AGENDA NHS Leeds CCG Governing Body Meeting

Date: Wednesday 23 May 2018 Time: 13:15 – 17:00 Venue: Thackray Medical Museum, Beckett Street, Leeds, LS9 7LN

Please note: agenda timings are approximate Item Description Lead Paper Time GB Welcome and Apologies Gordon Sinclair N 13:15 18/06 Purpose: To record apologies for absence and confirm the meeting is quorate.

GB Declarations of Interest Gordon Sinclair Y 18/07 Purpose: To record any Declarations of Interest relating to items on the agenda:

a) Financial Interest Where an individual may get direct financial benefit from the consequences of a decision they are involved in making;

b) Non-Financial professional interest Where an individual may obtain a non-financial professional benefit from the consequences of a decision they are involved in making;

c) Non-financial personal interest Where an individual may benefit personally in ways that are not directly linked to their professional career and do not give rise to a direct financial benefit, because of the decisions they are involved in making; and

d) Indirect Interests Where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making.

GB Questions from Members of the Public Gordon Sinclair N 13:20 18/08 Purpose: To receive questions from members of the public

GB Minutes from Previous Meetings: Gordon Sinclair Y 13:30 18/09 i. Leeds Health Commissioning & System Integration Board – 21 March 2018 ii. Governing Bodies Meeting in Common – 22 March 2018 iii. Extraordinary Governing Body meeting held on 11 April 2018

Item Description Lead Paper Time Purpose: To receive the minutes for approval

GB Matters Arising Gordon Sinclair N 13:35 18/10 Purpose: To consider any matters arising that are not considered elsewhere on the agenda GB Action Log Gordon Sinclair Y 18/11 Purpose: To review the outstanding actions from previous Board meetings

GB Annual Report & Accounts 2017/18 (NHS Leeds North, Visseh Pejhan- Y 13:40 18/12 Leeds South & East and Leeds West CCGs) Sykes i) ISA260 Report ii) Management Representation Letter iii) Individual Governing Body Declarations Statements Signing

Purpose: To receive the Annual Report & Accounts for approval

GB Patient Voice - Self-care management and initiatives Jo Harding N 13:55 18/13 Purpose: To receive patient experience information to inform the Board’s decision making

ASSURANCE GB Corporate Risk Register Phil Corrigan Y 14:10 18/14 Purpose: To receive the corporate risks for review

STRATEGY GB Strategic Review Phil Corrigan / Y 14:20 18/15 Katherine Purpose: To receive a briefing in relation to the West Yorkshire Sheerin & Harrogate STP, Leeds Health & Care Plan and CCG Strategy

GB Commissioning for Value Katherine Y 14:35 18/16 Sheerin Purpose: To receive an update on the Commissioning for Value Framework and current schemes

GB Director of Public Health Annual Report Ian Cameron Y 14:50 18/17 Purpose: To receive the report for review

BREAK FOR 5 MINUTES COMMITTEE CHAIRS SUMMARIES GB Audit Committee – 18 April 2018 Peter Myers Y 15:10 18/18 Purpose: To receive the summary for information and assurance

GB Remuneration & Nomination Committee – 11 April 2018 Stephen Ledger Y 18/19

Item Description Lead Paper Time Purpose: To receive the summary for information and assurance

GB Quality & Performance Committee – 9 May 2018 Stephen Ledger Y 18/20 Purpose: To receive the summary for information and assurance

COMMISSIONING GB Integrated Quality & Performance Report (IQPR) Katherine Y 15:20 18/21 Sheerin / Purpose: To receive the IQPR and consider any issues Jo Harding escalated by the Quality & Performance Committee

GB Finance Report – High Level Budgets Visseh Pejhan- Y 15:30 18/22 Sykes Purpose: To receive the high level budgets for approval

GB Chief Executive’s Report Phil Corrigan Y 15:40 18/23 Purpose: To receive an update on key issues from the CCGs’ Chief Executive

GOVERNANCE GB Policy Approval: Y 15:50 18/24 i) Pharmaceutical and Related Industries Joint Simon Stockill Working Policy ii) Managing Conflicts of Interest Policy Phil Corrigan

Purpose: To receive the policies for approval

GB Committee Terms of Reference Gordon Sinclair Y 16:00 18/25 Purpose: To receive the terms of reference for approval

STANDING ITEMS GB Questions from Members of the Public Gordon Sinclair N 16:10 18/26 Purpose: To receive questions from members of the public

GB Forward Work Programme 2018/19 Gordon Sinclair Y 16:20 18/27 Purpose: To receive the programme

GB Any Other Business Gordon Sinclair N 16:25 18/28

Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest" GB Confidential Minutes of the Governing Bodies Meeting held Gordon Sinclair Y 16:30 18/29 in Common on 22 March 2018

Item Description Lead Paper Time Purpose: To receive the minutes for approval

GB Interim Procurement Plan 2018/19 Visseh Pejhan- Y 16:35 18/30 Sykes Purpose: To receive the interim plan for approval

GB Consultation - Update Phil Corrigan Y 16:45 18/31 Purpose: To receive the update for information

Dates of Future Meetings: Wednesday 25 July 2018, 2pm Wednesday 26 September 2018, 2pm Wednesday 28 November 2018, 2pm Wednesday 30 January 2019, 2pm Wednesday 27 March 2019, 2pm

No Is the interest Job Title Name of practice (where Declared Interest- (Name of the Forename Surname Interests direct or Interest From Interest Until Action Taken to Mitigate Risk (where applicable) applicable) organisation and nature of business) Declared indirect? Interests Professional Professional Non-Financial Non-Financial Non-Financial Non-Financial Personal Interests Personal Financial Interests Financial GP CCG Member GP Body Governing Member Ben Browning Member Representative Lofthouse Surgery GP Partner in Lofthouse surgery Ongoing Declare conflict or perceived conflict within context XX X Direct of any relevant meeting or project work

Ben Browning Member Representative Lofthouse Surgery Shareholder in Leodis Care Ltd (now a Ongoing Declare conflict or perceived conflict within context XX dormant and non-trading company) X Direct of any relevant meeting or project work Ben Browning Member Representative Lofthouse Surgery Member of Leodis LLP (Shell company) Ongoing Declare conflict or perceived conflict within context XX X Direct of any relevant meeting or project work

Ben Browning Member Representative Lofthouse Surgery Spouse is a GP Partner in Lofthouse Ongoing Declare conflict or perceived conflict within context XX surgery X Indirect of any relevant meeting or project work

Ben Browning Member Representative Lofthouse Surgery Spouse is city-wide lead for Learning Ongoing Declare conflict or perceived conflict within context XX Disability services X Indirect of any relevant meeting or project work

Gordon Sinclair Clinical Chair Burton Croft Surgery Partner at Burton Croft Surgery 01/01/1993 Ongoing Declare conflict or perceived conflict within context XX X Direct of any relevant meeting or project work

Gordon Sinclair Clinical Chair Burton Croft Surgery Partner of Viva Healthcare LLP 01/01/2012 Ongoing Declare conflict or perceived conflict within context XX X Direct of any relevant meeting or project work

Gordon Sinclair Clinical Chair Burton Croft Surgery Headingley Pharmacy LLP – Viva 01/01/2012 Ongoing Declare conflict or perceived conflict within context XX Healthcare has a 25% interest X Direct of any relevant meeting or project work

Gordon Sinclair Clinical Chair Burton Croft Surgery Burton Croft Surgery is a shareholder of 01/01/2016 Ongoing Declare conflict or perceived conflict within context XX Leeds West Primary Care Network Ltd X Direct of any relevant meeting or project work

Ian Cameron Public Health Consultant Director of Public Health Leeds City 01/04/2016 Ongoing To declare any conflict or perceived conflict and in Council particular any decisions affecting joint working with X X Direct Leeds City Council including policy and resource decisions

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Partner Oakwood Lane Medical Practice 10/05/2012 Ongoing Declare conflict or perceived conflict within context XX Practice X Direct of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Director Jemjo Healthcare Ltd 10/05/2012 Ongoing Declare conflict or perceived conflict within context XX Practice X Direct of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Spouse business Airtight International Ltd 10/05/2012 Ongoing Declare conflict or perceived conflict within context XX Practice X Indirect of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Spouse business Nails 17 Ltd 10/05/2012 Ongoing Declare conflict or perceived conflict within context XX Practice X Indirect of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Director Leeds Jewish free school 16/01/2014 Ongoing Declare conflict or perceived conflict within context XX Practice X Direct of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Director Brodetsky Primary School 17/06/2014 Ongoing Declare conflict or perceived conflict within context XX Practice Foundation X Direct of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Chair of Governor's Brodetsky Primary 01/09/2012 Ongoing Declare conflict or perceived conflict within context XX Practice School X Direct of any relevant meeting or project work Jason Broch Assistant Clinical Chair Oakwood Lane Medical Founding Fellow of the Faculty of Clinical 01/05/2018 Ongoing Declare conflict or perceived conflict within context XX Practice Informatics X Direct of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Gartner UK - Clinical Advisor 03/05/2018 Ongoing Declare conflict or perceived conflict within context XX Practice X Direct of any relevant meeting or project work

Jason Broch Assistant Clinical Chair Oakwood Lane Medical Oakwood Lane Medical Practice is a 01/05/2018 Ongoing Declare conflict or perceived conflict within context XX Practice shareholder of Calibre Care Partners Ltd X Direct of any relevant meeting or project work (GP Federation) Jo Harding Director of Quality and X X Safety Direct

Julianne Lyons Member Representative Leeds Student Medical GP Partner at Leeds Student Medical 01/01/2016 Ongoing Declare conflict or perceived conflict within context XX Practice Practice X Direct of any relevant meeting or project work

Julianne Lyons Member Representative Leeds Student Medical Leeds Local Medical Committee Member 01/09/2013 Ongoing Declare conflict or perceived conflict within context XX Practice X Direct of any relevant meeting or project work

Julianne Lyons Member Representative Leeds Student Medical Spouse is a Director of Leeds 01/01/2013 ongoing Declare conflict or perceived conflict within context XX Practice Haematology plc X Indirect of any relevant meeting or project work

Julianne Lyons Member Representative Leeds Student Medical Spouse is a trustee of the British Society 01/04/2014 Ongoing Declare conflict or perceived conflict within context Practice for Haematology of any relevant meeting or project work XX X Indirect

Julianne Lyons Member Representative Leeds Student Medical Spouse is a trustee of UK Myeloma Forum 01/01/2013 Ongoing Declare conflict or perceived conflict within context XX Practice X Indirect of any relevant meeting or project work

Julianne Lyons Member Representative Leeds Student Medical Spouse is an employee of the University of 01/01/2015 Ongoing Declare conflict or perceived conflict within context XX Practice Leeds Indirect of any relevant meeting or project work

Julianne Lyons Member Representative Leeds Student Medical Spouse has an honorary contract with 01/01/2015 Ongoing Declare conflict or perceived conflict within context XX X Indirect Practice Leeds Teaching Hospitals NHS Trust of any relevant meeting or project work Julianne Lyons Member Representative Leeds Student Medical Shareholder of Leeds West Primary Care 01/10/2015 Ongoing Declare conflict or perceived conflict within context XX Practice Limited X Direct of any relevant meeting or project work

Peter Myers Lay Member for Audit and Director Finance Yorkshire Ltd 05/08/2015 Ongoing Declare conflict or perceived conflict within context X Conflict Matters X Direct of any relevant meeting or project work

Peter Myers Lay Member for Audit and Chairman of the Equine and Livestock 03-Aug-17 Ongoing Unlikely to cause conflict due to nature of interest. If Conflict Matters Insurance Group conflict arises to declare and withdraw if a decision X X Direct is being taken.

Philomena Corrigan Chief Executive Trustee for the Foundation of Nursing 01/12/2015 Ongoing Declare conflict or perceived conflict within context X X Direct of any relevant meeting or project work

Simon Stockill Medical Director Partner at Sleights and Sandsend Medical 01/04/2016 Ongoing Declare conflict or perceived conflict within context Practice, Whitby (Hambleton, of any relevant meeting or project work X Richmondshire & Whitby CCG) X Direct

Simon Stockill Medical Director GP Appraiser, NHS England (Yorkshire & 01/12/2013 Ongoing Declare conflict or perceived conflict within context X Humber) X Direct of any relevant meeting or project work

Simon Stockill Medical Director Clinical Lead for Quality Improvement 01/09/2016 Ongoing Declare conflict or perceived conflict within context X Ready Programme, Royal College of GPs X Direct of any relevant meeting or project work

Stephen Ledger Lay Member Assurance X Declare conflict or perceived conflict within context X of any relevant meeting or project work Sue Robins Director of Operational X X Delivery Visseh Pejhan- Chief Finance Officer Niece works for CCG as Digital 11/12/2017 Ongoing Not to participate in any decisions which may affect Sykes X Communications Officer X Indirect this post, e.g. cut budget

Angela Collins Lay Member for Patient and X Public Participation X

Sam Senior Lay Member for Primary Lay Member for Primary Care Bassetlaw Sep-17 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning CCG of any relevant meeting or project work X X Direct

Sam Senior Lay Member for Primary Lay Representative National School of May-16 Ongoing Declare conflict or perceived conflict within context X Care Co-Commissioning Healthcare Science X Direct of any relevant meeting or project work Sam Senior Lay Member for Primary Lay Advisor Health Education England May-16 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning (West Midlands) of any relevant meeting or project work X X Direct

Sam Senior Lay Member for Primary Patient and Public Panel Member - Apr-17 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning National Institute Health Research of any relevant meeting or project work X X Direct

Sam Senior Lay Member for Primary Chairperson - Brimpton United Junior May-13 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning Football Club (S63 6BB) of any relevant meeting or project work X X Direct

Katherine Sheerin X Interim Director of Strategy, Director of Ambition Health Ltd X 30/09/2017 Ongoing Ambition Health Ltd not to bid and undertake any Performance & Planning Direct work in the Leeds Health economy whilst KS is in post.

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Draft Minutes NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting Wednesday 21 March 2018 2:00pm – 5:20pm Thackray Medical Museum, Leeds, Beckett Street, Leeds, LS9 7LN

Members Initials Role Present Apologies Philip Lewer (Chair) PL Lay Chair  JB  Dr Jason Broch Clinical Chair (item 85 – 114) Dr Ben Browning BB GP Representative  Philomena Corrigan PC Chief Officer  Nigel Gray NG Chief Officer System Integration  Jo Harding JH Director of Nursing and Quality  Dr Nick Ibbotson NI GP Representative  Dr Steve Ledger SL Lay Member - Assurance  Dr Julianne Lyons JL GP Representative  Peter Myers PM Lay Member - Governance  Dr Amal Paul AP GP Representative  Visseh Pejhan-Sykes VPS Chief Finance Officer  Graham Prestwich GP Lay Member - PPI  Manjit Purewal MP Joint Medical Director  SR Director of Commissioning, Susan Robins  Strategy and Performance Dr Gordon Sinclair GS Clinical Chair  Dr Simon Stockill SS Joint Medical Director  Gordon Tollefson GT Lay Member - PPI  Additional Attendees Dr Ian Cameron IC Director of Public Health  Dylan Roberts DR Chief Information Officer  KS Interim Director of Strategy and Katherine Sheerin  Planning Cath Roff CR Director of Adults & Health  Tanya Matilainen TM Healthwatch Representative  Steve Walker SW Director of Children & Families 

Dr Alistair Walling AW Clinical Leader  LP Head of Corporate Governance Laura Parsons  and Risk BB Head of Programme Delivery, Becky Barwick  System Integration Sharon Katema SK Governance Manager  (Minutes) Members of the Public Observing the Meeting – none

No. Agenda Item Action LHCB Welcome and Apologies for absence 17/93 Philip Lewer welcomed everyone to the meeting. Apologies had been received on behalf of Peter Myers, Graham Prestwich, Manjit Purewal, Ben Browning, Amal Paul, Alistair Walling, Nick Ibbotson, Gordon Tollefson and Ian Cameron.

LHCB Declarations of interest 17/94

Members were asked to make any declarations of interest in relation to

agenda items. No declarations of interest were made.

LHCB Patient Voice – Gypsy and Travelers community experience of accessing 17/95 healthcare in Leeds.

The Board heard from Liz Keat, an Outreach Nurse who had been working with roadside and housed families from the gypsy and traveller community since January 2017. The role explored the outreach/in-reach model and aspired to work on creating a good relationships within this community. In providing an outline on the barriers that this community faced, Liz cited an example of a family resident in Cottingley Springs, who although not representative of the community view, had faced barriers that prevented them from accessing healthcare in Leeds.

A number of important issues on the Gypsy and Traveller community were highlighted, including:  Life expectancy was the lowest of any ethnic group, at around 50 years.  Individuals were more likely to have long term medical conditions.  Individuals were more likely to have been affected by suicide.  Most were carers although they would not necessarily identify themselves as a carer.  Some missed appointments could be attributed to the high levels of illiteracy within the community and the limited timeframe to book an appointment under the Choose and Book service. This had been further compounded by delays in the delivery of post as Cottingley Springs residents needed to collect their post from the Royal Mail sorting offices.

No. Agenda Item Action  Lack of trust and confidence in the healthcare services.  Roadside travellers found it difficult to register at practices as they needed to have a permanent address despite NHS England advising that they did not necessarily need to have a fixed address in order to register.  Prejudices and misconceptions from the public with regards to the community, discouraged the community from accessing health services.

The Board thanked the outreach nurse for her contribution and insight.

The Leeds Health Commissioning and System Integration Board resolved to:

a) NOTE the Patient Voice.

LHCB Questions from Members of the Public 17/96

There were no questions from the public.

LHCB Minutes of the Meeting held on 25 January 2018 17/97 The minutes of the meeting of the Leeds Health Commissioning and System Integration Board of 25 January 2018 were agreed and approved as a true and accurate record of proceedings.

The Leeds Health Commissioning and System Integration Board resolved to:

a) APPROVE the minutes of the meeting held on 25 January 2018.

LHCB Matters Arising 17/98

There were no matters arising.

LHCB Action Log 17/99 The Board considered the Action Log and made a number of updates as follows:

 LHCB17/35 – It was noted that an update to the template would be made at the next Business Intelligence meeting the following week.  LHCB 17/58 – The alignment of risks reported at a West Yorkshire level with CCG risks would be considered at the Governing Body meeting in May 2018.

The Leeds Health Commissioning and System Integration Board resolved to:

a) NOTE the action log and the updates provided.

No. Agenda Item Action LHCB Corporate Risk Register 17/100 It was noted that there were 55 active risks on the CCG risk register, five of which had been escalated to the CCG Corporate Risk Register as they had a score of red 16. These included:-

 Risk 541: System Resilience; impact on the health and social care system within Leeds  Risk 466: Achievement of the national ambulance standards which remained at a score of red 16  Risk 339: Cancer waiting times remained a concern as there was an under achievement of overall performance for 62 day urgent GP referral to treatment of all cancers overall at Leeds Teaching Hospitals Trust (LTHT)  Risk 659: System resilience variable risk  Following review of Risk 660, the score had been reduced to amber 9 to reflect the delivery of high quality primary care standards within the CCG.

The Board discussed risk 532: Commissioner and/or Lead provider fails to achieve the operational standard for the 18 week Referral to Treatment Time which remained at a score of red 16. It was noted that creating a better sharing platform across the West Yorkshire STP would minimise complications faced by practices and their ability to access or share information.

Whilst it was noted that turnaround times for Yorkshire Ambulance Service were encouraging, concerns remained on job cycle times and the resource intensity of attending to calls. It was highlighted that Ambulance Response times, had not been achieved as performance was reported at county level. However, the position was expected to improve as CCG specific performance would be available from April 2018, which would also be included in the Integrated Quality and Performance Report (IQPR).

Further to the request for an update on the cancellation of elective surgeries, it was noted that LTHT was still addressing the issue and that no elective operations for benign cancers had been scheduled for the previous 8 weeks. In terms of the urgent treatment solutions, there were still challenges for patients were waiting too long to get admitted in Accident and Emergency and the impact on the workforce who were trying to cope with the workload.

The Leeds Health Commissioning and System Integration Board resolved to:

a) NOTE the corporate risk register as presented to the Board and the controls, assurances and mitigating actions that are in place to manage the risks.

No. Agenda Item Action LHCB System Integration Update 17/101 The Board was advised that the programme continued to make good progress and was on track to deliver its aims. In terms of collaboration and shared accountability, it was noted that Leeds three GP Federations had created a single Confederation for the city.

The Population Health Management (PHM) Programme would be renamed as the System Integration Programme to reflect the language used in the national policy and the local feedback. In terms of the programme leadership, the System Integration Programme would be within the remit of the Director of Strategy, Planning and Performance. It was highlighted that the Integrated Commissioning Executive (ICE) meeting had approved the decision for the People living with Frailty at the End of Life (EoL) to be the initial population group under the PHM programmes’ workstream.

In terms of communication and involvement, a Communication and Engagement narrative which focussed on the neighbourhood delivery model and Local Care Partnerships (LCPs) had been developed. Following an event with members of the public, a number of priorities had been identified which would be considered in the development of LCPs going forward.

The Leeds Health Commissioning and System Integration Board resolved to:

a) NOTE the progress made across the programme over the last 12 months; b) NOTE the proposed changes to the programme within the context of the local and regional developments; and c) NOTE the planned next steps for the programme over the next 12 months.

LCHB Chair’s Summary of the Primary Care Commissioning Committees 17/102 meeting in common – 24 and 30 January 2018

Philip Lewer presented the summary of the Primary Care Commissioning Committees (PCCC) meetings in common held on 24 and 30 January 2018. A number of practice specific matters had been considered at the meeting including the future provision of services at Cottingley Surgery and the proposal to commence patient engagement which had been approved. It was noted that the Leeds South and East PCCC had approved a list dispersal of the Radshan Medical Centre and for the engagement work to be undertaken with the patient population and local providers in readiness for the end of contract.

A procurement strategy to find an alternative provider of medical services practices at New Cross Surgery and Middleton had been agreed. In relation to Swillington Health practice, meetings had taken place with local practices who were interested in delivering a service for the site.

No. Agenda Item Action

The Committee had considered its draft annual report for 2017/8 and noted the positive outcome of the Committee Effectiveness self-assessment questionnaire.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the report.

LCHB Finance & Commissioning for Value Committee – 15 March 2018 17/103 Visseh Pejhan-Sykes presented the summary of the Joint Finance and Commissioning for Value Committee which took place on 15 March 2018. With the development of the Commissioning for Value Delivery Board, it was noted that the Finance and Commissioning for Value (CfV) committee was running in parallel and therefore duplicating the work of the CfV Board. An update would be presented to the Board following a review of the governance structures.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the report.

LCHB Chair’s Summary of the Patient Assurance Group meeting – 25 January 17/104 2018

It was noted that meetings for the Patient Assurance Groups had been held on 25 January 2018 and 22 February 2018. The Interim PAG had revised and highlighted that a Patient Assurance Group Tracker would enable the PAG to assure the Board that engagement was taking place appropriate to the service change.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the report.

LHCB Chair’s Summary of the Audit Committees in Common meeting – 26 17/105 February 2018

Visseh Pejhan-Sykes presented the summary from the Audit Committees in common meeting held on 26 February 2018. Of particular note was the update on the requirements to ensure compliance with the General Data Protection Regulations (GDPR) which would be presented at the Governing Body meeting the following day.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the report.

No. Agenda Item Action LHCB Chair’s Summary of the Quality and Performance Committee meeting – 8 17/106 March 2018

Steve Ledger presented the summary of the Quality and Performance Committee meeting held on 8 March 2018. In addition to reviewing the red risks which are presented to the Board and included in the Corporate Risk Register, the committee reviewed and tracked the amber risks relating to quality and performance on behalf of the Board.

It was noted that significant financial risks had been highlighted and there was a lack of clarity regarding the funding arrangements under the Transforming Care Partnership. The committee had agreed that the level of assurance in the transforming care agenda was limited and that it would monitor the performance through the relevant indicators on the Integrated Quality and Performance Report (IQPR). The governance and reporting structure would be clarified, including the Transforming Care Partnership Board.

In relation to risk 635 on the failure to meet the Emergency Care Standard which was rated amber, the Board agreed with the rating and agreed to review SR the performance after three months.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the report.

LHCB Integrated Quality and Performance Report (IQPR) 17/107 Sue Robins presented the IQPR which included an assessment of performance across a number of dashboards. Members were assured that the impact of the cancellation of elective surgery was being monitored and the CCG was working with the Trust to support recovery.

Jo Harding provided an update on a case in the media relating to a patient who had reported a poor experience after being moved to a non designated area within LTHT. The Trust had provided details of their strict protocols relating to non designated areas and this has been witnessed at a quality walkround visit. The care provided was not unsafe and there was no harm to the patient.

There had also been reports relating to an incident in February 2015 where a patient with schizophrenia had assaulted two other patients. NHS England had informed the CCG that an independent investigation was taking place and the report was awaited.

The Leeds Health Commissioning and System Integration Board resolved to:

a) NOTE the IQPR dashboards and the current areas of underperformance and mitigating action; and

No. Agenda Item Action b) SUPPORT the continued development of the IQPR.

LHCB Finance Report 17/108 Visseh Pejhan-Sykes presented the Finance report which provided an update on the combined financial positions of the Leeds CCGs for the 11 months until 28 February 2018, and the expected outturn position for the 2017-18 financial years.

The CCGs were on track to achieve the target surplus. Quality, Innovation, Productivity and Prevention schemes were now being tracked as part of the commissioning for value process.

The draft financial plan had been submitted, which was required to demonstrate a 20% saving in running costs.

The Leeds Health Commissioning & System Integration Board resolved to:

a) NOTE the Month 11 financial position; and b) NOTE the reporting of progress to the Senior Management Team.

LHCB Chief Executive’s Report 17/109 Phil Corrigan presented the report and particularly highlighted the following:  The CCG merger was on track, and appointments had been made to all Governing Body positions. Drs Julianne Lyons, Ben Browning and Keith Miller had been elected as member representatives for the CCG.  The Leeds Health and Care Academy was progressing well and offered the potential for integration of learning and development and created an opportunity for people to work across organisational and professional boundaries.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the report.

17/110 Review of Committees Reporting into the Board

Members considered the outcome of the reviews of the Committees which report into the Board. With regards to ways in which effectiveness of the Board could be improved, it was noted there was a need to reduce jargon and that the chairs of the new committees would need to consider the recommendations made.

The Leeds Health Commissioning and System Integration Board resolved to:

a) NOTE the annual reports from the committees; and b) NOTE that the Committee’s terms of reference were being reviewed as

No. Agenda Item Action part of the CCG merger.

LHCB Questions from Members of the Public 17/111 There were no further questions from the public.

LHCB Forward Work Programme 2017/18 17/112 The work programme for 2017/18 was presented. The work programme for 2018/19 onwards would be presented to the Governing Body of the merged CCG.

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the forward work programme.

LHCB Any Other Business 17/113 No other business was raised.

Exclusion of the Press and Public

The Leeds Health Commissioning and System Integration Board resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960).

LHCB Confidential Minutes of the Meeting held on 25 January 2018 17/114 The minutes from the confidential meeting held on 25 January 2018, were approved as a correct and accurate record.

The Leeds Health Commissioning and System Integration Board resolved to:

a) APPROVE the minutes of the confidential meeting of 25 January 2018.

IFI1 Minutes of the West Yorkshire & Harrogate Joint Committee meeting held on 9 January 2018

The Leeds Health Commissioning and System Integration Board resolved to:

a) RECEIVE the minutes of the West Yorkshire & Harrogate Joint Committee meetings held on 9 January 2018 for information.

No. Agenda Item Action Closing Remarks

Gordon Sinclair led the Board in thanking Philip Lewer on behalf of the three CCGs for having successfully chaired the meetings and for being a great asset during the transitional year. The Board wished him well in his new role as Chair of Calderdale and Huddersfield NHS Foundation Trust.

Date of Next Meeting:

There would be no future meeting as this was the last meeting of the Board.

Approved and signed by: Dr Gordon Sinclair, Clinical Chair

Date:

Minutes NHS Leeds North CCG, NHS Leeds South & East CCG and NHS Leeds West CCG – Governing Bodies Meeting in Common Thursday 22 March 2018 3:30pm – 4:15pm Britannia Leeds Bradford Airport Hotel, Leeds, LS16 9JJ

Leeds Leeds Leeds Members Initials Role Apologies North S&E West Philip Lewer (Chair for PL Lay Chair  LSE and Convener) Dr Jason Broch JB Clinical Chair  (Chair for LN) Dr Gordon Sinclair GS Clinical Chair  (Chair for LW) Dr Ben Browning BB GP Representative  Philomena Corrigan PC Chief Executive    IC Consultant in Public Health    Dr Ian Cameron Medicine Dr Mark Freeman MF Secondary Care Consultant  Diane Hampshire DH Non Executive Board Nurse  Jo Harding JH Director of Nursing and Quality    Dr Simon Hulme SH GP Representative  Dr Nick Ibbotson NI GP Representative  Dr Steve Ledger SL Lay Member – Assurance  Dr Mark Liu ML GP Representative  Dr Julianne Lyons JL GP Representative  Dr David Mitchell DM Secondary Care Consultant  Petra Morgan PM Practice Management  Representative Peter Myers PMy Lay Member – Governance  Dr Amal Paul AP GP Representative  Visseh Pejhan-Sykes VPS Chief Finance Officer    Graham Prestwich GP Lay Member – PPI    AP Lay Member – PPI / Deputy Angie Pullen  Chair Dr Manjit Purewal MP Joint Medical Director  Brian Roebuck BR Lay Member 

Leeds Leeds Leeds Members Initials Role Apologies North S&E West Susan Robins SR Director of Commissioning   

Chris Schofield CS Lay Member – Governance 

Dr Simon Stockill SS Joint Medical Director    Gordon Tollefson GT Lay Member – PPI  Dr Alistair Walling AW Clinical Leader  Additional Attendees Laura Parsons LP Head of Corporate Governance   

(Minutes) & Risk Members of the Public Observing the Meeting – 2

No. Agenda Item Action GB17/11 Welcome and Apologies for absence PL welcomed everyone to the meeting. Apologies had been received as noted above. It was noted that the Leeds West CCG Governing Body was not quorate, therefore the approval of decisions made today would be sought by e-mail from an additional Governing Body member to meet the quorum requirement of 10 members.

GB17/12 Declarations of interest Members were asked to raise any declarations of interest in relation to agenda items. No declarations were raised.

GB17/13 Questions from Members of the Public The meeting was opened up to the public to take any questions they had at

this stage. No questions were raised.

GB17/14 Minutes of the Governing Body meetings held in common on 2 August 2017 PL presented the minutes of the Governing Body meetings held in common on 2 August 2017 for approval.

The Governing Bodies in Common: a) approved the minutes of the Governing Body meetings held in common on 2 August 2017.

GB17/15 General Data Protection Regulations (GDPR) VPS presented an update on the General Data Protection Regulations (GDPR), the impact on the CCGs and the changes required to ensure compliance. A working group had been established to develop and oversee an action plan. The actions required include raising staff awareness and implementing training, and reviewing policies and procedures. A Data Protection Officer (DPO) had been appointed, which is a mandatory role under GDPR. This would be a shared role with Leeds City Council.

No. Agenda Item Action

Support for member practices had been provided by the Local Medical Committee, and GDPR would also be discussed at members’ meetings. JL highlighted that this needed to be prioritised as the recent members’ meetings had been cancelled due to adverse weather.

IC emphasised the need for the requirements to be taken seriously and be overseen at Governing Body level. He informed members of the work undertaken at Leeds City Council, such as the inclusion of GDPR in Directors’ VPS appraisals. It was agreed to provide a further update at the next Governing Body meeting in May, when the regulations were due to come into force.

The Governing Bodies in Common: a) acknowledged the report and the regulations, and supported the changes required to be implemented to ensure compliance.

GB17/16 Ratification of Urgent Decisions GS informed members of an urgent decision taken since the last Governing Body meeting, to extend Dr Stephen Ledger’s terms of appointment as Lay Member – Assurance on the Leeds West CCG Governing Body to 31 March 2018.

The Leeds West CCG Governing Body was asked to ratify this decision.

The Leeds West CCG Governing Body: a) ratified the urgent decision to extend Dr Stephen Ledger’s term of appointment to 31 March 2018.

GB17/17 Review of Committees Reporting into the Governing Bodies The annual reports of the Remuneration & Nomination Committees, Audit Committees and Primary Care Commissioning Committees were presented for information.

It was noted that the Remuneration & Nomination Committees had not fulfilled the nomination responsibilities due to the CCG merger and the appointment of a new Governing Body, however this would be picked up by the Committee during 2018/19.

Some minor issues had been raised, which would be brought to the attention of the chairs of these Committees within the merged CCG.

The Governing Bodies in Common: a) received the annual reports; and b) noted that the Committee terms of reference were being reviewed as part of the CCG merger process.

GB17/18 Progress on the Leeds CCGs Merger PC presented an update on progress towards the merger of the three Leeds

No. Agenda Item Action CCGs from 1 April 2018. The majority of Governing Body appointments were now complete. The interviews for the Director of Strategy, Performance and Planning would take place on 27 March. All staff would transfer to WIRA House as the single base for the CCG, and building works would start on 26 March to enable this. Confirmation had been received from NHS England that the merger was authorised to take place, and all conditions had been satisfied. A communications plan was in place and an update would be provided to stakeholders next week. The Transition Steering Group had held its final meeting and there were no actions to carry forward.

At this point in the meeting, PL asked if there were any questions from the members of public present. A question was raised regarding the appointment of the Secondary Care Doctor on the Governing Body. PC confirmed that an appointment had been made and the appointee would commence in post from 1 June 2018. Dr Ian Cameron would cover this role on a temporary basis in the intervening period.

The Governing Bodies in Common: a) noted the progress towards the merger of the three Leeds CCGs from 1 April 2018.

The Governing Bodies in Common resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

GB17/19 Confidential Minutes of the Governing Body meetings held in common on 2 August 2017 PL presented the confidential minutes of the Governing Body meetings held in common on 2 August 2017 for approval.

The Governing Bodies in Common: a) approved the confidential minutes of the Governing Body meetings held in common on 2 August 2017.

GB17/20 Ratification of Urgent Decisions (Confidential) Considered in the confidential part of the meeting.

GB17/21 Any Other Business As this was the final meeting of the current Governing Bodies prior to the merger, JB thanked everyone who had worked for the CCG and expressed his appreciation to member practices for their support.

GS thanked all Governing Body members, particularly CS for chairing the Audit Committees and AP for her support with patient engagement and chairing the interim Patient Assurance Group. He also thanked SH and ML who were stepping down from their role as GP Representatives.

PL thanked the member practices and acknowledged the work undertaken by

No. Agenda Item Action the previous Directors of Leeds South & East CCG including Dr Andy Harris, Dr Dave Mitchell and Matt Ward.

IFI1 Chairs Summary of the Audit Committee meetings

The Governing Bodies in Common: a) received the summary of the Audit Committees meeting in common held on 27 September 2017 and 26 February 2018 for information.

IFI2 Chairs Summary of the Remuneration & Nomination Committee meetings

The Governing Bodies in Common: a) received the summary of the Remuneration & Nomination Committees meeting in common held on 31 August, 22 November and 13 December 2017, and 14 March 2018.

IFI3 Chairs Summary of the Leeds Health Commissioning and System Integration Board meetings

The Governing Bodies in Common: a) received the summaries of the Leeds Health Commissioning and System Integration Board meetings held on 26 July, 21 September, 22 November 2017, and 25 January 2018.

Approved and signed by:

Dr Gordon Sinclair, Clinical Chair, NHS Leeds CCG

Date:

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Minutes NHS Leeds CCG – Governing Body Meeting Wednesday 11 April 2018 9:00am – 9:45am The Old Fire Station, Gipton Approach, Leeds, LS9 6NL

Members Initials Role Present Apologies Dr Gordon Sinclair (Chair) GS Clinical Chair  Sally Bower SB Head of Patient Safety and Medicines  Optimisation Commissioning Team (on behalf of Jo Harding) Dr Jason Broch JB Assistant Clinical Chair  Dr Ben Browning BB GP Representative  Angela Collins AC Lay Member – Patient & Public  Involvement Philomena Corrigan PC Chief Executive  IC Secondary Care Consultant / Consultant  Dr Ian Cameron in Public Health Medicine Jo Harding JH Director of Nursing and Quality  Dr Stephen Ledger SL Lay Member – Assurance  Dr Julianne Lyons JL GP Representative  Peter Myers PM Lay Member – Governance  Visseh Pejhan-Sykes VPS Chief Finance Officer  Samantha Senior SS Lay Member – Primary Care Co-  Commissioning KS Interim Director of Strategy, Performance  Katherine Sheerin & Planning Dr Simon Stockill SSt Medical Director  Additional Attendees Susan Robins SR Director of Operational Delivery  Laura Parsons (Minutes) LP Head of Corporate Governance & Risk  Members of the Public Observing the Meeting – 1

No. Agenda Item Action GB18/01 Welcome and Apologies for absence GS welcomed everyone to the extraordinary Governing Body, which was required to ensure appropriate approval of the Operational Plan prior to 30 April 2018. He particularly welcomed AC and SS to their first Governing Body meeting. Apologies had been received from JH, JL and PM. GS welcomed SB

No. Agenda Item Action who was deputising for JH.

GB18/02 Declarations of interest Members were asked to raise any declarations of interest in relation to agenda items. No declarations were raised.

GB18/03 Questions from Members of the Public The meeting was opened up to the public to take any questions they had at this stage.

A question was received in relation to the impact of smoking on pressures in urgent care and plans to address this. PC explained that this was included in

the Leeds Health and Care Plan, and the West Yorkshire & Harrogate Sustainability and Transformation Plan (STP). IC confirmed that a target to reduce smoking prevalence was included in the Leeds Health and Care Plan, of which prevention is a key strand. SSt also confirmed that smoking cessation is included in the primary care quality improvement scheme.

GB18/04 Operational Planning Narrative 2018/19 KS presented the operational planning narrative which had been completed in line with the template provided by NHS England. The draft plan was submitted on 8 March 2018 and some of the activity projections were raised following the receipt of feedback. VPS presented the financial plan. Some amendments were expected in relation to pay increases, however the impact was still to be confirmed. The CCG was required to demonstrate a 20% saving in running costs (£3.4m) following the merger of the three CCGs in Leeds.

BB queried whether the pay increase would also be applied to primary care staff. SS explained that the announcement related to agenda for change staff only. The contract value for general practice had already been confirmed.

KS informed members that consultancy support had been procured to review the primary care workforce, associated risks, and future requirements. This issue was also included on the work plan for the Quality and Performance Committee, which was seeking assurance that appropriate actions were being taken to address workforce issues.

In relation to future drawdown arrangements, the CCG was assuming that the surplus would not be available for drawdown due to pressures across the system. There would be an opportunity to apply for transformation funding as part of the West Yorkshire and Harrogate Sustainability and Transformation Partnership.

It was not expected that any significant changes would be made to the plans prior to final submission on 30 April 2018.

The Governing Body: a) reviewed the Leeds CCG Operational Planning Narrative 2018/19 and

No. Agenda Item Action the overview of the Leeds CCG Financial Plan 2018/19; and b) delegated authority to the Clinical Chair and Chief Executive to approve the final version of the activity and financial plans prior to submission on 30 April 2018.

GB18/05 Financial Policy Approval VPS presented the Budgetary Control Framework, Detailed Financial Policies, Operational Scheme of Delegation and Procurement Policy for approval. The draft versions had been reviewed by the Audit Committee and the CCG’s external auditors. It was proposed to increase delegation limits to the executive team in line with the size of the organisation. The Procurement Policy had been updated by the Associate Director of Procurement and Contracting, who is a procurement specialist.

In relation to the Procurement Policy, it was agreed to include a specific reference to partnership working with Leeds City Council and the Leeds VPS/ Compact. It was also agreed to amend section 17 (Sustainable Procurement) MVT to reflect that the CCG will work to develop and support a sustainable local economy and health economy wherever possible. The final version of the policy would be circulated by e-mail for final approval. LP

SSe highlighted that the Governing Body would need to be sighted on the overall costs of Continuing Healthcare packages. SR explained that there is an established budget for Continuing Healthcare which is managed by the

team. It was agreed to review the Operational Scheme of Delegation in six month’s time to consider whether any changes were required. VPS/LP

It was agreed to amend the Operational Scheme of Delegation to clarify that LP the line manager can approve study leave within the UK. It was also agreed to consider decision making around medicines optimisation and whether this should be included.

The Governing Body: a) approved the Budgetary Control Framework, Detailed Financial Policies; b) approved the Operational Scheme of Delegation subject to the amendment noted above in relation to study leave; and c) agreed that the Procurement Policy would be amended as noted above and circulated by e-mail for final approval.

Approved and signed by:

Dr Gordon Sinclair, Clinical Chair, NHS Leeds CCG

Date:

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MINUTES ACTION LOG – GOVERNING BODY

ITEM ACTION ACTION: ACTION BY: COMPLETED/UPDATE NO: NO: 21 September 2017 LHCB 1 To include the performance implications for Leeds CCGs as a result Phil Corrigan A template for recording of West Yorkshire performance within the IQPR performance across West Yorkshire 17/35 is in development. Update to be provided in May 2018. 22 November 2017 LHCB 1 SMT to consider alignment of risks reported at West Yorkshire level Phil Corrigan In progress, update to be provided in 17/58 with CCG risks and report back to Board/Quality & Performance May 2018. Committee. 21 March 2018 LHCB 1 Rating of risk 635 (emergency care standard performance) to be Sue Robins Risk rating to be reviewed in June reviewed in 3 months. 2018. 17/106 22 March 2018 GB 1 Update on GDPR to be provided in May 2018. Visseh Pejhan- Included in Chief Executive’s Sykes Report. 17/15 Completed 11 April 2018 GB 1 Procurement Policy to be amended as agreed and circulated by e- Visseh Pejhan- Policy updated. To be circulated by mail for final approval. Sykes / e-mail. 18/05 Michelle Van Toop / Laura Parsons GB 2 Operational Scheme of Delegation to be amended as agreed. Laura Parsons Completed 18/05 GB 3 Operational Scheme of Delegation to be reviewed in Visseh Pejhan- Added to Governing Body work plan October/November 2018. Sykes / Laura Completed 18/05 Parsons

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Agenda Item: GB 18/14 FOI Exempt: N

NHS Leeds CCG – Governing Body Meeting

Date of meeting: 23 May 2018

Title: Corporate Risk Register May 2018

Lead Governing Body Member: Phil Corrigan, Tick as Category of Paper appropriate Chief Executive () Report Author: Joanna Howard, Head of Clinical Decision Governance Reviewed by EMT/SMT as appropriate: N/A Discussion 

Reviewed by other Committee: Audit Committee 18th April 2018 Primary Care Operational Group 4th April 2018 Information Quality & Performance Committee 9 May 2018

Checked by Finance: N/A

Approved by Lead Governing Body member: Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual The CCG is required to have a robust risk management requirements process in place Financial Implications N/A Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY:

The CCG utilises Datix as an internal risk management system which enables risks to be recorded and managed by all members of staff. Each risk is aligned to a CCG committee for overview and scrutiny.

The risks are included on the CCG operational risk register and reviewed within individual directorates and by the executive management team on a regular basis. The CCG committees receive and review the risks rated as high amber (12) and above. The Governing Body receives the corporate risk register (all red risks scored at 15 and above) for review at each meeting and supported by the CCG committee chair updates. The CCG Governing Body Assurance Framework is currently under review and will be aligned to the CCG ambitions.

As per the CCG risk management strategy all risks at a score of 12 and above are presented to the relevant CCG committee for review and assurance. Assurance on areas of concern is reported from the CCG committees to the Governing Body via the CCG committee chair report.

There are currently 54 active risks on the CCG risk register, two of which have been escalated to the CCG corporate risk register as they have a score of red 16:

Red risks

 Risk 532: Commissioner and/or lead provider fails to achieve the operational standard for the 18 week Referral to Treatment Time has remained at a risk score of red 16. This is because 52 week waits have increased at the end of March 2018 and may continue to increase because of the backlog that has built up due to the cancellation of routine surgery. Surgery has now been resumed but the amount of additional operating required to clear the back-log is significant. Clearance plans are in place for most specialties and will be sufficient to meet the national requirement to halve 52 week waiters by March 2019. This risk is being further reviewed so that the Leeds position will be reported as a separate risk to the overall Leeds Teaching Hospitals NHS Trust (LTHT) position, similar to the 62 day referral to treatment risk.

 Risk 339: Cancer under achievement of 62 day urgent GP referral to treatment standard overall at LTHT remains at the same risk level. LTHT has delivered significant improvements internally allowing them to exceed the 85% target for those patients whose pathway originates in Leeds or that are received by day 38. However, where patients are referred after day 38 performance is lower. West Yorkshire and Harrogate STP Cancer Alliance is working across providers to try to further improve the timeliness of pathways and transfers. New breach and allocation guidance comes into place April 2018 but is not possible to model the impact on this for LTHT as it reflects new patients and systems for which the data is not available (i.e. it is not possible for LTHT to track a patients pathway prior to admission to the Trust). Concern about the ability to manage new guidance has been raised nationally to NHS England.

Three risks have reduced from red to amber since the last meeting:

The system resilience risks have been reviewed, and due to the current position and additional

2 controls and assurances that have been implemented, these have reduced in risk score from a red 16 to a risk score of amber 12. The system resilience risks include:

 Risk 541: System resilience risk – impacts to the health and social care system within Leeds; and

 Risk 659: System resilience variable risks (business continuity).

Risk 466, achievement of the national ambulance standards, has reduced from a risk score of red 16 to an amber 12. This risk has reduced in score due to the overall improvements that have been made to performance and quality. Additional funding has also been allocated and it is therefore expected that performance will continue to improve. Due to the Ambulance Response Pilot being in the initial stages of development, performance is only provided on a Yorkshire and Humber level and therefore the risk will remain at an amber 12 until a local performance position can be determined.

The CCG risk register can be found in Appendix 1 and provides a summary of the current controls and assurances in place to mitigate each risk and an update on each risk has also been included within the synopsis section.

The Governing Body is asked to review the risks on the corporate risk register, including the controls and assurances as well as the supporting information from the committees which can be found within the committee Chair summaries.

Whilst some areas of performance and quality are not in line with agreed targets there is reasonable mitigation and action being taken to rectify the issues as well as established risk management systems and processes in place within the CCG.

NEXT STEPS:

 All risks will be reviewed as per the bi-monthly cycle in accordance with the CCG risk management strategy and presented to the assigned committee for review.  Development of the new Governing Body Assurance Framework which is aligned to the CCG ambitions.  The corporate risk register will be presented to the CCG Governing Body at each meeting.

RECOMMENDATION:

The Governing Body is asked to:

Review the corporate risk register and note the controls, assurances and mitigating actions that are in place to manage the risks.

THIS PAGE IS INTENTIONALLY BLANK Appendix 1 Risk Register

ID Title Description Secondary Risks Controls Gaps in controls Costs Assurance Gaps in assurance Synopsis/Actions

Rating

(initial) (initial)

(initial)

Director

Manager (current) (current) (current)

Risk level

Likelihood Likelihood

Committee Committee

Responsible

Review date

Accountable

Consequence Consequence Consequence Rating (initial)

Performance monitored monthly at Elective Care Working Group and actioned appropriately. LTHT has delivered considerable improvements internally allowing them to exceed the 85% target for those patients Cancer under LTHT have weekly Access Meetings to monitor. Limited ability to influence pathways in whose pathway originates in Leeds or are received by day 38. However, where patients arrive at the Trust after day achievement of 62 Cancer waiting times - under achievement of overall referring trusts, leading to higher We await conclusion of LTHT has a Cancer Board to oversee delivery of recovery plans reporting 38 performance is lower. West Yorkshire and Harrogate STP Cancer Alliance is working across providers to try to day urgent GP Failure to deliver NHS Constitution standards All patients tracked and clinically prioritised.

339 performance 62 days urgent GP referral to treatment of 20 proportions of patients referred later national work on breach to LTHT Trust Board. further improve the timeliness of pathways and transfers. New breach and allocation guidance comes into place April 16 Major Major referral to treatment required nationally. Major all cancers, LTHT total. than day 38. allocation. 2018 but is not possible to model the impact on this for LTHT as it reflects new patients and systems for which the

30/04/2018 standard overall at Reports received by LTHT Cancer Board. Lewis, Helen West Yorkshire actions being developed as part of WY&H STP cancer data is not available (i.e. it is not possible for LTHT to track a patients pathway prior to admission to the Trust). LTHT

alliance Concern about the ability to manage new guidance has been raised nationally to NHS England.

Quality and Performance Committee

Susan RobinsSusan - ofDirector Commissioning

Expected to at occur least weekly. Likely to occur.

Expected to at occur least daily. More likely to thanoccur not. Very Very High Priority - Reduce urgently involving Management Senior

Many of the pathways with high volumes of over 18 week waits are commissioned by NHSE (dental, clinical genetics and paediatric subspecialties). The CCG commissioned specialties underperforming are: ENT (mostly OP capacity issues being addressed by offering choice); General Surgery (mostly bed/theatre capacity where some choice can be offered but not for more complex patients); Plastics (mostly theatre capacity); Orthopaedics (mainly spinal outpatients); All relevant specialties have clearance plans agreed with Chief Operating Officer at LTHT. Urology (mix of outpatients and inpatients); ‘other’ mostly Paediatric ENT (mix of OP and IP). Commissioner Funding for additional capacity agreed within contracts. and/or Lead provider Failure to achieve the Referral to Treatment Time Monthly update at joint LTHT /CCG Elective Care Working Group to The Inpatient/overnight stay capacity remains constrained, which is impacting on the numbers of long waiters, fails to achieve the standard of no more than 8% of patients waiting more Work is ongoing to create the capacity but there are risks given the increased demand on review progress and identify any further actions that can be taken by particularly those who cannot be operated on in the Independent Sector. A number of patients have been

532 operational standard than 18 weeks from Referral To Treatment in each 16 16 Major Major Major Major beds through non elective pressures. CCGs contacted and offered choice in the independent Sector to try to address some of the long waiting issues, but some for the 18 week reporting specialty at month end either as a CCG or

30/04/2018 procedures cannot be carried out at tariff in the private sector. Referral to within LTHT as lead provider for Leeds residents. Lewis, Helen Monthly review of demand growth against commissioned activity. Focus on outpatient Treatment Time capacity 52 week waits have increased at the end of March 2018 and may continue to increase because of the backlog that has built up due to the cancellation of routine surgery. Surgery has now been resumed but the amount of additional

Quality and Performance Committee operating required to clear the back-log is significant. Clearance plans are in place for most specialities and will be

Susan RobinsSusan - ofDirector Commissioning sufficient to meet the national requirement to halve 52 week waiters by March 2019.

Expected to at occur least weekly. Likely to occur. Expected to at occur least weekly. Likely to occur.

Funding has been made available through the contract but capacity remains the constraint Very Very High Priority - Reduce urgently involving Management Senior This risk is being considered so that the Leeds position and LTHT overall position are reported as separate risks (similar to 62 day risks).

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Agenda Item: GB 18/15 FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 23 May 2018

Title: Update on the development of the CCG Strategic Plan Lead Governing Body Member: Phil Corrigan, Tick as Chief Executive / Katherine Sheerin, Director of Category of Paper appropriate Strategy, Performance & Planning () Report Author: Katherine Sheerin Decision

Reviewed by EMT/SMT/Date: N/A Discussion 

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date):

Approved by Lead Governing Body member (Y/N): Yes

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual No requirements Financial Implications No Communication and Involvement No Issues Workforce Issues No Equality Issues including Equality No Impact assessment Environmental Issues No Information Governance Issues No including Privacy Impact Assessment

EXECUTIVE SUMMARY:

The purpose of this paper is to provide the Governing Body with an update on the development of the Strategic Plan for NHS Leeds CCG, and to explain how this fits within the wider strategic context of West Yorkshire and the work with partners across the city of Leeds.

NEXT STEPS:

The CCG Strategic Plan will continue to be developed over the next two months through further Governing Body / Executive Management Team (EMT) / Senior Management Team (SMT) workshops and engagement with practice members and other partners.

It will then be brought to the July meeting of the Governing Body for formal approval, and will include a high level action plan to describe how the CCG takes the work forward.

There will also be an on-going process to ensure alignment with wider strategic work, including at the West Yorkshire footprint.

RECOMMENDATION:

The Governing Body is asked to:

(a) Note the progress in developing the CCG Strategic Plan.

1. SUMMARY

1.1 The purpose of this paper is to provide the Governing Body with an update on the development of the Strategic Plan for NHS Leeds CCG, and to explain how this fits within the wider strategic context of West Yorkshire and the work with partners across the city of Leeds.

2. BACKGROUND

2.1 NHS Leeds CCG became a statutory body in April 2018, responsible for commissioning the majority of health care services for the people of Leeds. It will invest its annual budget of £1.2bn to ensure people have good access to high quality health services in primary, community and hospital care settings, and to improve the health and wellbeing of the city’s people.

2.2 The CCG was formed from the merger of Leeds North, Leeds South and East and Leeds West CCGs which have been in place since April 2013. By bringing together the expertise and experience gained over the last 5 years, and by bringing together the commissioning budgets, the new CCG for the city is now in a pivotal position to engineer and lead the changes required to secure high quality services within a sustainable system and to improve health outcomes.

The CCG is now preparing a Strategic Plan which will set out –

. A clear narrative for our members, the public and their representatives . A clear understanding by the Governing Body of what we are collectively accountable for beyond the statutory mandate . A clear reference point for the senior managers to empower the staff in the CCG to work innovatively and effectively . A clear and realistic sense of purpose for the organisation to be truly transformational

2.3 The National Context

The Five Year Forward View, published in October 2014, has set the agenda for the NHS for the remainder of this decade. It described the dramatic improvements which had been achieved in cancer and cardiac outcomes, access and waiting times and increased patient satisfaction. However, it also set out that the quality of care is still too variable, health inequalities remain deeply rooted and that patient needs are changing, with more people living with multiple long term conditions, new treatment options emerging and service pressures building. So, given this growing demand, efficiency challenges and known future funding, the NHS has a funding gap of £30bn by 2020/21.

2.4 The paper set out how the three gaps – health, quality of care and finance - could be addressed through -

. A radical upgrade in prevention and public health . Far greater control for people when they do need services, including more support for carers . Decisive steps to be taken by the NHS to break down the barriers in care, with a number of ‘new care models’ described which would integrate services across traditional organisational boundaries

2.4 It was proposed that with fundamental action to change the model of care and improve productivity, the majority of the financial gap could be met.

2.5 The Regional Context - West Yorkshire and Harrogate

In order to address the three gaps set out in the Five Year Forward View, Sustainability and Transformation Partnerships (STP) have been created across the country to bring together the NHS (commissioners and providers) with Local Authorities, community and voluntary sector organisations to develop and implement solutions.

2.6 The STP footprint for West Yorkshire and Harrogate provides care and treatment to 2.6m people with a budget of £5.6bn. In relation to the financial gap, it is estimated that an additional £1bn will be needed each year to meet anticipated pressures.

2.7 The STP has identified a number of priorities including smoking, diabetes, cancer, suicides and cardiovascular disease (CVD). There is a programme of work which sets out how £0.9bn can be spent differently and in a way that reduces the cost and changes the demand for services, thereby enabling us to meet the needs of a growing and ageing population.

2.8 In order to optimise commissioning on this footprint, a Joint Committee has been established across all 9 CCGs in West Yorkshire and Harrogate (WY&H). This Committee has delegated authority to take commissioning decisions at WY&H level on specific programmes including: cancer, elective care/standardisation of commissioning policies, mental health, stroke and urgent care. The Committee aims to ensure that its decisions include public and patient engagement, clinical input and have authority from the CCGs. 2.9 Although it can only make decisions on the programmes of work that have been delegated to it, the Committee also makes recommendations to the CCGs on other matters where it feels that a WY&H-wide approach would be beneficial. 2.10 To make sure that decision making is open and transparent, the Committee has an independent lay chair and two lay members drawn from the CCGs. Meetings are held in public and are also streamed ‘live’ on the Committee’s web pages. There is a ‘patient story’ at most meetings, which enables the Committee to get the perspective of patients and service users.

2.11 Highlights of the Committee’s work Elective care/standardisation of commissioning policies The programme aims to improve health by better prevention and supporting healthier choices. This will reduce variation, inconsistency and the perception of a ‘postcode lottery’ and has the potential to create financial efficiency gains. The Committee agreed an approach in which before surgery, patients are offered a choice of services to address lifestyle factors. It agreed to standardise commissioning policy across WY&H for procedures of limited clinical value and elective orthopaedic surgery. It also supported the development of new approaches to outpatient services in elective orthopaedic surgery and eye care. 2.12 Mental health The Committee noted work by mental health providers to share beds, improve access to local services and reduce out of area placements. It supported work by CCGs to review commissioning plans, reduce variation and establish common levels of community services across WY&H. The Committee supported the development of new care models for Child & Adolescent Mental Health Services (CAMHS) & Adult Eating Disorders and agreed to develop a joint approach to commissioning acute mental health services.

2.13 Stroke The Committee considered a proposal for the 11 CCGs to work together to further improve the detection and treatment of Atrial Fibrillation (AF), a fast and erratic heartbeat which is a major cause of stroke. It recommended that each CCG agree an aspiration to detect and treat 89% of patients with AF and adopt a targeted and phased approach to working with their local practices.

2.14 Urgent and emergency care The programme aims to ensure that people get the right care, in the right place at the right time. The Committee noted that NHS England required all CCGs to have an Integrated Urgent Care (IUC) programme in place by 1 April 2019 and considered recommendations to achieve this. The work was being overseen by the Y&H Joint Strategic Commissioning Board. The Committee recommended that a formal procurement process be undertaken, using a ‘structured dialogue’ approach which would enable the service model to be refined with providers. This was particularly important given the complexity of delivering services in 3 STP areas across Yorkshire and the Humber. 2.15 There have also been discussions across West Yorkshire and Harrogate regarding whether the partners should operate as an Integrated Care System. This means taking collective responsibility for managing resources, delivering NHS standards and improving the health of the population. This would demonstrate a level of trust and maturity which enables the system to have more direct control over any transformation resources. However, the

partners have been clear that this cannot be at the expense of subsidiarity and the need to build from local plans.

2.16 The Local Context – the city of Leeds

The Leeds Health and Wellbeing Strategy sets out the clear ambition that -

‘Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest.’

It sets out 12 priority areas and a number of measures as follows:

2.17 The Health and Wellbeing Board which oversees the strategy is characterised by strong partnership working, with providers (including primary care and the voluntary sector) well represented alongside commissioners.

2.18 The city is keen to recognise and build on its strengths, taking an assets based approach to securing long term growth and improvements. In terms of health services, there is a wealth of statutory and non-statutory provision, with the quality of services delivered recognised as good and outstanding in many areas.

2.19 Whilst there has been good progress, the most recent Public Health Annual Report (2017/18) highlights the declining life expectancy for women, with static life expectancy for men. This is primarily accounted for by increasing infant mortality, deaths of women from alcohol harm, and deaths of men from suicide and drug overdoses. It is essential that this is considered in the city’s commissioning plans going forward.

2.20 The Leeds Plan

The Leeds Plan has been developed over the last 18 months as the local response to the STP. It brings together organisations across the city in a practical way to deliver on the following four programmes of work:

. Prevention . Proactive care and self-management . Optimising secondary care . Urgent care and rapid response

2.21 There is full Programme Management Office to support this work, with leadership from across the system to ensure delivery.

3. PROPOSAL

3.1 The CCG is developing a Strategic Plan, which provides the clear narrative for how we will commission over the next three years to deliver our contribution to the Health and Wellbeing Strategy.

3.2 Through a series of workshops with the Governing Body, Executive Management and Senior Management Team members, we have developed our strategic commitments which will form the foundations of the Strategic Plan as follows:-

3.3 We will focus our resources to -

. Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city

3.4 We will work with our partners and the people of Leeds to -

. Support a greater focus on the wider determinants of health . Increase their confidence to manage their own health and well-being . Achieve better integrated care for the population of Leeds . Create the conditions for health and care needs to be addressed around local neighbourhoods

3.5 We have also considered the indicators in the Health and Wellbeing Strategy and have identified the following measures for which we will take the lead in delivering –

. Reducing avoidable years of life lost . Supporting people to manage their health condition . Avoiding early death for people with a serious mental illness . Reducing unnecessary time patients spend in hospital . Reducing preventable hospital admissions . Reducing repeat emergency visits to hospital

3.6 We will develop clear and measurable targets against each of these indicators, agreed with our partners. And for each of the indicators we will ensure that improvements are made more quickly in the communities and groups with the poorest outcomes now, not just look at progress in Leeds overall.

3.7 The Strategic Plan will then set out at a high level how the CCG will deliver against its commitments and secure improvements against the indicators. Key to this will be having a renewed focus on responding to the health needs of marginalised communities so that we can really work towards improving the health of the poorest the fastest.

3.8 To do this, we will commission and design services shaped around the needs of those groups first, involving people in how services are shaped and delivered. Leeds has always been good at commissioning for the majority, but we recognise we need to re-think how we ensure services are commissioned in a far more inclusive way, starting with the more specific needs of poorer communities. So rather than ‘add on’ to universal services, our starting point will be that universal services work for all, by involving people who have more difficulties accessing them in their design.

3.9 We will work far more closely with colleagues across the Local Authority, in particular in public health but also in regeneration, transport and housing, children and adult services, to ensure that the intelligence regarding all aspects of community life informs our commissioning decisions and that we are maximising the Leeds pound.

3.10 We will go further in our work with commissioners of children’s and adults’ services, and build really strong aligned commissioning approaches which result in integrated provision. And there will be different degrees of alignment dependent on the opportunity to improve care – from a single voice to truly integrated budgets and teams.

3.11 We will also have a different approach to provider development and procurement. Where it makes sense, we will work with local providers to support their integration and collaboration thus enabling them to offer higher quality, more comprehensive services for the long term. Part of this will be encouraging local statutory providers to work together and with the third sector and private sector in order to take more innovative approaches to improved health and services.

3.12 The foundation of this is the registered list in primary care, and we will continue to support the development of primary care at scale through the Leeds GP Confederation, with

delivery through Local Care Partnerships. This will secure the sustainability of primary care for the city, enabling a voice for collaboration across other providers and economies of scale, whilst at the same time really integrated and shaping services for local communities, thus supporting more care out of hospital, better use of resources and better health outcomes.

3.13 We also recognise that for some services, there are real benefits in working across the West Yorkshire footprint. We will continue to do this where it makes sense, being mindful of balancing wider system sustainability with the need to focus on local challenges.

3.14 In summary, we will lead a transformation of commissioning with a strategic approach to improving health outcomes, greater alignment with colleagues across the local authority to secure integrated provision and a transfer of some of our resources to providers to support service improvement and integration – all within the overall goal of improving the health of the poorest the fastest.

4. NEXT STEPS

4.1 Over the coming weeks, the Strategic Plan will be further developed so that it describes what we need to do in more practical terms to transform commissioning as described above, and so deliver our strategic commitments.

This will include –

. Seeing through the ‘One Voice’ programme, in particular to support the Confederation to work with primary care to create successful Local Partnerships.

. Confirming how we ensure greater alignment of commissioning with the local authority where most effective.

. Accelerating the work of the System Integration programme, using the work on services for people with frailty as a ‘trailblazer’ for how we take forward outcomes based commissioning.

. Confirming how we take forward the aligned incentives contract approach, so that we secure greater coherence of direction across providers in the city and better integration of services.

. Articulating how this work fits with wider developments at West Yorkshire and Harrogate.

4.2 The Strategic Plan will be presented to the Governing Body at its July meeting for formal approval and will be underpinned by an Organisational Development Plan for the CCG.

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1 Not applicable to this paper but will need full consideration as the work of the CCG Strategy is implemented.

6. FINANCIAL IMPLICATIONS AND RISK

6.1 Not applicable to this paper but will need full consideration as the work of the CCG Strategy is implemented.

7. COMMUNICATIONS AND INVOLVEMENT

7.1 As the CCG’s Strategic Plan is developed it will be shared with key stakeholders including practice members, partners and the public, with a public facing document produced.

8. WORKFORCE

8.1 The changes to commissioning described in the Strategic Plan will have an impact on the CCG and wider workforce across the city. For the CCG, the changes will be considered as part of the Organisational Development plan. For the wider system, effective workforce planning to ensure there are the right skills in the right place at the right time will be needed. Responsibility for this will need to be clarified and a comprehensive plan developed.

9. EQUALITY IMPACT ASSESSMENT

9.1 Not applicable to this paper but will need full consideration as the work of the CCG Strategy is implemented.

10. ENVIRONMENTAL

10.1 Not applicable to this paper but will need full consideration as the work of the CCG Strategy is implemented.

11. RECOMMENDATION

The Governing Body is asked to:

a) Note the progress in the development of the CCG Strategic Plan.

Agenda Item: GB 18/16 FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 23 May 2018

Title: The Commissioning for Value Programme

Lead Governing Body Member: Katherine Tick as Sheerin, Director of Strategy, Planning & Category of Paper appropriate Performance () Report Author: John Tatton, Associate Director Decision of Planning Reviewed by EMT/SMT/Date: N/A Discussion

Reviewed by Committee/Date: N/A Information  Checked by Finance (Y/N/N/A - Date): N/A

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual The CfV Programme contributes to the CCG’s ability to requirements deliver statutory duties Financial Implications The CfV Programme supports the CCG in the development and delivery of its financial plan Communication and Involvement Issues The CfV Programme approach will embed the requirement for appropriate communication and engagement in all commissioning change programmes Workforce Issues N/A Equality Issues including Equality Impact The CfV Programme approach supports the organisational assessment approach to embedding the need for equality impact assessment in all commissioning proposals Environmental Issues N/A Information Governance Issues including The CfV Programme approach supports the organisation Privacy Impact Assessment in embedding Privacy Impact Assessments in all Commissioning Change proposals

EXECUTIVE SUMMARY:

The NHS is under significant service and financial pressure. In 2015 it was estimated that the NHS would need to find £22 billion in efficiencies by 2020 in order to achieve financial balance. As a Clinical Commissioning Group (CCG) this equates to the need to find £34M worth of efficiencies every year. The funding gap has to be addressed whilst at the same time ensuring that patients continue to receive safe, high quality accessible services and that we improve the population’s health and wellbeing.

Leeds CCG has established the Commissioning for Value (CfV) Programme to ensure that its financial and commissioning resources are targeted at delivering the changes that offer the best value for money for our population. It is important to recognise that the Programme focus extends to securing value in its widest i.e. the delivery of benefits in terms of quality of services, health outcomes and Finance.

The programme has been developed to provide a mechanism through which the CCG will ensure that: a) The CCG has a robust process for approving commissioning change initiatives b) All commissioning change initiatives have clearly articulated milestones and benefits c) Progress in delivering commissioning change initiatives can be effectively tracked d) Ensure alignment of commissioning change plans with the CCG Strategic Objectives

The Commissioning for Value Programme is in its early stages of development and has been up and running for 3 months.

This paper provides details on the programme, its governance and progress to date with development and delivery.

NEXT STEPS:

Over the coming months the CCG will - a) Further develop the Commissioning for Value Programme to ensure that it supports alignment of commissioning activities with the CCG’s emerging strategic priorities. b) Ensure that all existing projects have completed all CfV templates and so enable the organisation to monitor key milestones and the delivery of expected quality, health outcomes and financial benefits. c) Agree the prioritisation process that will support the review of all existing and future commissioning projects to ensure strategic alignment and optimal use of resources. d) Confirm the decision making processes for future business cases to support the CCG’s investment and resource allocation processes to ensure alignment with the organisation’s strategic priorities. RECOMMENDATION:

The Governing Body is asked to: (a) NOTE progress to date with the development of the Commissioning for Value Programme.

1. SUMMARY

1.1. This paper provides an update on progress to date with the CCG Commissioning for Value (CfV) Programme.

2. BACKGROUND

2.1. During 2017/18 Leeds North, South and East and West CCGs began working in partnership under one management team. In September 2017 the three CCGs began developing its service and financial plans in readiness for the merger in April 2018.

2.2. The planning process quickly identified a need for the organisation to create a new and better way of tracking its work programs and their intended benefits. This need was highlighted by the fact that finance and planning leads were having difficulty understanding how many of the existing work plans contributed to the delivery of the CCGs corporate objectives, most obviously the link between the CCG commissioning plans and the need for the CCG to deliver financial savings.

2.3. In December 2017 the CCG bought in some external support to develop, design and embed a programme infrastructure and provide delivery support to give the CCGs the best start in delivering their QiPP Programme. The QiPP Programme was subsequently renamed Commissioning for Value in recognition of the fact that many members of CCG staff associate the term QiPP with financial savings. The CfV approach therefore ensures the focus on all intended benefits including financial savings, quality improvements or support better health outcomes.

2.4. During the period from January through to March 2018 commissioning teams received significant support to complete a toolkit for each of their current or planned commissioning plans.

2.5. At the same time as the toolkits were being populated the CCG established a CfV Delivery Board. The CfV Delivery Board is chaired by the CCGs Executive Director of Strategy with a membership that includes a further 4 Executive Directors along with a number of senior managers (see Appendix A). The Board oversees the delivery of all CfV project plans. A CfV Plan is defined as:

‘Any commissioning team activity that has the potential to lead to improvements in quality and / or make efficiency savings’

2.6. The CfV Delivery Board is supported by the CCG’s Planning and Performance Team who are responsible for the day to day running of the Project Management Office (PMO). The PMO is responsible for the design and development of a set of standard tools and toolkits which are to be deployed across the organisation. These tools include standard business case and project plan templates. The PMO ensures that all plans are kept up to date and produces a monthly report to the CFV Delivery Board on progress with projects. The PMO is responsible for ensuring that all projects are effectively documented with defined milestones and that all intended projects benefits are clearly identified and appropriately monitored.

2.7. It is important to note that the planning team is trying to ensure that the PMO role is developed in such a way as to balance the needs of the organisation with regards to providing a reporting function with the need to support commissioning teams in the development of Business Cases and completion of CfV toolkits. As such the Planning Team is currently engaging with commissioning teams to support the development of CfV Programme. This includes seeking views on the type of support that commissioners will require in future, views on the development of business case processes and how they would like to see the Planning Teams PMO function engage with them to ensure timely reporting of progress.

2.8. The CfV Board meets on a monthly basis with each commissioning team’s plan being reviewed every other month. At each meeting the CfV Board will review progress of current plans by exception i.e. only focus on those plans that are not on track or where there are significant risks to delivery. This will ensure that the organisation takes a systematic approach to understanding how its overall programme of work is developing and any risks to delivery. An example of a CfV highlight report is included as Appendix B. The draft Terms of Reference are attached at Appendix C.

3. CURRENT POSITION

3.1. Whilst the CfV Programme is a new development, significant progress has already been made. To date the CCG has identified over 80 commissioning projects in various stages of development that vary considerably in size, impact and complexity.

3.2. Of the 80 plus projects roughly 50% are at proposal and/or business case stage with the remaining 50% in the processes of being commissioned or being rolled out. The CfV Delivery Board has decided that it will only monitor the progress of those schemes that have gone beyond proposal scale i.e. where a business case is either being developed or has been approved and the project is moving forward. At present there are 56 projects in this category.

3.3. Those projects that are currently in the proposal stage will be subject to the CCG’s new business planning and prioritisation process which will be confirmed over the coming weeks. This provides an opportunity to ensure alignment with the CCG’s strategic commitments.

3.4. Of those projects that have gone beyond proposal stage there is a significant amount of work to do to ensure that all have fully completed the CfV toolkits. Completion is required to ensure that the CfV Board is able to effectively monitor delivery of key project milestones and associated quality, health outcome and financial benefits. At present roughly 50% of projects have not yet quantified financial or quality impacts.

3.5. As an example at present, £9m of savings has been quantified from CfV projects against a target of £34M. Until the templates are completed and have undergone a rigorous quality assurance process the CfV Board will not be in a position to report on whether the level of resources expected to be released through the 2018 commissioning change programme is accurate and to what extent further work is required to address any gap.

3.6. Over the coming three months commissioning teams are being supported by corporate teams to ensure completion of the CfV templates to the required standard. This will enable the CfV Board to gain a much better overview of how the current portfolio of projects will support the delivery of improvement in health and quality outcomes along with supporting an understanding of how plans contribute to the CCGs financial challenge. This will support the CCG in planning and prioritising its future investment initiatives.

3.7. Through developing the CfV Programme, the Delivery Board has already identified a number of issues and challenges in taking forward the programme as follows:

a) Lack of capacity within teams and across corporate functions to support analysis b) Lack of skills / capacity to support effective quantification of non-financial benefits c) Resource allocation across commissioning teams vs relative benefits of portfolio d) Alignment of number of smaller projects into more strategic programmes e) Lack of alignment of existing plans with strategic objectives

3.8. Clearly further work is required to address some of the issues above and plans are being developed to increase capacity and support available to teams to undertake work. This includes the increase in skills and capacity in the informatics team to undertake non- financial benefits analysis and within the CCG planning team to support teams to develop business cases and project plans.

3.9. Given the above the CfV Board is also taking a lead role in agreeing the business case development, prioritisation and approvals process. In future it is anticipated that all new business cases will pass through a series of gateways or stages and be assessed against a standard set of criteria that include factors such as financial impact, alignment with strategic objectives, clinical effectiveness and impact on population health outcomes.

3.10 The new business case process is being designed to ensure that all new commissioning change proposals fit with both strategic priorities and that through the requirement for inclusion of clear milestones plus intended quality, health outcome and financial impact analysis at developments stage can be easily tracked and monitored through the CfV programme if and when approved.

3.11 Governance: The CCG is currently developing its governance structure which will confirm how the CfV Board will report progress and provide assurance in future.

4. NEXT STEPS

4.1. Over the next three months the CfV Delivery Board will focus attention in the following areas:

a) Further developing the CfV Programme to ensure that it supports ongoing development of the CCGs commissioning work programme ensuring alignment with the CCG emerging strategic priorities.

b) Ensuring that all existing projects have completed all CfV templates that enable the organisation to monitor key milestones and a delivery of expected quality, health outcomes and financial benefits. c) Agreeing the prioritisation process that will support the review of all existing and future commissioning projects to ensure alignment with key priorities. d) Confirming the decision making processes for future business cases to support the CCGs investment and resource allocation processes to ensure alignment with the organisation’s strategic priorities.

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1. Whilst detail not included in this paper it is clear that the CfV Programme will in future significantly contribute to the CCGs ability to deliver statutory/regulatory and contractual duties.

6. FINANCIAL IMPLICATIONS AND RISK

6.1. The CfV Programme will support the development and delivery of its financial and QiPP plan.

7. COMMUNICATIONS AND INVOLVEMENT

7.1. The CfV Programme approach will support the requirement for embedding communication and engagement activities in all commissioning change programmes.

8. WORKFORCE

8.1. The CfV approach will support the CCG in identifying organisational development needs and also in the allocation of resources to commissioning activities that will offer the greatest benefits to the population of Leeds.

9. EQUALITY IMPACT ASSESSMENT

9.1. The CfV Programme will support the embedding of the need for equality impact assessment in all commissioning business cases

10. ENVIRONMENTAL

10.1. The development of new business case prioritisation and procurement processes and provides an opportunity for the CCG to consider how sustainability and social value are included in commissioning activities.

11. RECOMMENDATION

The Governing Body is asked to:

a) NOTE progress to date with the development of the Commissioning for Value Programme.

Appendix A

Commissioning for Value Delivery Board Membership

Katherine Sheerin Director of Strategy, Planning and Performance (Interim) Visseh Pejhan-Sykes Director of Finance Jo Harding Director of Quality and Safety Sue Robins Director of Commissioning Simon Stockill Medical Director John Tatton Associate Director of Planning and Performance Nichola Stephens Head of IMT Health and Care Matt Turner Deputy Chief Finance Officer – Commissioning and Contracting Mark Fox Head of Operational Planning and Performance

THIS PAGE IS INTENTIONALLY BLANK Appendix B

SCHEME HIGHLIGHT REPORT St Georges Centre pilot UTC Return to Cover Sheet

Scheme Information Report Submission Date RAGB Status for the Current Period Finance Totals for 2018/2019 Responsible Team Unplanned Care April‐18 Finance Green PYE £'000 FYE £'000 Scheme Sponsor Debra Taylor‐Tate Activity To Complete Planned 0 ‐698 Scheme Lead Kate Parker Scheme Stage Quality To Complete Actual 0 0 Scheme Reference UC4 4. Delivery Overall Green Variance 0 698

Scheme Overview Milestones RAGB Planned Forecast Actual A requirement from NHS England. MOU signed To standardise the community offer for urgent care/rapid response needs by creating urgent treatment centres. It is expected that this will reduce the number of attendances at Emergency Departments. Other benefits are expected to include: Green 24/04/2018 24/04/2018 − Standardised offer of urgent care in the community, addressing inequalities − More streamlined service − Single front door pilot is live − Better understanding of where to go when a patient has an urgent care need Blue 20/03/2018 20/03/2018 20/03/2018

Key outputs: 100% compliance with 27 core standards ‐Pilot Treatment Centre (St George's) live Green 31/05/2018 31/05/2018

Scheme Scope In Scope Out of Scope development pathways agreed Community UTC pilot (St Georges Centre) Community UTC pilot (St Georges Centre) Blue 18/04/2018 18/04/2018 18/04/2018 Services to include Services: − GP OOH − All non‐urgent services − LSE Federation Extended access hub evaluation agreed − Minor injury unit Access ‐ No direct dial Green 09/07/2018 09/07/2018 − Walk‐in centre − Dignostics Estates ‐ Procuring new premises (potential that this will be in scope for full rollout if successful) evaluation report issues to Board − Direct booking through 111 − ASC rapid response Green 31/03/2019 31/03/2019 − Refering into SPUR − Potential consultant input (TBC) service specification for community UTC's finalised ‐minor illness Green 31/03/2019 31/03/2019

Scheme Update Last Reporting Period Next Reporting Period contract awarded Green 01/02/2020 01/02/2020 Service went live 20 March 2018 according to schedule Provide an update of service to date No unexpected issues with the go live date Update on agreed areas for development as part of the pilot Services are working well within the UTC Work towards any partial/non compliant stanards of the NHSE mandate go live date Amends made to time of ANP/care navigator role to make the services as effective as possible Monthly performance meetings to be scheduled in Green 01/04/2020 01/04/2020 Development session 18/04/2018 to explore further developments Direct booking to be in place by 31/05/2018 MOU being finalised and agreed between Commissioner and Provider, including SOP and other protocols Weekly data being provided to Commissioners from the 4 services Working towards 100% compliance against the 27 core standards

Reason for Overall Scheme RAGB Status Mitigation Actions to Progress the Scheme (if Overall Scheme RAGB Status is Red or Amber) Pilot went live 20 March 2018. Services performing well Development session to take place 18/04/2018 to further develop the pilot

Decision or Support Required from the Commissioning for Value Delivery Board

Risk ID Escalate Top 5 Scheme Risks ‐ Description Owner Mitigation Actions Risk Score Progress Against Actions R05 Yes May have to go out to procurement for 01 April 2019 R10 No there is not sufficient room at the SGC to develop the pilot

Issue ID Escalate Top 5 Scheme Issues ‐ Description Owner Actions to Resolve Priority Progress Against Actions

8 Appendix C

Commissioning for Value Delivery Board

Terms of Reference

Version: Draft

Approved by: Commissioning for Value Delivery Board

Date Approved:

Responsible Director: Katherine Sheerin

Review Date:

Page 1 of 3

1. Role

1.1 The Commissioning for Value (CfV) Delivery Board will oversee the Commissioning for Value Programme which will ensure that the CCG’s commissioning activities are focused on improving outcomes, quality and financial effectiveness in line with its strategic commitments.

1.2 This will include ensuring the delivery of existing commissioning schemes, prioritising them where necessary, and providing a robust framework for making decisions on any future investments.

2. Responsibilities

i. Ensure that the CCG has full sight of all commissioning schemes which have an impact on quality, health outcomes and financial effectiveness.

ii. Ensure that each scheme has an effective performance monitoring arrangement, with benefits and milestones for delivery clearly articulated.

iii. Provide support, guidance and challenge to sponsors and scheme leads, ensuring a co- ordinated approach to the delivery of individual schemes.

iv. Ensure that schemes as a total package remain aligned with the strategic intent and objectives of the commissioning partnership

v. Review and approve consolidated monthly highlight reports

vi. Review and approve changes to the programme of work vii. Manage scheme risks, issues, assumptions and (inter)dependencies that have been escalated viii. Provide links to other boards/stakeholder groups within the Leeds health system and ensuring effective communication and engagement

ix. Ensure that the schemes comply with the CCGs’ policies and procedures, e.g. information governance, quality and equality impact, clinical engagement, etc.

x. Ensure that there is a robust process for approving investment in new schemes (recurrent and non-recurrent) that is consistent across the organisation and promotes strategic alignment. This will include the documentation to support business cases, a prioritisation process and a clear decision making framework.

xi. Hold a prioritised list of schemes for future investments and make recommendations when resources are available. xii. Promote and support the Commissioning for Value Programme and ensure key stakeholders are aware of the programme and are supportive of its successful delivery

Page 2 of 3

3. Membership

Scheme Leads will attend as required to support the exception reporting process. Initially this will be on a bi-monthly basis.

4. Frequency and Method of Working

4.1 Chair: Director of Strategy and Planning

4.2 Vice Chair: Director of Finance

4.3 Quorum: The group will be a quorum and decisions can be made when a minimum of the chair, or deputy chair and at least five additional members are present. It will be important that nominated members commit to attend the Board. Where this is not possible a named deputy will be encouraged to attend. Deputies must be able to contribute and make decisions on behalf of the individual that they are representing. Deputising arrangements should be agreed with the Chair.

4.4 Frequency of meetings: Monthly

5. Agenda Setting

5.1 The chair will set and prioritise agenda items. The agenda and supporting documentation will be issued as a minimum 72 hours in advance of the meeting by the Programme Management Office. Within each meeting a number of items will be reported and managed on a regular basis. These will include but will not be limited to:

 Validating the key decisions from the previous meeting and updating the actions log;  Reviewing the Commissioning for Value scheme commissioning area highlight reports;  Reviewing progress against the benefits of these schemes;  Resolution of any risks and issues escalated by the enabling groups or Board members;  A deep dive of a scheme;

6. Reporting

6.1 Whilst the CCG is confirming its governance arrangements, the Commissioning for Value Delivery Board will report into the CCG Executive Team. This will be reviewed in July 2018.

Page 3 of 3

Agenda Item: GB 18/17 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 23 May 2018 Title: The Annual Report of the Director of Public Health 2017/2018 Nobody Left Behind: Good Health & A Strong Economy Lead Governing Body Member: Dr Ian Cameron, Tick as Category of Paper appropriate Director of Public Health () Report Author: Decision Dr Ian Cameron Reviewed by EMT/SMT/Date: N/A Discussion 

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual This report is a statutory responsibility of the Director of requirements Public Health Financial Implications N/A Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY: The latest life expectancy figures for Leeds show a fall in life expectancy for women and a static position for men. This comes on the back of a concerning picture around deprivation statistics in the city.

This year’s Annual Report of the Director of Public Health focuses on the reasons behind the current life expectancy figures.

The report also provides an update on the progress from last year on those key public health indicators most related to the Leeds Health & Wellbeing Strategy.

NEXT STEPS: The implications from the Annual Report of the Director of Public Health will be incorporated into the future work programmes of the CCG.

RECOMMENDATION: The Governing Body is asked to:  Note the content of the Annual Report of the Director of Public Health and support the recommendations;  Request that Public Health consider the funding of the Public Health England national review into life expectancy and report back to the Governing Body on implications for Leeds and the CCG.  Consider how the CCG currently reflects gender differences in health, experiences and outcomes in its operations and what further actions are needed in relation to the Director of Public Health’s report.  Consider how the CCG currently reflects gender differences in its monitoring arrangements and what further actions are needed in relation to the Director of Public Health’s report.

1 Summary

1.1 The Director of Public Health’s Annual Report 2017/18 entitled Nobody Left Behind: Good Health and A Strong Economy was launched at the Executive Board of Leeds City Council on March 21st 2018. 1.2 Through the Leeds Health and Well Being Strategy, the city has a clear direction of travel to improve health and well being and to reduce health inequalities. This is backed by an increasing breadth and depth of partnership working centred around the Leeds Health and Well Being Board. 1.3 Progress is being made. Just recently Leeds has been identified in a national independent report as the best core city for well being. 1.4 Tackling poverty, including child poverty, and the wider determinants of health remain the cornerstone to reducing health inequalities. However, the continuing difficult financial climate faced by individuals and families is detrimental to health and well being. 1.5 The latest life expectancy figures for Leeds show a fall in life expectancy for women and a static position for men. This picture does not match the ambitions for health improvement and reducing health inequalities as set out in the Leeds Health & Wellbeing Strategy. 1.6 The decline and stalling of life expectancy may turn out to be a temporary position, but does come on the back of a concerning picture around deprivation statistics in the city. 1.7 This year’s report focuses on the reasons behind the current life expectancy figures and covers infant mortality; alcohol related deaths in women; drug related deaths in men, suicides in men; self harm and women. 1.8 The report also covers Inclusive Growth and the contribution that can be made by the Leeds Inclusive Growth Strategy to reducing health inequalities. 1.9 The report provides an update on the progress from last year on those key public health indicators most related to the Leeds Health & Wellbeing Strategy. 1.10 A comparison with the other core cities shows a very similar picture of change including a fall in life expectancy for females.

2 Background

2.1 Under the Health & Social Care Act 2012 (Section 31) the Director of Public Health has a duty to write an annual report on the health of the population. Within the same section of the Act, the council has a duty to publish the report. 2.2 The Annual Reports of the Medical Officer of Health (predecessor name of the Director of Public Health) became a statutory requirement under the 1875 Public Health Act but the Leeds Medical Officers of Health had produced such reports right from the first appointment in 1866. The Annual Reports are held in Leeds Central Library.

3 Proposal

3.1 Leeds has much to be proud about. Progress can be judged by obvious physical developments such as Trinity Leeds and Victoria Gate. In addition, progress can be judged by a broader sense of what it is like to live here. Leeds has been named best city in Britain for quality of life. Even more recently, this year the ‘What Works Centre for Well Being’ produced a national, independent report that identified Leeds as the best core city well being. 3.2 The Leeds Health and Well Being Board has set a clear direction of travel to improve health and well being and to reduce health inequalities through the Leeds Health and Well Being Strategy. Tackling poverty, including child poverty along with other wider determinants of health remain the cornerstone for action and this is reflected in the new Leeds Health and Care Plan and the Best Council Plan 2018/19-2020/21. 3.3 However, the current financial climate is extremely challenging for individuals and families and detrimental to health and well being. While the breadth and depth of partnership working on health and well being has developed to an astonishing degree over the last few years organisations including Leeds City Council are also faced with financial challenges. Hence the greater emphasis on a partnership approach to the "Leeds pound". 3.4 Included within last year’s Annual Report of the Director of Public Health was a statistical appendix that set out the starting position of the new Leeds Health & Wellbeing Strategy 2016-2021. This covered the seven health status indicators within the new strategy alongside key indicators that related to the public health issues described as priorities in the Leeds Health & Wellbeing Strategy. 3.5 This year’s Annual Report of the Director of Public Health provides an update as an appendix. Inevitably a one year update means that there are not statistically significant changes for many indicators. This includes physical activity, one of the health status indicators in the Leeds Health & Wellbeing Strategy. 3.6 There has though been progress in some areas. The levels of excess weight (overweight or obese) is reducing in 4-5 year olds and is now below the England average. This is a health status measure in the Health & Wellbeing Strategy. Teenage pregnancy rates continue to fall in Leeds, although still above the England average. The Leeds My Health My School survey identifies a reduction in bullying at school albeit this is still high at 30% describing being bullied in the last year. This forms part of a health status indicator in the Health & Wellbeing Strategy. 3.7 Smoking is the largest single preventable cause of ill health and health inequalities. Smoking levels amongst adults have dropped to 17.8% - the lowest recorded. This is a health status measure in the Health & Wellbeing Strategy. Cancer mortality rates for those under 75 years are reducing. This is to be welcomed and is a positive contrast to the position in the Annual Reports of around ten years ago when cancer rates for females were essentially staying the same and with small declines for males. The hope is that the progress made over the last 5-10 years in reducing cardio-vascular disease mortality and the inequality gap can be replicated for cancer.

3.8 Leeds has a worse rate than England for those dying before the age of 75 years with a serious mental illness – a health status indicator in the Health & Wellbeing Strategy. However the way data is collected means no proper comparisons over time can be made yet. 3.9 There has then been progress. However, the most striking comparison from last year is a decline in life expectancy in women and a static life expectancy in men. 3.10 The reasons for this concerning position forms the basis of this year’s Annual Report of the Director of Public Health. 3.11 We may find that the next set of life expectancy figures show a rise again. In which case this has been a false alarm. However, the current life expectancy figures follow the latest Indices of Deprivation for Leeds that have previously been presented to the Executive Board. These showed a greater number of our communities now in the worst 10% super output areas (SOA’s) in the country alongside a greater number in the best 10% super output areas (SOA’s) in the country. 3.12 There is a national context. Improvements in life expectancy figures for England as a whole have slowed down markedly both for men and women in recent years. We continue to be in the “age of austerity” as declared by the prime minister in 2009. 3.13 Improving the socioeconomic position of the people of Leeds is a crucial foundation for health & wellbeing and to reducing health inequalities. The Annual Report describes the work of the Inclusive Growth Commission led by the Royal Society for the Encouragement of the Art, Manufacturers and Commerce in 2017 and the call for a new look at economic growth. The Annual Report then goes on to make recommendations about the contribution the new Leeds Inclusive Growth Strategy can make to help reverse the deprivation indicators and inequalities in our city. 3.14 The Annual Report focuses particularly on the underlying reasons behind the fall in life expectancy for women and the static position for male life expectancy. Perhaps surprisingly, the big killers – cardiovascular, cancer, respiratory disease – are not the reasons. 3.15 A rise in infant mortality (deaths of live births under the age of one year) accounts for around half of the lack of improvement in life expectancy. The Executive Board will be aware that Leeds has made tremendous progress over the last ten years in reducing infant mortality and reducing the inequality gap on infant mortality within the city. 3.16 From being on a national “worry” list with subsequent implementation of a partnership Infant Mortality Plan, Leeds has reduced infant mortality to below that for England. A remarkable achievement for a major urban city. However, a rise from a low of 35 deaths in 2012 to 49 in 2016 has resulted in an infant mortality for 2014-2016 of 4.4/1000 live births – above the England figure of 3.9/1000. This small rise, albeit important, has had a disproportionate effect on the life expectancy figures. 3.17 In recent years Leeds has broadened its approach to infant mortality to the period from conception to the child’s second birthday – the first thousand days and described as Best Start. Best Start is a priority in the Leeds Health & Wellbeing Strategy and the Annual Report confirms the importance of a continued focus on implementing the Best Start Plan 2015 – 2019.

3.18 There are three other significant causes for the disappointing life expectancy figures – a rise in deaths in women from alcohol related liver disease, a rise in deaths in men from drug related overdoses and a rise in deaths in men who have taken their own lives. 3.19 For each of these three public health issues there is a section describing the current position in Leeds, the actions being taken in Leeds and recommendations for further action. Case studies are used to describe the impact on individual Leeds residents of excess alcohol, heroin use, experiences of attempting to take one’s own life. 3.20 In relation to increasing deaths in women from alcohol related liver disease recommendations include social marketing targeted at young women, increased identification and brief advice in primary care and secondary care, reviewing alcohol treatment needs and services for women. 3.21 In relation to increasing drug related deaths in men recommendations include use of drug misuse death audit data to better target interventions, reviewing opiate users. 3.22 In relation to increasing numbers of men taking their own lives recommendations include ensuring that 30-50 year old men remain a priority within the implementation of Leeds Suicide Prevention Plan. 3.23 The Annual Report covers one further area – self-harm by women especially in the 16- 24 year age group. While not directly linked to the life expectancy figures this is an area of increasing concern. A comparison with last year’s Annual Report on the Leeds My Health My School survey shows a rise in the number of primary and secondary students feeling stressed or anxious – now over one in five. This is also part of one of the health status indicators in the Leeds Health & Wellbeing Strategy. This rise coupled with an increase in admissions for women who self-harm has warranted inclusion in this year’s Annual Report. Again case studies have been used to better highlight the issue with recommendations for further action. 3.24 The Annual Report acknowledges the need to have a greater understanding of gender in relation to health & wellbeing – including those who cross traditional gender boundaries (trans) whether permanently or otherwise. Leeds City Council in conjunction with Leeds Beckett University has undertaken the largest men’s health needs assessment in the country. There is a recommendation that a comprehensive health needs assessment for women should be undertaken for Leeds. 3.25 Finally, the report covers the importance of local public health information and intelligence that can analyse issues within our city. Public Health England provide an excellent service but one that stops at the Leeds boundary. Fortunately, Leeds City Council has a nationally recognised Public Health Intelligence team. The need for this service will only increase and Leeds City Council is to be commended for combining Public Health intelligence with the intelligence function of the Leeds Clinical Commissioning Groups. 3.26 The Annual Report is available online and readers are signposted for further information on the health statistics for Leeds at http://observatory.leeds.gov.uk 3.27 Looking at Leeds in relation to the other core cities, then what is striking is that where indicators have worsened for Leeds, then that has also occurred in the other core cities. For example, all, bar one, core city has seen a decline in female life expectancy.

4 Next steps

4.1 The implications from the Annual Report of the Director of Public Health will be incorporated into the future work programmes of the CCG 5 Statutory/Legal/Regulatory Contractual

5.1 Publication of the Annual Report of the Director of Public Health will enable Leeds City Council to meet its statutory requirements under the Health & Social Care Act 2012.

6 Financial Implications and Risk

6.1 There are no risks identified with the publication of the Annual Report of the Director of Public Health.

7 Communications and Involvement

7.1 Various initiatives described in the Annual Report have been developed with the public.

7.2 Members of the public have helped write this and previous Annual Reports through personal stories and experience.

7.3 There is a communications plan associated with this year’s Annual Report.

8 Workforce

8.1 There are no immediate workforce issues.

9 Equality Impact Assessment

9.1 The Annual report recognises the differential impact of gender on health issues impacting on life expectancy.

10 Environmental

10.1 There are no environmental issues.

11 Recommendation:

11.1 The Governing Body is asked to:  Note the content of the Annual Report of the Director of Public Health and support the recommendations.  Request that Public Health consider the funding of the Public Health England national review into life expectancy and report back to the Governing Body on implications for Leeds and the CCG.

 Consider how the CCG currently reflects gender differences in health, experiences and outcomes in its operations and what further actions are needed in relation to the Director of Public Health’s report.  Consider how the CCG currently reflects gender differences in its monitoring arrangements and what further actions are needed in relation to the Director of Public Health’s report.

Agenda Item: GB 18/18 FOI Exempt: No

NHS Leeds CCG – Governing Body Meeting

Date of meeting: 23 May 2018

Title: Audit Committee meeting 18th April 2018 - Summary

Lead Governing Body Member: Peter Myers, Lay Tick as Category of Paper appropriate Member for Audit and Conflict of Interest () Report Author: Sharon Katema, Corporate Decision Governance Manager Discussion Information  Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY:

This report provides the Governing Body with a summary of items discussed, outcomes and risks identified at the Audit Committee meeting held on 18th April 2018.

RECOMMENDATION:

The Governing Body is asked to: RECEIVE the report.

Description of key items of business discussed and key outcomes

Please note that this is a brief summary of the items considered and decisions taken at the Audit Committee meeting held on 18th April 2018. Further information can be obtained by reference to the minutes of that meeting.

Items of positive assurance or issues to be raised

Finance The Audit Committee received an update on the combined financial positions of the Leeds CCGs and the expected outturn position for the 2017-18 financial year. The CCG was on track to achieve the key financial targets and there were no significant issues at the end of month 11. The Committee noted that Quality, Innovation, Productivity and Prevention (QIPP) continued to be a key risk as it remained unachieved. The QIPP position in particular would continue to be reported to the Governing Body. The Committee noted the finance update.

Risk Management The Committee reviewed the risk management arrangements that are in place within the CCG and noted the current risk position as outlined in the Risk Register. The Governing Body Assurance Framework would be presented at the Governing Body workshop in June. The Audit Committee noted the controls and assurances in place in relation to the risks that

1 are aligned to the committee.

Internal audit The Committee noted progress against the audit plan, and progress on implementing recommendations. The Committee discussed the Care Home Quality Audit which had received limited assurance and requested that this be brought to the attention of the Governing Body. The Committee approved the Strategic Audit Plan 2018/19 to 2020/2 and the Operational Audit Plan 2018/19.

External audit The Committee noted that the audit of Annual Reports and Accounts was due to start on 30 April and no major concerns had been brought to their attention.

Counter fraud The Committee received the progress report, highlighting recent activity including investigative work undertaken on behalf of the CCG. The Committee noted that included a potential high value, high profile fraud case involving a GP practice within Leeds.

Governance The Committee received the Register of Interest, Register of Gifts and Hospitality and the Register of Procurement Decisions. They noted the draft Annual Governance Statements for the former three CCGs.

Any additional comments

None.

Agenda Item: GB 18/19 FOI Exempt: No

NHS Leeds CCG – Governing Body Meeting

Date of meeting: 23 May 2018 Title: Chair’s Summary of the Remuneration & Nomination Committee meeting held on 11 April 2018 Lead Governing Body Member: Dr Steve Ledger, Tick as Category of Paper appropriate Lay Member - Assurance () Report Author: Laura Parsons, Head of Corporate Decision Governance & Risk Discussion  Information Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY:

1. This report provides the Governing Body with a summary of items discussed at the Remuneration and Nomination Committee meeting held on 11 April 2018.

RECOMMENDATION:

The Governing Body is asked to:

(a) RECEIVE the report.

Description of key items of business discussed and key outcomes Terms of Reference The Committee reviewed its draft Terms of Reference. It was agreed to include an addition to reflect that the Committee will consider the diversity of the Governing Body as part of succession planning and nominations of future members.

Governing Body Membership Details of the roles on the Governing Body were presented for information, including job descriptions.

Remuneration for Governing Body Members The Committee ratified the remuneration for all members of the Governing Body, as recommended by the shadow Remuneration & Nomination Committee meeting held on 14 March 2018.

No member was involved in approving their own remuneration.

Remuneration for Associate Medical Directors Members considered and agreed a pay range for the Associate Medical Directors.

Payments in Lieu of Notice

Some payments in lieu of notice were ratified.

Updates to HR Policies Members approved updates to the following policies, to reflect the requirements of the General Data Protection Regulation (GDPR):

- Disciplinary Policy - Grievance Policy - Managing Absence Policy - Recruitment and Selection Policy

It was also agreed to include a standard statement in the remaining HR Policies and Procedures, which do not require detailed GDPR information: ‘The CCG is committed to ensuring that all personal information is managed in accordance with current data protection legislation, professional codes of practice and records management and confidentiality guidance. More detailed information can be found in the CCG’s Data Protection and Confidentiality and Related Policies and Procedures.’

Agenda Item: GB 18/20 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 23 May 2018

Title: Chair’s Summary of Quality & Performance Committee Meeting held on 9 May 2018

Lead Board Member: Dr Steve Ledger, Lay Tick as Member, Assurance and Chair – Quality & Category of Paper appropriate Performance Committee () Report Author: Dr Steve Ledger Decision Discussion  Information Approved by Lead Board member (Y/N): Y

EXECUTIVE SUMMARY:

1. This report provides the NHS Leeds CCG Governing Body with a summary of items discussed, outcomes and risks identified at the Quality & Performance Committee meeting held on 9 May 2018.

RECOMMENDATION:

The Governing Body is asked to: (a) RECEIVE the report.

Description of key items of business discussed 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Quality & Performance Committee on 9 May 2018. Further information can be obtained by reference to the minutes of that meeting.

Actions from Previous Meetings

2. An update was provided in relation to the outcome of the Improving Access to Psychological Therapies (IAPT) review. The Committee noted the recommended level of assurance as reasonable.

Equality Delivery System 2017/18

3. A revised process was presented in relation to Equality Delivery System (EDS2) for 2018, including a focus on a smaller number of workstreams over a longer timescale, to maximise the impact on equality outcomes. The Committee was in agreement that there were some points that required clarification, including how the quality work outside of the EDS2 workstreams would be captured. The Committee considered the recommended level of assurance and agreed that this was currently limited.

4. An update will be required at the next meeting in order to provide additional assurance and clarification.

Integrated Quality & Performance Report (IQPR)

5. The Committee was informed that performance against the Referral to Treatment target was narrowly missed by 0.9%. There was a risk in relation to the number of patients waiting over 52 weeks which was highlighted at 47 patients.

6. Performance against the A & E waiting time target was not met and had been delivered in 67.5% of cases. Members were informed that a system wide recovery plan has been developed and will be presented to the Quality & Performance Committee at the next meeting.

7. Members were informed that the waiting time for autistic spectrum disorder has improved from 52 weeks to 18 weeks.

8. Following reflection on the recent measles outbreak, the Quality and Performance Committee agreed to include immunisations within the IQPR for future reporting and monitoring.

Providers Under Enhanced Surveillance

9. The Committee received a summary of the providers that were currently under Routine+ Surveillance, Enhanced Surveillance and Formal Action, and the actions being taken as a result.

CCG Risk Register

10. The risk register was presented. The Committee agreed that the full risk register provides controls and assurances.

11. A query was raised as to whether the current breast screening issue should be escalated on to the risk register as a reputational risk. Members acknowledged that the overall responsibility lies with Public Health England (PHE), therefore if was agreed that this did not need to be added to the risk register. However, there is a need for the CCG to gain an understanding of the local impact and information is awaited from PHE.

Quality Impact of Integrating Care

12. The Head of Programme Delivery – System Integration presented an overview on the progress of the System Integration programme. Members acknowledged that this was a strategic paper are they were asked to consider the key questions. The key areas for discussion included commissioning for outcomes, integrated care and local care partnerships.

13. In relation to commissioning for outcomes, members noted the importance of working

collaboratively in relation to quality indicators. The Committee acknowledged that as a CCG there is a statutory responsibility to hold providers to account, however it was felt that over time the CCG will be holding the system to account.

14. The Committee considered the key questions relating to integrated care and noted the cultural shift that providers will need support with. The Committee felt that within this context CCG capacity and capability needs to be incorporated into the Organisational Development Plan and the workforce strategy for the CCG.

15. Members commented that in relation to Local Care Partnerships, there may be difficulties faced as a starting point due to the differences across geographies. It was noted that clinical accountability and governance should be clear and learning should be shared at a partnership provider level.

Memorandum of Understanding for Reporting Serious Incidents in Police Custody

16. The committee considered a proposed change to the reporting arrangements of SI's involving healthcare provision within police custody or other secure or detained settings, to be submitted to NHSE for review, rather than the CCG as currently. Full assurance was provided that oversight will be retained through several mechanisms, but the change will streamline and enhance the process overall.

17. There was a query as to whether this is taking place elsewhere and members were informed that it is difficult to compare as all areas are commissioned differently.

18. The Committee approved the change.

Patient Insight Group Update

19. The Committee received a summary update on the work and outcomes of the Patient Insight Group. The Patient Experience Framework will be presented to the Committee on 11 July 2018. A query was raised regarding assurance levels for the CCG and informing future decisions based on patient experience. Members noted that an annual report evidencing what has been done as a result of patient feedback and patient experience will be undertaken and shared with the Committee.

Individual Funding Requests Policies

20. The Committee considered the amendments to the current Individual Funding Request Policies. It was confirmed that the policies fall in line with national guidance and members agreed to approve the policy amendments.

Committee Development

21. The Committee considered the key areas that were raised from the Committee annual assessment undertaken in March 2018. Members agreed to make a recommendation to the Governing Body to hold a Governing Body workshop relating to the development of Quality Improvement and Quality Assurance.

22. The Committee acknowledged that committee development is a continuous process. Strategies/Policies approved  Amendment to the Individual Funding Requests Policies

Items of positive assurance or issues to be raised with the NHS Leeds CCG Governing Body The Committee wishes to highlight the following issues:

 Limited assurance in relation to Equality Delivery System.  Acknowledgement of the breast screening national issue and that the overall responsibility lies with Public Health England (PHE).

Any other Comments N/A

Agenda Item: GB 18/21 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 23 May 2018

Title: The Integrated Quality and Performance Report (IQPR)

Lead Governing Body Members: Tick as Sue Robins, Director of Commissioning Category of Paper appropriate Jo Harding, Director of Nursing and Quality () Report Author: Various Decision

Reviewed by EMT/SMT/Date: n/a Discussion 

Reviewed by Committee/Date: Quality & Performance Committee, 9th May 2018 Information

Checked by Finance (Y/N/N/A - Date): n/a

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual N/A requirements Financial Implications N/A Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY: This report provides assurance to the organisation that we are delivering against the requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described. The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:  NHS Constitution and Operational Planning  Quality and Safety The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance. NEXT STEPS: The key actions which will be undertaken in relation to performance are as follows:  To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.

The key actions which will be undertaken in relation to the development of the IQPR are as follows:  To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics and Quality in the development of the report and identification of local measures;  To work with commissioning teams to develop a minimum of three-year work plans as part of a broader commissioning and performance management framework, which will provide strategic milestones for inclusion within the IQPR. RECOMMENDATION: The Governing Body is asked to:

a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action

PURPOSE OF REPORT

1.1 This report provides assurance to the organisation that we are delivering against the requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described.

1.2 The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:  NHS Constitution and Operational Planning  Quality and Safety

1.3 The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.

2. SUMMARY OF KEY PERFORMANCE ISSUES

2.1 Planned Care and Long Term Conditions  In February 2018, the 92% Referral to Treatment standard was narrowly missed for Leeds patients (91.1%). Improvements linked to outpatients at Leeds Teaching Hospitals NHS Trust (LTHT), particularly around high volume pathways such as spinal surgery where there has been a big focus on outpatient clearance, improve the likelihood of the standard being achieved in future.

 There remain significant risks to waiting times for elective surgical patients because of the significant reductions in elective surgery from December onwards. This has led to a significant increase in over 18, over 40 and over 52 week waiters. There were 25 Leeds CCG patients over 52 weeks at the end of February and 47 at the end of March.

 In February the Leeds CCG achieved all but 2 of the cancer standards. The main 62 day GP referral to treatment time target has been achieved for the second month in a row (85.3% against a standard of 85%) The two areas of under-achievement were 62 day upgrades (5 out of 19 not treated within 62 days) and referrals from NHS screening programme (2 patients out of 12 not treated within 62 days).

 The shortage of beds has led to some patients on a cancer pathway being cancelled with the numbers still high in March. Some patients are cancelled at a diagnostic phase rather than at a treatment phase. All patients are tracked and re-dated as quickly as possible. Delays in patients being transferred into LTHT also impacts on the overall performance for LTHT and for Leeds patients as patients are treated in date order other than for clinical exceptions.

2.2 Unplanned Care  The 4 hour A&E waiting time was delivered in 67.5% of cases at Leeds Teaching Hospitals NHS Trust (LTHT) during March 2018 (against the 95% standard), which is the lowest it has ever been at the Trust. LTHT continue to experience continued pressure with patient flow across the trust which has a significant impact on the achievement of the Emergency Care Standard.

 Emergency Department attendances have not experienced any significant growth in 2017/18 and the key contributors to the deterioration of this standard’s performance remains to be slow patient flow and discharge volumes which are not sufficient to create the capacity required to enable optimum system flow.

 Both the average response times for category 1 and category 2 ambulance standards were not achieved by Yorkshire Ambulance Service in February-18. The target of at least 90% of category 1 calls responded to within 15 minutes was achieved. Local intelligence reports show that Yorkshire Ambulance Service had no issues to report in Leeds but experienced delays in surrounding areas due to handover and turnaround.

2.3 Mental Health and Learning Disabilities  Improving Access to Psychological Therapies (IAPT) access continues to be below target. The target for 17/18 is for 16.8% of the prevalent population to be accessing IAPT support by the end of March 2018; the latest performance for Leeds is 12.2% against a year-to-date target of 15.4%. A recovery plan is in place which is monitored by monthly submissions to MH commissioners and quarterly performance meetings.

2.4 Children’s and Maternity  Both waiting times for referrals to the eating disorder services measures met the desired performance levels in Q3 of 2017/18 for Leeds North and Leeds South and East CCGs. Due to small numbers, performance has been suppressed for this quarter for Leeds West CCG.

2.5 Continuing Healthcare (CHC)  We are currently underperforming against the two Continuing Healthcare Quality Premium measures. Q3 performance for assessments taking place in an acute hospital setting for Leeds was 21.0% against a target of 15%. Performance remains below desired levels due to the huge surge in demand that required nurses diverted from other teams to support.

2.6 Neighbourhood Care  There are a total of 227 beds commissioned via the Community Care Beds contract, which is now fully mobilised. We are continuing to develop a process for the identification of delayed discharges in conjunction with the bed bureau and Leeds City Council (Adult Social Care). Patients delayed in community beds are not subject to the national delayed transfer of care definitions, therefore work is underway to develop a suite of delay indicators to assist in understanding the quality of service being provided.

2.7 Proactive Care and Population Commissioning  Personal Health Budget (PHB) figure for 2017/18 was 177 against a target of 314. Whilst we have continued to make slow but steady progress in the existing cohorts, we are actively exploring extending the PHB offer to new cohort groups, including end-of-life and some mental health patients. During Q4 we have started to explore PHBs for renal dialysis transportation and have started discussions with colleagues at LCC and NHSE to explore how we can better link PHBs with the Collaborative Care & Support Planning approach to self-management which is now being delivered in over 70 GP practices across the city.

 Leeds Wheelchair Service started to offer PHBs from 1st April 2018. Once fully implemented, we anticipate the PHB numbers will significantly increase to approximately 300 new PHBs per quarter, thereby enabling us to meet our March 2019 target (540 PHBs).

3. NEXT STEPS

3.1 The key actions which will be undertaken in relation to performance are as follows:  To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.

3.2 The key actions which will be undertaken in relation to the development of the IQPR are as follows:  To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics and Quality in the development of the report and identification of local measures;

4. RECOMMENDATION

The Governing Body is asked to:

a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action

THIS PAGE IS INTENTIONALLY BLANK The Integrated Quality and Performance Report

Report Period: February 2018

Contents

Indicator Tables NHS Constitution and Operational Planning Measures Page 2‐3 Quality and Safety Page 4

Report Key

RAG Rating 92.5% Note: The RAG rating applied within this report is based upon calculating 88.0% a limit of 5% higher/lower relative to the expected standard/target. 85.0% For example, if the expected Standard is a minimum of 92%...

'Green' performance would be ≥ 92% 'Amber' performance would be 87.4% ≤ x < 92% 'Red' performance would be < 87.4%

Performance measures shown to be 'Amber' should still be interpreted as underperforming ‐ a RAG rating has only been applied to serve as a visual guide to understand how close performance is to the expected standard. They should not be interpreted as being currently within a tolerance level.

Interpreting Trends Trend analysis is currently based upon comparing the latest performance with the performance in the previous period. A green arrow represents an improvement in performance An amber arrow represents no change in performance A red arrow represents a deterioration in performance NHS Constitution and Operational Planning Measures Performance Measures (1 of 2)

Measure Period Target Leeds Leeds S&E Leeds Leeds Leeds (YTD) Leeds North West Trend NHS Constitution RTT Incomplete Pathway Feb‐18 92% 90.6% 91.3% 91.2% 91.1%

Diagnostic Waiting Times Feb‐18 99% 99.9% 99.8% 99.8% 99.4%

Cancer ‐ 2 Week Wait Feb‐18 93% 94.1% 94.6% 94.6% 94.5% 95.1%

Cancer ‐ 2 Week Wait (Breast) Feb‐18 93% 91.4% 94.6% 93.8% 93.6% 95.1%

Cancer ‐ 31 Day First Treatment Feb‐18 96% 100.0% 97.8% 98.0% 98.4% 96.8%

Cancer ‐ 31 Day Surgery Feb‐18 94% 100.0% 100.0% 100.0% 100.0% 96.2%

Cancer ‐ 31 Day Drugs Feb‐18 98% 100.0% 100.0% 100.0% 100.0% 99.9%

Cancer ‐ 31 Day Radiotherapy Feb‐18 94% 100.0% 100.0% 100.0% 100.0% 100.0%

Cancer ‐ 62 Day GP Referral Feb‐18 85% 93.3% 82.6% 83.0% 85.3% 83.8%

Cancer ‐ 62 Day Screening Feb‐18 90% 87.5% 100.0% 66.7% 83.3% 86.0%

Cancer ‐ 62 Day Upgrade Feb‐18 90% 100.0% 81.8% 57.1% 73.7% 81.0% A&E A&E Waiting Times ‐ % 4 hours or less (LTHT (LGI & SJUH Only)) Mar‐18 95% 67.5% 80.5% Ambulance Ambulance Calls Closed by Telephone Advice Jan‐18 7.2% 7.0% (Hear & Treat ‐ YAS Trust Total From Sept17 onwards) Incidents Managed Without Need for Transport to A&E Jan‐18 23.5% 22.7% (See & Treat ‐ YAS Trust Total From Sept17 onwards) Mental Health Dementia ‐ Estimated Diagnosis Rate Feb‐18 66.7% 68.5% 79.7% 73.1% 73.9%

IAPT Access (YTD) Feb‐18 15.4% 10.6% 11.1% 14.0% 12.2%

IAPT Recovery Feb‐18 50% 57.8% 53.1% 55.5% 55.5% 52.2%

IAPT Waiting Times ‐ 6 Weeks Feb‐18 75% 91.2% 93.2% 97.2% 94.6%

IAPT Waiting Times ‐ 18 Weeks Feb‐18 95% 98.3% 99.2% 99.1% 98.9%

EIP ‐ Psychosis treated within two weeks of referral Feb‐18 50% 75.0% 85.7% 50.0% 73.3% 70.4%

Improve access rate to CYPMH 30% No data available due to data quality issues Waiting Times for Routine Referrals to CYP Eating Disorder Services ‐ Within 4 2017/18 Q3 60% 95.5% 90.6% ** n/a Weeks (Rolling 12 Months) Waiting Times for Urgent Referrals to CYP Eating Disorder Services ‐ Within 1 2017/18 Q3 95% 100.0% 100.0% ** n/a Week (Rolling 12 Months) Other Commitments e‐Referral Coverage Mar‐18 80% 85.5% 74.0% 77.5% 78.2% 30.9 Personal Health Budgets (per 100,000) ‐ YTD 2017/18 Q3 22.3 22.3 16.7 17.8 (Leeds) Children Waiting no more than 18 Weeks for a Wheelchair 2017/18 Q4 92% 90.9% 93.3% 94.7% 93.7% 95.2% 100% by Extended access (evening and weekends) at GP services Mar‐17 70%~ 69%# 100.0% 69%** Oct 2018 LD Patient Projections Reliance on Inpatient Care for People with LD or Autism ‐ CCGs 2017/18 Q3 18 22

Reliance on Inpatient Care for People with LD or Autism ‐ NHS England 2017/18 Q3 23 19

Page 2 NHS Constitution and Operational Planning Measures Performance Measures (2 of 2)

Measure Period Target Leeds Leeds S&E Leeds Leeds Leeds (YTD) Leeds North West Trend Quality Premiums (QP) 12 months to 54.9% Cancers diagnosed at early stage (detected at stage 1 and 2) 55.7% 51.2% 54.4% 50.9% 2016/17 Q3 (Leeds) Overall experience of making a GP appointment Jan‐Mar 17 tbc 74.5% 69.6% 78.7% 74.9%

NHS CHC eligibility decision made within 28 days 2017/18 Q3 >80% 48.8% 66.7% 66.2% 61.9% 56.2%

Full NHS CHC assessments taking place in an acute hospital setting 2017/18 Q3 <15% 17.3% 23.9% 20.4% 21.0% 13.8%

43.1% Recovery rate of people accessing IAPT services identified as BAME Dec‐17 52.1% 40.9% 48.7% 47.7% 51.3% (Leeds) 9.7% Proportion of people accessing IAPT services aged 65+ Dec‐17 6.4% 4.3% 1.7% 3.4% 4.4% (Leeds) 480 Whole health economy ‐ E. coli blood stream infections (12 months) Dec‐17 130 235 248 613 453 (Leeds) Whole health economy ‐ collection and reporting of a core primary care data Q2 2017/18 n/a No data currently available set for all E coli BSI from Q2 2017/18 Antibiotic prescribing for UTI in primary care ‐ Trimethoprim: Nitrofurantoin 12 months to 0.67 0.42 0.43 0.36 0.40 prescribing ratio* Jan 2018 Antibiotic prescribing for UTI in primary care ‐ number of trimethoprim items 12 months to 11,803 1,938 2,754 2,952 7,644 prescribed to patients aged ≥70 years* Jan 2018 12 months to Prescribing in primary care ‐ items per STAR‐PU* 1.161 0.991 1.102 0.948 1.014 Jan 2018 57.6% Reported to estimated prevalence of hypertension (%) Q3 2017/18 58.0% 60.1% 55.0% 57.5% (Leeds)

* Average of CCGs

Page 3 Quality and Safety Performance Measures

Measure Target / Period LTHT LCH LYPFT Other* Nat Av in period YTD in period YTD in period YTD in period YTD Patient Safety Feb 18 to Serious Incidents n/a 17 75 14 78 3 43 2 22 Mar 18 Feb 18 to Never Events n/a 27000001 Mar 18 Oct 16 to Mortality Rate (Standardised Hospital Mortality Index) 1.00 0.992 Sep 17 MRSA Blood Stream Infection 0 Feb‐18 16

Clostridium difficile Infection 95 Feb‐18 16 115

Classic Safety Thermometer (Harm Free Care) 94.1% Feb‐18 94.9% No Data 99.5%

Mental Health Safety Thermometer (% feeling safe) 87.8% Feb‐18 85.9%

Patient Experience

Friends and Family Test (% recommended) ‐ A&E 86.8% Feb‐18 82.4% 84.8%

Friends and Family Test (% recommended) ‐ Inpatient 95.9% Feb‐18 93.4% 94.8%

Friends and Family Test (% recommended) ‐ Outpatient 93.8% Feb‐18 92.7% 93.2%

Friends and Family Test (% recommended) ‐ Maternity Antenatal 96.2% Feb‐18 93.7% 97.3%

Friends and Family Test (% recommended) ‐ Maternity Birth 96.5% Feb‐18 95.5% 94.4%

Friends and Family Test (% recommended) ‐ Postnatal Ward 94.6% Feb‐18 93.4% 97.0%

Friends and Family Test (% recommended) ‐ Postnatal Ward (Community) 97.9% Feb‐18 96.6% 97.8%

Friends and Family Test (% recommended) ‐ Mental Health 88.2% Feb‐18 85.8% 79.3% 94.4% 82.3%

Friends and Family Test (% recommended) ‐ Community 95.5% Feb‐18 96.7% 96.6%

Friends and Family Test (% recommended) ‐ See and Treat/Non‐Conveyance (YAS) 94.2% No Data No Data

Friends and Family Test (% recommended) ‐ Patient Transport Service (YAS) 83.5% No Data No Data

Complaints ‐ Total Received n/a Feb‐18 62 846 22 190 18 198 107 YAS 833 YAS

Staffing 12.5% 15.7% 11.8% Staff Turnover variable 12.56% (Dec) (Nov) (YAS) Sickness variable Nov‐17 4.55% 6.18% 4.93% 5.63%

Page 4

Agenda Item: GB 18/22 FOI Exempt: No

NHS Leeds CCG – Governing Body Meeting

Date of meeting: 23rd May 2018

Title: High Level Budgets 2018-19

Lead Governing Body Member: Visseh Pejhan- Tick as Category of Paper appropriate Sykes, Chief Finance Officer () Report Author: Visseh Pejhan-Sykes, Chief Decision Finance Officer  Reviewed by EMT/SMT: N/A Discussion

Reviewed by Committee: Information

Checked by Finance (Y/N/N/A): Y

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to:

1. People will live longer and have healthier lives X 2. People will live full, active and independent lives X 3. People’s quality of life will be improved by access to quality services X 4. People will be actively involved in their health and their care X 5. People will live in healthy, safe and sustainable communities X

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual Budgets set in line with statutory and regulatory requirements requirements as detailed Financial Implications Budget setting and monitoring is a key component of financial controls Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY: High level budgets for NHS Leeds CCG for 2018-19 are attached at Appendix A. These have been prepared from the final submission of the operating plan to NHSE on 30th April 2018 (overview attached at Appendix B). The final submission of the operating plan does not differ materially from the draft submission approved by Governing Body on 11th April 2018, and continues to meet the business rules and control total required by NHS England (NHSE). The plan and budgets are set on the following basis  Delivery of key national targets and local priorities  In year breakeven position in relation to the advised allocation  Maintain the existing CCG cumulative surplus of £40.4m (3.7%)  0.5% contingency reserves (£6.1m) uncommitted at start of year  No longer any requirement for a non recurrent reserve for sustainability and transformation  Running costs not to exceed allocation; running costs budgets are reflective of the part year effect of infrastructure reductions and realignment of staff to system transformation. The full year effect equates to a 20% reduction in running costs expenditure  The in year QIPP requirement is £34.3m (2.8%) and there is significant risk associated with achievement NEXT STEPS:

Updates on the 2018-19 financial position will continue to be presented to the Governing Body and/ or SMT each on alternative months to ensure that the CCG’s financial position is reported and reviewed formally under the CCG’s governance arrangements every month.

RECOMMENDATION:

The Governing Body is asked to:

(a) Approve the high level budgets for 2018-19.

2 Appendix A

2017-18 2018-19 2018-19 2018-19 budget budget Non compared to compared NHS Leeds CCG 2018- Annual Recurrent Recurrent 2017-18 to 2017-18 19 High Level Budgets Budget Outturn Budget Budget Total Budget outturn budget £'000 £'000 £'000 £'000 £'000 £'000 £'000 Programme Services Acute Services 580,082 587,084 572,762 790 573,552 -13,533 -6,530 Mental Health Services 132,079 130,563 134,872 38 134,910 4,347 2,831 Community Health Services 135,946 135,851 133,045 950 133,995 -1,857 -1,952 Continuing Care Services 52,665 52,840 53,685 0 53,685 845 1,020 Prescribing and Primary Care Services 152,548 151,551 154,244 1,332 155,576 4,025 3,028 Other 9,418 4,889 15,613 2,027 17,640 12,751 8,222 Primary Care Co-Commissioning 109,321 109,706 112,484 0 112,484 2,778 3,163

Total Programme Services 1,172,060 1,172,485 1,176,705 5,137 1,181,842 9,357 9,781

RUNNING COSTS 17,459 16,017 13,930 624 14,555 -1,463 -2,904

RESERVES 576 110 15,946 0 15,946 15,836 15,370

CONTINGENCY 0 0 6,092 0 6,092 6,092 6,092

SUSTAINABILITY & TRANSFORMATION RESERVE 5,231 0 0 0 0 0 -5,231

CCG Net Expenditure 1,195,326 1,188,612 1,212,673 5,761 1,218,434 29,823 23,108

In year allocation 1,217,915 519 1,218,434

In year position 5,242 -5,242 0

THIS PAGE IS INTENTIONALLY BLANK Appendix B Overview of 2018-19 Plan Submission 30.04.18 NHS Leeds CCG 15F

Financial Position

Revenue Resource Limit £ 000 2017/18 blank12018/19 Recurrent 1,175,500 1,217,915 Non-Recurrent 19,826 519 Total In-Year allocation 1,195,326 1,218,434

Income and Expenditure Acute 580,416 573,552 Mental Health 131,804 134,910 Community 132,832 133,993 Continuing Care 50,916 53,685 Primary Care 150,853 155,576 Other Programme 16,067 33,583 Primary Care Co-Commissioning 109,706 112,484 Total Programme Costs 1,172,594 1,197,783

Running Costs 16,018 14,555

Contingency - 6,096

Total Costs 1,188,612 1,218,434

£ 000 2017/18 2018/19 Underspend/(Deficit) In-Year Movement 6,715 0 In-Year (RAG) GREEN GREEN

Net Risk/Headroom 0 Risk Adjusted Underspend/(Deficit) 0 Risk Adjusted Underspend/(Deficit) (RAG) GREEN

Underlying position - Underspend/ (Deficit) 7,177 5,242 Underlying position - Underspend/ (Deficit) % 0.6% 0.5% Underlying position (RAG) AMBER AMBER

Contingency - 6,096 Contingency % 0.0% 0.5% Contingency (RAG) GREEN

Notified Running Cost Allocation 17,459 17,446 Running Cost 16,018 14,555 Under / (Overspend) 1,441 2,891 Running Costs (RAG) GREEN GREEN Population Size (000) 876.0 881.7 Spend per head (£) 18.29 16.51

Key Planning Assumptions 2017/18 2018/19 Notified Allocation Change (£'000) 30,542 Notified Allocation Change (%) 3 sep ccg 2.9% Tariff Change - Acute (%) 3 sep ccg 0.1% Tariff Change - Non Acute (%) 3 sep ccg 0.0% Demographic Growth (%) 3 sep ccg 1.9% Non Demographic Growth - Acute (%) 3 sep ccg 0.0% Non Demographic Growth - Cont.Care(%) 3 sep ccg 0.5% Non Demographic Growth - Prescribing (%) 3 sep ccg 3.4% Non Demographic Growth - Other Non Acute (%) 3 sep ccg 0.1% Mental Health Investment Standard Y Net Efficiency Savings £ 000 2017/18 2018/19 Recurrent (inclusive of full year effect) 23,800 34,339 Non-Recurrent - - Total 23,800 34,339 % of Notified Resource 2.0% 2.8% Unidentified - 0 % Unidentified 0.0% 0.0%

Non Recurrent Requirement - This is no longer a requirement £ 000 2017/18 2018/19 Value 10,488 - Agreed plans in place 4,375 Difference 10,488 (4,375)

BCF Minimum Pooled Fund 51,229 52,202 RAG GREEN GREEN

BALANCE SHEET memorandum - Movement on historic underspend/(deficit) 2017/18 2018/19 Brought forward underspend/(deficit) 33,662 40,377 Adjusted for in-year (drawdown)/draw-up - - In-year change from plan/In-year deficit 6,715 0 Balance carried forward 40,377 40,377 Underspend/(Deficit) % 3.7% 3.7% Underspend (RAG) GREEN GREEN

Allowable drawdown within business rules 23,000 29,323 Validation

Risk Adjusted Underspend/(Deficit) Cumlative 40,377 Risk Adjusted Underspend/(Deficit) % 3.7% Risk Adjusted Underspend/(Deficit) (RAG) GREEN

Agenda Item: GB 18/23 FOI Exempt: N

NHS Leeds CCG – Governing Body Meeting

Date of meeting: 23 May 2018

Title: Chief Executive’s Report Tick as Lead Board Member: Phil Corrigan, Chief Category of Paper appropriate Executive () Report Author: Phil Corrigan, Chief Executive Decision

Reviewed by EMT/SMT: N/A  Discussion

Reviewed by Committee: N/A Information

Checked by Finance (Y/N/N/A): N/A

Approved by Lead Board member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to:

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual N/A requirements Financial Implications N/A Communication and Involvement N/A Issues Workforce Issues N/A Equality Issues including Equality N/A Impact assessment Environmental Issues N/A Information Governance Issues N/A including Privacy Impact Assessment

EXECUTIVE SUMMARY:

The Chief Executive’s report informs the Governing Body of:

CCG staff event The CCG held its first event for all staff since officially becoming a single CCG on Thursday 26 April. The event was very well attended and received as it included an entertaining but thought provoking motivational presentation by Jamie Peacock OBE, former Leeds Rhinos rugby league player, Great Britain captain and current Hull Kingston Rovers Head of Rugby and England’s team manager. Jamie is continuing 6 weeks 1:1 coaching with 10 members of staff.

“Ask the question: Break the Silence. Introducing Routine Enquiry in General Practice” On 18 April 2018 NHS Leeds Clinical Commissioning Group in partnership with the Safer Leeds Domestic Violence Team, with support and funding from NHS England North Region, held a regional safeguarding conference for GPs, Primary Care Nurses, Safeguarding Named GPs and Named Nurses in Primary Care entitled “Ask the question: Break the Silence. Introducing Routine Enquiry in General Practice”. The focus was on challenging the perspectives of primary care staff regarding domestic abuse and to introduce the model of routine enquiry in general practice which is currently be rolled out across Leeds.

The agenda and speaker presentations included “Ask the Question: Break the Silence, The Leeds Approach”; Primary Care Notification Processes; the Community Rehabilitation Company: describing the work they do with perpetrators; Honour Based Abuse & Forced Marriage – Karma Nirvana; MaD Theatre Company - Black Eyes and Cottage Pies: A play about domestic abuse within families and teenage relationships, and a discussion with people who have lived experience of domestic abuse.

The conference was well attended (50 delegates) and the speaker presentations were aimed at level 2/3 safeguarding training requirements.

Of particular interest to delegates was the Primary Care Notification Process that the CCG Safeguarding Team has developed.

In 2017 a total of 3141 notifications of High Risk victims have been sent to GP’s across Leeds. Data collection has been an essential part of identifying high risk areas, in particular GP practices with increased numbers of patients experiencing Domestic Violence.

In the past two years since a health representative from the CCG safeguarding team has been part of the daily meeting, we have seen a 3 fold increase of referrals from GP practice into the MARAC. This would correlate to the training and information being delivered and reiterated into primary care. Bespoke training sessions have been delivered to high risk identified practices, along with presentations to the GP safeguarding peer review meetings across the city. The presentation included an overview of the information sharing process from the meeting to GP, consent issues and good practice when recording information on the electronic patient record.

A brief overview of the Domestic Abuse template for SystemOne and EMIS, developed by the CCG with support from the Safer Leeds Team was given. The new template allows the GP to record that they have asked the question, the patient’s response and any action taken; it also

2 includes a DV/A flag to alert GPs and other health practitioners accessing the system. GPs can also access local and national numbers and referral information about high risk cases and MARAC (Multi Agency Risk Assessment Conference) via links on the template. Feedback to date from Primary care is one of positivity and includes:

‘MARAC is helping health care professionals coordinate information which helps to safeguard victims of domestic abuse in a way that is now consistent and responsive. The new process is much improved in highlighting, referring and identifying these vulnerable patients’. ‘MARAC increases awareness, highlights the difficulties patients are having and gives the GP / Nurse opportunity to offer support’. ‘Until we started receiving MARAC alerts in the Practice we were largely unaware of the number of patients experiencing domestic violence. MARAC has increased awareness of domestic violence within the team and allowed safeguarding leads the opportunity to follow-up notifications with offers of support to patients’.

Conference Evaluation

Evaluation of the conference was positive and is summarised below:

General overview Strongly Disagree/ agree/ Neither Strongly Agree disagree The event as a whole signposted me to more 98% 2% information The topics covered are relevant to my role 100% The topics covered enhanced my knowledge for my 100% role The conference delivery met my expectations 98% 2% The speakers and presentations were of high quality 100% and the content appropriate

General Data Protection Regulations

Background

The General Data Protection Regulations come into force on 25 May 2018. These regulations have been created in response to the new digital age, which is processing masses of personal data. The GDPR is part of the suite of laws that protect citizen’s human rights, the requirements aim to regulate and safeguard citizens in the use of their data. Many of the concepts behind the GDPR reflect the CCGs own values in respecting the individual and placing their wants and needs at the centre of what we do.

A brief update on the progress to date on GDPR for the CCG is provided below.

Summary

1. An easy read privacy notice has been produced and made available on the CCG website for the public explaining how their information is used and for what purpose. 2. Information asset mapping is in the process of being completed to map all the CCG’s information flows and who owns the information. This is an information audit which takes into account any personal data we hold and who we share it with.

3. All relevant policies have been updated to reflect GDPR and approved by the appropriate boards. 4. The CCG has completed the Data and Cyber Security Protection requirements return for NHS Improvement (NHS England) which measure progress against Cyber Essentials. 5. All the IT kit at the CCG is currently being replaced with laptops with encryption software to meet cyber requirements. This is to modernise the CCG and enable people to work flexibly and securely. 6. Following the merger off the three CCGS a new single IT file structure has been created in line with GDPR principles, a data cleanse is taking place on documentation in compliance with records management policy to reduce unnecessary information. 7. GDPR Training sessions are scheduled for all CCG staff and are mandatory. 8. All contracts will be updated to include a relevant GDPR statement and clear information governance statement on who is the data controller and processor. 9. We have recruited to two information governance posts and a record manager posts who will drive the GDPR agenda and implementation plan forward for the CCG

MindMate A campaign was launched in March / April of this year to help raise awareness of the support available to young people for their mental health and wellbeing. MindMate is a Leeds-based website (www.mindmate.org.uk) for young people (14 to 24 years of ages), their families (parents/carers) and the professionals who support them. A number of activities have been undertaken over the past couple of months, this includes:  Becoming the first NHS organisation to promote mental health on Football Manager 2018 targeting young people in particular males. This was done by having pitch side adverts and these were “geo-targeted”, which means only people in Leeds would have seen the MindMate promotion #  Producing posters for schools (including specialist inclusive learning centres) and children’s centres to promote MindMate  We have done some bus advertising with First Bus who have backed the campaign  We undertook a social media campaign, by doing a #MindMay8 Thunderclap, this was supported by international and local rugby legend Jamie Peacock MBE. A total of 233 people supported MindMate to promote positive mental health for young people.

We have more activities planned during summer, this will include attending couple of the Breeze events and Crossgate Shopping Centre to promote MindMate.

Seriously Working with our partners we continue to promote our Seriously (https://seriouslyresistant.com/) campaign, to raise awareness of antibiotic resistance with members of the public in Leeds. We’ve undertaken the following activities:  Working alongside Community Pharmacy West Yorkshire, we sent out Seriously campaign packs to 187 pharmacies as well as GP practices. Purpose of this was to raise the profile of Seriously, collect pledges and giving people the opportunity to ask questions about antibiotics  We now have a total of 14 antibiotic ambassadors and 12 community hubs  We’re continuing to increase the number of pledges by attending citywide events as well

as universities, these include; Apprenticeship Recruitment Fair, First Direct Arena, University of Leeds and Leeds Beckett University  Presence at Leeds City Bus Station where we spoke to people about antibiotic resistance and collected pledges at the same time  Build a superbug activity at Stanningley Primary School, this was to look at how Seriously could be embedded into schools.

Compact for Leeds The NHS has a clear commitment, outlined within the Five Year Forward View, to develop stronger partnerships with the voluntary and community sector as part of a new relationship with patients and communities. This relationship can be strengthened through the adoption of the recently refreshed Compact for Leeds (2017) – Appendix 1, which looks to strengthen connections between Public and Third Sector, in order to deliver the best possible outcomes for the people of Leeds.

The Compact for Leeds sets out 8 Principles and explains how partners will work together to enable communities to be more resilient and take greater role in making Leeds the Best City in the UK as well as promote social responsibility and social value.

In order to help support the implementation of the Compact a number of standards have been developed that the CCG are encouraged to adopt and apply. They include behaviours and expectations that help partners in the city ensure that they are able to deliver the thriving sector as described in the Leeds Third Sector Ambition Statement.

It is hoped that through application of the standards and raising awareness of the Compact will promote a consistent approach to commissioning practice and encourage more integrated thinking and effective work for the benefit of the citizens of Leeds. Partners including NHS Leeds CCG are invited to commit to work towards the principles and values.

RECOMMENDATION:

The Governing Body is asked to: (a) Receive the Chief Executive’s report; and (b) Endorse the Compact for Leeds.

The COMPACT for Leeds (2017)

An agreement to strengthen relationships between the public and the third sector in order to deliver the best possible outcomes for the people of Leeds

Compact values and understandings . everything that we do as partners is done for the benefit of the people of Leeds, enabling resilient communities where citizens take action to make a difference, . we share a commitment to the city ambitions, the spirit and practice of civic enterprise, . we share a commitment to maintaining and developing a thriving third sector, . we recognise that we are interdependent and work together for mutual benefit, . we have to work within available resources that are linked to current priorities, . we accept our responsibility to make the partnerships that serve the city effective.

Compact principles Maximising Social Value; a compassionate Leeds where everyone benefits from the city’s economic growth and public and third sector partners promote social responsibility, building social capital and delivering social value. Working Together; a Leeds where partners work together to more effectively meet the needs and aspirations of the people of the city. Engaging Communities; a Leeds where partners work together to ensure that, individually and collectively, people have a voice that shapes decisions and makes a difference. Building Resilient Communities and a Dynamic Third Sector; a Leeds where partners work together to support communities to become stronger, so that they can take a full part in the development of the city, recognising we need to build third sector capacity in order for it to support resilient communities and deliver services effectively. Sharing information; a Leeds where partners are open and share information and intelligence, so that everyone can make informed decisions in the interests of the people of the city. Maximising the Impact of Resources; a Leeds where partners work together to support innovation, encourage enterprise and ensure that the available local and external investment, in- kind contributions and other resources are used in the most effective way and are directed at the agreed priorities and the needs of the people of Leeds. Promoting Volunteering; a Leeds where partners work together to ensure that formal and informal volunteering is encouraged, promoted, valued and recognised. Promoting Equality, Fairness, Good Community Relations and Equity of Outcomes for All; a Leeds where partners work together to ensure that equality, equity and fairness are at the heart of all decision making and where conditions are created for good community relations in all parts of the city and across all communities.

The COMPACT for Leeds (2017) sets out the values and principles that public and third sector partners commit to as they work together A Compact leaflet is available which explains the context in which the Compact operates and provides contacts for help and advice. An accompanying document, the Compact for Leeds Standards of Practice (2017) describes some of the ways that the Compact for Leeds can be put into practice.

Compact for Leeds: not a set of rules, but a way of working

THIS PAGE IS INTENTIONALLY BLANK

Agenda Item: GB 18/24i FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 23rd May 2018

Title: Joint Working Policy

Lead Governing Body Member: Dr Simon Tick as Category of Paper appropriate Stockill, Medical Director () Report Author: Heather Edmonds, Head of Clinical Pharmacy Development /  Decision Sally Bower, Head of Medicines Optimisation and Patient Safety Reviewed by EMT/SMT/Date: March 2018 Discussion

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual N/A requirements Financial Implications N/A Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY:

1. Department of Health Guidance encourages NHS organisations and their staff to consider opportunities for joint working with the pharmaceutical industry, where there are clear advantages to patient care and improvements to patients’ health and well-being.

2. The NHS does not always have the expertise or necessary tools to aid implementation of innovation or best practice at the pace or scale that it desires. Pharmaceutical and other health care companies may wish to partner with the CCG to support this adoption of innovation.

3. It is essential that all projects or dealings with the Industry are open and transparent and are subject to the widest scrutiny to enable likely pitfalls to be highlighted at an early stage.

4. This policy aims to:  Provide all staff working for or on behalf of NHS Leeds CCG with a framework and guidance for appropriate joint working  Ensure at all times that the interests of patients, public and NHS Leeds CCG are upheld and maintained  Assist NHS Leeds CCG to achieve its objectives and delivery of national and local priorities by building effective and appropriate working relationships with the pharmaceutical and related industries  Inform and advise staff of their responsibilities when entering into joint working arrangements with the pharmaceutical and related industries.

5. This policy was approved for use within LW CCG. The Governing Body is asked to approve the Joint Working Policy on behalf of NHS Leeds CCG.

NEXT STEPS:

6. This policy will be reviewed every 3 years or when changes to local or national policy dictate.

RECOMMENDATION:

The Governing Body is asked to:

(a) APPROVE the Joint Working Policy.

Pharmaceutical and Related Industries Joint Working Policy

Review and Amendment Log / Version Control Sheet

Responsible Officer: Jo Harding, Director of Quality and Safety

Clinical Lead: Dr Gaye Sheerman-Chase, Prescribing Lead

Sally Bower, Head of Patient Safety and Medicines Author: Optimisation

Date Approved:

Committee: Governing Body

Version: 2.0

Review Date: February 2019

Version History

Version no. Date Author Description Circulation Senior February 1.0 Sally Bower Initial draft Management Team 2016 Patient leaders Amended from Leeds Senior 2.0 March 2018 Sally Bower West to Leeds CCG Management Team Partnership Patient leaders

Contents

Page 1. Introduction 4 2. Purpose 4 3 Definition of Joint Working 5 4 Values 5 5 Principles of Assessing Joint Working Approval 6 6 Minimum Dataset for Project Approval 7 7 Confidential and Patient Identifiable Information 7 8 Freedom of Information 8 9 Duties / Accountabilities / Responsibilities 8 10 Responsibilities for Approval 9 11 Public Sector Equality Duty 9 12 Scope of the Policy 9 13 Monitoring Compliance with the Document 9 14 Arrangements for Review 9 15 Dissemination 9 16 References 10 17 Appendices 10

Appendices Appendix 1 Equality Impact Assessment Appendix 2 Joint Working Criteria

1 Introduction

Department of Health Guidance encourages NHS organisations and their staff to consider opportunities for joint working with the pharmaceutical industry, where there are clear advantages to patient care and improvements to patients’ health and well-being.

In the past, contact between the Pharmaceutical Industry and primary health care professionals has revolved around the purchase or promotion of specific products and the provision of sponsorship e.g. to support educational events or training. More recently, the Industry has begun to focus on enhancing its links with the NHS. Many companies have developed internal structures to encourage closer liaison with GP practices, CCGs and health care professionals working for CCGs.

The NHS does not always have the expertise or necessary tools to aid implementation of innovation or best practice at the pace or scale that it desires. Pharmaceutical and other health care companies may wish to partner with the CCG to support this adoption of innovation. The ‘Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS’ report sets out a strategy for collaboration between the NHS and industry to improve health outcomes for patients.

It is essential that all projects or dealings with the Industry are open and transparent and are subject to the widest scrutiny to enable likely pitfalls to be highlighted at an early stage.

2 Purpose The aim of this policy is to:

. Provide all staff working for or on behalf of NHS Leeds CCG with a framework and guidance for appropriate joint working

. Ensure at all times that the interests of patients, public and NHS Leeds CCG are upheld and maintained

. Assist NHS Leeds CCG to achieve its objectives and delivery of national and local priorities by building effective and appropriate working relationships with the pharmaceutical and related industries

. Inform and advise staff of their responsibilities when entering into joint working arrangements with the pharmaceutical and related industries. Specifically, it aims to:

o Assist NHS Leeds CCG and its staff in maintaining appropriate ethical standards in the conduct of NHS business.

o Highlight that NHS staff are accountable for achieving the best possible health care within the resources available.

Staff are reminded that at all times they have a responsibility to comply with their own professional codes of conduct and CCG’s standards of business conduct policy. In the interests of transparency staff must comply with CCG’s Hospitality, gifts and sponsorship policy and Declarations of interests policy.

Representatives of the pharmaceutical industry must comply with the ABPI Code of Practice for the Pharmaceutical Industry as a condition of their membership. If staff believe that a pharmaceutical industry representative has broken the Code, they can report their complaint to the Director of the Prescription Medicines Code of Practice Authority (PMCPA) at [email protected]

3 Definition of Joint Working

For the purpose of this policy, joint working is defined as situations where, for the benefit of patients, the NHS and commercial organisations pool skills, experience and/or resources for the joint development and implementation of patient centred projects and share a commitment to successful delivery. Joint working differs from sponsorship, where pharmaceutical companies simply provide funds for a specific event or work programme.

4. Values

In line with the NHS Code of Conduct three public service values underpin the work of the NHS:

• Accountability – everything done by those who work in the NHS must be able to stand the test of parliamentary scrutiny, public judgements of propriety and professional codes of conduct;

• Probity – there should be an absolute standard of honesty in dealing with the assets of the NHS. Integrity should be the hallmark of all personal conduct in decisions affecting patients, staff and suppliers, and in the use of information acquired in the course of NHS duties. This includes ensuring that integrity is not only ensured in all decision making processes, but that it is also clearly perceivable from the point of view of a stakeholder or third party, and

• Openness – there should be sufficient transparency about NHS activities to promote confidence between the organisation and its staff, patients and the public

5 Principles for Joint Working Arrangements

Joint working arrangements should be of mutual benefit, with the principal beneficiary being the patient. The length of the arrangement, the potential implications for patients and the NHS, together with the perceived benefits for all parties, should be clearly outlined before entering into any joint working arrangement.

The following principles also apply:

 Staff must be aware of NHS guidance, the legal position and appropriate and relevant professional codes of conduct in relation to joint working initiatives.

 Contracts will be negotiated in line with NHS values.

 Confidentiality of information received in the course of duty must be respected and never used outside the scope of the specific project.

 Joint working arrangements should take place at a corporate, rather than an individual level.

 Clinical and financial outcomes will be assessed through a process of risk assessment.

 Each company that enters into a joint venture with NHS Leeds CCG will be acknowledged for resources provided; however NHS Leeds CCG will not endorse a particular product or company as a result of the joint venture.

 NHS Leeds CCG or its staff will not agree to practice under any condition that compromises professional independence or judgement, or imposes such conditions on other health care professionals.

 A mutually agreed and effective exit strategy will be in place at the outset of any joint working arrangement detailing the responsibilities of each party and capable of dealing with a situation where premature termination may become necessary.

 Where such collaborations are being considered then the proposal must be presented at a Governing Body meeting for approval before any formal agreement is made. Legal advice may also be necessary.

 NHS Leeds CCG will retain control of all projects.

6 Minimum Data Set Required for Project Approval

Each joint working arrangement will be supported by a project initiation document setting out the following:

 The vision, objectives and outcomes of the project

 The benefits to the patient of the proposed joint working initiative

 The benefits to NHS Leeds CCG

 The benefits for the pharmaceutical company

 Deliverables and key success factors

 The resources the pharmaceutical company will provide

 The resources that NHS Leeds CCG will provide

 Timelines and milestones

 Accountabilities, roles and responsibilities

 Governance and Project Management arrangements

 Any issues identified in relation to information governance and/or information sharing

 Any issues identified in relation to public sector procurement duties

 Arrangements for monitoring and evaluation

 An exit strategy

7 Confidential and Patient Identifiable Data

The project should be assessed at an early stage to determine if access to sensitive data such as confidential or patient identifiable information is proposed as part of the project.

The Senior Information Risk Owner should be approached for advice where the project may require access to confidential or sensitive CCG information.

The CCG Caldicott Guardian should be approached for advice where the proposal may require access to patient identifiable information.

8 Freedom of Information

NHS Leeds CCG supports the principles of transparency enshrined in the Freedom of Information Act. Arrangements made between the CCG and the Pharmaceutical and related industries will be made available in line with Freedom of Information legislation.

9 Duties / Accountabilities and Responsibilities

Duties within organisation

The CCG’s lead project manager will be responsible for developing the project proposal and getting advice from the CCG’s Head of Medicines Optimisation, Senior Information Risk Owner, Caldicott Guardian, Head of Contracting and Communication and Engagement team on the appropriateness of the proposed project.

The CCG’s Head of Medicines Optimisation will be responsible for providing advice on whether the joint working initiative meets best practice guidelines. A check of all joint working proposals will also be made to ensure that the proposed initiatives do not conflict with existing CCG prescribing policies and guidelines.

The Senior Information Risk Owner will be responsible for ensuring that any proposed information sharing as part of a joint working agreements is in line with the CCG’s legal duties.

The CCG Caldicott Guardian is responsible for assessing if any proposed access to patient identifiable data meets the Caldicott principles.

The CCG’s Head of Contracting is responsible for advising if there are any implications from the CCG’s public sector procurement duties.

The CCG’s Head of Communication and Engagement is responsible for including in the engagement plan outlining information in section 6 and ensuring that risks identified are managed.

10 Responsibilities for approval

Proposals for joint working will be reviewed by the CCG Quality team to consider the quality aspects of the proposal and Finance team to consider financial, procurement and links to CCG priorities.

Recommendations from the Quality and Finance teams will be taken to a public Governing Body Meeting for formal approval of the joint working proposal.

11 Public Sector Equality Duty

NHS Leeds CCG aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others.

12 Scope of the Policy

This policy applies to NHS Leeds CCG including all employees, co-opted members and members of the Governing Body and its committees, who must comply with the arrangements outlined in this policy.

13 Monitoring Compliance with the Document

The NHS Leeds CCG Audit Committee will monitor compliance with the policy.

14 Arrangements for Review

This policy will be reviewed three years after the date of authorisation. The policy may be reviewed sooner if there is a change in legislation or new national guidance.

15 Dissemination

This policy will be shared with all members of the Senior Management Team, Clinical Leads and Governing Body. It will be published on both the CCG intranet and internet sites.

16 References

The following policies were used as the basis of this policy

1. Department of Health, 2008. Best practice guidance for joint working between the NHS and the pharmaceutical industry.

2. Standards of business conduct for NHS Staff HSG (93) 5 DH Best Practice Guidance for Joint Working between the NHS and the Pharmaceutical Industry, February 2008 Department of Health, 2008.

3. Best practice guidance for joint working between the NHS and the pharmaceutical industry ABPI 2006, Code of Practice for the Pharmaceutical Industry Department of Health, 2004. Code of Conduct: Code of Accountability in the NHS. 2nd Ed

4. Leeds CCG Standards of business conduct policy, Hospitality, gifts and sponsorship policy and Declaration of interests policy.

5. Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS. Department of Health. 2011.

17. Appendices

Appendix 1

Equality Impact Assessment Tool

Pharmaceutical and Related Industries Joint Working Policy Yes/No Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race No Ethnic origins (including gypsies and No travellers) Nationality No Gender No Culture No Religion or belief No Sexual orientation including lesbian, No gay and bisexual people Age No Disability - learning disabilities, No physical disability, sensory impairment and mental health problems

2. Is there any evidence that some No groups are affected differently? 3. If you have identified potential No discrimination, are any exceptions valid, legal and/or justifiable?

4. Is the impact of the policy/guidance No No impact has been identified from likely to be negative? the proposed policy. An Equality Impact Assessment will need to be carried out on proposed schemes to be considered under this policy. 5. If so can the impact be avoided?

6. What alternatives are there to achieving the policy/guidance without the impact?

7. Can we reduce the impact by taking different action?

If you have identified a potential discriminatory impact of this procedural document, please refer it to, together with any suggestions as to the action required to avoid/reduce this impact.

Appendix 2 Joint Working Criteria (adapted from the Association of British Pharmaceutical Industry Joint Working Guide) All potential parties should review this checklist and satisfy themselves that each criterion would be met under the project. If the answer to any of the questions below is no, the project is not a true joint working arrangement and should not be viewed as such. Appropriate steps to address the outstanding areas should be taken before proceeding further.

YES NO

1 The main benefit of the project is focused on the patient  

2 All parties acknowledge the arrangements may also benefit the NHS and   pharmaceutical partners involved

3 Any subsequent benefits are at an organisational level and not specific to   any individual

4 There is a significant contribution of pooled resources (taking into account   people, finance, equipment, & time) from each of the parties involved

5 There is a shared commitment to joint development, implementation, and   successful delivery of a patient‐centred project by all parties involved

6 Patient outcomes of the project will be measured and documented  

7 All partners are committed to publishing an executive summary of the Joint   Working Agreement

8 All proposed treatments involved are in line national guidance where it   exists and based on evidence‐based clinical practice

9 All activities are to be conducted in an open and transparent manner  

10 Exit strategy and any contingency arrangements have been agreed  

11 Are you satisfied with your knowledge of the collaborating organisation i.e. is there evidence of audited accounts, is the organisation and ownership known?  

12 Is the proposal on offer consistent with NHS Leeds CCG partnership priorities?  

THIS PAGE IS INTENTIONALLY BLANK

Agenda Item: GB 18/24ii FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 23rd May 2018

Title: Managing Conflicts of Interest Policy

Lead Governing Body Member: Phil Corrigan, Tick as Category of Paper appropriate Chief Executive () Report Author: Laura Parsons, Head of Corporate Decision Governance & Risk  Reviewed by EMT/SMT/Date: N/A Discussion

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual The CCG is required to have a robust Managing Conflicts requirements of Interest Policy in line with NHS England statutory guidance. Financial Implications N/A Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY:

1. An updated conflicts of interest policy was approved by the Leeds Health Commissioning & System Integration Board in July 2017, to reflect revised statutory guidance from NHS England.

2. The auditors have reviewed the CCG’s conflicts of interest arrangements and have recommended that Appendix K of the statutory guidance is added to the policy, relating to conflicts and the commissioning of new care models. Discussions are being held with the Heads of Programme Delivery – System Integration to consider how this guidance can be applied in practice.

3. The policy was also due for an annual review in July 2018, therefore a review of the policy has been undertaken. Minor amendments have been made to reflect updated job titles, and to reflect the CCG merger.

NEXT STEPS:

4. The updated policy will be published on the CCG website.

RECOMMENDATION:

The Governing Body is asked to:

(a) APPROVE the Managing Conflicts of Interest Policy.

Managing conflicts of interest policy

Version Version 2 Ratified by Governing Body Date ratified TBC Name and title of originator/Authors Head of Corporate Governance & Risk Name of responsible Audit Committee Committee/Individual Date issued May 2018 Review date May 2019 Target audience See section 1.6

CONTENTS Page

1. Introduction 3

2. Definition of an interest 4

3. Equality statement 7

4. Principles 7

5. Roles and responsibilities 8

6. Declaring interests 9

7. Register of interests 10

8. Publication of registers 11

9. Appointing Governing Body or committee members and senior staff 12

10. Conflicts of interest at meetings 13

11. Managing conflicts of interest throughout the commissioning cycle 16

12. Raising concerns and breaches 20

13. Conflicts of interest training 23

APPENDIX 1- Declaration of interests form 24

APPENDIX 2 – Register of interests template 28

APPENDIX 3 – Declarations of interest checklist for chairs 29

APPENDIX 4 – Minutes template for recording declarations of interest 32

APPENDIX 5 – Procurement checklist 33

APPENDIX 6 – Register of procurement decisions template 35

APPENDIX 7 – Declaration of interests for bidders/contractors template 36

APPENDIX 8 - Summary of key aspects of the NHS England statutory 38 guidance on managing conflicts of interest relating to commissioning of new care models

1. Introduction

1.1 Managing conflicts of interest appropriately is essential for protecting the integrity of the NHS commissioning system and to protect Leeds CCG and GP practices from any perceptions of wrongdoing. Commissioners need the highest level of transparency so they can demonstrate that conflicts of interest are managed in a way that cannot undermine the probity and accountability of the organisation.

1.2 It will not be possible to avoid conflicts of interest. They are inevitable in many aspects of public life, including the NHS. Healthcare professionals have always had to manage competing interests. However, by recognising where and how they arise and dealing with them appropriately, commissioners will be able to ensure proper governance, robust decision-making and appropriate decisions about the use of public money.

1.3 A conflict of interest is defined as:

“a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”

1.4 This policy seeks to ensure that conflicts are identified, declared and recorded, and that clear mechanisms exist to manage or diffuse conflicts of interest when they arise. It is also important to acknowledge that conflicts may not always be obvious to, or recognised by, the individuals concerned. Therefore, a policy based on full disclosure regarding competing interests will best safeguard healthcare professionals as they exercise their new commissioning responsibilities. NHS Leeds CCG’s Managing Conflicts of Interest Policy is based on the principle of: “If in doubt, disclose”.

1.5 The Health and Social Care Act 2012 places a duty on the NHS Commissioning Board to publish guidance for CCGs on managing conflicts and a duty on CCGs to have regard to such guidance. It also requires that CCGs set out in their constitution their proposed arrangements for managing conflicts of interest. This policy provides more specific, additional safeguards that the CCG has put in place. It reflects the revised statutory guidance for CCGs on Managing Conflicts of Interest, issued by NHS England in June 2017.

1.6 This policy applies to:

 All CCG employees, including all full and part-time staff, staff on sessional or short term contracts, students and trainees (including apprentices), agency staff, seconded staff.  Members of the CCG’s Governing Body, Committees, Sub Committees and Sub Groups, including co-opted members, appointed deputies and members of committees/groups from other organisations

(where the CCG is participating in a joint committee alongside other CCGs, any interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG).  Members of the CCG – defined as GP partners (or where the practice is a company, each director) and any individual directly involved with the business or decision making of the CCG.

Who are referred to collectively in this policy as ‘individuals within the CCG’.

2. Definition of an interest

2.1 For the purposes of this policy a conflict of interest is defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold” 1.

2.2 A conflict of interest may be:

Actual Potential There is a material conflict between There is the possibility of a material one or more interests. conflict between one or more interests in the future.

2.3 Individuals within the CCG may hold interests for which they cannot see potential conflict. However, caution is always advisable because others may see it differently. It will be important to exercise judgement and to declare such interests where there is otherwise a risk of imputation of improper conduct. The perception of an interest can be as damaging as an actual conflict of interest.

2.4 Conflicts of interest can arise in many situations, environments and forms of commissioning, with an increased risk in primary care commissioning, out-of- hours commissioning and involvement with integrated care organisations and new care models, as individuals within the CCG may here find themselves in a position of being both commissioner and provider of services. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring. References in this policy to ‘new care models’ refer to Multi-speciality Community Providers (MCP), Primary and Acute Care Systems (PACS) or other arrangements of a similar scale or scope.

2.5 Interests fall into the four categories outlined below. A benefit may arise from the making of a gain or the avoidance of a loss:

1 Managing conflicts of interests in the NHS: Guidance for staff and organisations.2017. https://www.england.nhs.uk/wp-content/uploads/2017/02/guidance-managing-conflicts-of- interestnhs.pdf

2.6 Financial interests

This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include an individual being:  A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. This includes involvement with a potential provider of a new care model;  A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;  A management consultant for a provider;  A provider of clinical private practice;  In employment outside of the CCG;  In receipt of secondary income;  In receipt of a grant from a provider;  In receipt of any payments (for example honoraria, one-off payments, day allowances or travel or subsistence) from a provider;  In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role;  Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider); or  Substantively employed by another organisation, i.e. when on secondment.

2.7 Non-financial professional interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

 An advocate for a particular group of patients;  A GP with special interests e.g. in dermatology, acupuncture, etc.;  An active member of a particular specialist professional body (although routine GP membership of the Royal College of General Practitioners (RCGP), British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);  An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE);  Engaged in a research role;  Involved in the development and holding of patents and other intellectual property rights which allow staff to protect something that they create, preventing unauthorised use of products or the copying of protected ideas;

 GPs and practice managers, who are members of the Governing Body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

2.8 Non-financial personal interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

 A voluntary sector champion for a provider;  A volunteer for a provider;  A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;  Suffering from a particular condition requiring individually funded treatment;  A member of a lobby or pressure group with an interest in health.

2.9 Indirect interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as described above) for example, a:

 Spouse / partner  Close relative e.g., parent, grandparent, child, grandchild or sibling;  Close friend or associate;  Business partner. A declaration of interest for a “business partner” in a GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim). Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG. 2.10 NHS England has published conflicts of interests case studies which are available on its website here. 2.11 The above categories and examples are not exhaustive and a common sense approach should be adopted. Individuals within the CCG should exercise discretion on a case by case basis, including in relation to new care model arrangements, having regard to the principles set out in section 4 of this policy, in deciding whether any other role, relationship or interest may impair or otherwise influence the individual’s judgement or actions in their role within the CCG. If so, this should be declared and appropriately managed.

3. Equality statement

3.1 This policy applies to all employees, Governing Body and Committee members and members of the NHS Leeds CCGs Partnership irrespective of age, race, colour, religion, disability, nationality, ethnic origin, gender, sexual orientation or marital status, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or trade union membership.

3.2 A full Equality Impact Assessment is not considered to be necessary as this policy will not have a detrimental impact on a particular group.

4. Principles

4.1 The CCG observes the following principles of good governance:

 The Nolan Principles of selflessness, integrity, objectivity, accountability, openness, honesty and leadership2  The Good Governance Standards for Public Services (2004), Office for Public Management (OPM) and Chartered Institute of Public Finance and Accountancy (CIPFA)3  The seven key principles of the NHS Constitution4  The Equality Act 20105  The UK Corporate Governance Code6  Standards for members of NHS boards and CCG governing bodies in England7

4.2 The CCG endorses other principles that can safeguard against conflicts of interest:

 Doing business appropriately;  Being proactive about identifying and minimising the risks of conflicts;  Being balanced and proportionate in managing conflicts;  Being transparent and documenting every stage in the commissioning cycle; and  Creating an environment and culture where individuals feel supported and confident in declaring relevant information and raising any concerns.

2 The 7 principles of public life https://www.gov.uk/government/publications/the-7-principles-of-public- life 3 The Good Governance Standards for Public Services, 2004, OPM and CIPFA http://www.opm.co.uk/wp-content/uploads/2014/01/Good-Governance-Standard-for-Public- Services.pdf 4 The seven key principles of the NHS Constitution http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx 5 The Equality Act 2010 http://www.legislation.gov.uk/ukpga/2010/15/contents 6 UK Corporate Governance Code https://www.frc.org.uk/Our-Work/Codes-Standards/Corporate- governance/UK-Corporate-Governance-Code.aspx 7 Standards for members of NHS boards and CCG governing bodies in England http://www.professionalstandards.org.uk/publications/detail/standards-for-members-of-nhs-boards- andclinical-commissioning-group-governing-bodies-in-england

4.3 The CCG also recognises that:

 A perception of wrongdoing, impaired judgement or undue influence can be as detrimental as any of them actually occurring.  If in doubt, it is better to assume the existence of a conflict of interest and manage it appropriately rather than ignore it.  For a conflict of interest to exist, financial gain is not necessary.

4.4 This policy reflects ‘Managing Conflicts of Interests: Revised Statutory Guidance for CCGs 2017’ (Issued by NHS England, June 2017). It should be read alongside the following Leeds CCG documents:

 Anti-Fraud, Bribery and Corruption Policy;  Code of Conduct for NHS Managers, also contained within individual contracts of employment;  Whistleblowing Policy;  Working Time Regulations Policy (including Secondary Employment);  Disciplinary Policy;  Procurement Policy; and  Standards of Business Conduct Policy.

5. Roles and responsibilities

5.1 The Accountable Officer has overall accountability for the CCG’s management of conflicts of interest.

5.2 The Conflicts of Interest Guardian, who will be the Chair of the Audit Committee, will:

 Act as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest;  Be a safe point of contact for employees or workers of the CCG to raise any concerns in relation to this policy;  Support the rigorous application of conflict of interest principles and policies;  Provide independent advice and judgment where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation;  Provide advice on minimising the risks of conflicts of interest; and  If an individual requests that information is not included in the public register(s), decide whether the information should be published or not.

5.3 The Head of Corporate Governance & Risk has day to day responsibility for managing conflict of interests, including:

 Maintaining the CCG’s register(s) of interest and the other registers referred to in this policy;

 Supporting the Conflicts of Interest Guardian to enable them to carry out the role effectively;  Providing advice, support, and guidance on how conflicts of interest should be managed; and  Ensuring that appropriate administrative processes are put in place.

5.4 All members of the Governing Body must act in accordance with this policy and lead by example in acting with the utmost integrity and ensuring adherence to all relevant regulations, policies and procedures.

5.5 Line Managers are responsible for assisting employees in complying with this policy by ensuring that this policy and its requirements are brought to the attention of employees for whom they are responsible, and that those employees are aware of its implications for their work.

5.5 All individuals within the CCG are required to be aware of and comply with the policy.

5.6 If any individual within the CCG has any doubt about the relevance of an interest, this should be discussed with the Conflicts of Interest Guardian or the Head of Corporate Governance.

6. Declaring interests

6.1 All individuals within the CCG must declare any interests that might have any bearing on the work of the CCG:

a) on appointment - applicants for any appointment to the CCG or its Governing Body or any committees should be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests should again be made and recorded. b) annually - declarations will be sought from all relevant individuals on an annual basis and where there are no interests or changes to declare, a “nil return” will be recorded. c) at meetings - all attendees are required to declare their interests as a standing agenda item for every Governing Body, committee, sub- committee or working group meeting, before the item is discussed. Even if an interest has been recorded in the register of interests, it should still be declared in meetings where matters relating to that interest are discussed. Declarations of interest must be recorded in minutes of meetings. d) on changing role, responsibility or circumstances - whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests (e.g. where an individual takes on a new role outside the CCG, enters into a new business or relationship, starts a new project/piece of work or may be affected by a procurement decision e.g. if their role may transfer to a proposed new provider), a further declaration should be made to reflect the change in circumstances as soon as possible, and in any event within 28 days. This could involve a conflict of interest ceasing to exist or a new one materialising. It is the

individual’s responsibility to make a further declaration as soon as possible, rather than waiting to be asked. e) if they come to know that the CCG has entered into (or proposes to enter into) a financial arrangement in which they or any person connected with them has any interest, direct or indirect.

6.2 CCG staff should declare any interests by completing the declaration of interests form at Appendix 1 and submitting this to their Line Manager, within 28 days. Line Managers will record the interests and make a decision on whether the declaration is deemed to require any action to ensure transparency and avoid a conflict of interest. If required, Line Managers should seek advice on appropriate action from the Head of Corporate Governance & Risk and/or Conflicts of Interest Guardian.

6.3 Line Managers should hold any interests declared on the individual’s personal file. All interests should be declared as and when they arise. Individuals are responsible for ensuring that their registered interests are kept up to date at all times.

6.4 Once any arrangements for mitigating the risk have been agreed by the individual’s Line Manager, these should be documented on the approved form and submitted to the Head of Corporate Governance & Risk. Such arrangements will specify:

• whether and when an individual should withdraw from a specified activity, on a temporary or permanent basis; and

• monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

6.5 Where an individual is unclear about the arrangements for managing the interest, they should seek advice from their Line Manager.

6.6 All other individuals should submit declarations directly to the Head of Corporate Governance & Risk using the form at Appendix 1, who will decide, in conjunction with the Conflicts of Interest Guardian, whether any specific arrangements are required to manage the conflicts or potential conflicts declared.

6.7 Although the interest may be declared, this does not remove the individual’s personal responsibilities of removing themselves from a position or situation which may result in a potential breach of this policy.

7. Register of Interests

7.1 Registers will be maintained of the interests of individuals within the CCG, specified in paragraph 1.6.

7.2 The registers for all the above will be published on the CCG’s website and maintained by the Head of Corporate Governance & Risk. The register(s) will

be reviewed annually, and updated as necessary. For a new declaration, the relevant register will be updated inside 28 days. All individuals within the CCG must submit a nil declaration where they have no interests or changes to declare. All interests will remain on the register for a minimum of 6 months after the interest has expired. The CCG will retain a private record of historic interests for a minimum of 6 years after the date on which it expired.

7.3 Where an individual is unable to provide a declaration in writing, e.g. if a conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.

7.4 Registers will include:

 Name of the person declaring the interest;  Position within, or relationship with, the CCG (or NHS England in the event of joint committees);  Type of interest e.g., financial interests, non-financial professional interests;  Description of interest, including for indirect interests details of the relationship with the person who has the interest;  The dates from which the interest relates; and  The actions to be taken to mitigate risk - these should be agreed with the individual’s line manager or a senior manager within the CCG.

7.5 A template is attached at Appendix 2.

7.6 The register of interests will be reviewed at every Audit Committee meeting. The Governing Body will review the register of interests on an annual basis.

8. Publication of registers

8.1 The CCG will publish the register of interests and gifts and hospitality and the register of procurement decisions described below, in a prominent place on the CCG’s website. 8.2 Although all individuals must declare interests, the CCG will only publish the interests of decision makers. Decision makers are defined as follows:

 All governing body members;  Members of advisory groups which contribute to direct or delegated decision making on the commissioning or provision of taxpayer funded services such as working groups involved in service redesign or stakeholder engagement that will affect future provision of services;  Members of the Primary Care Commissioning Committee (PCCC);  Members of other committees of the CCG e.g., audit committee, remuneration committee etc.;  Members of new care models joint provider / commissioner groups / committees;

 Members of procurement (sub-)committees;  Individuals on Agenda for Change band 8d and above;  Management, administrative and clinical staff who have the power to enter into contracts on behalf of the CCG;  Management, administrative and clinical staff involved in decision making concerning the commissioning of services, purchasing of goods, medicines, medical devices or equipment, and formulary decisions; and  Management, administrative and clinical staff responsible for processing payments on behalf of the CCG. 8.2 In exceptional circumstances, where the public disclosure of information could give rise to a real risk of harm or is prohibited by law, an individual’s name and/or other information may be redacted from the publicly available register(s). Where an individual believes that substantial damage or distress may be caused, to him/herself or somebody else by the publication of information about them, they are entitled to request that the information is not published. Such requests must be made in writing. Decisions not to publish information will be made by the Conflicts of Interest Guardian for the CCG, who will seek appropriate legal advice where required, and a confidential un- redacted version of the register(s) will be retained.

8.3 All decision making staff will be made aware, in advance of publication, that the register(s) will be kept, how the information on the register(s) may be used or shared and that the register(s) will be published. This will be done by the provision of a fair processing notice that details the identity of the data controller, the purposes for which the registers are held and published, how the information on the register(s) may be used or shared and contact details for the data protection officer. This information will also be provided to individuals identified in the register(s) because they are in a relationship with the person making the declaration. 8.4 All individuals who are not decision makers but who are still required to make a declaration of interest(s) will be made aware that the register(s) will be kept and how the information on the register(s) may be used or shared. This will be done by the provision of a separate fair processing notice that details the identity of the data controller, the purposes for which the register(s) are held, how the information on the register(s) may be used or shared and contact details for the data protection officer. This information will also be provided to individuals identified in the register(s) because they are in a relationship with the person making the declaration. 9. Appointing Governing Body or committee members and senior staff

9.1 On appointing Governing Body, committee or sub-committee members and senior staff, the CCG will consider whether conflicts of interest should exclude individuals from being appointed to the relevant role. The CCG will assess the materiality of the interest, in particular whether the individual (or any person with whom they have a close association could benefit (whether financially or

otherwise) from any decision the CCG might make. This will be particularly relevant for Governing Body, committee and sub-committee appointments, but should also be considered for all employees and especially those operating at senior level.

9.2 The CCG will also determine the extent of the interest and the nature of the appointee’s proposed role within the CCG. If the interest is related to an area of business significant enough that the individual would be unable to operate effectively and make a full and proper contribution in the proposed role, then that individual should not be appointed to the role.

9.3 Any individual who has a material interest in an organisation which provides, or is likely to provide, substantial services to the CCG (whether as a provider of healthcare or commissioning support services, or otherwise) should recognise the inherent conflict of interest risk that may arise and should not be a member of the Governing Body or a committee or sub-committee of the CCG, in particular if the nature and extent of their interest and the nature of their proposed role is such that they are likely to need to exclude themselves from decision-making on so regular a basis that it significantly limits their ability to effectively perform that role.

10. Managing conflicts of interest at meetings

10.1 Declarations of interests will be a standing item on all meeting agendas. The chair of a meeting of the CCG’s Governing Body or any of its committees, sub- committees or groups has ultimate responsibility for deciding whether there is a conflict of interest and for taking the appropriate course of action in order to manage the conflict of interest. In reaching this decision the chair will seek advice from the Head of Corporate Governance & Risk or their representative, or where there is not one, another senior manager.

10.2 In the event that the chair of a meeting has a conflict of interest, the vice chair is responsible for deciding the appropriate course of action in order to manage the conflict of interest. If the vice chair is also conflicted then the remaining non-conflicted voting members of the meeting should agree between themselves how to manage the conflict(s).

10.3 In making such decisions, the chair (or vice chair or remaining non-conflicted members as above) may wish to consult with the Conflicts of Interest Guardian or another member of the Governing Body.

10.4 It is good practice for the chair, with support of the CCG’s Head of Corporate Governance & Risk and, if required, the Conflicts of Interest Guardian, to proactively consider ahead of meetings what conflicts are likely to arise and how they should be managed, including taking steps to ensure that supporting papers for particular agenda items of private sessions/meetings are not sent to conflicted individuals in advance of the meeting where relevant.

10.5 Chairs will be provided with a declaration of interests checklist (attached at Appendix 3) with the meeting papers, which will include details of any declarations of interest which have already been made by members of the Governing Body / committee / sub-group.

10.6 The chair should ask at the beginning of each meeting if anyone has any conflicts of interest to declare in relation to the business to be transacted at the meeting. Each member of the group should declare any interests which are relevant to the business of the meeting whether or not those interests have previously been declared. Any new interests which are declared at a meeting must be included on the CCG’s relevant register of interests to ensure it is up-to-date. Similarly, any new offers of gifts or hospitality which are declared at a meeting must be added to the register of gifts and hospitality.

10.7 It is the responsibility of each individual member of the meeting to declare any relevant interests which they may have. However, should the chair or any other member of the meeting be aware of facts or circumstances which may give rise to a conflict of interests but which have not been declared then they should bring this to the attention of the chair who will decide whether there is a conflict of interest and the appropriate course of action to take in order to manage the conflict of interest.

10.8 If, after a meeting, the chair or any other member becomes aware that a conflict of interest has not been declared, they should raise this with the Head of Corporate Governance & Risk or Conflicts of Interest Guardian who will consider the appropriate course of action.

10.9 When a member of the meeting (including the chair or vice chair) has a conflict of interest in relation to one or more items of business, the chair (or vice chair or remaining non-conflicted members where relevant as described above) must decide how to manage the conflict. The appropriate course of action will depend on the particular circumstances, but could include one or more of the following:

 Where the chair has a conflict of interest, deciding that the vice chair (or another non-conflicted member of the meeting if the vice chair is also conflicted) should chair all or part of the meeting;  Requiring the individual who has a conflict of interest (including the chair or vice chair if necessary) not to attend the meeting;  Ensuring that the individual does not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict;  Requiring the individual to leave the discussion when the relevant matter(s) are being discussed and when any decisions are being taken in relation to those matter(s). In private meetings, this could include requiring the individual to leave the room and in public meetings to either leave the room or join the audience in the public gallery;  Allowing the individual to participate in some or all of the discussion when the relevant matter(s) are being discussed but requiring them to leave the meeting when any decisions are being taken in relation to those matter(s).

This may be appropriate where, for example, the conflicted individual has important relevant knowledge and experience of the matter(s) under discussion, which it would be of benefit for the meeting to hear, but this will depend on the nature and extent of the interest which has been declared;  Noting the interest and ensuring that all attendees are aware of the nature and extent of the interest, but allowing the individual to remain and participate in both the discussion and in any decisions. This is only likely to be the appropriate course of action where it is decided that the interest which has been declared is either immaterial or not relevant to the matter(s) under discussion.

10.10 Where the conflict of interest relates to outside employment and an individual continues to participate in meetings pursuant to the preceding two bullet points, he or she should ensure that the capacity in which they continue to participate in the discussions is made clear and correctly recorded in the meeting minutes. Where it is appropriate for them to participate in decisions they must only do so if they are acting in their CCG role.

10.11 Where over half of members withdraw from a part of a meeting – due to the arrangements agreed for the management of conflicts of interests - the chair (or deputy) will determine whether or not the discussion can proceed. In making this decision the chair will consider whether the meeting is quorate in accordance with the required number /balance of membership.

10.12 Where the meeting is not quorate the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall consult with the Conflicts of Interest Guardian on the action to be taken. This may include:

 requiring another committee or sub-committee which can be quorate to progress the item of business; or if this is not possible,  inviting on a temporary basis one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that the group can progress the item of business:

 a member of the CCG who is interest free;  an individual nominated by a member to act on their behalf in the dealings between it and the CCG;  a member of a relevant Health and Wellbeing Board;  a member of a board/Governing Body for another CCG.

10.13 The minutes will record all declarations of interest and actions taken in mitigation. A minutes template for recording declarations is attached at Appendix 4.

11. Managing conflicts of interest throughout the commissioning cycle

11.1 Conflicts of interest need to be managed appropriately throughout the whole commissioning cycle. At the outset of a commissioning process, the relevant interests of all individuals involved should be identified and clear arrangements put in place to manage any conflicts of interest. This includes consideration as to which stages of the process an individual should not participate in, and, in some circumstances, whether they should be involved in the process at all. The CCG will identify and appropriately manage any conflicts of interest that may arise where staff are involved in both the management of existing contracts and the procurement of related / replacement contracts. The CCG will also identify as soon as possible where staff might transfer to a provider (or their role may materially change) following the award of a contract. This will be treated as a relevant interest, and the CCG will manage the potential conflict. Designing service requirements 11.2 The way in which services are designed can either increase or decrease perceived or actual conflicts of interest. Public involvement supports transparent and credible commissioning decisions. It should happen at every stage of the commissioning cycle from needs assessment, planning and prioritisation to service design, procurement and monitoring. The CCG has a legal duty under the Act to involve patients and the public in their respective commissioning processes and decisions. Provider engagement 11.3 It is good practice to engage relevant providers, especially clinicians, in confirming that the design of service specifications will meet patient needs. This may include providers from the acute, primary, community, and mental health sectors, and may include NHS, third sector and private sector providers. Such engagement, done transparently and fairly, is entirely legal. However, conflicts of interest, as well as challenges to the fairness of the procurement process, can arise if a commissioner engages selectively with only certain providers (be they incumbent or potential new providers) in developing a service specification for a contract for which they may later bid. Individuals should be particularly mindful of these issues when engaging with existing / potential providers in relation to the development of new care models. 11.4 Provider engagement should follow the three main principles of procurement law, namely equal treatment, non-discrimination and transparency. This includes ensuring that the same information is given to all at the same time and procedures are transparent. This mitigates the risk of potential legal challenge. 11.5 As the service design develops, it is good practice to engage with a range of providers on an on-going basis to seek comments on the proposed design e.g., via the commissioners website and/or via workshops with interested

parties (ensuring a record is kept of all interaction). NHS Improvement has issued guidance on the use of provider boards in service design.8 11.6 Engagement should help to shape the requirement to meet patient need, but it is important not to gear the requirement in favour of any particular provider(s). If appropriate, the advice of an independent clinical adviser on the design of the service should be secured. 11.7 Individuals should ensure that decisions are documented to ensure that the CCG meets its obligations under, but not limited to, the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and the Public Contracts Regulations 2015. Specifications 11.8 The CCG will seek, as far as possible, to specify the outcomes that it wishes to see delivered through a new service, rather than the process by which these outcomes are to be achieved. As well as supporting innovation, this helps prevent bias towards particular providers in the specification of services. The CCG will also ensure that careful consideration is given to the appropriate degree of financial risk transfer in any new contractual model. 11.9 Specifications should be clear and transparent, reflecting the depth of engagement, and set out the basis on which any contract will be awarded. Procurement and awarding grants 11.10 The CCG will seek to recognise and manage any conflicts or potential conflicts of interest that may arise in relation to the procurement of any services or the administration of grants. “Procurement” relates to any purchase of goods, services or works and the term “procurement decision” should be understood in a wide sense to ensure transparency of decision making on spending public funds. The decision to use a single tender action, for instance, is a procurement decision and if it results in the CCG entering into a new contract, extending an existing contract, or materially altering the terms of an existing contract, then it is a decision that should be recorded. 11.11 NHS England and CCGs must comply with two different regimes of procurement law and regulation when commissioning healthcare services: the NHS procurement regime, and the European procurement regime:

 The NHS procurement regime – the NHS (Procurement, Patient Choice and Competition (No.2)) Regulations 2013: made under S75 of the 2012 Act; apply only to NHS England and CCGs; enforced by NHS Improvement; and  The European procurement regime – Public Contracts Regulations 2015 (PCR 2015): incorporate the European Public Contracts Directive into national law; apply to all public contracts over the threshold value;

8 Monitor, Case closure decision on Greater Manchester and Cheshire cancer surgery services, January 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284832/ManchesterCas eClosure.pdf

enforced through the Courts. The general principles arising under the Treaty on the Functioning of the European Union of equal treatment, transparency, mutual recognition, non-discrimination and proportionality may apply even to public contracts for healthcare services falling below the threshold value if there is likely to be interest from providers in other member states. 11.12 Whilst the two regimes overlap in terms of some of their requirements, they are not the same – so compliance with one regime does not automatically mean compliance with the other. The National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 state:

 CCGs must not award a contract for the provision of NHS health care services where conflicts, or potential conflicts, between the interests involved in commissioning such services and the interests involved in providing them affect, or appear to affect, the integrity of the award of that contract; and  CCGs must keep a record of how it managed any such conflict in relation to NHS commissioning contracts it has entered into. 11.13 Paragraph 24 of PCR 2015 states: “Contracting authorities shall take appropriate measures to effectively prevent, identify and remedy conflicts of interest arising in the conduct of procurement procedures so as to avoid any distortion of competition and to ensure equal treatment of all economic operators”. Conflicts of interest are described as “any situation where relevant staff members have, directly or indirectly, a financial, economic or other personal interest which might be perceived to compromise their impartiality and independence in the context of the procurement procedure”. 11.14 The Procurement, Patient Choice and Competition Regulations (PPCCR) place requirements on commissioners to ensure that they adhere to good practice in relation to procurement, run a fair, transparent process that does not discriminate against any provider, do not engage in anti-competitive behaviour that is against the interest of patients, and protect the right of patients to make choices about their healthcare. Furthermore the PPCCR places requirements on commissioners to secure high quality, efficient NHS healthcare services that meet the needs of the people who use those services. The PCR 2015 are focussed on ensuring a fair and open selection process for providers. 11.15 The CCG will use a procurement checklist (see Appendix 5) to record the factors that should be addressed when drawing up its plans to commission services. This will help to evidence the CCG’s deliberations on conflicts of interest. The CCG will make the evidence of its management of conflicts publicly available, and the relevant information from the procurement template will be used to complete the register of procurement decisions. Complete transparency around procurement will provide:

 Evidence that the CCG is seeking and encouraging scrutiny of its decision-making process;

 A record of the public involvement throughout the commissioning of the service;  A record of how the proposed service meets local needs and priorities for partners such as the Health and Wellbeing Boards, local Healthwatch and local communities;  Evidence to the audit committee and internal and external auditors that a robust process has been followed in deciding to commission the service, in selecting the appropriate procurement route, and in addressing potential conflicts. 11.16 External services such as commissioning support services (CSSs) can play an important role in helping CCGs decide the most appropriate procurement route, undertake procurements and manage contracts in ways that manage conflicts of interest and preserve the integrity of decision-making. The CCG will assure itself that a CSS’ business processes are robust and enable the CCG to meet its duties in relation to procurement (including those relating to the management of conflicts of interest). This will require the CSS to declare any conflicts of interest it may have in relation to the work commissioned by the CCG. 11.17 A CCG cannot, however, lawfully delegate commissioning decisions to an external provider of commissioning support. Although CSSs are likely to play a key role in helping to develop specifications, preparing tender documentation, inviting expressions of interest and inviting tenders, the CCG itself will need to:

 Determine and sign off the specification and evaluation criteria;  Decide and sign off decisions on which providers to invite to tender; and  Make final decisions on the selection of the provider. Register of procurement decisions 11.18 The CCG will maintain a register of procurement decisions taken with a value in excess of £100,000, either for the procurement of a new service or any extension or material variation of a current contract. This will include:

 The details of the decision;  Who was involved in making the decision (including the name of the CCG clinical lead, the CCG contract manager, the name of the decision making committee and the name of any other individuals with decision-making responsibility);  A summary of any conflicts of interest in relation to the decision and how this was managed by the CCG; and  The award decision taken. 11.19 The register of procurement decisions will be updated whenever a procurement decision is taken, using the register at Appendix 6. The Procurement, Patient Choice and Competition Regulations 9(1) place a requirement on commissioners to maintain and publish on their website a record of each contract it awards. The register of procurement decisions will be made publicly available and easily accessible to patients and the public by:

 Ensuring that the register is available in a prominent place on the CCG’s website; and  Making the register available upon request for inspection at the CCG’s headquarters. Declarations of interests for bidders / contractors 11.20 As part of the CCG’s procurement processes, bidders will be asked to declare any conflicts of interest. This allows the CCG to ensure that it complies with the principles of equal treatment and transparency. When a bidder declares a conflict, the CCG will decide how best to deal with it to ensure that no bidder is treated differently to any other. A declaration of interests for bidders/ contractors template is attached at Appendix 7. 11.21 It will not usually be appropriate to declare such a conflict on the register of procurement decisions, as it may compromise the anonymity of bidders during the procurement process. However, the CCG will retain an internal audit trail of how the conflict or perceived conflict was dealt with to allow it to provide information at a later date if required. The CCG is required under regulation 84 of the Public Contract Regulations 2015 to make and retain records of contract award decisions and key decisions that are made during the procurement process (there is no obligation to publish them). Such records must include “communications with economic operators and internal deliberations” which should include decisions made in relation to actual or perceived conflicts of interest declared by bidders. These records must be retained for a period of at least three years from the date of award of the contract. Contract Monitoring 11.22 The management of conflicts of interest applies to all aspects of the commissioning cycle, including contract management. Any contract monitoring will consider conflicts of interest as part of the process i.e., the chair of a contract management meeting will invite declarations of interests; record any declared interests in the minutes of the meeting; and manage any conflicts appropriately and in line with this guidance. This equally applies where a contract is held jointly with another organisation such as the Local Authority or with other CCGs under lead commissioner arrangements. 11.23 The individuals involved in the monitoring of a contract should not have any direct or indirect financial, professional or personal interest in the incumbent provider or in any other provider that could prevent them, or be perceived to prevent them, from carrying out their role in an impartial, fair and transparent manner. The CCG will be mindful of any potential conflicts of interest when it disseminates any contract or performance information/reports on providers, and manage the risks appropriately.

12. Raising concerns and breaches 12.1 There will be situations when interests will not be identified, declared or managed appropriately and effectively. This may happen innocently, accidentally, or because of the deliberate actions of staff or organisations. For the purposes of this policy these situations are referred to as ‘breaches’.

12.2 It is the duty of every individual within the CCG to speak up about genuine concerns in relation to the management of conflicts of interests, and to report any concerns in accordance with the terms of this policy and the CCG’s Whistleblowing Policy or with the whistleblowing policy of the relevant employer organisation (where the breach is being reported by an employee or worker of another organisation). Individuals should not ignore their suspicions or seek to investigate them, but speak to the CCG’s Conflict of Interest Guardian or the Head of Corporate Governance.

12.3 Where a breach is suspected or has occurred, this will be investigated by the Head of Corporate Governance & Risk who will draw on other expertise available to the organisation such as internal audit. The findings will be shared with the Conflicts of Interest Guardian and the breach formally reported to the Audit Committee.

12.4 A review of lessons learned will be conducted by the Head of Corporate Governance & Risk following any incident of non-compliance with this policy and the report reviewed by the CCG’s Audit Committee. Anonymised details of breaches will be published on the CCG’s website for the purpose of learning and development.

12.5 Anyone who wishes to report a suspected or known breach of the policy, who is not an employee or worker of the CCG, should ensure that they comply with their own organisation’s whistleblowing policy, since most such policies should provide protection against detriment or dismissal.

12.6 All notifications will be treated with appropriate confidentiality at all times, in accordance with the CCG’s policies and applicable laws, and the person making such disclosures can expect an appropriate explanation of any decisions taken as a result of any investigation.

12.7 Providers, patients and other third parties can make a complaint to NHS Improvement in relation to a commissioner’s conduct under the Procurement Patient Choice and Competition Regulations. The regulations are designed as an accessible and effective alternative to challenging decisions in the courts.

Fraud or Bribery

12.8 Any suspicions or concerns of acts of fraud or bribery can be reported online via https://www.reportnhsfraud.nhs.uk/ or via the NHS Fraud and Corruption Reporting Line on 0800 0284060. This provides an easily accessible and confidential route for the reporting of genuine suspicions of fraud within or affecting the NHS. All calls are dealt with by experienced trained staff and any caller who wishes to remain anonymous may do so. Please refer to the CCG’s Anti-Fraud, Bribery and Corruption Policy for further details.

Impact of non-compliance

12.9 Failure to comply with the CCG’s policy on conflicts of interest management can have serious implications for the CCG and any individuals concerned.

Civil implications

12.10 If conflicts of interest are not effectively managed, CCGs could face civil challenges to decisions they make. For instance, if breaches occur during a service re-design or procurement exercise, the CCG risks a legal challenge from providers that could potentially overturn the award of a contract, lead to damages claims against the CCG, and necessitate a repeat of the procurement process. This could delay the development of better services and care for patients, waste public money and damage the CCG’s reputation. In extreme cases, staff and other individuals could face personal civil liability, for example a claim for misfeasance in public office.

Criminal implications

12.10 Failure to manage conflicts of interest could lead to criminal proceedings including for offences such as fraud, bribery and corruption. This could have implications for CCGs and linked organisations, and the individuals who are engaged by them. The Fraud Act 2006 created a criminal offence of fraud and defines three ways of committing it:  Fraud by false representation;  Fraud by failing to disclose information; and,  Fraud by abuse of position.

12.11 In these cases, the offender’s conduct must be dishonest and their intention must be to make a gain, or cause a loss (or the risk of a loss) to another. Fraud carries a maximum sentence of 10 years imprisonment and /or a fine if convicted in the Crown Court or 6 months imprisonment and/or a fine in the Magistrates’ Court. The offences can be committed by a body corporate.

12.12 Bribery is generally defined as giving or offering someone a financial or other advantage to encourage that person to perform certain functions or activities. The Bribery Act 2010 reformed the criminal law of bribery, making it easier to tackle this offence proactively in both the public and private sectors. It introduced a corporate offence which means that commercial organisations, including NHS bodies, will be exposed to criminal liability, punishable by an unlimited fine, for failing to prevent bribery.

12.13 The offences of bribing another person, being bribed or bribery of foreign public officials in relation to an individual carries a maximum sentence of 10 years imprisonment and/or a fine if convicted in the Crown Court and 6 months imprisonment and/or a fine in the Magistrates’ Court. In relation to a body corporate the penalty for these offences is a fine.

Disciplinary implications

12.14 Individuals who fail to disclose any relevant interests or who otherwise breach this policy will be subject to investigation and, where appropriate, to disciplinary action in accordance with the CCG’s Disciplinary Policy. Individuals should be aware that the outcomes of such action may, if appropriate, result in the termination of their employment or position with the CCG.

Professional regulatory implications

12.15 Statutorily regulated healthcare professionals who work for, or are engaged by, CCGs are under professional duties imposed by their relevant regulator to act appropriately with regard to conflicts of interest. The CCG will report statutorily regulated healthcare professionals to their regulator if they believe that they have acted improperly, so that these concerns can be investigated. Statutorily regulated healthcare professionals should be made aware that the consequences for inappropriate action could include fitness to practise proceedings being brought against them, and that they could, if appropriate, be struck off by their professional regulator as a result.

13. Conflicts of interest training

13.1 The CCG will ensure that training is offered to all individuals within the CCG on the management of conflicts of interest. This is to ensure staff and others within the CCG understand what conflicts are and how to manage them effectively. All individuals within the CCG are required to complete this mandatory training on an annual basis.

Appendix 1: Declaration of interests form

Name:

Position within, or relationship with, the CCG (or NHS England in the event of joint committees) Details of interest held (complete all that are applicable) Type of Description of interest (including for indirect Date of interest Actions to be taken to mitigate risk (if required) interest interests, details of the relationship with the person (see reverse who has the interest) From & To To be agreed with line manager (CCG employees of form) only)

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that the CCG holds.

I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary action may result.

I am / am not a decision maker [delete as applicable]. If you are band 8d or higher, or undertake any of the activities listed overleaf then you are a decision maker.

I do / do not [delete as applicable] give my consent for this information to published on registers that the CCG holds. If consent is NOT given please give reasons:

Declarer’s signature: …………………………………………. Date: ………………..

For CCG employees only:

Signature of line manager: …………………………………. Name: ……………………………

Position: ………………………………………. Date: ………………..

Types of interest

Type of Description interest Financial This is where an individual may get direct financial benefits from the consequences Interests of a commissioning decision. This could, for example, include being:  A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. This includes involvement with a potential provider of a new

care model;  A shareholder (or similar owner interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.  A management consultant for a provider;  A provider of clinical private practice;  In employment outside of the CCG;  In receipt of secondary income;  In receipt of a grant from a provider;  In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider  In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and  Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider.

Non-Financial This is where an individual may obtain a non-financial professional benefit from the Professional consequences of a commissioning decision, such as increasing their professional Interests reputation or status or promoting their professional career. This may, for example, include situations where the individual is:  An advocate for a particular group of patients;  A GP with special interests e.g., in dermatology, acupuncture etc.  An active member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);  An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE);  Engaged in a research role;  The development and holding of patents and other intellectual property rights which allow staff to protect something that they create, preventing unauthorised use of products or the copying of protected ideas; or  GPs and practice managers, who are members of the governing body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices

Non-Financial This is where an individual may benefit personally in ways which are not directly Personal linked to their professional career and do not give rise to a direct financial benefit. Interests This could include, for example, where the individual is:  A voluntary sector champion for a provider;  A volunteer for a provider;  A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

 Suffering from a particular condition requiring individually funded treatment;

 A member of a lobby or pressure group with an interest in health and care.

Indirect This is where an individual has a close association with an individual who has a Interests financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include:  Spouse / partner;  Close relative e.g., parent, grandparent, child, grandchild or sibling;  Close friend or associate; or  Business partner Decision Maker Decision makers are defined as follows:  All governing body members;  Members of advisory groups which contribute to direct or delegated decision making on the commissioning or provision of taxpayer funded services such as working groups involved in service redesign or stakeholder engagement that will affect future provision of services;  Members of the Primary Care Commissioning Committee (PCCC);  Members of other committees of the CCG e.g., audit committee, remuneration committee etc.;  Members of new care models joint provider / commissioner groups / committees;  Members of procurement (sub-)committees;  Individuals on Agenda for Change band 8d and above;  Management, administrative and clinical staff who have the power to enter into contracts on behalf of the CCG;  Management, administrative and clinical staff involved in decision making concerning the commissioning of services, purchasing of goods, medicines, medical devices or equipment, and formulary decisions; andManagement, administrative and clinical staff responsible for processing payments on behalf of the CCG,

Appendix 2: Register of Interests template

Appendix 3: Declarations of interest checklist for chairs

Under the Health and Social Care Act 2012, there is a legal obligation to manage conflicts of interest appropriately. It is essential that declarations of interest and actions arising from the declarations are recorded formally and consistently across all CCG governing body, committee and sub-committee meetings. This checklist has been developed with the intention of providing support in conflicts of interest management to the Chair of the meeting- prior to, during and following the meeting. It does not cover the requirements for declaring interests outside of the committee process

Timing Checklist for Chairs Responsibility

In advance of the meeting 1. The agenda to include a standing Meeting Chair and item on declaration of interests to secretariat enable individuals to raise any issues and/or make a declaration at the meeting.

2. A definition of conflicts of Meeting Chair and interest should also be secretariat accompanied with each agenda to provide clarity for all recipients.

3. Agenda to be circulated to enable Meeting Chair and attendees (including visitors) to secretariat identify any interests relating specifically to the agenda items being considered. A form (see below) will also be circulated on which attendees can record any interests relating to the agenda items.

4. Members should return the Meeting members form to the Chair or Head of Corporate Governance as soon as an actual or potential conflict is identified.

5. Chair to review a summary Meeting Chair report from preceding meetings i.e. sub-committee, working group, etc., detailing any conflicts of interest declared and how this was managed.

6. A copy of the members’ Meeting Chair declared interests is checked to establish any actual or potential conflicts of interest that may occur during the meeting.

During the meeting 7. Chair requests members to Meeting Chair

declare any interests in agenda items, including the nature of the conflict.

8. Chair makes a decision as to Meeting Chair how to manage each interest which has been declared, including whether / to what extent the individual member should continue to participate in the meeting, on a case by case basis, and this decision is recorded.

9. As minimum requirement, the Secretariat following should be recorded in the minutes of the meeting:

 Individual declaring the interest;  At what point the interest was declared;  The nature of the interest;  The Chair’s decision and resulting action taken;  The point during the meeting at which any individuals retired from and returned to the meeting - even if an interest has not been declared

 Visitors in attendance who participate in the meeting must also follow the meeting protocol and declare any interests in a timely manner Following the meeting 10. All new interests declared at Individual(s) the meeting should be promptly declaring interest(s) updated onto the declaration of interest form.

11. All new completed declarations Designated person of interest should be transferred responsible for onto the register of interests. registers of interest

12. If, following the meeting, the Person who chair or any other member becomes becomes aware of aware that a conflict of interest the conflict has not been declared, they should raise this with the Head of Corporate Governance or Conflicts of Interest Guardian who will consider the appropriate course of action.

DECLARATION OF INTERESTS FORM – MEETINGS

Please complete and return this form to the Head of Corporate Governance & Risk prior to the start of the meeting, or at any point at which you become aware of an interest during the meeting.

Name:

Meeting:

Date:

Agenda item in which you have Type of Interest: Brief Description of your Arrangement for managing the an interest  Financial interest conflict of interest (to be  Non Financial Professional agreed with the Chair of the  Non Financial Personal meeting)  Indirect

Signed:

Appendix 4: Template for recording minutes

Item no Agenda item Actions

Declarations of interest SK reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of the CCG.

Declarations are listed in the CCG’s Register of Interests. The Register is available via the CCG website at the following link: [link to be inserted]

Declarations of interest from sub committees None declared

Declarations of interest from today’s meeting The following update was received at the meeting: With reference to business to be discussed at this meeting, MS declared that he is a shareholder in XXX Care Ltd.

SK declared that the meeting is quorate and that MS would not be included in any discussions on agenda item X due to a direct conflict of interest which could potentially lead to financial gain for MS.

SK and MS discussed the conflict of interest, which is recorded on the register of interest, before the meeting and MS agreed to remove himself from the table and not be involved in the discussion around agenda item X.

Agenda Item

MS left the meeting, excluding himself from the discussion regarding xx.

MS was brought back into the meeting.

Appendix 5: Procurement checklist

Service:

Question Comment/Evidence

1. How does the proposal deliver good or improved outcomes and value for money- what are the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations?

2. How have you involved the public in the decision to commission this service?

3. What range of health professionals have been involved in considering the proposals?

4. What range of potential providers have been involved in considering the proposals?

5. How have you involved the Health and Wellbeing Board? How does the proposal support the priorities in the joint health and wellbeing strategy?

6. What are the proposals for monitoring the quality of the service?

7. What systems will there be to monitor and publish data on referral patterns?

8. Have all conflicts and potential conflicts of interests been appropriately declared and entered on registers? 9. In respect of every conflict or potential conflict, you must record how you have managed that conflict or potential conflict. Has the management of all conflicts been recorded with a brief explanation of how they have been managed? 10. Why have you chosen this procurement route e.g. single action tender*?

11. What additional external involvement will there be in scrutinising the proposed decisions? 12. How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision making process and award of any contract?

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply)

13. How have you determined a fair price for the service?

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers

14. How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for proposed direct awards to GP providers

15. What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider? 16. In what ways does the proposed service go beyond what GP practices should expect to provide under the GP contract? 17. What assurances will there be that a GP practice is providing high quality services under the GP contract before it has the opportunity to provide any new services?

*Taking into account all relevant regulations (e.g. the NHS (Procurement, patient choice and competition) (No.2 Regulations 2013 and guidance (e.g. that of Monitor))

Appendix 6: Register of Procurement Decisions Template

Appendix 7 - Template of conflict of interests for bidders /contractors

This page requires completion of details of organisations Page 2 overleaf requires completion of details of individuals

Name of organisation:

Details of interest held

Type of interest Details

Provision of services or other work for the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG or NHS England or professional, which the public could perceive may impair or otherwise influence the CCG’s or nay of its members or employees’ judgments, decisions or actions

Name of relevant (complete for all relevant persons) person

Details of interest held: Personal interest or that Type of interest Details of a family member, close friend or other acquaintance? Provision of services or other work for the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG or NHS England or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members or employees’ judgments, decisions or actions

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update the information as necessary.

Signed:

On behalf of:

Date:

Appendix 8 - Summary of key aspects of the NHS England statutory guidance on managing conflicts of interest relating to commissioning of new care models

Introduction

1. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring. They arise in many situations, environments and forms of commissioning.

2. Where CCGs are commissioning new care models9, particularly those that include primary medical services, it is likely that there will be some individuals with roles in the CCG (whether clinical or non-clinical), that also have roles within a potential provider, or may be affected by decisions relating to new care models. Any conflicts of interest must be identified and appropriately managed, in accordance with this statutory guidance.

3. This annex is intended to provide further advice and support to help CCGs to manage conflicts of interest in the commissioning of new care models. It summarises key aspects of the statutory guidance which are of particular relevance to commissioning new care models rather than setting out new requirements. Whilst this annex highlights some of the key aspects of the statutory guidance, CCGs should always refer to, and comply with, the full statutory guidance.

Identifying and managing conflicts of interest

4. The statutory guidance for CCGs is clear that any individual who has a material interest in an organisation which provides, or is likely to provide, substantial services to a CCG (whether as a provider of healthcare or provider of commissioning support services, or otherwise) should recognise the inherent conflict of interest risk that may arise and should not be a member of the governing body or of a committee or sub-committee of the CCG.

5. In the case of new care models, it is perhaps likely that there will be individuals with roles in both the CCG and new care model provider/potential provider. These conflicts of interest should be identified as soon as possible, and appropriately managed locally. The position should also be reviewed whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests. For example where an individual takes on a new role outside the CCG, or enters into a new business or relationship, these new interests should be promptly declared and appropriately managed in accordance with the statutory guidance.

9 Where we refer to ‘new care models’ in this note, we are referring to any Multi-speciality Community Provider (MCP), Primary and Acute Care Systems (PACS) or other arrangements of a similar scale or scope that (directly or indirectly) includes primary medical services.

6. There will be occasions where the conflict of interest is profound and acute. In such scenarios (such as where an individual has a direct financial interest which gives rise to a conflict, e.g., secondary employment or involvement with an organisation which benefits financially from contracts for the supply of goods and services to a CCG or aspires to be a new care model provider), it is likely that CCGs will want to consider whether, practically, such an interest is manageable at all. CCGs should note that this can arise in relation to both clinical and non-clinical members/roles. If an interest is not manageable, the appropriate course of action may be to refuse to allow the circumstances which gave rise to the conflict to persist. This may require an individual to step down from a particular role and/or move to another role within the CCG and may require the CCG to take action to terminate an appointment if the individual refuses to step down. CCGs should ensure that their contracts of employment and letters of appointment, HR policies, governing body and committee terms of reference and standing orders are reviewed to ensure that they enable the CCG to take appropriate action to manage conflicts of interest robustly and effectively in such circumstances.

7. Where a member of CCG staff participating in a meeting has dual roles, for example a role with the CCG and a role with a new care model provider organisation, but it is not considered necessary to exclude them from the whole or any part of a CCG meeting, he or she should ensure that the capacity in which they continue to participate in the discussions is made clear and correctly recorded in the meeting minutes, but where it is appropriate for them to participate in decisions they must only do so if they are acting in their CCG role.

8. CCGs should take all reasonable steps to ensure that employees, committee members, contractors and others engaged under contract with them are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engaged in, any employment or consultancy work in addition to their work with the CCG (for example, in relation to new care model arrangements).

9. CCGs should identify as soon as possible where staff might be affected by the outcome of a procurement exercise, e.g., they may transfer to a provider (or their role may materially change) following the award of a contract. This should be treated as a relevant interest, and CCGs should ensure they manage the potential conflict. This conflict of interest arises as soon as individuals are able to identify that their role may be personally affected.

10. Similarly, CCGs should identify and manage potential conflicts of interest where staff are involved in both the contract management of existing contracts, and involved in procurement of related new contracts.

Governance arrangements

11. Appropriate governance arrangements must be put in place that ensure that conflicts of interest are identified and managed appropriately, in accordance

with this statutory guidance, without compromising the CCG’s ability to make robust commissioning decisions.

12. We know that some CCGs are adapting existing governance arrangements and others developing new ones to manage the risks that can arise when commissioning new care models. We are therefore, not recommending a “one size fits” all governance approach, but have included some examples of governance models which CCGs may want to consider.

13. The principles set out in the general statutory guidance on managing conflicts of interest (paragraph 19-23), including the Nolan Principles and the Good Governance Standards for Public Services (2004), should underpin all governance arrangements.

14. CCGs should consider whether it is appropriate for the Governing Body to take decisions on new care models or (if there are too many conflicted members to make this possible) whether it would be appropriate to refer decisions to a CCG committee.

Primary Care Commissioning Committee

15. Where a CCG has full delegation for primary medical services, CCGs could consider delegating the commissioning and contract management of the entire new care model to its Primary Care Commissioning Committee. This Committee is constituted with a lay and executive majority, and includes a requirement to invite a Local Authority and Healthwatch representative to attend (see paragraph 97 onwards of the CCG guidance).

16. Should this approach be adopted, the CCG may also want to increase the representation of other relevant clinicians on the Primary Care Commissioning Committee when new care models are being considered, as mentioned in Paragraph 98 of this guidance. The use of the Primary Care Commissioning Committee may assist with the management of conflicts/quorum issues at governing body level without the creation of a new forum/committee within the CCG.

17. If the CCG does not have a Primary Care Commissioning Committee, the CCG might want to consider whether it would be appropriate/advantageous to establish either:

a) A new care model commissioning committee (with membership including relevant non-conflicted clinicians, and formal decision making powers similar to a Primary Care Commissioning Committee (“NCM Commissioning Committee”); or

b) A separate clinical advisory committee, to act as an advisory body to provide clinical input to the Governing Body in connection with a new care model project, with representation from all providers involved or potentially involved in the new care model but with formal decision making powers

remaining reserved to the governing body (“NCM Clinical Advisory Committee”).

NCM Commissioning Committee

18. The establishment of a NCM Commissioning Committee could help to provide an alternative forum for decisions where it is not possible/appropriate for decisions to be made by the Governing Body due to the existence of multiple conflicts of interest amongst members of the Governing Body. The NCM Commissioning Committee should be established as a sub-committee of the Governing Body.

19. The CCG could make the NCM Commissioning Committee responsible for oversight of the procurement process and provide assurance that appropriate governance is in place, managing conflicts of interest and making decisions in relation to new care models on behalf of the CCG. CCGs may need to amend their constitution if it does not currently contain a power to set up such a committee either with formal delegated decision making powers or containing the proposed categories of individuals (see below).

20. The NCM Commissioning Committee should be chaired by a lay member and include non-conflicted GPs and CCG members, and relevant non-conflicted secondary care clinicians.

NCM Clinical Advisory Committee

21. This advisory committee would need to include appropriate clinical representation from all potential providers, but have no decision making powers. With conflicts of interest declared and managed appropriately, the NCM Clinical Advisory Committee could formally advise the CCG Governing Body on clinical matters relating to the new care model, in accordance with a scope and remit specified by the Governing Body.

22. This would provide assurance that there is appropriate clinical input into Governing Body decisions, whilst creating a clear distinction between the clinical/provider side input and the commissioner decision-making powers (retained by the Governing Body, with any conflicts on the Governing Body managed in accordance with this statutory guidance and constitution of the CCG).

23. From a procurement perspective the Public Contracts Regulations 2015 encourage early market engagement and input into procurement processes. However, this must be managed very carefully and done in an open, transparent and fair way. Advice should therefore be taken as to how best to constitute the NCM Clinical Advisory Committee to ensure all potential participants have the same opportunity. Furthermore it would also be important to ensure that the advice provided to the CCG by this committee is considered proportionately alongside all other relevant information. Ultimately it will be the responsibility of the CCG to run an award process in accordance with the

relevant procurement rules and this should be a process which does not unfairly favour any one particular provider or group of providers.

24. When considering what approach to adopt (whether adopting an NCM Commissioning Committee, NCM Clinical Advisory committee or otherwise) each CCG will need to consider the best approach for their particular circumstances whilst ensuring robust governance arrangements are put in place. Depending on the circumstances, either of the approaches in paragraph 17 above may help to give the CCG assurance that there was appropriate clinical input into decisions, whilst supporting the management of conflicts. When considering its options the CCG will, in particular, need to bear in mind any joint / delegated commissioning arrangements that it already has in place either with NHS England, other CCGs or local authorities and how those arrangements impact on its options.

Provider engagement

25. It is good practice to engage relevant providers, especially clinicians, in confirming that the design of service specifications will meet patient needs. This may include providers from the acute, primary, community, and mental health sectors, and may include NHS, third sector and private sector providers. Such engagement, done transparently and fairly, is entirely legal. However, conflicts of interest, as well as challenges to the fairness of the procurement process, can arise if a commissioner engages selectively with only certain providers (be they incumbent or potential new providers) in developing a service specification for a contract for which they may later bid. CCGs should be particularly mindful of these issues when engaging with existing / potential providers in relation to the development of new care models and CCGs must ensure they comply with their statutory obligations including, but not limited to, their obligations under the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and the Public Contracts Regulations 2015.

Agenda Item: GB 18/25 FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 23rd May 2018

Title: Committee Terms of Reference

Reviewed by Committee/Date: Audit Committee – 18 April 2018 Remuneration & Nomination Committee – 11 April Information 2018 Quality & Performance Committee – 9 May 2018

Checked by Finance (Y/N/N/A - Date): N/A

Approved by Lead Governing Body member (Y/N): Y

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A Statutory/Legal/Regulatory/Contractual N/A requirements Financial Implications N/A Communication and Involvement Issues N/A Workforce Issues N/A Equality Issues including Equality Impact N/A assessment Environmental Issues N/A Information Governance Issues including N/A Privacy Impact Assessment

EXECUTIVE SUMMARY:

1. The Governing Body is asked to approve terms of reference for its committees, as set out in the CCG Constitution:

 Audit Committee (Appendix 1)  Remuneration & Nomination Committee (Appendix 2)  Quality & Performance Committee (Appendix 3)

2. The draft terms of reference have been reviewed by the relevant committee and suggested amendments have been incorporated as appropriate.

3. Members are asked to note that the Primary Care Commissioning Committee will be requested to approve its terms of reference as it is a committee of the CCG rather than a committee of the Governing Body.

4. The CCG Constitution also includes reference to a Finance Committee, Clinical Commissioning Forum and Patient Assurance Group. A paper will be submitted to the next Governing Body seeking approval of proposals relating to these groups. A brief update is provided below in relation to each:

Finance Committee

5. A Finance and Commissioning for Value Committee was in operation during 2017/18, however on reflection, it is considered that the functions undertaken by this Committee should be retained by the Governing Body to ensure appropriate oversight.

Clinical Commissioning Forum

6. A Clinical Commissioning Forum is required to ensure appropriate clinical advice and input into commissioning proposals and this will be a key part of the Commissioning for Value process. A proposal will be presented to the next Governing Body meeting as to where this forum should sit within the overall governance structure.

Patient Assurance Group

7. Discussions have taken place with the Lay Member – Patient & Public Involvement, Communications & Engagement team and Corporate Governance regarding the Patient Assurance Group (PAG). It is proposed that patient/public representation on this Group will be drawn from the new Leeds CCG Health Volunteer programme, which will build on the previous work of the Patient Champions programme.

8. Health Volunteers will be recruited through an application and informal interview process. Successful applicants will be allocated to a member of the CCG Engagement Team and, in addition to completing an induction training session, will receive ongoing one-to-one support, and additional training input as necessary.

9. Health Volunteers will be given additional support to prepare for specialist roles, such as

attending the PAG, and responsibility for attending the PAG could be flexible, enabling a number of Health Volunteers to share the responsibility amongst the group.

NEXT STEPS:

10. The approved terms of reference will be published on the CCG website.

11. A paper will be submitted to the next Governing Body to seek approval of proposals relating to the Finance Committee, Clinical Commissioning Forum and Patient Assurance Group, alongside any associated constitutional amendments.

RECOMMENDATION:

The Governing Body is asked to:

(a) Approve the terms of reference for the Audit Committee, Remuneration & Nomination Committee and Quality & Performance Committee; and (b) Note that proposals will be presented at the next Governing Body meeting in relation to the Finance Committee, Clinical Commissioning Forum and Patient Assurance Group.

THIS PAGE IS INTENTIONALLY BLANK Appendix 1

Audit Committee

Terms of Reference

Version: 1.0

Approved by:

Date approved:

Date issued:

Responsible Director: Chief Finance Officer

Review date:

1. Introduction

1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing. It has a clear vision to be a healthy, caring city for all ages, where people who are poorest improve their health the fastest. To realise this vision, the CCG and Leeds City Council need to change how we commission services so that the health and care system is sustainable, services are of high quality and we make best use of the ‘Leeds pound’.

1.2 The CCG aims to provide more integrated care, based on the needs of local people. To do this, the CCG and Leeds City Council will work together to change how care is commissioned, and work with current and future providers to develop a new, more integrated health and social care system.

1.3 The CCG has recognised that in a similar way to many healthcare economies around the world, it will be necessary to adopt a Population Health Management (PHM) approach. The key building blocks of PHM are:

 Commissioning needs to be more strategic and outcomes-based rather than activity-based.

 Some current commissioning functions would be more effectively used to develop a new provider landscape of integrated, accountable providers working towards common goals.

 This would be enabled by new payment and incentive mechanisms supported by better use of information and technology.

2. Role of the Committee

2.1 The Committee shall critically review the CCG’s financial reporting and internal control principles and ensure an appropriate relationship with both internal and external auditors is maintained. It will approve a comprehensive system of internal control, including budgetary control, that underpins the effective, efficient and economic operation of the CCG.

Integrated governance, risk management and internal control

2.2 Review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the clinical commissioning group’s activities that support the achievement of the clinical commissioning group’s objectives.

2.3 Receive assurance that the CCG Governing Body has an appropriate, up to date and co-ordinated range of systems, policies and procedures in place to manage risk.

2.4 Enable the CCG Governing Body to fulfil its responsibility to manage risk by providing evidence of compliance with all risk management processes.

2.5 In particular, the committee will review the adequacy and effectiveness of:

 The CCG Assurance Framework and Risk Register  CCG Executive Reports  Other appropriate reports from Managers

2.6 In carrying out this work the committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the overarching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

Internal audit

2.7 The Committee shall ensure that there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Accountable Officer and CCG. This will be achieved by:

 Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.  Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework.  Considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources.  Ensuring that the internal audit function is adequately resourced and has appropriate standing within the CCG.  An annual review of the effectiveness of internal audit.

External audit

2.8 The Committee shall review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:

 Consideration of the performance of the external auditors, as far as the rules governing the appointment permit.  Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.  Discussion with the external auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee.  Review of all external audit reports, including the report to those charged with governance, agreement of all audit fees and any other work undertaken outside the annual audit plan, together with the appropriateness of management responses.

Other assurance functions

2.9 The Audit Committee shall review the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the CCG.

2.10 These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).

Counter fraud

2.11 The Committee shall approve the CCG’s counter fraud and security management arrangements and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

2.12 In accordance with 3.2 of the NHS Counter Fraud Authority’s (NHSCFA) Fraud Commissioners Standards, the Committee has stated its commitment to ensuring commissioners achieve these standards and therefore requires assurance that they are being met via NHSCFA’s quality assurance programme.

Management

2.13 The Committee shall request and review reports and positive assurances from directors and managers on the overall arrangements for governance, risk management and internal control.

2.14 The Committee may also request specific reports from individual functions within the clinical commissioning group as they may be appropriate to the overall arrangements.

Financial reporting

2.15 The Audit Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance.

2.16 The Committee shall ensure that the systems for financial reporting to the CCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the CCG.

2.17 The Audit Committee shall review the annual report and financial statements before submission to the Governing Body and the Clinical Commissioning Group, focusing particularly on:

 The wording in the governance statement and other disclosures relevant to the terms of reference of the committee;  Changes in, and compliance with, accounting policies, practices and estimation techniques;  Unadjusted mis-statements in the financial statements;  Significant judgements in preparing of the financial statements;  Significant adjustments resulting from the audit;  Letter of representation;  Qualitative aspects of financial reporting; and  Explanations for significant variances

2.17 The work of the Committee will provide the Governing Body with assurance on the CCGs’ delivery of its statutory duty to act effectively, efficiently and economically.

Whistleblowing

2.18 The Committee shall review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.

3. Membership

3.1 The membership of the Committee will be as follows:

Members (Voting)

 Lay Member – Audit and Conflicts of Interest  One other Lay Member or the Secondary Care Consultant  One Member Representative

In attendance (Non Voting)

 Chief Finance Officer  Head of Corporate Governance  Internal Audit  Local Counter Fraud Specialist  External Audit

3.2 The Chair of the Committee will be the Lay Member – Audit and Conflicts of Interest.

3.3 The Deputy Chair of the Committee will be a CCG Lay Member, Member Representative or Secondary Care Consultant.

3.4 In the event of the Chair being unable to attend all or part of the meeting, he or she will nominate a Deputy Chair to Chair the meeting.

3.5 In addition to those named in the table above as being ‘in attendance’:

 At least once a year or as required the Committee will meet privately with the external and internal auditors.  Regardless of attendance, external audit, internal audit, local counter fraud and security management (NHS Counter Fraud Authority) providers will have full and unrestricted rights of access to the Audit Committee.  The Accountable Officer should be invited to attend and discuss, at least annually with the committee, the process for assurance that supports the

Annual Governance Statement. He or she should also normally attend when the Committee considers the draft internal audit plan and the annual accounts.  Any other directors (or similar) may be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director.  The Chair of the Governing Body may also be invited to attend one meeting each year in order to form a view on, and understanding of, the Committee’s operations.

4. Quoracy and voting

4.1 The quorum of the Committee is two voting members of the Committee.

4.2 If the Committee is not quorate the meeting may be postponed at the discretion of the Chair.

4.3 The aim of the Committee will be to achieve consensus decision making, should a vote need to be taken, only the members of the Committee shall be allowed to vote. In the event of a tied vote, the Chair will have a casting vote.

5. Operation of the Committee

5.1 The Committee will hold at least four meetings per year.

5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum of seven working days’ notice should be given when calling an extraordinary meeting.

5.3 The External Auditor or Head of Internal Audit may request a meeting if they consider that one is necessary.

5.4 The agenda and supporting papers will be circulated to all members of a meeting at least five working days before the date of the meeting.

5.5 With the agreement of the Chair, items of urgent business may be added to the agenda after circulation to members.

5.6 In the case of an emergency the Chair may take urgent action to decide any matter within the remit of the Committee, subject to consultation with at least two other members of the Committee. Any such action will be reported to the next Committee meeting.

5.7 Minutes will be issued at latest 10 working days following each meeting and a Chair’s Summary will be submitted to the subsequent meeting of the Governing Body.

5.8 Secretarial support will be provided to ensure appropriate support to the Chair and Committee members in relation to the organisation and conduct of meetings.

6. Conduct of the Committee

6.1 Members of the Committee shall at all times comply with the standards of business conduct and managing conflicts of interest as laid down in each of the CCG’s Constitutions and the Managing Conflicts of Interest Policy.

6.2 All declarations of interest will be declared at the beginning of each meeting and actions taken in mitigation will be recorded in the minutes.

7. Accountability and Reporting

7.1 The Committee is accountable to the Governing Body.

7.2 The Committee will produce an annual work plan in consultation with the Governing Body.

7.3 A Chair’s summary will be presented to the Governing Body.

7.4 The Committee is authorised by the Governing Body to commission any reports or surveys or to create working groups as necessary to help it fulfil its obligations and will remain accountable for any working groups. The minutes of such groups will be presented to the Committee.

8. Review of the Committee

8.1 The Committee will undertake an annual self-assessment of its performance against the annual plan, membership and terms of reference. Any resulting proposed changes to the terms of reference will be submitted for approval by the Governing Body.

8.2 These terms of reference and membership will be reviewed at least annually following their approval.

8 Appendix 2

Remuneration and Nomination Committee

Terms of reference

Version: 1.0

Approved by:

Date approved:

Date issued:

Responsible Director: Chief Executive

Review date:

1. Introduction

 Commissioning needs to be more strategic and outcomes-based rather than activity-based.

 Some current commissioning functions would be more effectively used to develop a new provider landscape of integrated, accountable providers working towards common goals.

 This would be enabled by new payment and incentive mechanisms supported by better use of information and technology.

2. Role of the Committee

2.1 Remuneration

2.1.1 The Committee shall make decisions on the remuneration, including terms, conditions, pay and allowances (e.g. any pension scheme it might establish as an alternative to the NHS pension scheme) and redundancy/severance, of all Governing Body members and Clinical Leads of the CCG.

2.1.2 The Committee will also make recommendations to the CCG Governing Body on decisions about the remuneration, including terms, conditions, pay and allowances (e.g. any pension scheme it might establish as an alternative to the NHS pension scheme) and redundancy/severance, of all employees and people who provide services to the CCG.

2.1.3 The Committee shall approve all HR policies.

2.2 Nomination

2.2.1 The Committee shall have delegated authority from the Governing body to:

 regularly evaluate the balance of skills, experience, independence, diversity and knowledge of the CCG Governing Body and make recommendations to the Governing Body with regard to any changes

 give full consideration to succession planning for directors and other senior executives in the course of its work, taking into account the challenges and opportunities facing the CCG, the diversity of the Governing Body and the skills and expertise needed on the Governing Body in the future

 keep under review the leadership needs of the organisation, both executive and non-executive, with a view to ensuring the continued ability of the organisation to deliver its stated aims

 keep up to date and fully informed about strategic issues and commercial changes affecting the CCG and changes to the environment in which it operates

 as and when vacancies arise on the Governing Body, evaluate the balance of skills, knowledge, experience and diversity on the Governing Body, and, in the light of this evaluation advise on the role and capabilities required for particular appointments

 in respect of non-elected Governing Body members and other senior executives, the Committee shall in identifying suitable candidates:

o use open advertising or the services of external advisers to facilitate the search

o consider candidates from a wide range of backgrounds

o consider candidates on merit and against objective criteria and with due regard for the benefits of diversity on the Governing Body, including gender, taking care that appointees have enough time available to devote to the position

o in the case of the Accountable Officer the Committee shall coordinate with the national assessment, accreditation, selection and recruitment process

 in respect of the appointment of the Chair of the Governing Body, the Committee should agree a job specification, including the time commitment expected

 review the results of the Governing Body and committee performance evaluation process that relate to the composition of the Governing Body and review annually the time required from non-executive directors

 formulate plans for succession for both executive and non-executive directors and in particular:

. for the key roles of Clinical Chair and Accountable Officer

. membership of the audit and remuneration committees, and any other Governing Body committees as appropriate, in consultation with the chairs of those committees

. the re-appointment of any non-executive director at the conclusion of their specified term of office having given due regard to their performance and ability to continue to contribute to the Governing Body in the light of the knowledge, skills and experience required

. performance and ability to continue to contribute to the Governing Body in the light of the knowledge, skills and experience required and the need for progressive refreshing of the Governing Body

. any matters relating to the continuation in office of any director at any time including the suspension or termination of service of an executive director as an employee of the CCG subject to the provisions of the law and their service contract.

2.3 The work of the Committee will provide the Governing Body with assurance on the CCGs’ delivery of the following statutory duties:  pay its employees remuneration, fees and allowances in accordance with determinations made by the Governing Body, and determine any other terms and conditions of service of the CCG’s employees.  determine the remuneration and travelling or other allowances of members of its Governing Body.

3. Membership

3.1 The membership of the Committee will be as follows:

Members (Voting)

 At least three Lay Members  One Member Representative  Clinical Chair

In attendance (Non-Voting)

 Accountable Officer  Head of Corporate Governance  Human Resources Representative

3.2 The Chair of the Committee will be a CCG Lay Member, and cannot be the CCG Chair.

3.3 The Deputy Chair of the Committee will be a CCG Lay Member.

3.4 Other Directors, senior managers and external advisors shall be invited to attend where appropriate. They should not, however, be in attendance for discussions about their own remuneration and terms of service.

4 Quoracy and voting

4.1 The quorum of the Committee is a minimum of two voting members, one of these must be a lay member, except when considering lay member remuneration.

4.2 If the Committee is not quorate the meeting may be postponed at the discretion of the Chair.

4.3 The aim of the Committee will be to achieve consensus decision- making. Should a vote need to be taken, only the members of the Committee shall be allowed to vote. In the event of a tied vote, the Chair will have a casting vote.

5 Operation of the Committee

5.1 The Committee will hold at least three meetings per year.

5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum of seven working days’ notice should be given when calling an extraordinary meeting.

5.3 The agenda and supporting papers will be circulated to all members of a meeting at least five working days before the date of the meeting.

5.4 With the agreement of the Chair, items of urgent business may be added to the agenda after circulation to members.

5.5 In the case of an emergency the Chair may take urgent action to decide any matter within the remit of the Committee, subject to consultation with at least two other members of the Committee. Any such action will be reported to the next Committee meeting.

5.6 Minutes will be issued at latest 10 working days following each meeting and a Chair’s Summary will be submitted to the subsequent meeting of the Governing Body.

5.7 Secretarial support will be provided to ensure appropriate support to the Chair and Committee members in relation to the organisation and conduct of meetings.

6 Conduct of the Committee

6.1 Members of the Committee shall at all times comply with the standards of business conduct and managing conflicts of interest as laid down in each of the CCG’s Constitution and the Managing Conflicts of Interest Policy.

6.2 All declarations of interest will be declared at the beginning of each meeting and actions taken in mitigation will be recorded in the minutes.

7 Accountability and Reporting

7.1 The Committee is accountable to the Governing Body.

7.2 The Committee will produce an annual work plan in consultation with the Governing Body.

7.3 A Chair’s summary will be presented to the Governing Body.

8 Review of the Committee

8.2 These terms of reference and membership will be reviewed at least annually following their approval.

THIS PAGE IS INTENTIONALLY BLANK Appendix 3

Quality & Performance Committee

Terms of Reference

Version: 1.0

Approved by:

Date approved:

Date issued:

Responsible Director: Director of Quality & Safety

Review date:

1. Introduction

 strategic and outcomes-based commissioning rather than activity-based;

 effective use of commissioning functions to develop a new provider landscape of integrated accountable providers working towards common goals;

 new payment and incentive mechanisms supported by better use of information and technology.

2. Role of the Committee

2.1 The committee is responsible for the oversight and monitoring of:  the quality of commissioned services including patient experience, safety and clinical effectiveness;  the effectiveness and performance of commissioned services;  the performance of the CCG and their delivery of agreed outcomes.

2.2 The committee will support the Governing Body in ensuring the continuous improvement in the quality of services commissioned on behalf of the CCG. The committee aims to ensure that quality sits at the heart of everything the CCG

does, and that evidence from quality assurance processes drives the quality improvement agenda across the Leeds healthcare economy.

2.3 The Shared Commitment to Quality from the National Quality Board provides a single shared view of quality. The NHS Five Year Forward View confirms a national commitment to high-quality, person centred care for all and describes the changes that are needed to deliver a sustainable health and care system. This approach builds on the existing definition of quality:

2.4 Quality care is not achieved by focusing on one or two aspects of this definition; high quality care encompasses all aspects with equal importance being placed on each. This includes providers and commissioners working in partnership to ensure organisations are well-led, resourced sustainably and equitable for all.

2.5 In fulfilling its role the Committee will seek reasonable assurance relating to the quality and performance of commissioned services. The committee defines reasonable assurance as evidence that performance / quality is in line with agreed targets or trajectories, or where it is not, there is reasonable mitigation

and an action plan to rectify any issues (the Committee will agree on a case by case basis what constitutes reasonable mitigation).

2.6 Where the Committee receives insufficient assurance, it will challenge, assess risks and escalate to the Governing Body or Primary Care Commissioning Committee if necessary.

2.7 The Committee will be responsible for exercising the following functions:

2.8 Performance: Oversee the management of the CCG’s performance and delivery of agreed outcomes by:

a) monitoring performance against national and local targets b) monitoring performance against the standards, targets and outcomes set out in the CCG’s operational and strategic plans c) reviewing the CCG’s benchmarked performance against statutory frameworks including the NHS Outcomes Framework and Improvement and Assessment Framework d) ensuring action plans are developed and implemented to address any areas of unsatisfactory performance and drive improvement e) overseeing the continuous development of the scope, format, presentation and mechanisms of the system of performance reporting f) reviewing those risks on the CCG risk register and Governing Body Assurance Framework which have been assigned to the committee and ensure that appropriate and effective mitigating actions are in place g) seeking assurance that the CCG is fulfilling its statutory duties for equality and diversity, as set out in the Equality Act 2010 h) seeking assurance of appropriate compliance by the CCG with the legal requirements for:  emergency planning  information governance  health and safety

2.9 Quality of commissioned services: The committee will ensure the effective delivery of quality performance across the full range of commissioned services and seek assurances that sound systems for quality improvement and clinical governance are in place in line with statutory requirements, by:

a) monitoring the quality performance of all providers, including detailed reports on services that are commissioned across acute, community and primary care b) reviewing specific action plans or recovery plans as they relate to quality c) approving arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and secure continuous improvement in quality

and patient outcomes, including the arrangements for dealing with exceptional funding requests d) reviewing quality performance with regard to commissioning for value

2.10 Patient experience: The committee will seek assurance that effective systems are in place to monitor and improve patient experience by:

a) receiving patient experience reports and information relating to commissioned services b) reviewing themes and trends and ensuring lessons learned are translated into changes in way services are provided c) approving the CCG’s arrangements for the handling of patient complaints, concerns or enquiries in accordance with relevant regulations

2.11 Clinical Effectiveness: The committee seeks to gain assurance that there are effective systems and processes in place to monitor and gain oversight of clinical effectiveness. This will include:

a) receiving assurance that there is appropriate monitoring of compliance with guidance including NICE guidelines and technical appraisals b) monitoring the performance of trusts against the agreed Commissioning for Quality and Innovation scheme (CQUINs) c) receiving Quality Account updates d) receiving assurance that providers have robust clinical audit procedures that address trust priorities, facilitate service improvement and provide assurances that agreed clinical standards are being met

2.12 Safety: The committee shall seek assurances regarding safety by:

a) receiving assurance that the accepted recommendations of national inquiries and national and local reviews have been considered and actioned with respect to the CCG and commissioned services including primary care b) overseeing safeguarding arrangements to assure that the CCG’s statutory responsibilities for safeguarding children and adults at risk are met and that robust actions are taken to address concerns via receipt of regular reports c) overseeing and seeking assurance that effective systems are in place in relation to CCG services including serious incident management, continuing healthcare and medicines management

2.13 The work of the committee will provide the Governing Body with assurance on the CCG’s delivery of the following statutory duties:  secure continuous improvement in the quality of services (including primary medical services);  secure health services that have regard to the NHS constitution;

 reduce inequalities;  promote integration of health and social care;  promote innovation; and  promote research, and education and training.

3. Membership

3.1 The membership of the committee will be as follows:

 at least three non-executive or lay governing body members  CCG Director of Quality & Safety  CCG Director of Strategy, Performance and Planning  CCG Director of Operational Delivery  CCG Medical Director

3.2 The committee will be chaired by a non-executive or lay member, to be appointed by the committee.

3.3 The committee will appoint a deputy Chair from the remaining non-executive or lay members.

3.4 Deputies may attend on behalf of executive members, with delegated voting rights. The Executive member shall remain accountable for decisions made on their behalf.

3.5 Other directors and senior managers will be invited to attend where appropriate.

4. Quoracy and voting

4.1 The quorum is a minimum of 4 members. This must include the Chair or Deputy Chair, one executive and one non executive or lay member.

4.2 If the committee is not quorate the meeting may be postponed at the discretion of the Chair.

4.3 The committee will endeavour to make decisions by reaching a consensus. Where a consensus cannot be reached, the Chair will take the committee’s views on the issue forward for consideration by the Governing Body.

5. Operation of the Committee

5.1 Meetings will be held bi-monthly.

5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum of seven working days’ notice should be given when calling an extraordinary meeting.

5.3 The agenda and supporting papers will be circulated to all members at least five working days before the date of the meeting.

5.4 With the agreement of the Chair, items of urgent business may be added to the agenda after circulation to members.

5.5 In the case of an emergency the Chair may take urgent action to decide any matter within the remit of the committee, subject to consultation with at least two other members of the committee, one of which must be a non-executive or lay member. Any such action should be reported at the next committee meeting.

5.6 Minutes will be issued at latest 10 working days following each meeting and a Chair’s Summary will be submitted to the subsequent Governing Body meeting. A summary regarding issues relating to primary medical care services will be submitted to the subsequent meeting of the Primary Care Commissioning Committee.

5.7 Secretarial support will be provided to ensure appropriate support to the Chair and committee members in relation to the organisation and conduct of meetings.

6.0 Conduct of the Committee

6.1 Members of the committee shall at all times comply with the standards of business conduct and managing conflicts of interest as laid down in the CCG Constitution and the Managing Conflicts of Interest Policy.

6.2 All declarations of interest will be declared at the beginning of each meeting and actions taken in mitigation will be recorded in the minutes.

7.0 Accountability and Reporting

7.1 The committee is accountable to the Governing Body.

7.2 The committee will produce an annual work plan in consultation with the Governing Body.

7.3 A Chair’s summary will be presented to the Governing Body.

7.4 The committee is authorised by the Governing Body to commission any reports or surveys or to create working groups as necessary to help it fulfil its obligations and will remain accountable for any working groups. The minutes of such groups will be presented to the committee.

8.0 Review of the Committee

8.1 The committee will produce an annual work plan in consultation with the Governing Body.

8.2 The committee will undertake an annual self-assessment of its performance against the annual plan, membership and terms of reference. This self- assessment will form the basis of the annual report. Any resulting proposed changes to the terms of reference will be submitted for approval by the Governing Body.

8.3 These terms of reference and membership will be reviewed at least annually following their approval.

GOVERNING BODY FORWARD WORK PLAN 2018/19

ITEM MAY JULY SEPT NOV JAN MAR Lead Officer STANDING ITEMS Welcome & apologies X X X X X X Chair Declarations of interest X X X X X X Chair Minutes of previous meeting X X X X X X Chair Matters arising X X X X X X Chair Action log X X X X X X Chair Questions from members of the public X X X X X X Chair Patient Voice X X X X X X JH PERFORMANCE Chief Officer’s Report X X X X X X PC Integrated Quality & Performance Report X X X X X X KS / JH FINANCE Finance Report X X X X X VPS Approval of Annual Report & Accounts X VPS Approval of Annual Budget X X VPS STRATEGY Strategic Review: X X X X X X - CCG Strategy PC - Leeds Health & Care Plan - West Yorkshire & Harrogate STP Commissioning for Value Update X X X X X X KS CCG Operating Plan X KS/VPS Director of Public Health Annual Report X IC RISK Governing Body Assurance Framework X X X X X PC Corporate Risk Register X X X X X X PC STATUTORY DUTIES Assurance on delivery of Statutory Duties X Various GOVERNANCE Approval of Procurement Plan 2018/19 X VPS Interim Procurement Plan 2018/19 X VPS Approval of Business Cases/Investments over Various £1.5m (as required) Chair’s Summary of Committee Meetings X X X X X X Committee Chairs Committee Terms of Reference X X Committee

Chairs 1

ITEM MAY JULY SEPT NOV JAN MAR Lead Officer Committee Annual Reports X Committee

Chairs Approval of Governing Body Appointments / Chair Reappointments (as required) Approval of amendments to Constitution (as X Chair required) Forward Work Plan X X X X X X Chair Policy Approval (as required) X Various Review of Operational Scheme of Delegation X VPS