancer patients. There are 1,585 breaches of the 52 week standard which is an increase of 844 from last month; however the 52 week breach position in month is continuing to perform better than submitted trajectory. • Outpatient activity during January has been targeted according to the clinical urgency of the patient, and there has been both an administrative and clinical review of outpatient waiting lists. Where possible this has been through non face to face services to reduce footfall on site. Concerns shared regarding waiting list processes for bowel screening and ophthalmology RECOMMENDATIONS FOR THE QUALITY & SAFEGUARDING COMMITTEE To note and feedback any concerns to PCCG Clinical Quality Manager
3
Risk Ref PHT.05 Date Opened Aug 2015 Risk 2: PHU: Emergency Department & Urgent Care Scoring Impact Likelihood Score Pathway
REPORTING April 2021 LAST UPDATED Mar 2021 Original 4 Moderate 5 Certain 20 MONTH RISK ADMINISTERED Simon Freathy, SEHCCG Current 4 Major 4 Almost Certain 16 BY DESCRIPTION OF RISK If pressure on PHT emergency department continues to rise and fluctuate and if there is inadequate staffing then care may fall short of required standards resulting in compromised safety, experience and quality of care. This risk is enhanced by the challenges to manage COVID-19 red and green pathways. KEY CONTROLS/GAPS IN CONTROLS • System and provider escalation processes reviewed and in place • Admission avoidance work programme in place • Shared Assurance and Improvement Project meeting monthly • Performance report in place and reviewed at various meetings to identify areas of concern • System-wide operational delivery group meeting 3x per week • SILVER command group meeting 3x per week ASSURANCE/GAPS IN ASSURANCE System meetings including Silver ACTIONS • System-wide urgent care improvement programme in place and being implemented • System-wide urgent care improvement programme metrics developed. • Operational delivery group meetings in place to discuss actions required to support system management • Integrated Care Partnership work programme. • Contingency and winter plans in place • Winter table top exercises in training LATEST NOTE Risk rating now reduced to 16: • Emergency Department (ED) demand at QAH & GWMH continues below the levels seen last year and continues to reflect the current national lockdown position with a continued reduction in walk in patients circa 50% when compared to forecast for February. Admissions remain static as would be expected at this time of year. COVID admissions have reduced through the month which is expected to continue based on the current national lockdown. • Ambulance handovers continue to improve with no 60 minute holds reported within month despite ambulance arrivals remaining high through February. This has been supported by the ongoing use of Paediatric ED as Adult capacity with the relocation of Paediatrics ED to the Children's Assessment Unit (CAU). The focus on Medically Optimised for Discharge (MOFD) during the month has also supported the flow through the organisation which is directly correlated to ambulance handover performance. With the need to bring Paediatric ED back in the near future work is underway to develop alternative surge capacity within Medicine and Urgent Care to continue to support this performance. 4
• The Trust medical bed base continues to run above 100% occupancy and for the majority of the month remained around 110%. This has been supported by the reduced elective activity brought about by the COVID position of the organisation. Over March the rebalance of this bed base will be required as the elective programme begins to move into its recovery programme. • MOFD numbers within month have remained above 80 for the month and haven’t seen any significant increases or reductions; this is monitored on a daily basis. • NHS111 first streaming tool continues to perform within its trial phase. Work has been ongoing to improve the tools performance in particular around red flags and fractures. RECOMMENDATIONS FOR THE QUALITY & SAFEGUARDING COMMITTEE To note and feedback any concerns to PCCG Clinical Quality Manager
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R.Ports. RISK REF DATE OPENED Nov 2017 CARE HOMES: Quality and Safety Concerns across QUA16 RISK 1: Risk administered by Nicola Andrews Portsmouth City Residential Service Provision SCORING Impact Likelihood Score Original 4 major 3 Possible 12 REPORTING MONTH April 2021 LAST UPDATED 9 March 2021 Current 4 major 3 Possible 12
DESCRIPTION MITIGATING ACTIONS Portsmouth Clinical Commissioning Group and Portsmouth Adult Social Care rely on There are a number of initiatives to improve the landscape across Portsmouth residential service providers to provide safe quality care for vulnerable residents. If there is City Residential Service Provision in place including the Enhanced Care Home not sufficient capacity of good quality residential care then the flow in and out of the Team, the Quality Improvement Team and the Medicines Optimisation Team. urgent care system is severely compromised. There are a number of professionals working together to support care homes There have been concerns raised about the quality and safety of residential services, to manage the Covid-19 pandemic in line with the National Social Care Plan. reflected within Care Quality Commission inspection ratings across residential service There is work underway in conjunction with providers and partners to review provision. Although the picture has improved there is still a significant number of care and design the support offer to homes moving forward post Covid-19. homes in the city that remain rated overall as ‘Requires Improvement’ CURRENT POSITION There are no homes rated as ‘Inadequate’ by CQC. The percentage of Portsmouth care homes rated as Requires Improvement by CQC remains at 33%. There are 2 Nursing Homes and 11 Residential Homes rated by CQC as ‘Requires Improvement’.
ASSURANCE STATEMENT Pre Covid 19 arrangements have been on hold to enable a more reactive and appropriate response to the Covid-19 outbreak. The joint Quality Board involving Portsmouth Adult Social Care, Portsmouth Clinical Commissioning Group, Portsmouth Healthwatch and the Care Quality Commission has merged with the ‘Support to Care Homes and Dom Care’ meeting established in response to Covid-19. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING COMMITTEE
Maintain current risk score whilst work to support the care homes is being reviewed and re-developed.
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RISK REF R.Ports. QUA19 DATE OPENED Nov 2017 CARE HOMES: Patient care & patient experience - loss of Risk administered by Nicola Andrews, PCCG RISK 2: provision at short notice SCORING Impact Likelihood Score Original 4 major 3 Possible 12 REPORTING MONTH April 2021 LAST UPDATED 9 March 2021 Current 4 major 2 Unlikely 8
DESCRIPTION MITIGATING ACTIONS There are concerns that care homes may be closed by CQC at short notice. If homes are closed at The business as usual function of the Quality Improvement Team short notice then there is potential for harm or negative clinical outcomes and experience. is currently suspended and the team are working with other partners and the care homes, to provide advice and support with managing risks, in particular those associated with Covid- CURRENT POSITION 19. There are no homes rated by CQC as ‘Inadequate’ or homes subject to special measures from CQC.
ASSURANCE STATEMENT The Quality Improvement Team is currently working closely with colleagues in PCC and other partners to deliver support to care homes during the Covid-19 outbreak.
The home closure framework is in place to support the closure process where homes are forced to close to reduce the potential for adverse outcomes and experience. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING COMMITTEE
Maintain the risk score at 8.
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2. Residential, Nursing & Domiciliary Care
Residential, Nursing and Domiciliary Care
REPORTING April 2021 LAST UPDATED 12/04/2021 VIRTUAL MEETING 21ST APRIL 2021 MONTH
CURRENT POSITION / KEY CHANGES Covid 19 Outbreaks/ Exposures – o The number of outbreaks and exposures in social care residential settings has reduced in line with the national and local reductions in levels of covid positive people. At the time of writing there was only one care home in an outbreak, with an end date of 14/04/21. One other care home has had an exposure, with one member of staff testing positive. Covid- 19 Response Support to Providers o Continues as outlined previously, though scaled down due to reduction in outbreaks. Development of future role of Quality Improvement Team and wider quality support to social care providers o Work to develop a future quality support offer to the social care sector is being overseen by the Care Provider Quality and Resilience meeting. o Work includes development of a Quality Framework, evolving the operational group meetings established as part of the Covid response into part of the new Business as Usual, and a review of role of the QIT. o With a reduction in Covid response work, the QIT is currently leading the Quality Framework workstream, working with HCPC to develop reviews that incorporate quality audit with contract monitoring, working with the communications team on a communications offer using MS Teams, leading work to formalise the operational group as a sub-group of the Care Provider Quality and Resilience meeting, re-establishing/further developing champions groups and continuing with implementation of RESTORE2 jointly with the Enhanced Care Home Team. Future management of risks o It is proposed that a register/dashboard to provide oversight of risks and concerns across all social care providers, replacing and extending the one previously held on Pentana, is developed. This will be overseen by the Care Provider Quality and Resilience Group. Risks identified for individual providers and mitigating actions being implemented will be recorded on the ASC risk register, again overseen by the Care Provider Quality and Resilience Group. Permission is therefore sought from QSC to close the two risks on the Quality and Safeguarding Risk Register and for monitoring of risk in this sector to be passed to the Care Provider Quality and Resilience Group. The risks currently open on the Quality and Safeguarding Risk Register are very general, which should be visible from the whole sector view of concerns possible with a dashboard, and greater clarity of actions and progress will be possible, if risk specific to individual providers are recorded. This will allow more meaningful monitoring and reporting. The Care Provider Quality and Resilience Group is a joint PCC and PCCG strategic group. MATTERS OF NOTE Market Failure – Many care homes are running on significantly reduced occupancy increasing risk of care homes deciding to withdraw from the market. PCC are leading on the response to the resilience of the market in line with statutory responsibilities.
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3. Safeguarding Safeguarding REPORTING April 2021 LAST UPDATED 13.04.21 VIRTUAL MEETING: 21.4.21 MONTH
CURRENT RISKS The safeguarding team is not able to attend all scheduled meetings, due to an increased demand of need and a WTE vacancy within the team. The post has now been recruited to and the successful candidate (Vicki Fisher) started with the team 08.03.21. She will have an induction phase and therefore the risk remains until she is able to start managing her own caseload. CURRENT CONCERNS The pills by post for emergency medical abortion is still in discussion at both a local and national level. There remains discrepancies with data, what constitutes an SI and the Safeguarding of Children, especially those aged <16.
MATTERS OF NOTE Twice monthly Safeguarding Children Huddle continues with colleagues from Police, LA, PHT and Solent all dialling to discuss local safeguarding issues within Portsmouth. Monthly safeguarding adult huddle continues with agencies (as above) dialling in. All GP Surgeries were invited to a Safeguarding Peer Supervision session on the 24th March 2021. The Safeguarding Team provided them with an update of national and local safeguarding issues and also allowed the opportunity to discuss any other safeguarding concerns. Due to the ongoing lockdown and pressures on providers, numerous meetings with providers have been cancelled. The Designated Nurse Safeguarding merge for colleagues in Hampshire, IOW and Southampton continues with the expectation that they will be fully integrated by June 2021. This was presented to a joint (adult/children) Exec Board, which has resulted in the Board Managers writing, to the ICS Chief Exec asking for her to consider a more LA placed based Authority. Mapping of all open S42 has begun and action trackers for each provider drawn-up. From the 1st April 2021 Portsmouth LA agreed to start accepting UASM arriving at the Port. Helen Daley and Sarah Shore met with Safeguarding Team at PHU as it was identified that safeguarding records are currently being stored separately and therefore not accessible to staff. Processes were agreed to raise alerts and access to records to be given to appropriate staff. ONGOING SAFEGUARDING ISSUES 2 Domestic Homicide Reviews are currently being undertaken. PSAB will be undertaking a further 2 SARs and a thematic review – awaiting authors to be identified. The SAR for ‘Pamela’ has commenced and the Practitioners Workshop has been held. 12 ongoing/open SAR cases SCR for child J is ongoing. PSCP is in the process of finding an independent author for the newly identified Child Safeguarding Practice Review (the overlay case)
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4. Providers 4(a) Portsmouth Hospitals University Trust
Portsmouth Hospitals University Trust- District general hospital providing comprehensive range of acute and specialist services REPORTING MONTH April 2021 LAST UPDATED April 2021 VIRTUAL MEETING : 21.4.21 KEY AREAS Please note most data and comments are from February so situation will have changed. Preparation for COVID-19 -Impact and Mitigating Actions • Continued system wide working. The average number of new daily cases continues to decline on average. Portsmouth prevalence down to 60 per 100,000 against the UK average of 59 (15.03.21). As widely reported this is due to vaccine rollout and national lockdown the local picture is improving. Critical care occupancy has reduced although this is steady and the department continues to be above baseline capacity of 19 beds. Attention will now focus on the next phase of resilience as part of the response. Emergency Care • ED demand continues below the levels seen last year (pre-covid) with a continued reduction in walk in patients circa 50% when compared to forecast for February. Admissions remain static, as is usual for the time of year. COVID admissions have reduced through the month. •Ambulance handovers continue to improve with no 60- minute holds reported within month. This despite ambulance arrivals remaining high through February. The focus on Medically Optimised for Discharge (MOFD) during the month has also supported the flow through the organisation, which is directly correlated to ambulance handover performance. With the need to bring Paediatric ED back in the near future, work is underway to develop alternative surge capacity within Medicine and Urgent Care to continue to support this performance. •The Trust medical bed base remained around 110% occupancy for the month. This has been supported by the reduced elective activity brought about by the COVID position of the organisation. Over March the rebalance of this bed base will be required as the elective programme begins to move into its recovery programme. •MOFD numbers within month have remained above 80 for the month and have not seen any significant increases or reductions; this is monitored on a daily basis. Cancer (provisional) •January achieved 9/9 standards. 62 days –86.2% 148.5 treatments and 20.5 Breaches. Over 104 days -2.5 breaches / 4 patients. •8/9 Standards are currently achieving for February. 18 Week RTT (provisional) •Number of patients waiting for treatment increased from 35,807 last month to 36,379 at the end of February There with continued focus on treating urgent and cancer patients. Theatre capacity has reduced due to the increasing levels of patients requiring ICU. At the end of February there are 2722 breaches of the 52 week standard which is an increase of 1143 from last month. Diagnostics (provisional) •February provisional position is 90.9% against recovery trajectory of 86.1%. •Independent sector capacity providing 40 CT and 80 MRI per week secured until the end of March and there has been good up take of waiting list initiatives to support ultrasound delivery. Stroke (provisional) •Indicative data for January is showing achievement of 9/13 performance indicators against 74 records, with a small amount of records still to upload. It is anticipated that once complete, 10/13 will be achieved.
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SAFETY/QUALITY MATTERS •The new pharmacy robot is in operation, which will help support a reduction in dispensing errors. •300 new bedside lockers with integral patient own drug (POD) lockers have been procured. These lockers will not only ensure the safe storage of medicines but will enable patients to self-medicate. •There has been a continued decrease in COVID nosocomial infections, and a corresponding reduction in the number of active outbreaks over the last month. •The Infection Prevention and Control reference groups has progressed works in relation to ventilation, lateral flow testing and screening compliance. •Although patient numbers and acuity remains high in the Trust, there has been an improvement in vital signs compliance. •Despite the intensity and duration of the COVID pandemic there has been no up-surge in the number of cardiac arrests; the improvement trend seen over the past few years continues. This reflects the early identification of deterioration and appropriate planning and effective decision making around ceilings of care •Two category 4 pressure ulcers have been externally reported onto STEIS in February. One evolved from a Suspected Deep Tissue Injury in September 2020 and is under investigation; the second developed in January 2021 and was reported to the Tissue Viability team via an external incident. •Work has been completed to move Dementia and VTE risk assessments from Vitalpacto to Bedview. With effect from mid- April both Dementia and VTE assessment recording will be a mandatory field on Bedview. • Across HIOW trusts have been awaiting guidance regarding SI declarations around Nosocomial Covid deaths. This has nearly been finalised but PHU have a pilot process in place to start in April. There is concern that despite a regional guide being produced, trusts will not declare the same as each other. There will be CCG oversight at weekly panels to review cases. It is expected this could take six months to get through. Military support has been sourced to assist. • In relation to Ockenden/maternity services at PHU, here is a monthly report to PHU exec board; the action plan is discussed and monitored at the maternity board which has CCG representation; a non-exec director attends maternity board, quality & performance and the board; there has been a thematic review and the actions for this are included in the action plan. • Work continues around looking at issues of discharge when patients are returned back to PHU as too unwell for place discharged to. CONCERNS •The increase in activity and sustained OPEL 4 status due to the pandemic has had an impact on all quality metrics; recovery work is now underway. •.The continued increase in the rate of reported pressure damage throughout February reflects the acuity, frailty and immobility of inpatients affected by COVID (11 unstageable wounds, one grade 4, one grade 3 reported during February). • There has been a spike in harmful falls during February. The falls specialist nurse is prioritising the review of patients reported to have more than one inpatient fall. Themes from SWARMS identify confused ambulant patients mobilising whilst unsupervised and subsequently falling (particularly at night). • Child and Adolescent Mental Health Services (CAMHS) continue to have staffing difficulties and are operating a virtual service via telephone. The Mental Health Liaison Team have agreed to cover gaps in CAMHS service as a temporary measure and a tier system has been introduced to prioritise cases and avoid unnecessary admissions. • Oversight of Ophthalmology action plan. CCG are liaising with trust to establish best way of getting assurance of progress being made and avoid duplication of discussions. OTHER MATTERS OF NOTE •Since the launch as the first hospital hub in the Hampshire and Isle of Wight area in December the Trust has delivered over 30,000 doses of the COVID-19 vaccine and over 87% of Trust staff have been vaccinated. •Smart survey feedback is in place for the COVID Vaccination Hub, 444 responses were received at the beginning of March with 99.1% positive and 0.9% negative. The comments were overwhelming positive. • An audit was undertaken of 15 cases where a patient used the redirect pathway to St James. Due to the low numbers it is felt not to be financially viable to maintain this pathway. The system will revert to attendance at ED/111 from 31st March 2021. • The MH strategy for the Trust will now be picked up in a working group involving Risk, Dementia Lead and Transformation lead. • Penny Emerit has replaced Mark Cubbon as Chief Executive.
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4(b) Solent NHS Trust Solent NHS Trust (Community and Mental Health Services) REPORTING MONTH April 2021 LAST UPDATED April 2021 VIRTUAL MEETING 21.4.21 KEY AREAS Adults Portsmouth - Specialist services planned return to BAU (ie continence service) as staff redeployed back. - Jubilee House future subject to ongoing discussions between Solent and commissioners. - There remain issues with regard discharges from PHU being “medically optimised for discharge” versus “medically fit for discharge”. This is a wider piece of work being looked at by PHU. Solent continues to highlight these cases to PHU. Children & Families - Health visiting pressures. Increase in complexity of cases that service is working on. - Closer to Home teams. The CAMHS Provider Collaborative for Wessex and Dorset have requested Solent lead the service for both Portsmouth & South East Hants as well as Southampton and South West Hants. Staffing models being agreed as well as pathways. Overall plan is an alternative to Tier 4 admission with a home in reach model. Mental health - Waiting times A2i improved from 9 to 7 weeks. - Psychological therapy waiting list. Although waiting times up, list has decreased from October 20 by 22%.The number of people in therapy v on list in Nov 2019 was 77% more people on list than in therapy. Now down to 18%. - Recovery teams are running over capacity due to vacancies, unplanned long term leave and planned leave. Risk mitigation in place with caseload weighting and ICM assistance. SAFETY/QUALITY MATTERS Covid outbreaks on Spinnaker and Brooker wards all closed and wards all open and running as “covid normal”. Staff challenges and waiting list issues remain and are likely to for the foreseeable future. No evidence currently of safety concerns although will be monitored through Solent incident panels. Discussions and oversight also taking place at HQP service leads as to anything further that can be done. QIA’s now focused on return to previous or new ways of working with over 90 reviewed. New NHS Patient Safety Strategy. Plans for implementation and responsibilities have been prepared and distributed with revised dates. CONCERNS As to be expected across all services, staff sickness (long covid), vacancies, increased demand and staff morale. Work continues in all areas to assist. Practitioner model covering inpatients and PRRT impacted by departures and inability to recruit. Any gaps being picked up by G.P cover. Workstream to look at model and future provision underway. OTHER MATTERS OF NOTE Draft Quality Account for last year submitted to CCG for comment. EPMA procurement underway with expected go live date of September 2021. Vaccination centres continue. Positive feedback throughout. Some concern regarding competency of workforce (arriving at centre without competency sign off). This is risk managed locally. Also some issues around social distancing. Reminders and environment changes in place.
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4(c) SCAS 111, 999 & NEPTS
SCAS – 111, 999 & Patient Transport (PTS)
REPORTING MONTH April 2021 LAST UPDATED 9 April 2021 VIRTUAL MEETING 21 April 2021
CURRENT POSITION Monthly catch up Teams meetings are taking place between SCAS and Commissioners in place of CRMs & CQRMs at present.
MATTERS OF NOTE Update from the Teams meetings held on 8 April 2021 999 Activity across the south has reduced over the last few weeks and the service is meeting targets; fire and military support has now ceased Task time increased significantly over the bank holiday weekend and SCAS are currently investigating It is anticipated that the week of June 21st is likely to be the start of a difficult couple of weeks due to further lifting of lockdown measures 100% of SCAS staff have been offered the vaccine and 99% of the entire workforce, including volunteers; private providers etc. have received the offer of a vaccine. There has been an overall 5% decline rate. 1st vaccine rollout is complete for frontline staff and all are now booked for a second jab with an expected completion of 2nd vaccine rollout mid-May. A small number of staff (5) chose not to take up the vaccine (maternity) All shielding staff have returned to work SCAS are predicting potential elevated staff sickness levels over the next year due to mental health issues brought about by pandemic working.
111 Nationally the pressure on the 111 service remains high with SCAS sitting fifth in the country based on performance (mid-range) The service saw some challenges over the bank holiday weekend, with over 7400 calls taken on the Saturday (well above predicted levels) and national contingency activation for other providers on and off throughout the period There are an increasing number of calls coming in from people who have had the covid vaccine and are experiencing known covid side effects Rolling recruitment drive continuing Staff sickness is at 11% with covid related sickness beginning to reduce The service raised a serious incident involving the random loss of 102 triaged cases which should have gone from 111 to the PHL/OOH services on the Adastra system between 01/02/2021 and 18/03/2021. Mitigation is in place to prevent a repeat and all cases are under review. At this time all bar 6 cases have been reviewed and potential harm has been identified in 1 (SEH CCG patient). A full investigation is under way and will be reported to the Portsmouth SI Panel. PTS Activity remains stable following the bank holiday period, with the good Friday proving to be a particularly busy day system wide The service is currently running around 85% pre covid levels of activity All shielding staff have now returned The Call Centre was hit with a large call volume Tuesday following the bank holiday weekend Sickness stands at 10% for transport staff with some staff suffering from long covid; sickness levels in the call centre are at 9.3%
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4(d) Portsmouth Primary Care Alliance (PPCA)
PPCA
REPORTING MONTH April 2021 LAST UPDATED 9 April 2021 VIRTUAL MEETING 21 April 2021
CURRENT POSITION
COVID 19 Dispositions decreased during February, representing 2.4% of all cases since March 2020 During February there were 52 patients admitted to the virtual ward (CO@home) and 88 patients discharged. On February 28 there were 14 patients being monitored Call quality audit, staff training compliance, patient satisfaction and paramedic feedback all remain reassuringly good At the March contract review meeting PPCA asked for contract and quality monitoring meetings to now move to quarterly rather than monthly and this is being considered by commissioners.
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4(e) Practice Plus Group (PPG)
Practice Plus Group (PPG)
REPORTING MONTH April 2021 LAST UPDATED 9 April 2021 VIRTUAL MEETING 21 April 2021
CURRENT POSITION
Day Surgery PPG continue to support PHU with the surge national contract (Diagnostics only) Nursing staff are currently redeployed to PHU Day surgery will not restart until the critical care transfer SLA with PHU can be reinstated.
Serious Incident A serious incident was raised in March 2021 in relation to a diagnostic incident which occurred in August 2020. In summary, a large lesion on the hip was missed by the reporting radiologist. An investigation is underway in partnership with Everlight, the company whom PPG currently commission to carry out radiology reviews.
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4(f) AJM Healthcare – Wheelchair Services:
AJM Healthcare (Wheelchair Services) REPORTING MONTH April 2021 LAST UPDATED April 2021 VIRTUAL MEETING 210421 KEY AREAS Please note CRMs and quality meetings currently stood down so minimal reporting and none since last QSC. SAFETY/QUALITY MATTERS No changes CONCERNS No changes OTHER MATTERS OF NOTE No changes
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4(g) Rowans Hospice:
Rowans Hospice (Palliative Care) REPORTING MONTH April 2021 LAST UPDATED April 2021 VIRTUAL MEETING 210421 KEY AREAS No outbreak issues. SAFETY/QUALITY MATTERS No changes CONCERNS No changes OTHER MATTERS OF NOTE They are LFD and PCR testing staff and volunteers who opt in but trying to push this to all. Looking at how they move things forward with services, Living Well Centre being one of those. Also offer visitor to patient testing – not a great uptake. They remain hopeful to have the inpatient renovation completed July this year. Currently are working on 18 beds that have been completed.
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4(h) Spire Healthcare Limited:
Spire Portsmouth
REPORTING MONTH April 2021 LAST UPDATED 9 March 2021 VIRTUAL MEETING 21 April 2021
CURRENT POSITION No update for April 2021 Spire is currently supporting the national contract via PHU by providing chemotherapy. Discussions are currently underway on the provision of some endoscopy procedures.
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GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 9a
Title Governing Board Work Programme
The attached work programme details the meeting programme over the 2021/2022 financial year.
Items for meeting agendas are in keeping with the work of the Board
as outlined in the CCG’s Constitution and supporting documents. Purpose of Paper
It is anticipated that the Joint Commissioning Board will be re- established to oversee commissioning and business cases as determined within our operating model. These have been highlighted within the attached document.
The Governing Board are requested to:
Recommendations/ Approve the work programme and proposal outlined for the Actions requested reporting requirements Note the re-established of the Joint Commissioning Board and its function.
Engagement Activities – Clinical, Stakeholder and Not applicable Public/Patient
Item previously Not applicable considered at
Potential Conflicts of Interests for Board None Members
Author Justina Jeffs, Head of Governance
Sponsoring member Dr Elizabeth Fellows, Chair
Date of Paper 5 May 2021
Governing Board Work Programme 2021/22 What Lead (management When May Jul Sept Nov Jan Mar lead) 19 21 15 17 19 16 Meeting in Public Governing Board Work Programme Chair Annual x Register of Interest Chair Every x x x x x x Register of Interest – All Staff Chair Annual x Declarations of Interest Chair Every x x x x x x Minutes of Previous Meeting Chair Every x x x x x x CCG Executive Report Managing Director Every x x x x x x Quality and Safeguarding Report QSC Chair Every x x x x x x Finance Report Chief Finance Officer Every x x x x x x Performance Report Chief Finance Officer Every x x x x x x Corporate Risk Register/GBAF Managing Director As req’d x Health and Care Portsmouth Covid-19 Update Director of Public Health Every x x x x x x Hampshire & IOW ICS Update Accountable Officer Every x x x x x x Portsmouth & SE Hampshire ICP Update Managing Director Every x x x x x x Portsmouth City Update CEO of PCC Every x x x x x x Commissioning Decisions & Reports Managing Director/CEO As req’d x x x x x x of PCC Procurements/Business Cases reserved to the GB Managing Director/ CEO As req’d x x x x x x of PCC Approved Minutes: Primary Care Commissioning Committee PCCC Chair Every x x x x x x Health and Well Being Board Clinical Lead Every x x x x x x Audit Committee Audit Committee Chair Every x x x x x x Quality & Safeguarding Committee QSC Chair Every x x x x x x Joint Commissioning Board Managing Director Every x x x x x x
Verbal Reports from Committee Chairs Committee Chairs As req’d Minutes from AGM Chair Annual x Annual Reports: CCG Annual Report and Accounts (Jul/Sep) Chief Finance Officer Annual x x (at AGM)
What Lead (management When May Jul Sept Nov Jan Mar lead) 19 21 15 17 19 16 Operating/Annual Commissioning Plan Chief Finance Officer Annual x Financial Strategy and Budget Setting Chief Finance Officer Annual x Opening Annual Budgets Chief Finance Officer Annual x National Stakeholder Survey Results Chair Annual x Safeguarding Annual Report QSC Chair Annual x Equality & Diversity Annual Report Managing Director Annual x Patient Engagement Annual Report Lay Member Annual x Committee Annual Reports Annual x Quality & Safeguarding Committee QSC Chair Primary Care Commissioning Committee PCCC Chair Audit Committee Audit Committee Chair Remuneration Committee Rem Committee Chair Governance Arrangements Annual Review Chair Annual x Complaints Annual Report Managing Director Annual x Annual Work Programme Chair Annual x
Meeting in Private Minutes of Previous Meeting Chair Every x x x x x x Declarations of Interest Chair Every x x x x x x Approved Minutes: Audit Committee Pt II Audit Committee Chair Following AC x x x Remuneration Committee Rem Committee Chair Following RC x x Quality & Safeguarding Committee QSC Chair Every x x x x x x Primary Care Commissioning Committee (Part II) PCCC Chair Every x x x x x x
Key: QSC - Quality and Safeguarding Committee PCCC - Primary Care Commissioning Committee CEO of PCC - Chief Executive Officer of Portsmouth City Council
GOVERNING BOARD
Date of Meeting 19 May 2021 Agenda Item No 9b
Title Committee Reports Cover Sheet
The CCG undertook a Governance Review during the early part of
2021. One of the recommendations from this review was the Purpose of Paper amendment of the cover sheets used for committee reports and
papers to strengthen the information to the committees.
Recommendations/ The Governing Board is asked to approve the use of the revised cover Actions requested sheet for all CCG Committees.
Engagement Activities – Clinical, Stakeholder and Not applicable Public/Patient
Item previously Not applicable considered at
Potential Conflicts of Interests for Board None Members
Author Justina Jeffs, Head of Governance
Sponsoring member Jo York, Managing Director
Date of Paper 11 May 2021
Name of Board/Committee
Title of Paper Agenda Item Date of Meeting Director Lead Authors
For Decision To Ratify Link to Purpose strategic To Discuss objective To Note/Receive
Executive Summary
Recommendations Publication Include on public website
Please provide details on the impact of following aspects Equality and quality impact assessment Patient and stakeholder engagement Financial and resource implications/impact Legal implications Principal risk(s) relating to this paper Key Committees/Groups where evidence supporting this paper has been considered
GOVERNING BOARD MEETING
Date of Meeting 19 May 2021 Agenda Item No 10
Title Minutes of Other Meetings
To accept the following:
Primary Care Commissioning Committee Minutes of the Primary Care Commissioning Committee meeting held on 28 January 2021.
Purpose of Paper Audit Committee Minutes of the Audit Committee meeting held on 9 December 2020.
Recommendations/ Accept Actions requested
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at Potential Conflicts of Interests for Board N/A Members
Author Various
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 11 May 2021
APPROVED
Minutes of the Primary Care Commissioning Committee meeting held on Thursday 28 January 2021 at 9.30am – 11.30am via MS Teams
Summary of Actions Agenda Action Who By Item 6. Approved Chair’s Action for Standard S Cooper/J Jeffs On-going Operating Procedures relating to the use of COVID-19 vaccinations
The Committee agreed that Simon Cooper and Justina Jeffs will discuss and implement the processes around the frequent changes to the Standard Operating Procedures.
12. Overview of the proposed Primary Care C Horan Next meeting CQUIN 2021/22
Christine Horan will circulate the updated proposed CQUIN report for approval.
Present: Margaret Geary - Lay Member (Chair) Simon Cooper - Director of Medicines Optimisation/Interim Director of Primary Care Jason Eastman - Associate Director of IM&T Dr Nick Moore - Clinical Executive (GP) Julia O’Mara - CCG Nurse Advisor Jackie Powell - Lay Member David Scarborough - Practice Manager Representative Michelle Spandley - Chief Finance Officer Jo York - Director (New Models of Care)
Apologies: Helen Atkinson - Director of Public Health Nicola Burnett - Deputy Chief Finance Officer Mark Compton - Director of Transformation Justina Jeffs - Head of Governance Jo Hanswenzl - NHS England Lisa Harding - Director of Primary Care (Local Medical Committees) Dr Clare Sieber - Local Medical Committees Medical Director (GP) Andy Silvester - Lay Member later
In Attendance: Claire Currie - Consultant in Public Health Andrea Edgeson - Senior Finance Manager Roger Batterbury - Healthwatch Representative Christine Horan - Primary Care Improvement Manager Carol Giles - Primary Care Senior Commissioning Manager Sylvia Macey - Primary Care Estates Manager Steve McInnes - Primary Care Relationship Manager Stephen Orobio - Clinical Quality Manager Rebecca Spandley - Assistant Finance Manager Lisa Stray - Executive Assistant, Business Services (Minutes)
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1. Apologies and Welcome
Margaret Geary welcomed members to the meeting, noted the apologies as above and reminded those present of the following:
• In following the Government’s guidance on COVID-19, this meeting was live streamed, with the agreement that the papers for the meeting would be made publically available at the earliest opportunity. • The CCG undertakes Primary Care Co-commissioning under delegated powers from NHS England • In order to support the management of any conflicts of interests, the Chair is a lay member of the CCG. • The Chair will determine action to be taken where members declare a conflict in line with the CCG’s policies.
2. Declarations/Conflicts of Interest
David Scarborough, Practice Manager Representative, as working in Primary Care due to role as Practice Manager for Trafalgar Medical Group and Dr Nick Moore, Clinical Executive and local GP working at the Derby Road Practice declared an indirect conflict for Agenda Items 5, 9, 10 and 11. Margaret Geary, as the Chair, agreed that he could participate in the discussion but not in any decision-making.
3. Minutes of Previous Meeting
The minutes of the Primary Care Commissioning Committee meeting held on Thursday 26 November 2020 were approved as an accurate record subject to the following change:
Page 3, Paragraph 10 Agenda Item 5. Primary Care Finance Report – amend ‘financial regime has been amended for 2021/21’ to ‘‘financial regime has been amended for 2020/21’.
Agenda Action Progress Item 7. Matters Arising from Thursday 24 September 2020 Awaiting the final sign minutes: off from the Regional Team. Hampshire and Isle of Wight (HIOW) Digital HIOW have been Primary Care Roadmap Update successful in obtaining funding to extend the pilot in digitising the Lloyd George Notes within practices. Aim is to extend the pilot to include 1 practice from every CCG area in HIOW footprint. 4. Primary Care Risk Register
• Work with the Primary Care team to update the Ongoing. Risk Register with Primary Care Networks and Portsmouth Primary Care Alliance components, and Directed Enhanced Services and how this has impacted our care services. • Liaise with NHS England around PCSE service Although progress has issues. Receive comments or reviews from been made around the Committee, and will provide an update in Primary Care Support January. England (PCSE) • Escalate details of complaints from practices issues, work is on- 2
back to NHS England. going. Practices continue to experience difficulties around pensions and are not receiving replies from PCSE. Carol Giles will also feedback reported issues back to the Head of Primary Care.
4. Primary Care Risk Register
There were no new risks to report; however, the CCG was not in a position to stand down any COVID risks.
The Primary Care Risk Register would be updated as part of the team review. Practices would continue to be monitored and be informed of any mitigating actions required.
Steve McInnes explained that due to the service not improving, Primary Care Support England (PCSE) services still remained at Current Risk Score 12.
The Risk Register will be reviewed and amended accordingly.
The Primary Care Commissioning Committee noted the Primary Care Risk Register.
5. Primary Care Finance Summary – Month 9 2020/21
David Scarborough, Practice Manager Representative and Practice Manager at Trafalgar Medical Group, and Dr Nick Moore, Clinical Executive and local GP working at the Derby Road Practice, declared an indirect conflict with the information contained within this paper as it impacted on their practice. Margaret Geary, as the Chair, agreed that they could participate in the discussion but not in any decision-making.
The Primary Care financial position for Month 9 2020/21 report was presented to the Committee.
The Committee were asked to note the Month 9 financial position.
Key points:
− The CCG has received confirmation from NHS England that part of the Additional Roles Reimbursement Scheme funding is held centrally, and so the forecast has been adjusted accordingly to reflect the value of allocation received by the CCG. Reimbursement for expenditure exceeding allocation can be claimed by the CCG. It is anticipated that further recruitment will occur in Quarter 4, as per Primary Care Network workforce plans. − The number of Maternity, Paternity, Adoptive, or Sickness requiring locum cover has reduced compared to 2019/20. − The CCG is applying ‘income protection’ to locally commissioned schemes, to support Primary Care in the delivery of new priorities as a result of the pandemic and the vaccination programme underway. This also applies to the Minor Surgery and Primary Care Networks Directed Enhanced Services (reported in Delegated Commissioning). − The CCG has now received funding for several General Practice Forward View schemes, which will be committed in-year. − The CCG has received its share of the Sustainability and Transformation Partnership funding for the GP COVID Capacity Expansion Fund, and committed in full to our GP practices. 3
The Primary Care Commissioning Committee noted the month 9 position Primary Care Finance Report.
6. Approved Chair’s Action for Standard Operating Procedures relating to the use of COVID-19 vaccinations
The Approved Chairperson’s Action for Standard Operating Procedures relating to the use of COVID-19 vaccinations was presented to the Committee.
Key points:
• On the 8 December 2020, Dr Keith Ridge CBE, Chief Pharmaceutical Officer for England sent a letter to all Chief Pharmacists, Heads of Medicines Optimisation, CCG Chief Officers, and Community Trust Pharmacists. • The letter set out the principles and expectations necessary to maintain integrity, and therefore safety, quality and effectiveness, of the COVID-19 vaccines which were due to be given in the Portsmouth area from the week commencing 14 December 2020. • Alongside this letter were a number of Standard Operating Procedures that detailed handling, storage, ordering, disposal and administration of COVID vaccinations.
The Committee agreed that Simon Cooper and Justina Jeffs will discuss and implement the processes around the frequent changes to the Standard Operating Procedures. Action: S Cooper/J Jeffs
The Committee were asked to receive the paper.
The Primary Care Commissioning Committee approved the chairs action.
7. Primary Care Audit Report
The Committee received a very positive Primary Care Audit Report from Internal Audit, which concluded they had substantial assurance about the governance, risk and contract processes used by the Primary Care team in regard to commissioning services.
Overall Assessment
• Substantial Assurance
Key strategic findings
• There were adequate controls in place for the commissioning and procurement of services. • The latest Primary Care Strategy 2019-2021 was not published on the CCG’s website. • Some key documents omitted version control and review dates. • A good practice Procedure Strategy example had been shared with management.
Good practice identified
• The CCG has processes in place for consulting with the public and other relevant agencies. • The CCG has adequate procurement processes in place.
Carol Giles congratulated the Primary Care team on their achievements.
The Committee were asked to receive the Internal Audit report.
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The Primary Care Commissioning Committee received the report.
8. Healthwatch Portsmouth GP Surgery website review
The Healthwatch Portsmouth GP Surgery website review report was presented to the Committee. Roger Batterbury explained that the review had been conducted within the Portsmouth Primary Care Network areas. The purpose of the review had been to identify any gaps in information that could or could not be found on each GP website city wide. Although the report highlighted examples of good information provision, there were numerous areas for improvement in the accessibility of GP websites and the quality of information provided.
Committee members raised the following:
• As the report was completed back in August 2020, should there be some consideration given to provide updated information for COVID-19? • The report provided useful and positive information; however, some aspects of the report could be seen in a negative light. • Encouraging seeing that practices had received some positive reviews. • If some patients had difficulties using the website, how do we capture these patients?
The Committee agreed that Healthwatch Portsmouth, the Communications Team, and Patient Participation Group will work through the recommendations where improvement for access to services has been identified, and will continue to support practices around Primary Care Networks.
The Committee were asked to accept the report and its recommendations.
The Primary Care Commissioning Committee accepted the report and noted the recommendations.
9. Flu and COVID Vaccination Programmes
David Scarborough, Practice Manager Representative and Practice Manager at Trafalgar Medical Group, and Dr Nick Moore, Clinical Executive and local GP working at the Derby Road Practice, declared an indirect conflict with the information contained within this paper as it impacted on their practice. Margaret Geary, as the Chair, agreed that they could participate in the discussion but not in any decision-making.
The Flu and COVID Vaccination Programmes update on the progress of uptake of Flu and COVID-19 vaccinations across the city was presented to the Committee.
Flu
• 82% uptake for over 65 year olds – increased by 10% • 55% uptake for under 65 year olds – increased by 11% • 55% uptake for pregnant women
Simon Cooper reported that Flu vaccinations are continuing and uptake is significantly higher in comparison to previous years. Due to social distancing and good hygiene measures, the impacts of transmissions of the virus were lower than previous seasonal flu years.
COVID-19
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• Five sites have been set up and are running vaccination hubs. • Cohort 1 has been vaccinated; with Cohort groups 3 and 4 on target. • 100% of all delivered vaccine has been used with minimal wastage. • Reported vaccine supply issues and it has not always been possible to deliver vaccinations at pace that reflected the practices’ readiness. • Two community pharmacies have been identified in the city; Lalys at Guildhall Square with an option of the booking the vaccination via a GP practice (within a 45 mile radius) or via on the national booking system. The further community pharmacy will be on-line shortly. • Some additional vaccination sites from Primary Care Network areas will be utilised shortly.
Claire Currie thanked the exceptional efforts of the Primary Care and GP practices in successfully implementing the vaccination sites. Portsmouth Public Health welcomed a joint approach for future communications planning.
The Committee were asked to note the report.
The Primary Care Commissioning Committee noted the latest position of the national Flu and COVID-19 vaccinations programmes.
10. Portsdown Group Practice Personal Medical Services Contract Variation
David Scarborough, Practice Manager Representative and Practice Manager at Trafalgar Medical Group, and Dr Nick Moore, Clinical Executive and local GP working at the Derby Road Practice, declared an indirect conflict with the information contained within this paper as it impacted on their practice. Margaret Geary, as the Chair, agreed that they could participate in the discussion but not in any decision-making.
Steve McInnes presented the Portsdown Group Practice Personal Medical Services Contract Variation to the Committee. He explained that the practice are writing a new Partnership Deed and have formally requested the CCG to remove a Health Service Body status from their contact.
The Committee were asked to approve the variation to the Portsdown Group Practice Personal Medical Services contract.
The Primary Care Commissioning Committee approved the contract variation.
11. Primary Care CQUIN 2020/21 - use of funding for COVID activities
David Scarborough, Practice Manager Representative and Practice Manager at Trafalgar Medical Group, and Dr Nick Moore, Clinical Executive and local GP working at the Derby Road Practice, declared an indirect conflict with the information contained within this paper as it impacted on their practice. Margaret Geary, as the Chair, agreed that they could participate in the discussion but not in any decision-making.
The Committee agreed that the remaining Primary Care Commissioning for Quality and Innovation (CQUIN) funding for 20/21 could be used to support activities being undertaken by General Practice that are associated with COVID 19, but not funded from other sources.
The Primary Care Commissioning Committee agreed the proposal in the report.
12. Overview of the proposed Primary Care CQUIN 2021/22
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David Scarborough, Practice Manager Representative and Practice Manager at Trafalgar Medical Group, and Dr Nick Moore, Clinical Executive and local GP working at the Derby Road Practice, declared an indirect conflict with the information contained within this paper as it impacted on their practice. Margaret Geary, as the Chair, agreed that they could participate in the discussion but not in any decision-making.
An overview of the proposed Primary Care Commissioning for Quality and Innovation (CQUIN) 2021/22 was presented to the Committee. The one year scheme will commence on the 1st April 2021 until 31st March 2022, and will include both Commissioning and Prescribing elements. A proposal to stagger activity across the year has been considered, due to the current pandemic and increased pressures on city wide practices.
An element of the 2021/22 scheme will look at new ways of working, and how key scheme components will be delivered by practices. The Primary Care and Medicines Optimisation team will continue to support practices with the Technology section to agree the adoption of specific systems across the city.
Christine Horan will circulate the updated proposed CQUIN report for approval. Action: C Horan
The Primary Care Commissioning Committee agreed for the work on the CQUIN to continue.
13. Any Other Business
No further business.
14. Date of Next Meeting
The next Primary Care Commissioning Committee meeting to be live streamed subject to Government COVID-19 guidelines will take place on Thursday 25 March 2021 at 9.30am.
Member Name May 2020 Jul 2020 Sept 2020 Nov 2020 Jan 2021 March 2021 Margaret Geary Helen Atkinson A A A A A Simon Cooper A A A Jason Eastman A Dr Nick Moore A Julia O’Mara A A Jackie Powell A Terri Russell David Scarborough A Dr Clare Sieber A Andy Silvester A A A Michelle Spandley A Jo York A
- Present A – Apologies
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Minutes of a Meeting of the Audit Committee held on Wednesday 9 December 2020, 1:00-3:00pm Via Microsoft teams.
Summary of Actions
Agenda Action Who By Item
Present: Andy Silvester - Lay Member (Chair) Karen Atkinson - Governing Board Nurse Representative Graham Love - Lay Member Jackie Powell - Lay Member
In attendance: Corrine Braund - Grant Thornton, External Auditors Nikki Burnett - Deputy Chief Financial Officer Justina Jeffs - Head of Governance Hayley Matthews - IG Manager, South Central and West CSU Kevin Moloney - Internal Audit, TIAA Ltd Iain Murray - Grant Thornton, External Auditors Giles Parratt - Internal Audit, TIAA Tracy Sanders - Managing Director Michelle Spandley - Chief Finance Officer Karen Travers - Local Fraud & Security Management, Hampshire and Isle of Wight Fraud & Security Management Service
1. Apologies and Welcome Andy Silvester welcomed everyone to the meeting and confirmed consent to record the meeting for the purpose of the minutes, members agreed. There were no apologies received.
2. Register and Declarations of Interest A conflict was noted for the internal and external auditors in respect of item 8c as the supporting information also included their company contracting information with the CCG. The Audit Committee noted the Register and Declarations of Interests.
3. Minutes of the meeting held on 9 September 2020 The Audit Committee agreed the minutes held on 9 September 2020
Jackie Powell asked if there was an update on the Mental Health Investment Standard as the published standard was for the 18/19 financial year. Nikki Burnett confirmed that the 19/20 Standard was due for publication at the end of February 2021.
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a. Summary of Actions The summary of actions from the last meeting were discussed and reviewed as follows:
Agenda Action Who Progress Item 5b and Update risk register to reflect publication of the Mental Justina Jeffs Complete 9c Health Investment Standard 7c Q1 and Q2 information to be combined and presented Karen Travers Complete at the next meeting (Counter Fraud) 8c Procurement Register: Members were asked to All Complete feedback their views about including the SOEPS Forward View as a item within the Committee 9c Justina Jeffs and Jackie Powell to revise the risk Justina Jeffs/ Complete regarding patient engagement Jackie Powell b. Decision Log The Audit Committee noted the decisions log.
4. Deferred Items There were no deferred items
5. External Audit a. To receive Progress and Sector Briefings Corrine Braund informed members the work had started on the Mental Health Investment Standard 19/20. Meetings were taking place with CCG staff regarding the Annual Report and Accounts.
Justina Jeffs asked if the sector briefings could be sent out separately, in between meetings, however Ian Murray explained that this might not be possible.
Ian Murray stated that changes were taking place led by the National Audit Office and as a result work was becoming more complex. The Auditors Annual Report was much broader, covering all areas, not just risk areas. The additional cost of this was being worked through and would be discussed with Chief Finance Officers.
6. Internal Audit Update a. Progress Report Kevin Moloney presented the internal audit progress report. The Risk Management report indicated ‘reasonable’ assurance and the Primary Care Commissioning received ‘substantial’ assurance. There were no priority 1 recommendations.
There was a change to the plan to include work undertaken for PPCA Financial Controls. The draft report was being shared with the Chief Finance Officer. This work was completed within the contingency allocation within the Plan.
Graham Love commented that Quarter 4 of the Plan looked busy. Kevin Maloney and Giles Parratt highlighted the following:
Recognition that the PPCA work was outside of the police investigation and that TIAA would be meeting with the CCG to go through the findings over the coming week. 2
The Conflicts of Interest Audit relies on training which is not complete until quarter three. Data Security is required for national submission on 31 March each year which influences the Internal Audit timeframe and PPE was anticipated to be a quick piece of work. Covid had delayed some work by a quarter
Giles Parratt spoke to the Audit Plan highlighting the completed audits and the proposed approached for the next financial year which starts with mandatory requirements within the Plan followed by those requested by the CCG.
Members also noted the Client Briefings. Jackie Powell asked about EU Exit and was informed that CCGs were not being considered for this work at the moment. Tracy Sanders confirmed that EU Exit was being addressed across the whole of Hampshire and the Isle of Wight.
Michelle Spandley informed members that the Plan was shared with teams within the CCG and any proposed changes would be brought back to this Committee.
b. Follow-up recommendations Kevin Maloney commented that there were no actions outstanding and the final page of the report indicated those actions not yet due.
The Audit Committee reviewed and accepted the Internal Audit updates presented and agreed with the 2021/22 Plan.
7. Local Counter Fraud Services Karen Travers spoke to both the Counter Fraud and Local Security Management items on the agenda and highlighted the following from the reports provided: Fraud The self-assessment tool score continues to be an overall ‘green’. The latter part of Q2 was dominated by agency provision across many organisations in Hampshire along with an increased in fraud alerts due to Covid and the greater opportunities to commit and be the victim of fraud whilst working differently. New standards would be in place next year which include a Counter Fraud Strategy. The Local Strategy is planned for completion by 1 April 2021.
Karen Travers highlighted that the PPCA event was a theft and therefore not fraud. All of the information has been passed to Hampshire Constabulary who are taking this forward.
Karen Travers confirmed that the website (page 5) was available to all and could be accessed from any site. Nikki Burnett confirmed that this website had also been shared and communicated to staff via the intranet and explained that Karen Travers had attended Finance Team meetings in the first instance as this team had the most queries due to the nature of their work.
Security Karen Travers highlighted that this was also green on the self-assessment tools. New Security Standards would be coming in to place next year with a focus on violence and aggression reduction and prevention.
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Conflict Resolution online training was offered to all staff and remains a requirement for those staff working face-to-face with the public.
The Audit Committee thanked Karen Travers for her comprehensive and interesting reports and accepted the Counter Fraud and Security reports
8. Financial Matters a. Use of CCG Seal The seal was not used.
b. Finance Report Nikki Burnett Presented this item and highlighted the following: The CCG’s objective continued to be to achieve a balanced position by the year end. The CCG was on-track to deliver a £3.35m surplus which is likely to be move across the system. NHS England will be looking at the Hampshire and Isle of Wight STP position Month 7 was on track to deliver the plan. The CCG remains in a different finance regime The CCG was still awaiting a £1.6m balancing figure Payment to suppliers was over-achieving the target of 30 days Flow of cash was difficult to predict, particularly with regards to hospital discharge programmes with flows of cash between the CCG, PCC and the national team have resulted in a ‘lag’ in the system. Cash is ordered two months in advance. There was a material change to CHC assessments coming back on line and starting to increase. The backlog was being worked through.
Jackie Powell thanked the finance team for managing the financial situation and asked if the surplus was from our contingency. Nikki Burnett stated that we had a share in £2.5m Covid monies across the STP which was intended for additional schemes.
c. Register of Procurement Decisions Justina Jeffs spoke to this item and informed members that no procurements had been completed from the beginning of the financial year. A number of procurements were in process but not completed at this time.
Justina Jeffs also drew members’ attention to the attached Forward View provided by South of England Procurement Services detailing contracts held by the CCG and which the CCG was party to.
d. Single Tender Waiver Register No Single Tender Waivers had been completed from the previous meeting.
The Audit Committee noted all items under Financial Matters and approved the publication of the Register of Procurement Decisions and Single Tender Waiver Register (nil return) on the website.
9. Governance Matters a. Information Governance Update
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Hayley Matthews provided an update on IG matters and highlighted that there was a revised version of the Data Security Toolkit which the CCG would be using for its submission in March 2021. Andy Silvester asked if the Training could be raised again with CCG staff.
b. GBAF and Corporate Risk Register Justina Jeffs presented the GBAF, highlighting the information provided on the cover sheet. Jackie Powell highlighted the need to reconsider the wheelchair risk description. Graham Love stated that consideration should be given to financial risk due to the possibility of the use of the CCG reserves.
c. Register of Gifts/Hospitality The group noted the register of gifts and hospitality.
d. Audit Committee Workplan Members accepted the workplan
e. Committee Terms of Reference Members agreed the Terms of Reference subject to numbering being amended.
The Audit Committee noted all items within Under Agenda Item 9 and thanked Hayley Matthews and Justina Jeffs for their reports. The Committee also approved the publication of the Gifts & Hospitality Register on the CCG’s website.
10. Scrutiny Items There was no scrutiny item
11. Any Other Business. NHS England was undertaking a Governance Review of the CCG with the focus on two areas: the decisions taken regarding the Operating Model and the response to the PPCA event. Dr Fellows was in discussion with NHS England regarding the scope of the work. The Audit Committee would be kept informed of the progress of this work.
12. Reflections on the meeting/key messages. Andy Silvester stated that we are maintaining normal CCG business despite working from home and thanked everyone for their perseverance and assistance. He went on to say that a lot of work was taking place and that financially the CCG was ‘steady’.
Members of the Audit Committee also noted that this was the last meeting for Tracy Sanders who was leaving the organisation in February 2021. Andy Silvester thanked Tracy Sanders on behalf of all of the members, for her support throughout the years.
13. Dates and Times of future meetings The next meeting will be held on Wednesday 10th March 2021, 1.00pm – 3:00pm, via Microsoft Teams.
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Audit Committee – Attendance Log
Member Name June 2020 Sept 2020 December 2020 Andy Silvester (Chair)
Graham Love Jackie Powell Karen Atkinson
A – Apologies N/A – Not a member / left organisation
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