Governing Body

To be held on Thursday 20 th July 2017

From 1pm until 4pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ

Governing Body To be held on Thursday 20 July 2017 Commencing at 1pm – 4pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

PUBLIC AGENDA

Presenter Enc

1. Welcome and Introductions Chair Verbal

2. Apologies Chair Verbal

3. Declarations of Interest Chair Verbal

4. Questions from Members of the Public Chair Verbal (See our website for how to submit questions – required in advance)

5. Minutes of the previous meeting held on 15 June 2017 Chair Enc A

6. Matters Arising Chair Verbal

Strategy

7. Children’s Surgery and Anaesthesia Mrs Pederson & Enc B Dr Crichton

8. South Yorkshire & Bassetlaw Sustainability & Mrs Pederson Enc C Transformation Plan Memorandum of Understanding

Assurance

9. Quality & Performance Report Mr Russell & Enc D Mr Fitzgerald

• Spotlight Report on Learning Disabilities Mrs Gordon

• Spotlight Report on Community and End of Life Mrs Forrestall

• Looked After Children Report - Update Mr Russell

10. Finance Report Mrs Tingle Enc E

11. Assurance Framework Quarter 1 Report Mrs Atkins Enc F Whatley

Standing Items

12. Chair & Chief Officer Report Dr Crichton & Enc G Mrs Pederson

13. Locality Feedback Locality Leads Verbal

Items to Note/Receipt of Minutes

14. Receipt of Minutes Chair Enc H

• Quality & Patient Safety Committee – Minutes of the meeting held on 4 May 2017. • Primary Care Commissioning Committee – Minutes of the meeting held on 13 April 2017. • Executive Committee – Minutes of the meeting held on 3 May 2017. • South Yorkshire and Bassetlaw Sustainability and Transformation Partnership Collaborative Partnership Board – Minutes of the meeting held on 12 May 2017.

15. Any Other Business Chair Verbal

16. Date and Time of Next Meeting Chair Verbal

Thursday 17 August 2017 at 1pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

To resolve that representatives of the press, and Chair other members of the public, be excluded from the remainder of this 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.

Verbal

Item 1

Welcome & Introductions

Verbal

Item 2

Apologies for Absence

Verbal

Item 3

Declarations of Interest

Verbal

Item 4

Questions from Members of the Public

Enc A

Item 5

Minutes of the previous meeting

Minutes of the Governing Body Held on Thursday 15 June 2017 commencing at 1pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Members Dr David Crichton – NHS Doncaster CCG Chairman (Chair) Present: Miss Anthea Morris – Lay Member and Vice Chair of the Governing Body Mrs Sarah Whittle – Lay Member Dr Emyr Wyn Jones – Secondary Care Doctor Member Dr Nick Tupper – Locality Lead, Central Locality Dr Jeremy Bradley – Locality Lead, North East Locality Dr Marco Pieri – Locality Lead, North West Locality Dr Pat Barbour – Locality Lead, South East Locality Dr Khaimraj Singh – Locality Lead, South East Locality Dr Lindsey Britten – Locality Lead, South West Locality Dr Karen Wagstaff – Locality Lead, South West Locality Mrs Jackie Pederson – Chief Officer Mr Andrew Russell – Chief Nurse

Formal Mrs Sarah Atkins Whatley – Chief of Corporate Services Attendees Mrs Laura Sherburn – Chief of Partnerships Commissioning and Primary present Care Mr Anthony Fitzgerald – Chief of Strategy & Delivery Dr Rupert Suckling – Director of Public Health Mrs Deborah Hilditch – Healthwatch Representative (Attending on behalf of Mr Stephen Shore)

In Mrs Jayne Satterthwaite – PA (Taking Minutes) attendance: Mr Ian Carpenter, Head of Communications & Engagement Mrs Tracy Wyatt – Deputy Finance Officer – (Attending on behalf of Mrs Tingle) Mr Lee Golze - Head of Strategy & Delivery Children & Maternity (Item 8) Mr Ian Boldy – Head of All Age Individual Placements and Designated Nurse Safeguarding Adults (Item 8) Mrs Debbie Aitchison - Doncaster Intermediate Health and Social Care Project (Item 8)

ACTION

1. Welcome and Introductions

Dr Crichton welcomed everyone to the Governing Body meeting.

There were 6 members of the public and 1 NHS Doncaster CCG staff member in attendance at the meeting.

2. Apologies

Apologies for absence were received from:

• Mrs Linda Tully – Lay Member • Dr Niki Seddon – Locality Lead, North West Locality • Mrs Hayley Tingle – Chief Finance Officer • Mr Damian Allen – DMBC Representative

3. Declarations of Interest

The Chair reminded members of their obligations to declare any interest they may have on any issues arising at meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.

Declarations declared by members are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk

The meeting was noted as quorate.

Declarations of interest from sub-committee/working groups:

None declared.

Declarations of interest from today’s meeting:

None declared.

4. Questions from Members of the Public/ Patient Stories

Dr Crichton stated that the questions received from members of the public both related to Item 7 of the agenda the Doncaster Place Plan – Ernst & Young Phase 1 Report and would be answered as part of this item.

5. Minutes of the Previous Meeting held on 18 May 2017

The minutes of the meeting held on 18 May 2017 were agreed as an accurate record.

6. Matters Arising

Dr Crichton stated that the Quality & Patient Safety Committee Terms of Reference are an item on today’s agenda.

7. Doncaster Place Plan – Ernst & Young Phase 1 Report

Mr Fitzgerald explained that in 2016 Health and Social Care organisations across Doncaster developed the Doncaster Place Plan. The joint vision was that Care and support will be tailored to community strengths to help Doncaster residents maximise their independence, health and wellbeing. Doncaster residents will have access to excellent community and hospital based services when needed. The Doncaster Place Plan was approved by NHS Doncaster CCG Governing Body in October 2016.

In January 2017 Health & Social Care partners appointed Ernst & Young as a strategic partner to facilitate implementation of the Doncaster Place Plan. The report is the Phase 1 assessment of the Health and Social Care partnerships’ ability to implement the Doncaster Place Plan. It includes an assessment of readiness state across 6 key areas, and describes the key areas of focus for Phase 2 of implementation. The report has also been presented at the CCG Strategy & Organisational Development Forum meeting on 4 May 2017.

Mr Fitzgerald requested that the Governing Body note the Phase 1 state of assessment and support the recommendations and work programme for Phase 2 of implementation.

The Governing Body noted the Phase 1 state of assessment and supported the recommendations and work programme for Phase 2 of implementation.

Questions from Members of the Public

Dr Crichton informed the Governing Body that the following questions regarding the Doncaster Place Plan – Ernst & Young Phase 1 Report have been received from Mr Steve Merriman and Mr Doug Wright respectively.

• Page 64 of the Doncaster Place Plan – Ernst & Young Phase 1 Report says “The current governance of the Doncaster Place Plan is not fit for purpose” because of the lack of a formalised Steering Group, Working Group, Joint Commissioning Group or Joint Provider Group. How does this apparently serious assertion fit with the positive tone taken in the CCG report Key Summary which claims “There has been strong engagement with regards to governance processes”?

Mr Fitzgerald explained that Ernst & Young undertook a baseline assessment of current Governance processes and specifically their fitness for purpose toward moving to the future Health and Social care vision described within the Place Plan. The findings, (which were supported across the relevant organisations) were that these would need strengthening and formalising in order to enable the integration

3 approach described. This is true across integrated commissioning with the CCG and Local Authority, and indeed the Accountable Care approach across providers. As described within key summary areas, there has been excellent engagement across organisations to making this move, and this has included key leaders getting into the room with Ernst & Young to work through what arrangements are needed to formulise the governance process required in the “new system”.

At a meeting of the Health & Social Care Transformation Group (a regular meeting of all Chief Executives and leaders of health and social care organisations), Commissioners and the Providers will be describing these arrangements and the timelines for implementation. This will include a proposed revised Governance structure and a suite of Supporting Agreements, which will include Partnership Agreements, Areas of Delegated Authority, Supporting Terms of Reference and risk arrangements. These will clarify the responsibility of the relevant partnership groups and delegated functions. These proposed arrangements will of course be worked through with Governing Body members and brought for ratification before implementation.

Mr Merriman queried if a completion date had been identified and Mr Fitzgerald replied that shadow arrangements will be effective from 1 October 2017 and will be applicable for certain areas only and dependent upon the various Governing Bodies ratification.

• Page 18 of the Doncaster Place Plan – Ernst & Young Phase 1 Report: What is the current total WTE workforce; to what extent will the 8,500 WTE be impacted and how many of the 8,500 are likely to retain their jobs under their present conditions?

Mr Fitzgerald stated that the Doncaster Place Plan vision is centred on bringing frontline health and social care workforce together to collectively respond to the needs of the Doncaster population. It has been clear through assessment work (such as that undertaken in Intermediate Care) that there is duplication, siloed working and indeed gaps across the workforce that we intend to address through the more integrated approach suggested in the Doncaster Place Plan. Currently there are a number of vacancies across health and social care, and areas of workforce where recruitment has traditionally been difficult. The Doncaster Place Plan does not anticipate any job losses for front line staff. However there is an anticipation that as integration of front line teams takes place, job roles will change and develop. Most importantly this will be done with frontline staff – helping to shape the format of these teams. Terms and Conditions is something we will be conscious of, and will learn from other organisations who have undertaken a similar process.

Mr Wright queried if the staff and public had been informed. Mr Fitzgerald explained that there will be a wider element of engagement and communication with both staff and the public and NHS Doncaster CCG will be continuing to engage with the assistance of Healthwatch Doncaster to ensure information is communicated appropriately.

Mrs Hilditch reported that data received from a recent online survey, indicates that NHS Doncaster CCG was a top performer in its engagement with both the public and staff. It would be useful to discuss how Healthwatch can help shape future engagement and the most effective way to involve the 3 rd sector and voluntary groups.

Dr Crichton commented that this is an ongoing process and the report reflects the direction of travel to be undertaken.

8. Quality & Performance Report

Mr Russell and Mr Fitzgerald advised that the Quality and Performance Report was for noting by the Governing Body however wished to highlight the following points:

NHS Doncaster Clinical Commissioning Group (CCG) • 91.27% of patients waiting on an 18 week Referral to treatment (RTT) pathway were waiting less than 18 weeks at the end of March 2017, which is a slight improvement from February 2017. • 97.65% of patients waiting for a diagnostic test were waiting less than 6 weeks at the end of March which is a slight deterioration from

February. • Two week wait cancer performance rose slightly in March to 89.76% although failed for the third month running. NHS Doncaster CCG is working with the Trust to understand capacity and demand and

hospital initiated cancellations. One patient cancelled appointment and one patient chose not to have an appointment within the 2 week waiting time.

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation

Trust (DBTHFT) • A number of stroke indicators deteriorated in February.

Mr Russell informed the Governing Body that the Trust has acknowledged the deterioration in stroke performance and has

presented data and plans and given assurance that the average waiting times to be admitted onto the Stroke Ward is 4 ½ hours against the target of 4 hours. Those patients who are not admitted onto the ward on time commence treatment via outreach and assurance has also been given in respect of Thrombolysis. A meeting is to be

arranged with DBTHFT to share outputs and a ‘Deep Dive’ into the Stroke Unit will be initiated in July. Dr Tupper and Dr Singh will provide clinical input.

Dr Jones stated that as a commissioning organisation we need to be

assured, when commissioning the Hyper Acute Stroke Unit (HASU), the provider organisation is able to provide optimum care for patients. Dr Crichton advised that this will be discussed at the next Joint Committee of Clinical Commissioning Groups and Doncaster is one of the sites being considered as a HASU.

Dr Suckling queried if patient flow will be analysed and Mr Russell confirmed that it would be part of discussions with the Trust.

Delivery Plans Summary

This is the second month that a spotlight report on the Delivery Plans has been presented to the Governing Body. The Summary details the 12 Delivery Plans and measures in conjunction with key messages and indicates improvements made. Further work is required on the recording and timeliness of data, and next month details of the impact on the financial position will be reported.

Miss Morris queried how easy it would be to measure Delivery Plan commissioning against the budget. Mrs Wyatt stated that data is split by specialty and acuity and can be mapped against delivery. It all links to the Quality Innovation Productivity and Prevention (QIPP) target.

Spotlight on Children’s Delivery Plan

Dr Barbour gave a brief introduction to the presentation on the Children’s Delivery Plan and explained that paediatric nursing is currently provided by Rotherham Doncaster and South Humber Foundation Trust (RDaSH) and we are re-configuring financial allocations to include a respiratory nurse. Mr Golze stated that work is ongoing to address the complexity of the pathway and to stem the flow of patients with gastrointestinal problems and strengthen the paediatric rota within the A&E department and ensure patients are seen in the correct place. The Facing Futures is on track and a pilot is being undertaken to ensure a paediatric consultant is available to GP practices

Mr Golze gave the following Children and Maternity update:

Delivery Plan Areas • Improved community provision – care closer to home. • By the right person at the right time.

• Healthy and have a sense of wellbeing. • Excellent experiences of patient care.

Local Update • Place Plan - working with Ernst & Young our strategic partner. • Children and Young People Plan – Young People have been actively involved in the development of the plan which was presented at the Keepmoat Stadium on 23 May 2017. • Integrated commissioning model.

Regional Update • Transforming Care Partnership – Doncaster is leading a number of

workstreams. • Local Maternity System. • Working Together.

• Mental Health – This is high on the agenda. A green paper was received from the Prime Minister. There are more pastoral staff

within schools.

Mrs Hilditch reported that Mr Dennis Atkin is actively working with a specific cohort of children and young people and that she could facilitate a meeting with Mr Golze and Mr Atkin if required. Mrs Hilditch

Dr Suckling enquired when work would be completed regarding Maternity. Mr Golze advised that the submission date is 31 October 2017 after which a mapping exercise will be undertaken with the local maternity support group. Dr Suckling reported that infant mortality is high and further investigation is required to address this. Smoking in pregnancy has decreased by 12%.

Spotlight Report on Intermediate Care Delivery Plan

Mrs Aitchison gave the following update to the Governing Body:

• The Intermediate Care model has been presented to the Governing Body previously and we are currently testing referrals into the new model. • There are 4 key areas: o Increase Step up activities. o Increase community activity. o Simplify offer and access. o Integrate Mental Health. • Measures are under development. There are challenges in obtaining data from other sources. • There is a national audit on Intermediate Care. • The first test of the Rapid Response model has taken place and we are working collaboratively to simplify responsiveness. • YAS and GPs can now refer into the Falls Rapid Response service. • In May 2017 105 referrals were received and 84% of those patients were supported at home thereby avoiding an A&E attendance. 35 follow up phone calls were made to patients and 80% reported that they were helped to keep safer within their homes. Age UK also offer a statutory response, for example dog walking. • Feedback from staff report difficulties regarding the differing IT systems. The ‘Shared Record’ launch will take place next month. • Community Intermediate Care Team (CICT) and Steps are currently working together to design and integrated model offer with one Single Point of Access. • Next Steps – To actively engage with Care homes and introduce referrals into the service from them.

Dr Crichton queried how staff are adjusting to the new model. Mrs Aitchison reported that staff are keen to progress with the project and understand the rationale and strength of working collaboratively. We are working with Co-Create regarding more in depth follow up with those who have progressed through the model and with Healthwatch to gain a better understanding of the needs of Black and Minority 7

Ethnic BME groups.

Patient Story

A short video followed which featured Mrs Jayne Partington, Clinical Team Leader in unplanned nursing and implementation lead for Rapid Response pathway and Katherine, a lady who lives independently however has recently accessed the Rapid Response pathway.

Mrs Partington explained that Katherine’s GP had referred her to the Rapid Response team after she had been feeling unwell and as a result fell at 11pm in the evening. Katherine remained on the floor until 9am the next morning when she was able to shuffle along the floor to alert her neighbour. The Rapid Response team arrived 3 hours later. Katherine was issued with a frame by the physiotherapist and was given a shower stool and bed lever and pendant from social care.

Katherine reported that she now feels safer to maintain her independence at home and endorsed the service.

Dr Tupper commented that we need assurance that significant clinical involvement is available to those patients who may have underlying medical problems which result in a fall and there should be sufficient clinical capacity available to address this going forward. Mrs Aitchison reported that cases are reviewed fully on a daily basis which includes discussions with GPs, Emergency Care Practitioners nurses and first responders. A consultant reviews all cases.

Dr Suckling asked if there were plans to undertake an audit of costs and benefits of the service. Mrs Aitchison confirmed that an audit was currently in progress.

Dr Pieri reported that there a number of GPs who are unaware of the service and the levels of GP knowledge of it may vary. Mrs Aitchison stated that the Rapid Response team will be present at the Doncaster- wide Primary Care event on 29 June 2017 and will be available to answer any questions as part of the ‘Market Stall’ workshop.

Dr Crichton commented that this is an evolving service and lessons will be learned going forward.

Care Home Work Plan

Mr Boldy gave the following presentation on the Care Home Work Plan:

• There are 50 care homes in Doncaster providing 1,924 beds and caring for 1,596 residents at any one time. • There are 43 GP practices, 4 Home Care providers, multiple Community individual clinical visits and multi morbidity and polypharmacy issues. • There has been a total of 2535 A&E attendances of patients from

care homes; this is an increase of 6% during 2016. The majority of attendances occur between 8am and 8pm. • Almost 50% of patients are admitted into hospital – 30% have 0 or 1 day length of stay. 20% of patients have nothing abnormal detected; an 8% rise from 2015. • 18.2% of care homes in Doncaster in the Local Authority have been rated Inadequate or Requires Improvement. • Then main aims of the Doncaster Care Home Strategy is to: o Provide high quality care. o Reduce premature admissions to care homes. o Reduce hospital attendances and admissions. o Reduce out of area complex placements. o Skilled workforce. o Commission for outcomes. • The principles of a successful enhanced care home model is person centred care, co-production, quality and leadership. • The 7 care home element work streams include: o Enhanced Primary Care support. o Multi-disciplinary team. o Reablement & rehabilitation. o High quality care. o Joined up commissioning. o Workforce development. o Data, IT & Technology. • The team have reviewed the Project Board and Terms of Reference and set parameters, and processed and agreed priorities for Year 1. • A work plan is being developed for each priority, looking at best practice and vanguards. • In Years 2 and 3 the aim is to develop a Multi-disciplinary Team approach to wrap around the care home and primary care support. Reablement & Rehabilitation to aim to maximise independence within care setting. Joined up commissioning will enable co- production with providers and networked care homes. All this will be supported with data, IT & Technology.

Dr Tupper reported that care plans are not always in place and benefits would be gained if this was taking place.

Dr Jones advised the Governing Body that Mr Boldy provides detailed reports on Care Homes to the Quality & Patient Safety Committee meetings. His hard and positive work has resulted in impressive collaborative working with the local Authority. Mr Boldy stated that the presentation gave a ‘snap shot’ but did not reflect the investment of the 2 – 3 years work. Dr Tupper reported that work is being undertaken to establish how we can best interact with care homes to ensure their voice is heard.

Dr Crichton commented that the presentation has given the Governing Body some tangible understanding that we are proceeding in the right direction.

9. Chair and Chief Officer Report

Dr Crichton explained that the items included within the report were for information this month however wished to highlight that NHS Doncaster CCG is supporting the Cancer Research UK ‘Walk all over Cancer’ 10,000 steps a day campaign for June. A total of 30 NHS Doncaster CCG staff members have signed up to the campaign and in

the first week has jointly walked the equivalent of John o’ Groats to Land’s End.

The Governing Body noted the report.

10. Locality Feedback

Locality Leads gave the following feedback from their Locality meetings:

North East Locality – Dr Bradley confirmed that no meeting had taken place.

South East Locality – Dr Singh reported that the following item was discussed: • Mrs Sherburn attended the meeting to discuss the GP Five Year Forward View.

South West Locality – Dr Britten confirmed that the next meeting will take place 21 June 2017.

North West Locality – Dr Pieri reported that the following items were discussed: • Dr Alsindi attended the meeting to discuss the GP 5 Year Forward View. • Rapid Response model.

Central Locality – Dr Tupper confirmed that no meeting had taken place.

11. Items to Note

Working Together Joint Committee of Clinical Commissioning Groups Manual Agreement

Dr Crichton explained that the purpose of the Handbook/Agreement is to set out in practical terms how the local health system will work together in both commissioning and providing health services to the public, as well as how it will interact with the delivery of social care. As a first step, local health commissioners have decided to create a joint committee, through which they can both consider and undertake regional wide commissioning decisions. NHS Doncaster CCG is a member of this Joint Committee of Clinical Commissioning Groups (JC

CCG). The JC CCG has the primary purpose of enabling the CCG members to work effectively together, to collaborate and take joint decisions in the areas of work that they agree, by exercising the Joint Functions. The Joint Functions are those set out in the Delegation. The Member CCGs have agreed to delegate functions to the JC CCG in order to enable the Member CCGs to work effectively together, to collaborate and to take joint decisions in those areas of work delegated. The Member CCGs also consider that the delegation of functions will help the CCGs more easily collaborate and take integrated decisions with NHS England in respect of those services which are directly commissioned by NHS England for example specialised services.

Dr Crichton highlighted that an amendment has been made to the Manual to reflect the removal of Hardwick CCG from the JC CCG and requested that the Governing Body note the amendment and approve the Manual Agreement for the Joint Committee of Clinical Commissioning Groups.

The Governing Body noted and approved the Manual Agreement for the Joint Committee of Clinical Commissioning Groups.

Quality & Patient Safety Committee Terms of Reference

Dr Jones presented the Quality & Patient Safety Committee Terms of Reference to the Governing Body for noting and approval and stated that there had been no significant changes to the Terms of Reference. The Quality & Patient Safety Committee has discussed the remit for education and research which has been retained within the remit.

The Governing Body noted and approved the Quality & Patient Safety Committee Terms of Reference.

12. Receipt of Minutes

The following draft minutes were received and noted by the Governing Body:

• South Yorkshire and Bassetlaw Sustainability and Transformation Partnership Collaborative Partnership Board – Minutes of the meeting held on 7 April 2017. • Working Together Joint Committee of Clinical Commissioning Groups – Minutes from the meeting held on 18 April 2017.

13. Any Other Business

Dr Crichton informed the Governing Body that today was Mrs Sherburn’s last Governing Body meeting prior to her secondment to Primary Care Doncaster on 1 July 2017 and extended the Governing Body’s gratitude for her valuable contribution.

14. Date and Time of Next Meeting

Thursday 20 July 2017 at 1:00pm.

12 Verbal

Item 6

Matters Arising

Enc B

Item 7

Children’s Surgery & Anaesthesia

Meeting name Governing Body Meeting date 20 July 2017

Title of paper Children’s Surgery and Non-Specialised Anaesthesia

Executive / Mrs Jackie Pederson, Chief Officer Clinical Lead(s)

Mrs Marianna Hargreaves Author(s) Transformation Programme Lead, South Yorkshire & Bassetlaw Sustainability & Transformation Partnership

Purpose of Paper - Executive Summary

The purpose of the paper is to update the Governing Body on the decision taken by the Joint Committee of Clinical Commissioning Groups and Hardwick Clinical Commissioning Group on Wednesday 28 Jun 2017 to approve the changes to Children’s Non-Specialised Surgery and Anaesthesia services across the region.

Recommendation(s)

The Governing Body is asked to note the update.

Impact analysis Quality impact N/A Equality Full EIA will be part of Business Case stage impact Sustainability Review and Design is necessary for sustainability of these services into impact the future Financial To be completed at Business Case stage implications Legal N/A implications Management of Conflicts of Assessed as part of the proposal Interest Consultation / Engagement (internal Full consultation with stakeholders, patients and public on October 2016 departments, clinical, stakeholder & public/patient) Report previously Strategy & Organisational Development Forum, Governing Body presented at Risk To be completed at Business Case stage analysis Assurance 1.2, 1.3, 4.1, 4.2, 4.3 Framework

Children’s Surgery and Non Specialised Anaesthesia Update

4th July 2017 1. Purpose

The purpose of this brief is to update Governing Bodies on the decision taken by the Joint Committee of Clinical Commissioning Groups and Hardwick Clinical Commissioning Group on Wednesday 28 th June to approve the changes to children’s non specialised surgery and anaesthesia services across the region.

2. Summary

A decision was made by the Joint Committee of Clinical Commissioning Groups and Hardwick Clinical Commissioning Group to approve the decision making business case for children’s non specialised surgery and anaesthesia on Wednesday 28 th June.

Over the last three years clinical commissioners and hospital trusts providing services in Barnsley, Bassetlaw, Chesterfield, Doncaster, Rotherham and Sheffield have come together to review and improve the care and experiences of all children needing an emergency operation in our region.

By working together better across all hospitals and commissioning organisations, new ways of working have been developed which means the number of children affected by these changes reduced significantly since the launch of the consultation in October 2016 and this has given staff working in the services more opportunities to improve and enhance their skills.

Approval of the preferred model enables the majority of surgery to continue to be delivered locally and the development of three hubs, Doncaster Royal Infirmary, Sheffield Children’s Hospital and Pinderfields General Hospital in Wakefield.

The decision means that once implemented around one or two children per week needing an emergency operation for a small number of conditions, at night or at a weekend, will no longer be treated in hospitals in Barnsley, Chesterfield and Rotherham and will instead have their surgery at Doncaster Royal Infirmary, Sheffield Children’s Hospital or Pinderfield’s General Hospital where the right staff, with the right skills, will be available 24 hours a day, seven days a week. The service at Bassetlaw Hospital will remain the same as it already does not provide acute surgery for children out of hours.

3. Next Steps

Now the decision has been taken a mobilisation plan is under development. It has been agreed with CCG Accountable Officers that implementation will be taken forward within existing commissioning and contracting arrangements. Work is already underway to progress the designation process and further develop the managed clinical network to enable operational delivery. It is anticipated that the implementation will commence from quarter four 2017/18 onwards.

Enc C

Item 8

South Yorkshire & Bassetlaw Sustainability & Transformation Plan Memorandum of Understanding

Meeting name Governing Body Meeting date 20 July 2017

South Yorkshire & Bassetlaw Sustainability & Title of paper Transformation Plan Memorandum of Understanding

Executive / Mrs Jackie Pederson Clinical Lead(s) Will Cleary-Gray, Director South Yorkshire and Author(s) Bassetlaw Sustainability and Transformation

Purpose of Paper - Executive Summary

The Memorandum of Understanding is presented for agreement to support the direction of travel by the Governing Body.

Recommendation(s)

For agreement to support the direction of travel by the Governing Body

Impact analysis Quality impact Nil Equality Neutral impact Sustainability Nil impact Financial Nil implications Legal N/A implications Management of Conflicts of Conflicts of Interest managed as part of the proposal Interest Consultation / Engagement (internal Full consultation with stakeholders departments, clinical, stakeholder & public/patient) Report previously Strategy & Organisational Development Forum, Governing Body presented at Risk N/A analysis Assurance 3.1, 4.3 Framework

South Yorkshire and Bassetlaw Accountable Care System PMO Office: 722 Prince of Wales Road Sheffield S9 4EU 0114 305 4487

23 June 2017

Letter to: South Yorkshire and Bassetlaw Accountable Care System Chief Executives

Dear Colleague

Re: South Yorkshire and Bassetlaw Memorandum of Understanding

Following discussions at our boards, governing bodies and in council meetings on the draft Memorandum of Understanding (MoU) for South Yorkshire and Bassetlaw (SYB), I am pleased to attach the revised, final document. The final version takes into account your comments and feedback and reflects the changes you requested. In addition to the changes, you also raised questions about some of the detail in the MoU and involvement of your organisation and Place in how the processes might develop. These are now incorporated in a separate document which will be shared with you and we will be working through these important questions in the next phase and as our Accountable Care System (ACS) matures. If we are to achieve our ambitions, then we must always start with Place, allowing local areas to flourish as we collectively take on the challenges across our System. I would like to reiterate that the MoU does not replace the legal framework or responsibilities of our statutory organisations but instead sits alongside the framework to complement and enhance it. I would also draw your attention to your role within the Agreement. As a core partner, you are a ‘party to’ the Agreement ‘Parties to’ have majority relationships (patient flows and contracts) within and across SYB and you are signing the agreement to be part of the emerging ACS in SYB. You will be subject to delegated NHS powers and a new relationship with other Parties, with both of the NHS regulators and are assured a package of support to transform health and care. Your feedback and questions have been extremely valuable and as well as strengthening the document, will continue to shape our direction. I would like to thank you and your executive, non executive, lay colleagues and members for getting us to this point. The documents reflects a point in time. We are still in negotiation with NHS England and NHS Improvement and the Arms Length Bodies on our MoU and are looking to take it to the 12 July Collaborative Partnership Board with a view to having support by the end of July.

The nature of our collective governance cycle means that it has taken us some weeks to get to this milestone but I am sure you will agree that it has been a thorough and valuable process. Our success to date is undoubtedly down to the strong relationships that exist between us and a proven history of working together. As we continue on our journey, we are building on very strong foundations and I look forward to working with you as we strengthen our position to bring about better health, care and life chances for the people of South Yorkshire and Bassetlaw. We will be communicating about the ACS and our plans more widely in September and so the ask is that you now seek support for the direction of travel with your board, governing body and council meetings by the end of July.

Yours sincerely,

Sir Andrew Cash ACS Lead

Health and Care Working Together

South Yorkshire & Bassetlaw Accountable Care System

Memorandum of Understanding ‘Agreement’

June 2017

Title Memorandum of Understanding for South Yorkshire and Bassetlaw Sustainability and Transformation Partnership Drafting coordinator Will Cleary-Gray Target Audience SYB Collaborative Partnership Board Membership, Place Partnership and Boards, statutory organisation Boards, Governing Bodies, Councils, NHS England, NHS Improvement and the ALBs and the Department of Health Version V 0.3 Created Date 10 April 2017 Date of Issue Document Status Final Draft for adoption by local governance To be read in conjunction with Health and Care Plan Submission, November 2016, 5 Place Plans, individual statutory organisational plans and 5YFV Delivery Plan – next steps Document History:

Date Version Coordinating Details Author (s) 10 April 2017 0.1 Will Cleary-Gray Creation of document 28 April 0.2 Will Cleary-Gray Updated following CEO / AO Timeout on 28th April 2017 15 June 0.3 Will Cleary-Gray Updated following feedback from Boards, Governing Bodies and Councils Foreword from STP lead 23rd June 0.4 Will Cleary-Gray Initial feedback from CPB members

Approval by:

Foreword This document has been developed with South Yorkshire and Bassetlaw Health and Care partners. It is not a plan or a legal contract. We have already published our Plans across the five local Places and system in South Yorkshire and Bassetlaw. At the same time, each of our individual organisations has contracts in place. It does not replace the legal framework or responsibilities of our statutory organisations but instead sits alongside the framework to complement and enhance it. This document recognises the complexity of how health and care organisations currently work and interact together to provide the best possible care and services. It is also mindful of how health and care organisations are coming together to form partnerships locally in place; integrating health and care, commissioning and providing, including voluntary, community, GP, mental health and hospital services. At the same time, some of those same organisations have formed partnerships and are coming together across South Yorkshire and Bassetlaw to plan and commission strategically to ensure safe, sustainable and equitable acute services. In short, we are seeing increased collaboration, joint planning and integration of services that are focused entirely on bringing the greatest benefits to our population.

It is a complex picture and one which we must work through together as we continue to focus on what matters – the people in the populations we serve. This means constantly reviewing our approach, together with our staff, patients and citizens. We will also continue to build trust between us, working through what is best for our populations while using best practice where it exists and national guidance and support where we need it.

This document summarises and sets out our shared commitment to continue to work together on improving health and care for the people of Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield and collectively South Yorkshire and Bassetlaw. We still have much to work through and our plans and our approaches to delivering them continue to evolve.

This is our best assessment for 2017-19 on how we will work together, what we will work on and what we need to accelerate our vision and plans – the ‘Give’ and ‘Get’ which lies at the core of this MoU.

As we are in transition it is helpful to clarify how we are using terminology and acronyms for the purposes of this document. Sustainability and Transformation Plan (STP), Accountable Care System (ACS) and South Yorkshire and Bassetlaw Health and Care Partnership (SYB) are used throughout and they refer to the same thing – our SYB Partnership and our collaborative approach.

Sir Andrew Cash, ACS Lead

Contents

1. Introduction and Context ...... ………. 5 2. Parties and Partners ...... 7 3. Scope...... 8 4. System objectives ...... 9 5. Overarching principles ...... 11 6. Direction of travel and key milestones ...... 11 7. Governance, accountability and assurance ...... 13 7.1. Principles and underpining assumptions ...... 14 7.2. NHS assurance, regulation and accountability ...... 14 7.3. Quality and safety ...... 15 7.4. Financial ...... 15 7.5. Operational ...... 16 7.6. Shadow Accountable Care System ...... 16 7.7. ACS governance ...... 17 7.8. Joint Committees and Committees in Common (CiC) ...... 18 7.9. Place and accountable care development ...... 19 8. Delivery improvement 2017-18 /19 ...... 19 8.1. Efficiency programmes ...... 20 8.2. Managing demand and optimising care ...... 21 8.3. General practice and primary care ...... 21 8.4. Urgent and emergency care ...... 22 8.5. Mental health and learning disabilities ...... 23 8.6. Cancer ...... 23 8.7. Children’s and maternity services ...... 24 8.8. Workforce ...... 25 8.9. Digital and IT ...... 25 8.10. Development of accountable care in Place and System ...... 26 8.11. Commissioning reform ...... 26 8.12. Specialised services...... 27 8.13. Hospital services review ...... 28 9. National and regional support from NHS England, NHS Improvement and the Arms Length Bodies ...... 28 9.1. Capacity and capability ...... 28 9.2. Financial including capital ...... 28 9.3. Peer support (STP exemplars) ...... 29 10. Glossary…………………………………………………………………………………………………………………………… 30

1. Introduction and context

1.1. This document has been developed with South Yorkshire and Bassetlaw Health and Care partners. It is not a plan or a legal contract. We have already published our Plans across the five local Places and system in South Yorkshire and Bassetlaw. At the same time, each of our individual organisations has contracts in place. 1.2. It does not replace the legal framework or responsibilities of our statutory organisations but instead sits alongside the framework to complement and enhance it, setting out the framework within which our organisations will come together to establish how we will develop as an Accountable Care System. 1.3. South Yorkshire and Bassetlaw has five strong health and social care communities of Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield which have a long history of working together in each local Place and across South Yorkshire and Bassetlaw (SYB) to achieve positive change and improvements for local people. 1.4. The links between poverty and ill health are well established and are the driving force behind our joint working. Creating jobs, ensuring availability of affordable, good quality housing and targeting resources towards areas of greatest need and reducing inequalities are all important to reduce poverty and improve our health and wellbeing.

1.5. Our collective and collaborative approach is increasingly focused therefore on prevention, integration, physical and mental health and crucially, co-production with citizens and communities; addressing the wider determinants of health together. These are inextricably linked and include:  Employment, opportunity and business  Adult and child health and social care, enabling independence  Raising levels of education and skills to improve opportunity  Safe, clean and green environment  Life chances for all 1.6. Each health and social care organisation in each Place already has plans which have been developed in partnership and in some cases, for example the Better Care Fund Plan, these plans are jointly owned between health and social care. 1.7. There is a shared view that in order to transform our services to the degree required to achieve excellent and sustainable services in the future, we need to have a single shared vision and single shared plan both for each Place and for South Yorkshire and Bassetlaw. For this reason, leaders from across health and social care in each Place have come together to develop a single shared vision and single shared plan which has resulted in Place Plans and the SYB Plan. 1.8. South Yorkshire and Bassetlaw is therefore in a good position with a single shared vision and plan in each Place. This is made possible by the commitment and significant contributions of each constituent organisation. 1.9. This puts each of our localities, and system as a whole, in a strong position to develop and realise an ambitious set of health and social care services for our patients and service users; ensuring the best possible quality of care within available resources. 1.10. In developing a joint vision and plans in each Place, we intend to maximise the value of our collective action and, through our joined up efforts, accelerate our ability to transform the way we deliver services. Our Plans are not starting from scratch or replacing individual partners’ plans- they build on existing plans, taking a common view and identifying areas where it makes sense for us to work together and collaborate.

1.11. Central to these ambitions is developing different relationships with each other in Place, across the system and with those that assure and regulate our health services. This will enable us to focus on integrating health and social care services and ensuring safe, sustainable and equitable hospital services for everyone. 1.12. We are committed to ensuring citizens and staff have the opportunity to be involved in conversations to help shape the direction of travel in the ACS and in Place. This ranges from their role in wellness, prevention and self-care; identifying what’s important to the them in the delivery of services; as well as more specific consultation about service changes; and on the ongoing transparency and opportunity for them to hold us to account for delivery. 1.13. A key test of our new relationships will be the extent to which we adopt, as a first principle, an altruistic approach to each other as partners ‘working as one’. How we respond as partners in times of need will be crucial and we must always put the needs of individuals, patients and the public first. 1.14. This document sets out how we propose to organise ourselves to provide the best health and care, ensuring that decisions are always taken in the interest of the patients we serve. It allows us to push even further beyond organisational need and allows us to build on working together in each Place and working together across SYB - to take collective strategic decisions across the whole of South Yorkshire and Bassetlaw to lift the standard of care no matter where people live or the organisation charged with planning or delivering care. 1.15. South Yorkshire and Bassetlaw set out its strategic ambition and priorities to improve health and wellbeing for all local populations in the Health and Care plan published in November 2016, together with how this will be implemented in each of the five Place Plans across Bassetlaw, Barnsley, Doncaster, Rotherham and Sheffield. 1.16. Following publication of the Next Steps in the Five Year Forward View, South Yorkshire and Bassetlaw has been confirmed as a high performing system and named as one of the eight Accountable Care Systems nationally. This means being supported centrally with additional funding, capacity and capability to be able to have more local control over health and care resources and in the delivery of transformational changes to services for people of South Yorkshire and Bassetlaw. This ability to have more local control is mainly reflective of the potential devolved responsibilities from health, its regulatory and assurance framework and health funding and resources. 1.17. This ‘Agreement’ sets out the framework within which our partner organisations, including NHS England and NHS Improvement will come together ‘working as one’, in 2017/18 to establish how South Yorkshire and Bassetlaw will develop as an Accountable Care System. We will agree together the delegated powers and new relationships we adopt between partner organisations, health regulators and health assurers to better achieve ambitions set out in the Plan and five Place plans. 1.18. The MoU sets out the approach to collaborative working and ambition to work as a shadow Accountable Care System in 2017/18, together with key milestones to move to a full ACS in 2018/19. SYB will engage with NHS England centrally, the Department of Health and the national Arm’s Length Bodies (ALBs) to work through in 2017/18 how and what devolved NHS powers it will receive in 2018 as an Accountable Care System and which will be reflected in and subject to separate and specific agreements both with NHS England and local statutory organisations. Throughout this process we will be mindful of the legal duties placed on each partner organisation. 1.19. This ‘Agreement’ should be read in conjunction with the Plan, published in November 2016 and the five local Place plans across South Yorkshire and Bassetlaw. It should be viewed as a framework to enable collaborative working, secure central funding and support new

relationships with Arms Length Bodies (ALBs) in the pursuit of becoming an ACS to better deliver improved health and care for the population of South Yorkshire and Bassetlaw. 1.20. This ‘Agreement’ recognises the importance of integration of health and social care in each Place and that this will be an important factor in working through how the emerging Accountable Care Partnerships - which are being developed in each Place across partners and complement the ACS - develop to deliver improved care.

2. Parties to and partners in the Agreement 2.1. In developing this Agreement consideration has been given to the different relationships with constituent member organisations within the SYB ACS and the different relationship that organisations may wish to have with it. There are many partners working together - NHS and non NHS including local authorities and the voluntary sector each have respective governance, accountabilities and in many cases regulation responsibilities. 2.2. It is accepted that not all partners would want to be subject to many aspects of this agreement or indeed it would not be appropriate. NHS England and NHS Improvement have assisted SYB to establish clarity on which organisations should be Parties to and which might be Partners in this Agreement in context of NHS governance, accountability, regulation and assurance. For clarity, collectively, Parties to and Partners in are all members of the SYB Collaborative and its associated Partnership Board. 2.3. STP geographies were, in the large part, nationally defined. Core and associate partner terminology has been established over the course of developing the Plan to describe different partners and to support a wide and diverse partnership and to enable cross geographical boundary relationships and working. 2.3.1. For the purposes of this MoU core partners (‘Parties to’ the MoU) are NHS partners who have the majority relationships (patient flows and contracts) within and across SYB while Associate partners (‘Partners in’ the MoU) have majority relationships (patient flows and contracts) as core members of neighboring STPs, and relationships in SYB generally confined to a Place or Accountable Care Partnership (ACP). Associate partners are also likely to be subject to collaborative agreements in neighboring STPs or local ACP and receive support consistent with respective STPs. For clarity, collectively, ‘Parties to’ and ‘Partners in’ are all members of the SYB Collaborative and its associated Partnership Board 2.3.1. In the case of Chesterfield Royal Hospital NHS Foundation Trust, the trust became a core member in the partnership on the basis of its strong history of clinical networks within and across South Yorkshire and Bassetlaw including the Cancer Network and more recently the Cancer Alliance and its history of collaboration with acute trusts as part of the Acute Vanguard, resulting in significant acute flows into SYB. Early on in the plan development process, formal representation was made to NHS England and NHS Improvement jointly between the Partnership and Chesterfield Royal Hospital NHS FT for it to become a full partner in SYB which was supported. 2.3.1. It is recognised that Chesterfield sits within a neighboring STP and likely that it may be subject to agreements with the neighboring STP which will need to be worked through to establish the medium and longer term relationships with SYB ACS which may change. There may also be changes to the way other oragnisation engage in the MoU as we develop and mature as an ACS. This also applies to emerging organisations, federations and legal partnership including primary care federations and therefore we will need to review as we develop. 2.4. It is anticipated that Parties ‘to’ will sign the agreement as an emerging ACS in SYB, be subject to delegated NHS powers and a new relationship with each other, with both NHS regulators and assures and package of support to transform health and care.

2.5. It is anticipated that Partners ‘in’ will support the direction of travel and work in partnership with SYB ACS. In some cases they may be subject to separate agreements in neighboring ACS and aligned agreements in ACP in Place within SYB. 2.6. The Parties to this agreement are: 2.6.1. Commissioners  NHS Bassetlaw Clinical Commissioning Group  NHS Barnsley Clinical Commissioning Group  NHS England  NHS Doncaster Clinical Commissioning Group  NHS Rotherham Clinical Commissioning Group  NHS Sheffield Clinical Commissioning Group 2.6.2. Healthcare Providers  Barnsley Hospital NHS Foundation Trust  Chesterfield Royal Hospital NHS Foundation Trust  Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust  Sheffield Children’s Hospital NHS Foundation Trust  Sheffield Teaching Hospitals NHS Foundation Trust  The Rotherham NHS Foundation Trust  Sheffield Health and Social Care NHS Foundation Trust  Rotherham, Doncaster, South Humber NHS Foundation Trust  Yorkshire Ambulance Service NHS Trust 2.6.3. Heath Regulator, Assurer, Education and Training  NHS England  NHS Improvement  Health Education England  Public Health England 2.7. The Partners in this agreement are: 2.7.1. Local Authority partners  Barnsley Metropolitan Borough Council  Doncaster Metropolitan Borough Council  Nottinghamshire County Council / Bassetlaw District Council  Rotherham Metropolitan Borough Council  Sheffield City Council 2.7.2. Provider partners  Nottinghamshire Healthcare NHS Foundation Trust  South West Yorkshire Partnership NHS Foundation Trust  East Midland Ambulance Service NHS Trust  Doncaster Children’s Services Trust

3. Scope 3.1. The scope of South Yorkshire and Bassetlaw’s transformational plan covers all aspects of health and care, specifically:  Public health  Social care  Primary care (including GP contracts)

 Community services  Dental and screening services  Mental health services  Acute services  Specialised services  Research and development  Health education and innovation  Governance  Assurance  Regulation  Resources and finance  Capital and estate  Information sharing and digital integration  Workforce  Communication and engagement 3.2. Key enablers to include:  Appropriate governance and regulation  Delegation of resources from relevant national partners in line with the delegation of statutory functions  Access to fiscal and regulatory levers that enable the improvement of health and wellbeing outcomes through wider determinants e.g. education, employment etc.  Empowered system leadership, supported by effective governance and accountability arrangements  A shared strategic approach to capital and estates planning  A shared strategic approach to communications and engagement  A shared strategic approach to workforce planning (clinical and non-clinical)  Development of new payment mechanisms that remove perverse incentives and encourage/ support new models of care  Development of new information sharing system/ processes 3.3. Operating as a shadow ACS through 17/18, will require flexibility in terms of ways of working. As a result, it is expected that the scope will remain fluid over this time period, to allow arrangements to be tested and amended as required to secure the optimal outcomes.

4. System objectives 4.1. In our STP submission we set out the objectives for the SYB systems aligned to the dimensions of the triple aims of the STP. These are summarised below: 4.2. The parties share the following system objectives 4.3 Care and quality  Joined up, high quality services across hospitals, care homes, general practices, community and other services  Easy and convenient access to services across settings and times of day  Greater availability of services closer to home  Better quality, more specialised hospital based care  Greater availability and variety of non-health services that enhance people’s health

4.4 Health and wellbeing  Better support for individuals in relation to physical and mental wellness and prevention  A wider variety of healthy living schemes aimed at all communities within the population  Active networks and links that connect people across communities and provide support  Greater collaboration across the public sector relevant to the wider determinants of health

4.5 Finance and sustainability  High quality, efficient services which provide good value for money for tax payers  Reduced waste and greater efficiency in service delivery  Greater use of available funding in enabling individuals to stay well and providing care closer to their homes  A workforce and service that works flexibly to respond to individual needs and how people live locally, ensuring that the right skills and services are present in the right place and the right time

4.6 The NHS Constitution and Mandate sets out clearly what patients, the public and staff can expect from the NHS. SYB wants to build upon the rights and pledges of the Constitution and provide further opportunities for patients and the public to be involved in the future of their NHS - building on the Plan and the early conversations we have had with the citizens, patients and staff on these ambitions during February and March 2017.

4.7. The NHS Next Steps on the Five Year Forward View articulates why change is urgently needed, what that change might look like and how it can be achieved. It describes various models of care which could be provided in the future, defining the actions required at local and national level to support delivery. It sets out the development of new models and SYB is committed to being an early implementer and a test bed for new, innovative approaches of:

a. An Accountable Care System across SYB, with devolved freedoms, accountabilities and responsibilities and new relationships with member organisations, including NHS England, NHS Improvement and the ALBs b. A closer relationship between commissioning and providing, integrating and aligning approaches to strategic planning and transformation of services c. Accountable Care Partnerships with providers across SYB, delivering new models of acute and specialist care d. New models of commissioning at system level for acute services, reducing variation and duplication and minimising transactional activity e. Operating and managing a system control total for health f. Accountable Care Partnerships in each local Place delivering integrated health and social care aligned to an overall SYB ACS

4.8. SYB needs to develop different relationships and have freedoms and responsibilities to optimise its potential. This Agreement builds the collaborative partnership established to develop the Plan, creates the platform for SYB to build on these to implement its ambitions through the invitation to SYB commissioners and providers to develop an emerging ACS.

5. Overarching principles 5.1. In the documents that were submitted as part of the STP submission on 21 October 2016, STP partners made a commitment to upholding the principles summarised below:  Improving quality and outcomes - As a system, partners will work collectively to improve quality and population outcomes for people and reduce health inequalities for all of our local populations.  ‘No worse off’ principle – Decision making will be focused on the interests of people in SYB and our collaborative partnership will work to ensure those interests are served. We will ensure that our collective working and decisions do not lead to increased health inequalities or a worsening of health outcomes for any of our populations across SYB  Inclusiveness - All stakeholders (including commissioners, providers, patients, carers and partners) will be included in decision making and empowered to shape the system as it continues to develop. This will require active and sustained communications and engagement, informing and involving people early and in ways that allow them to get involved and help shape the direction of travel as we tackle the challenges  Participation - SYB will be involved in all decisions that materially impact on the health and care provided to its population or by its local partners  Integration - Partners will work to support improvements in outcomes through increased integration  Subsidiarity - Partners will work to support delegation of decision making to the most appropriate level, subject to robust governance and accountability mechanisms  In the NHS family - Healthcare services in SYB will remain part of the NHS. All the commitments described in this Agreement aim to (i) strengthen health and care in SYB and (ii) uphold the NHS values and standards  Transparency - Decision making will be underpinned by transparency and open information sharing between and amongst local and national partners  Co-production - National partners will take a co-production approach with SYB, in which decision making is facilitated by national partners to devolve and by local partners to ‘receive’ and deliver delegated functions  Form aligned to function - the delivery of shared outcomes will drive changes to organisational form where appropriate  Wider system (NHS) focused - Further delegation decisions will continue to be subject to consideration by national partners. o Local partners commit to working with national partners to ensure alignment between national policy objectives and the strategic direction taken locally. o Local partners will continue work to support nationally agreed priorities, including those set out in the Five Year Forward View.  Accountability - All organisations will retain their current statutory accountabilities for health and social care and any commitments made will remain subject to organisations’ continuing ability to meet these accountabilities.

6. Direction of travel and key milestones 6.1. This document outlines our desire, individually and collectively, to achieve our vision of health and care in SYB. A significant amount of work has been delivered through working together locally to progress the system to its current state. However, we know that more work remains to be done and that a clear roadmap, agreed with all parties, will provide a clear and transparent way forward. We will continue to work together as local partners and with national colleagues to define the specific mechanisms and timescales associated with any further delegation of responsibilities and associated funding. Delegation of functions

from national partners to local partners on behalf of the “system” will take place in a series of agreed steps, the speed and scale of which will likely be determined by:  The achievement of assurance criteria determined by national partners  Demonstrated capability  The strength/ appropriateness of governance arrangements  The clarity of the delivery plan  Suitability of gateway milestones 6.2. This approach will ensure that the system will only take on greater responsibilities and powers when it has the capability and resources to manage them appropriately.

Key milestones in the process include:  By end July 2017, an MoU Agreement between SYB Parties giving the Framework by which SYB will ‘work as one’ to develop as an Accountable Care System and implement its Plan.  By September 2017, taking staff and public feedback into account, we will refresh and rebrand the STP from a communications and engagement perspective to reflect becoming an ACS and what this means for the future of health and care  By September 2017 we will agree a delivery plan for 2017/19 for SYB ‘working as one’ to include priority areas including urgent and emergency care, primary care, mental health and learning disabilities and cancer to demonstrate delivery and enable testing of key ACS objectives outlines in 4.7.  By September 2017, governance and an approach for agreeing and monitoring investment decisions within the ACS will be agreed  By the end of October 2017, with capital and transformation funding, we will agree how we will operate a system control total for health in 18/19  By end October 2017, we will agree a new NHS single oversight and assurance framework for SYB to be operational by April 2018 with aligned resources to support an integrated SYB ACS oversight and assurance function which will work with streamlined regional and national oversight arrangements.  By end of October 2017, we will agree system and place commissioning responsibilities for agreed functions and services to enable alignment for ACPs to focus on new ways of contracting and allocating resources including population budgets, population health management and segmentation approaches for Place tier 0 - 1 and a system commissioning function for tier 2 and 3 services (all to be agreed).  By April 2018, we will agree governance and approach for delivery of tier 2 services following the hospital services review outcome to support a horizontally integrated accountable network of hospital based services.  Each of the five Places has confirmed they wish to continue to develop their Accountable Care arrangements and it is anticipated that these will be in shadow form in 2017/18.  By October 2017, SYB ACS will be ‘working as one’ with NHS England and NHS Improvement and working with ACPs in shadow form to provide support so that they will be legally constituted partnerships by April 2018 (at the latest).

7. Governance, accountability and assurance 7.0.1. This MoU does not replace the legal framework or responsibilities of our statutory organisations but instead sits alongside the framework to complement and enhance it. It recognises the complexity of how health and care organisations currently work and interact with each other to provide the best possible care and services. 7.0.2. Our health and care organisations are already coming together to form partnerships in Place; integrating health and care, commissioning and providing, including voluntary, community, GP, mental health and hospital services. These are taking varying forms and the governance and how this best supported in an overall ACS will be a key priority in 2017/18 and will be an area for which we will receive national guidance and support.

7.0.3. At the same time, some of these same organisations are forming necessary partnerships and coming together across South Yorkshire and Bassetlaw, either our hospitals, to ensure safe, sustainable and equitable acute services as a ‘group of hospitals’ or our health commissioners to make consistent strategic planning and commissioning decisions as a system commissioner. In all of this, how the traditional separation between health commissioning and providing and the focus on competition is giving way to a focus on collaboration and integration.

7.0.4. All of this ‘pushes’ at the boundaries of the existing legal frameworks but other systems have found ways to work where there is evidence that it better serves to make improvement to the populations we serve.

7.0.5. Current statutory requirements for CCG assurance 7.0.5.1 NHS England has a duty under the NHS Act 2006 (as amended by the 2012 act) to assess the performance of each CCG each year. The assessment must consider, in particular, the duties of CCGs to: improve the quality of services; reduce healthy qualities; obtain appropriate advice; involve and consult the public; and comply with financial duties. The 2012 Act provides powers for NHS England to intervene where it is not assured that the CCG is meeting its statutory duties. 7.0.5.2 NHS England must publish a report each year which summarises the results of each CCG's assessment. The detail of the CCG assurance framework which underpins the publication is NHS England policy rather than set in statute or regulation.

7.0.6. Current statutory requirements for Foundation Trust oversight 7.0.6.1. NHS Improvement (NHSI - the operational name which brought together Monitor and the Trust Development Authority (TDA) and their associated teams on 1 April 2016) has a duty under the NHS Act 2012 to ensure the operation of a licensing regime for Foundation Trusts (and other providers of NHS services). The licensing regime covers requirements on FTs in relation to: general conditions; pricing; choice and competition; integrated care; continuity of services; and governance. The 2012 Act provides powers for NHS improvement to enforce or set conditions on a provider’s license. 7.0.6.2. The licensing regime is underpinned by the NHS Improvement Single Operating Framework which aims to help providers attain and maintain CQC ratings of good or outstanding. The framework is NHS Improvement policy rather than set in statute regulations.

7.1 Principles and underpinning assumptions 7.1.1. The Agreement is drafted by all Parties including NHS England, NHS Improvement and the ALBs where this is appropriate. The Agreement is intended to be flexible to achieve the right balance of ‘Give’ and ‘Get’ - financial, capacity, capability or devolved freedoms and flexibilities in return for improved delivery, operational, financial, quality, and transformational change. 7.1.2. There will be continual engagement and consultation with Boards, Governing Bodies and Councils throughout development. ACSs are not statutory bodies - they supplement accountabilities of individual statutory organisations. 2017/18 will be the first phase of SYB ACS and statutory organisations will continue with statutory accountabilities and relationships with NHS England and NHS Improvement, which will retain legal responsibility for CCG assurance and FT oversight respectively.

7.1.3. From September 2017, SYB Health and Care Partnership will adopt the ‘Working Together’ brand and as such will continue to deliver NHS Constitution and Mandate commitments in full and remain part of the wider NHS System. The Health and Care Working Together Partnership will deliver the FYFV ambitions through the development of an Accountable Care System with five constituent Accountable Care Partnerships and implementation of its Health and Care Working Together Plan (October 2016, revised April 2017) and five Place Plans.

7.1.4. The development of the Accountable Care System during 2017/18 will establish how individual organisations will be held to account for their contribution to the delivery of NHS Constitution and Mandate and the Health and Care Working Together Plan. Each of the five Places has confirmed they wish to continue to develop their Accountable Care arrangements and it is anticipated that these will be in shadow form in 2017/18. What constitutes ‘shadow’ is to be worked through and to be discussed and agreed with statutory organisations. SYB ACS ‘working as one’ with NHS England and NHS Improvement will work with ACPs providing support where required, especially where ACPs look to move to legal forms.

7.1.5. Operational management of the assurance and oversight processes will be through SYB working together and we will deliver the principles of the two national frameworks with a locally developed model with an integrated single oversight and assurance process within the ACS.

7.1.6. SYB will be assured once, as a place, for delivery of the NHS constitution and mandate, financial and operational control and quality.

7.2. NHS assurance, regulation and accountability 7.2.1. We would expect to move to a SYB relationship with NHSI and NHSE providing a single ‘one stop shop’ regulatory relationship with NHSE and NHSI in the form of streamlined oversight arrangements. An integrated CCG Improvement Assessment Framework (IAF) and Trust single oversight framework. CCGs will still require an annual review with NHSE. This will be in place from April 2018.

7.2.2. Single Accountability Framework Within 2017/18, SYB working with NHS England and NHS Improvement will establish a Single Accountability Framework (SAF) which brings together the NHS England CCG Assurance

Framework and the NHS Improvement Single Operating Framework at a local level. The SAF will be implemented from 1 April 2018 and will set out:  The roles and responsibilities of the parties to this Agreement (CCGs, providers, NHS England and NHS Improvement)  The scope of the SAF including NHS constitutional commitments, national targets, quality indicators and productivity measures  The internal governance, assurance and reporting system within SYB to support delivery of the SAF  The external assurance and reporting system for SYB to NHS England and NHS Improvement  The agreed trigger points and process where NHS England and NHS Improvement may exercise their statutory responsibilities for intervention.

7.2.3. The Single Accountability Framework will operate in shadow form within 2017/18. In shadow form, its scope will reflect the priorities of SYB (for example, cancer and urgent & emergency care). 7.2.4. The scope of the SAF will widen as the ACS matures until it covers the full range of NHS responsibilities. The timeline for the development of the scope of the SAF will be agreed between the Parties to the Agreement. 7.2.5. In 17 / 18 we will align NHS England and NHS Improvement functions and resources to support delivery of the ‘integrated within SYB ACS’ element of the Single Accountability Framework.

7.3. Quality and safety 7.3.1. South Yorkshire and Bassetlaw has a well established quality and safety approach at, organisation, Place and System level. Very much of what is described in this MoU is about improving quality and safety. This is both through our organisations choosing to work together on common challenges and on those issues which are most in need of a different way of working or most likely to deliver improvements through our joint efforts. 7.3.2. We commit to reviewing our approaches in light of developing as an ACS in 2017/18 to ensure our quality and safety oversight and assurance best supports how we are coming together in Place, as emerging ACPs and across SYB as an overall ACS. 7.3.3. There is growing evidence that the improvements we are aiming to achieve within our plan will give measurable improvements in quality ahead of any financial efficiency improvements. We would therefore want to develop clear quality metrics for SYB to enable us to track these quality improvements.

7.4. Financial 7.4.1. There are a number of areas that the ACS wishes to develop in conjunction with NHS England and NHS Improvement to support robust governance, accountability and assurance. The proposals will be developed through the SYB Directors of Finance Steering Group and ultimately approved by the Collaborative Partnership Board. The areas to be considered are outlined below.

7.4.2 How a system control total would work across the ACS? This would focus on the following areas:  How to create in year flexibilities including the potential use of a contingency or other specific business rules?  How to reflect the impact of an agreed transformational scheme which differentially impacts organisational financial performance?  Consideration of Place based control totals?  Consideration of monitoring, management and reporting arrangements?  Whether a set of efficiency indicators could be used to inform the application of a system wide control total?

7.4.3 Consideration of moving to a risk based approach to contracts? Consideration will be given to developing a risk based approach to contracts where risks are identified and aligned to the organisation best placed to manage the risk and which supports the development of a system wide solution. 7.4.4 Investment decisions and business case development? Agreeing a process to ensure investment decisions are optimal for the ACS footprint and are consistent with the ACS strategy. This will include a process on how any additional capital, transformation and any other external funding can be best deployed across the ACS. Developing a process to agree financial principles and assumptions to be used in ACS business cases 7.4.4 Agreeing a process for business planning, financial reporting and performance To develop an ACS business planning process including agreement to a consistent set of planning assumptions, where appropriate, and taking into account national guidance. To develop in partnership with NHS England and NHS Improvement a monthly ACS report which covers both financial performance and performance against key operational targets.

7.5. Operational 7.5.1. In 2017/18 and as part of our approach to developing an integrated single oversight and assurance approach within SYB, we will review operational assurance and oversight including our approach to planning and delivery assurance so that it is integrated within SYB. We will also align NHS England and NHS Improvement functions and resources.

7.6. Shadow Accountable Care System 7.6.1. In 2017/18, SYB will develop as an Accountable Care System. This will include collective decision making, governance and a single accountability framework which will align the individual statutory responsibilities of Parties to the Agreement to the delivery of the Health and care Plan (November 2016). 7.6.2. Where it serves to improve population health outcomes and to meet the needs of patients, we will develop integrated working between commissioners and providers to transform services and reduce transactional costs in the system. 7.6.2. Each of the five Places will develop an Accountable Care Partnership (ACP) to deliver the ambition set out in its Place Plan and the wider Health and Care Plan (2016). The five ACPs will operate in shadow form within 2017/18 and will be legally constituted partnership by 1 April 2018, at the latest.

7.6.3. The five ACPs will bring together health and care services from statutory and non- statutory organisations to create a vertically integrated care system in each Place. This will include hospital services from tier 1. 7.6.4. Each of the five Places will explore new ways of contracting and allocating resources to its ACP including population budgets, population health management and segmentation approaches. 7.6.5. The five ACPs will connect between the five Places and with a horizontally integrated network of hospital based care (tiers 2 and 3) to support seamless care for patients and to create the overall accountable care system (ACS) for South Yorkshire and Bassetlaw. 7.6.6. A system wide commissioning function will be in place within 2017/18 which will result from a reform of commissioning. We will build on approaches we have established in SYB, integrating approaches to planning and transformation and explore new ways of contracting and allocating resources to network of hospital based care. From April 2018, we will start to test the ‘contract once’ with the ‘network of provider’ to support sustainable services and drive improved outcomes for patients.

7.7. ACS governance 7.7.1. South Yorkshire and Bassetlaw has established collaborative governance. This governance recognises statutory governance of member organisations and where statutory organisations have come together to formally delegate to a joint committee or Committees in Common. It serves to support and supplement where agreed and appropriate, statutory governance and is the basis from which we will develop as an ACS. 7.7.2. A summary of SYB governance includes an Oversight and Assurance Group, a Collaborative Partnership Board, an Executive Steering Group and a range of programme Boards and project Boards.

7.7.2.1. Oversight and Assurance Group: membership includes chairs from constituent statutory bodies including providers, commissioners, and Health and Wellbeing Boards with chief executives (CEOs) and accountable officers (AOs) in attendance. 7.7.2.2. Collaborative Partnership Board: membership includes CEOs and AOs from partner organisations including mental health and primary care, commissioning and local authority organisations, voluntary action groups, Healthwatch, NHS England and the ALBs. We also have clinical membership from primary and acute care. We plan to strengthen our Collaborative Partnership Board and review primary care input and wider clinical input and with lay membership. 7.7.2.3. Executive Steering Group: this group combines both the former STP executive steering group and the former finance oversight committee. Membership includes CEO and AO representation, together with directors of strategy, transformation and delivery and directors of finance. 7.7.2.4. Programme Boards: we have a range of programme boards delivering key priorities which are all led by a CEO and AO senior responsible officer (SRO). Each has a director of finance lead and a programme manager supporting. 7.7.3. This governance will remain in place for 2017/18 and during this time SYB will work with the Department of Health, NHS England, NHS Improvement and the ALBs as an ACS to review and establish governance that will best support us. This will be in place for 1 April 2018.

7.8. Joint Committees and Committees in Common 7.8.1. SYB CCGs, in partnership with North Derbyshire and Wakefield CCGs, have already established a joint committee and CCG governing bodies have delegated authority for the review of children’s surgery and hyper acute stroke services. The membership includes accountable officers, clinicians and lay members. During 2017/18, we will review the scope of delegation to reflect the outcomes of the Hospital Services Review and the Commissioning Review so that formal governance arrangements are in place by 1 April 2018. 7.8.2. SYB acute providers, in partnership with Chesterfield Royal Hospital NHS Foundation Trust and Mid Yorkshire Hospital NHS Trust, have established a Committees in Common (CiC) to better support collaborative working between trusts including streamlining decision making. The collaboration has already supported changes in a number of programme areas including support services (back office functions) and a number have been joint with commissioners working together across the same geographical area. 7.8.3. During 2017/18, we will review the scope of delegation to reflect outcomes of the Hospital Services Review and Commissioning Review so that governance arrangements are in place by 1 April 2018. At this stage, the wider acute provider partnership includes both acute providers and community mental health providers. However the CiC does not currently extend to community mental health providers 7.8.4. The two programme offices and teams supporting commissioning and provider collaborations have now co-located to provide a joined up approach to planning and transformation delivery of acute services across SYB.

7.9. Place and accountable care development 7.9.1. CCGs and local authorities will continue to receive their respective health and care funding and to be statutorily accountable for their allocation. 7.9.2. Within 2017/18 each CCG will agree with its corresponding local authority the integrated governance structure which will support the allocation of resources to their ACP based on delivery of their agreed Place plan, wider Health and Care plan and agreed local outcomes.

8. Delivery improvement 2017/18-19 8.0.1. South Yorkshire and Bassetlaw has developed a number of priorities to support delivery of its Plan. These are led by chief executives and accountable officers with strong input from senior clinicians, public health, senior finance and operational colleagues from member organisations. 8.0.2. Transformation priority workstreams include:  Urgent and emergency care  Cancer  Healthy lives, living well and prevention  Primary care  Mental health and learning disabilities  Elective care and diagnostics  Maternity and children’s

8.0.2.1. Enabler workstreams  Workforce  Digital and IT  Carter, estates and shared services  Finance  Communications and engagement

8.0.3. For 2017/18 – 19 South Yorkshire and Bassetlaw has identified a focused number of key priorities for delivery improvement ‘working as one’. We will align resources and priority workstreams to support delivery of these key priorities at all levels within the emerging Accountable Care System and we will use these priorities to test new ways of working together and with NHS England and NHS Improvement to show additional benefits to patient and service delivery: 1. at organisational level 2. at Place (ACP) level 3. at System (ACS) level

8.0.4. Catalyst for change – in 2017/18 we will focus delivery improvements in urgent and emergency care, primary care, mental health and learning disabilities and cancer (or subsets of these priority areas) where we plan to make tangible improvements which will serve as a real catalyst for change across SYB. Each of our transformational workstreams has taken a unique perspective on how best they can contribute to delivering the ‘key improvements’ set out in the Next Steps on the Five Year Forward View. We will also take a unified approach to tackle efficiency improvement ‘working as one’ where this makes sense to do so.

8.1. Efficiency programmes, back office, Carter, Naylor 8.1.1. The efficiency programmes agenda is being addressed through two workstreams.

8.1.2. Firstly; The Provider Efficiency Group, which is responsible for the oversight of the acute and mental health trust providers programme and is addressing the eight nationally defined corporate service areas to ensure that collaborative opportunities are identified and maximised, including consolidation where appropriate. Its strategic objective is to develop systems that capture and optimise the cost effectiveness of corporate services so that services are assessed not only on direct costs and non financial quality indicators, but in relation to professional influence in driving efficiencies across trust systems, policies and processes. Its key aim is to reduce service costs with the summary data for showing the SYB position as 27/44, with potential savings of £4.4m to £10m, taking into account the national median and upper quartile benchmarking data from 2015/16. This is in line with estimated savings contained in the case for change submission October 2016.

8.1.3. The workstream’s immediate priority is to achieve efficiency savings that will help to reduce the financial gap and, in particular, focus on savings and innovations that can be delivered during 2017/18. To enable effective oversight and delivery of collective solutions, a phased approach has been agreed on the key service areas that have shown, through the benchmarking data, the greatest saving opportunities, and which take into account the synergies and dependencies between these service areas. These are HR services, finance including payroll, and procurement.

8.1.4 . The ambition and commitment is to have regional networked arrangements using the same financial, HR and procurement solutions that will use consolidation and integration of transactional services as an enabler for common standardisation and streamlining of e- processes across all trusts to make efficiencies. Where and when appropriate, market testing may be undertaken.

8.1.5. The focus is therefore not just on changes to operating models but where with the use of technology and removal of transactional activity, significant efficiencies could be made. This is also reflected through formal HR streamlining and standardisation of priorities that target reduction of unwarranted variation and duplication across: workforce systems and compliance (including collaborative commercial relationships); general recruitment; bank and agency management (phase one focusing on medical agency including case for collaborative bank); occupational health/absence management; mandatory and statutory training; common bandings/gradings.

8.1.6. Secondly; there is a system wide Strategic Estates Group, the role of which is to provide strategic oversight, planning and direction to SYB clinical workstreams and the CCG Local Estate Forums (LEFs), enabling the delivery of more effective, Place based health facilities, property assets and health/public land across South Yorkshire and Bassetlaw. This workstream will support the implementation of a sustainable estate strategy that will help to deliver those objectives and also consider the findings of the Hospital Services Review and support the development and implementation of estates strategies arising from it. This will ensure a more integrated approach through the delivery of a smaller, more cost effective and efficient estate which is aligned more closely with the delivery of frontline public services.

8.1.7. The Strategic Estates Group brings together organisations which own health facilities, property assets and health/public land to facilitate the better use of all health and public

sector estate and will review principles for collaborative use of built assets. Its immediate priorities for 2017/18 – 2018/19 are based on three themes: strategic estates planning; aligning investment and disinvestment; and estates intelligence and spatial mapping.

8.1.8. Key outcomes are the production of a strategic estates plan and accompanying action plan, which sets out clear priorities for the delivery of better use of all local public land and property assets within respective geographical areas to deliver the estate objectives highlighted within the Health and Care Plan . It will also review the findings of the Naylor Review of surplus land and challenge partner organisations to address any recommendations, which will support the development of affordable estates and infrastructure plans and associated capital strategy

8.2. Managing demand and optimising care 8.2.1. The elective and diagnostic care workstream will be responsible for the planning, oversight and governance of a regional or sub regional elective and diagnostic care system. Closing the elective workstream’s gap will be achieved by focusing on two priorities: reducing system demand and improving efficiencies in how we deliver our services. These themes will be delivered at Place and System levels through eight interventions; however, immediate priorities for 2017-2019 are described below. 8.2.2. Correct referral pathway – we will implement best practice demand management approaches that will reduce unnecessary or inappropriate referrals and ensure patients reach their most appropriate treatment first time. This will be achieved by piloting local solutions to advice and guidance and referral support with consideration to developing a regional solution. We will undertake local place based reviews of clinical pathways to reduce demand and attendance in hospital by developing community based services. We will support local organisations to improve utilisation of non face-to-face clinic delivery, alternative workforce models to drive efficiency and ensure effective access and discharge policies are in place to reduce unnecessary follow up appointments. 8.2.3. Procedures of low clinical value and clinical thresholds – we will develop a SYB policy for effective commissioning including a common set of controls and clinical thresholds for procedures to ensure adherence to best practice guidance. 8.2.4. Diagnostics – we will implement workforce and IT solutions that will reduce the demand and capacity gap in radiology reporting. We will work with the cancer workstream to develop diagnostic solutions that support early diagnosis. 8.2.5. Clinical efficiency – we will use benchmarking analysis (Getting It Right First Time) to identify and target variation along clinical pathways in order to deliver efficiencies. We will ensure our surgical activity is aligned to the appropriate setting and we will identify and transfer activity that can be delivered closer to home in the community.

8.3. General practice and primary care 8.3.1. Supporting and investing in general practice and primary care is a national priority mirrored by key priorities for all of our local Places. During the course of 2017 -19 we will deliver extended access to general practice for 100% of the local population by March 2019 and where possible, take steps locally to boost GP numbers including improving retention.

8.3.2. Expand multidisciplinary care including clinical pharmacists, mental health therapists, physician associates and increase the number of nurses in general practice. 8.3.3. Ensure 100% of GP practices are working together in hubs or networks by March 2019 that offer a greater scope of services which are increasingly capable of taking on population health responsibilities. 8.3.4. Expand multi-disciplinary care by deploying SYB’s share of 1300 clinical pharmacists and 1500 mental health therapists, as well as physicians’ associates and increase the number of nurses in general practice.

8.4. Urgent and emergency care (UEC) 8.4.1. We will continue to develop and strengthen the urgent and emergency care networks and partnership working through the UEC Steering Board, which builds upon the UEC Network established in 2015. A programme of work is currently being developed to take account of national requirements and the case for change described in the Health and Care Plan, with delivery models developed at place with a joint focus on redesigning the urgent and emergency care system and developing out of hospital services to reduce demand on A&E and acute beds.

8.4.2. The Five Year Forward View identified seven UEC priorities which will be included in the work programme. Specific priorities for 2017/18 include;  We will work within Place and collectively across the System to ensure delivery of the four hour A&E standard and we will work as one with NHSE/I to agree improvement trajectories at System level with oversight on place delivery.  We will work with Place to ensure the implementation of primary care streaming for each emergency department and with NHSE/I to agree at system level targets for activity flows through primary care streaming.  We will work with Place to develop and identify the requirements for a clinical advisory service at three levels, 1) Place, 2) System 3) Regional to develop a hub and spoke arrangement to clinical advice using local clinicians/services where possible and scaling to system level where it is more efficient to do so.  We will work as one with NHSE/I to agree at System level a realistic improvement trajectory to increase the volume of calls transferred from 111 to a clinician, working with providers of 111, out of hours and with place to deliver the ambition of 50% by March 2018 ensuring that NHS 111 connects into the appropriate clinical services and patients are directed to the most appropriate clinician/service.  We will express an interest in becoming a pilot at system level for NHS 111 online in 2017/18 subject to the national roll out plan.  We will work with Place to develop a plan to have at least one designated urgent treatment centre established by March 2018, which will include a review of existing urgent care centres, minor injury and walk in services to establish the baseline position and develop a plan to have a model for urgent treatment centres across the System in place by 2019.  We will work with ambulance providers to implement the ambulance response programme and work as one with NHSE/I to develop realistic implementation plans. This will include working with Place to develop consistent offers on alternative pathways to conveyance to A&E.

 We will work with Place to improve patient discharges and flow through hospitals, including the establishment of a pilot to roll out the use of care home electronic bed states.  We will work with Place to establish a common and shared approach to escalation management developing a plan to roll out a single system for better connections between Place and allow System level oversight of pressures in the UEC system.  We will work as one with NHSI and NHSE to align differential standards to secure delivery of integrated urgent care between 111 and out of hours providers.

8.5. Mental health and learning disabilities (MHLD) 8.5.1 A number of priorities for the MHLD workstream have been identified, reflecting the requirements set out in Implementing the Five Year Forward View for Mental Health and identifying where and how a System level approach offers opportunities for improvements in service development and delivery. Key objectives for the workstream are:  Development of core 24 liaison mental health services in all acute hospitals to support a reduction in pressure on the urgent and emergency care system, including reducing emergency admissions and length of stay for people with mental health problems.  Providing support across all areas to develop integrated improving access to psychological therapies (IAPT) to ensure that people with long term conditions have their mental health needs met, reduce presentations for people with medically unexplained symptoms and improve patients’ ability to self manage to reduce reliance on healthcare services.  Taking a collaborative approach to developing perinatal mental health pathways and services.  Working with specialised commissioning on specialist beds and community alternatives across children and young people’s and secure mental health services.  Improving the management of people with complex dementia needs, as part of moving care closer to home across the mental health and learning disabilities health and social care system. 8.5.2 In addition to supporting delivery of national objectives, the workstream is proactively addressing local issues, including gaps in services for adults with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) and workforce issues. It will also work closely with the healthy lives, living well and prevention workstream to roll out innovations around social prescribing and employment support. 8.5.3 SYB will also oversee and support delivery of national objectives around access to services, including increasing access to psychological therapies, delivery of the 18 week referral to treatment target, and access to physical health checks for people with severe mental illnesses. 8.5.4 The workstream is also looking to explore opportunities for alternative commissioning and provider models where these will improve outcomes for patients, secure efficiency savings and secure service capacity and quality across SYB; including provider alliances and system commissioning.

8.6. Cancer 8.6.1. We will strengthen the newly formed Cancer Alliance by working with member organisations and at Place across the Cancer Alliance footprint; South Yorkshire, Bassetlaw and North Derbyshire. Our mandate and deliverables are explicitly articulated through the

Next Steps on the Five Year Forward View, the Cancer Taskforce strategy and our own Cancer Alliance Delivery Plan. Immediate priorities are outlined below:

 We will work to deliver the 62 day referral to treatment standard at System level as a single measure across our provider organisations by March 2018. This will create capacity to focus not only on the target but also enable us to focus on measures which hold the greatest significance to people affected by cancer such as quality of life, whilst also working to improve inter provider transfers within 38 days and improve earlier diagnosis.

 We will work with Place to implement interventions to achieve earlier diagnosis of cancer through raising awareness of signs and symptoms and maximising uptake in screening. We will understand capacity and demand across our diagnostics services, priorities in access to diagnostics and explore new models of access to diagnostics.

 We will support the delivery, through the local Cancer Alliance, of the strategic priorities to improve early diagnosis, services and outcomes for cancer patients as per the Cancer Taskforce report and facilitate the introduction of bowel cancer screening and primary HPV testing for cervical screening.

 We will continue to work with Place to fully deliver person centered care for people affected by cancer by implementing the living with and beyond cancer (LWABC) model of care.

 We have established an ‘advisory board’ of people affected by cancer to support decision making as part of our Living With and Beyond Cancer programme, one of our four Cancer Alliance workstreams. The Cancer Alliance board will also access this group on a topic by topic basis to support decision making on a range of issues such as performance.

8.7 Children’s and maternity care 8.7.1 We have established a Children’s and Maternity Delivery Board to support system transformation across three initial priority areas:-

1. Following public consultation, to reconfigure children’s surgery and anaesthesia, developing new models of care with consistent management across providers, with sustainable care pathways that meet the newly specified standards of care.

2. For the acutely ill child, there is variation in the provision of care, and local assessment (in line with the national picture) identifies the current models are not sustainable, particularly in terms of workforce sustainability and coordinated care pathways. Therefore, there is a need to plan across a larger footprint and network provision. The immediate priority is to work together to develop sustainable new models of care for acute paediatrics, ensuring equity for children right across the SYB area through the adoption of a consistent ‘blueprint’ for services in each Place. This will be supported by a managed clinical network (MCN), ensuring a strong clinical input throughout. The blueprint will include paediatric acute services and consistent management across hospital settings, promoting demand management and supported discharge models in community settings, and the use of short stay assessment models.

3. For maternity services, we will work together to review the current offer and develop a single implementation plan for maternity care across SYB proposing changes in line with the implementing better births, through our Local Maternity Systems (LMS).

8.8. Workforce 8.8.1. The Local Workforce Action Board (LWAB) is the main vehicle for driving and managing the workforce work stream. There is an overarching aim and ambition to make SYB an attractive place to work to both attract and retain staff. The LWAB is focusing on three initial priorities:  Development of the South Yorkshire and Bassetlaw region excellence centre (1 of 7 in England) which aims to raise the standard for support staff by promoting vocational education including focusing on apprenticeships, sharing resources and acting as a vehicle for innovation.  Creation of a faculty of advanced clinical practice for the region which aims to ensure consistent practice standards and secure resources for advanced clinical practitioners (ACPs) and physician associates (PAs).  Sustainable primary care; plans include an increase in GP, practice nurse and clinical support worker numbers, plus further development of physician associates, AHP practitioners, care navigators and clinical pharmacists. 8.8.2. As an enabling work stream, the LWAB is committed to supporting the SYB workstreams to identify their workforce requirements and transform their services.

8.9 Digital and IT 8.9.1. We will be relentless in focusing on the needs of our citizens and our patients and will seek opportunities for technology to improve the ability of our staff and our partners to meet those needs. Therefore, on the journey towards achieving our vision we will:  Directly support and influence the work of the SYB priority and enabling workstreams to ensure they are able to maximise the benefit of digital solutions.  Transform the way in which we engage with patients and citizens, supporting them to maintain their own health and wellbeing through digital solutions.  Improve the way in which health and care providers engage at all levels to ensure an integrated approach to digital transformation.  Accelerate mechanisms that promote record and data sharing as more care is delivered outside a hospital environment, enabling clinicians to provide the best care in all settings, particularly via the use of mobile technology.  Exploit big data analytics to inform frontline clinical decision making, provide real time system level management information and better targeting of prevention initiatives.  Support and empower our staff, patients and citizens so they can maximise the potential of new technologies as they become available to them.  Invest in interoperability and infrastructure to enable change

8.9.2. Focus areas from a recent development workshop (and a draft programme of interventions) are:  Digital inclusion  Self help connect  Wellbeing and recovery  Healthcare co-ordination

 Sharing data, predictive analytics  Shared services and information governance  Technical interoperability  Digital health innovation

8.10 Development of accountable care in Place and System 8.10.1. In 2017/18, SYB will develop as an Accountable Care System. This will include collective decision making, governance and a single accountability framework which will align the individual statutory responsibilities of Parties to the MoU to the delivery of the Health and Care Plan (November 2016). 8.10.2. Where it serves to improve population health outcomes and to meet the needs of patients, we will develop integrated working between commissioners and providers to transform services and reduce transactional costs in the system. 8.10.3. Each of the five Places will develop an Accountable Care Partnership (ACP) to deliver the ambition set out in its Place Plan and the wider Health and Care Plan (2016). The five ACPs will operate in shadow form within 2017/18 and will be legally constituted by 1 April 2018, at the latest. 8.10.4. The five ACPs will bring together health and care services from statutory and non statutory organisations to create an integrated care system in each Place. This will include hospital services from tier 1 (to be determined). 8.10.5. Each of the five Places will explore new ways of contracting and allocating resources to its ACP including population budgets, population health management and segmentation approaches. 8.10.6. The five ACPs will connect between the five Places and with a horizontally integrated network of hospital based care (Tiers 2 and 3 to be determined) to support seamless care for patients and to create the overall accountable care system (ACS) for South Yorkshire and Bassetlaw. 8.10.7. A system wide commissioning function will be in place within 2017/18 which will result from a reform of commissioning. We will build on approaches we have established in the STP, integrating approaches to planning and transformation and we will explore new ways of contracting and allocating resources to the integrated network of hospital based care.

8.11. Commissioning reform 8.11.1. During 2017/18, we will undertake a review of commissioning as part of our system reform. This will consider the development of ACP in Place and the developing ACS and will need to influence and respond to: a. The five ACPs bringing together health and care services from statutory and non statutory organisations to create a vertical and horizontal integrated care system in each Place, include hospital services from tier 1 (to be determined).

b. Developing new ways of contracting and allocating resources to its ACP including population budgets, population health management and segmentation approaches.

c. Connect between the five Places and with a horizontally integrated network of hospital based care (tiers 2 and 3 determined by the hospital services review and

delivery of safe and sustainable services) to support seamless care for patients and to create the overall Accountable Care System (ACS) for South Yorkshire and Bassetlaw.

d. Having a system wide commissioning function in place within 2017/18 with new ways of contracting and allocating resources to the integrated network of hospital based care. From April 2018, contracting once for a range of agreed services with the network to support sustainable services and drive improved outcomes for patients. Organisations have agreed to fully engage in the review to support the objectives and also to support implementation of the review recommendations.

8.12. Specialised services 8.12.1. In many clinical areas, including cancer, mental health and learning disabilities, the commissioning of services is often split across a number of different organisations, which makes it much more difficult to plan the provision of integrated care. Different sets of commissioners make separate decisions about areas of provision which – for the patient – combine to form their whole patient journey. In children and young people’s mental health, for example, young people move between types of provision that are commissioned and provided by separate organisations. 8.12.2. Whilst commissioning responsibilities have become more dispersed over recent years, our collective responsibility is to ensure that any differentiation in the commissioning of services does not manifest itself in fragmented services for patients. The development of the ACS gives the opportunity for specialised commissioners to work with local systems to ensure that joined up pathways are both commissioned and delivered across multiple health and social care settings and that the transitions between services are explicitly supported. 8.12.3. Commissioning specialised services across SYB helps remove some of the structural barriers that reinforce the separation between different elements of provision. It means that integration – for example between inpatient services and community services in mental health, or between chemotherapy and follow-up care in cancer – is ‘designed-in’ to local NHS services by joining up the commissioning processes across specialised and non specialised services, and across NHS and local authority care. Decision making is shifted as far as possible from the national to the local, to ensure it is based on the specific requirements of that geographical locality, giving local systems more say on how specialised budgets are spent in their area, making use of their deep understanding of their local population and giving them a voice in how resources are used locally in line with the established national service specifications. 8.12.4. The specialised services commissioned by NHS England include a diverse range of services, from the rare and highly specialised to more common/higher volume services. It follows that the most appropriate footprint for planning these services also varies (depending on a range of factors such as: patient numbers, shape of provision, financial risk, service specifications, strategy). NHS England has worked with its regional teams to undertake an initial segmentation of the services. This has resulted in developing a list of 20 services that are suitable for planning at populations up to 2.5m and thus at SYB level. During 17/18, work will take place with SYB and specialised commissioners to explore areas of focus that would be most relevant to work towards being part of the ACS. 8.12.5. Milestones: • Areas of focus for specialised services to be planned at an SYB level agreed - Mar 18 • Shadow run budget for areas of focus for specialised services agreed - from Apr 18

• Ensure that for areas of focus agreed, any decisions on changes to services is made in partnership with SYB – from Apr 18 • 18/19 – work towards integration of services within ACS.

Further work is still required to understand the staff resource implications of this work and this will be explored during 17/18.

8.13. Hospital services review 8.13.1. Both commissioners and acute providers across South Yorkshire and Bassetlaw, North Derbyshire and Wakefield have all committed to support an independent review of hospital services. The review will be completed in 2017/18. The terms of reference have been established and include the following key review objectives: a) Define and agree a set of criteria for what constitutes ‘Sustainable hospital services’ for each Place and for South Yorkshire and Bassetlaw, North Derbyshire and Mid Yorkshire (in the context of South Yorkshire and Bassetlaw).

b) Identify any services that are unsustainable and not resilient against these criteria, in the short, medium and long-term, including tertiary services delivered within and beyond SYB.

c) Put forward a future service delivery model or models which will deliver sustainable hospital services.

d) Consider the future role of a district general hospital in best meeting patient needs in the context of the aspirations outlined in the South Yorkshire and Bassetlaw Health and Care Plan and emergent models of sustainable service provision.

9. National and regional support from the Department of Health, NHS England, NHS Improvement and the Arms Length Bodies

9.1. Capacity and capability 9.1.1. To support SYB ACS development there will be a process of aligning resources from ALBs to support delivery and establishing ACS integrated single assurance and regulation approach. 9.1.2. National capability and capacity will be available to support SYB from central teams including governance, finance and efficiency, regulation and competition, systems and national programme teams, primary care, urgent care, cancer, mental health, including external support. 9.2. Financial including transformation and capital funding 9.2.1. In year one, an allocation of central funding has been ring fenced for the eight accelerating ACSs only. 9.2.2. SYB will therefore receive a share of the £450 million transformational funding allocated for the eight high performing systems and a share of the £325 million capital funding. How this funding is allocated to deliver our system plan is to be worked through and agreed. 9.2.3. Bespoke support to work through financial governance and operating a shared system control total and alternative payment models.

9.3. Nationally supported workstreams and peer support 9.3.1. National ACS workstreams/learning set have been established to work with and support the eight named Accountable Care Systems including:  Communications and public engagement  Leadership  Scaling up primary care  Urgent and emergency care  Devolved transformation funding  Spreading new care models and integrating care  Capital funding  Shared system control totals  Alternative payment models  System wide efficiency opportunities  Governance  Streamlining oversight  Future of commissioning functions  External partnerships to support population health.

10. Glossary of terms and acronyms

ACP Accountable Care Partnership. The partnerships forming in each of the five local places of Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield. or Advanced Clinical Practitioner

ACS Accountable Care System; here covering South Yorkshire and Bassetlaw with five constituent Places of Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield

ALB Arm’s Length Body; see https://www.gov.uk/government/publications/arms- length-bodies/our-arms-length-bodies

AO Accountable Officer at a Clinical Commissioning Group

Carter Lord Carter's review: ‘Unwarranted variation: A review of operational productivity and performance in English NHS acute hospitals’ (2016)

CCG Clinical Commissioning Group

CEO Chief Executive Officer

CiC Committees in Common

CPB Collaborative Partnership Board

CQC Care Quality Commission, the independent regulator of all health and social care services in England

DoH Department of Health

FT Foundation Trust; a semi--autonomous organisational unit within the NHS

FYFV Five Year Forward View; a strategy for the NHS (2014)

GB Governing Body - governance of Clinical Commissioning Groups

GP General Practitioner

GPFV General Practice Forward View

HEE Health Education England

HSR Hospital Services Review

IAPT Improving Access to Psychological Therapies

JC CCG Joint Committee of Clinical Commissioning Groups - a statutory body where two or more CCGs come together to form a joint decision making forum. It has delegated commissioning functions.

LA Local Authority, an administrative body in local government

LWAB Local Workforce Action Board sub regional group within Health Education England

MCP Multi-specialty community provider

MHLD Mental Health and Learning Disabilities

MoU Memorandum of Understanding; a formal agreement between two or more parties to establish official partnerships

Naylor Review Sir Robert Naylor’s review of NHS property and estates and how to make best use of the buildings and land (2017)

NHS National Health Service

NHS 111 A national free to call single non-emergency number medical helpline

NHSE NHS England

NHSI NHS Improvement; operating name for Monitor, NHS Trust Development Authority and teams from 2016

PA Physician’s Associate

PACS Primary and Acute Care System

Place(s) One of five geographical subdivisions of SYB with the same footprint as the ACPs

SAF Single Accountability Framework

SRO Senior Responsible Officer, the visible owner of the overall business change, accountable for successful delivery

STP Sustainability and Transformation Plans (2016); the NHS and local councils have come together in 44 areas covering all of England to develop proposals and make improvements to health and care

SYB South Yorkshire and Bassetlaw

TBA To be announced

TBC To be confirmed

UEC Urgent and emergency care

Vertical integration FYFV delivery next steps: horizontally operating provider organisations simultaneously operating as vertically integrated care system, partnering with local GP practices formed into clinical hubs serving 30,0000 – 50,000 populations

Horizontally integrated FYFV delivery next steps: Where provider organisations collaborate to form care systems. There are different forms; from virtual to actual mergers, for example, having ‘one hospital on several sites’ through clinically networked service delivery

Enc D

Item 9

Quality & Performance Report

Meeting name Governing Body Meeting date 20 July 2017

Title of paper Quality & Performance Report

Executive / Mr Andrew Russell, Chief Nurse Clinical Lead(s) Mr Anthony Fitzgerald, Chief of Strategy & Delivery Performance and Intelligence Team Author(s) Quality Team

Purpose of Paper - Executive Summary

This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body on an exception basis. The performance rating, indicated by Red, Amber, Green or Blue status, denotes the current month performance and does not reflect the historic trends.

The report structure has been updated from the June 2017 meeting of the Governing Body to the following sections: Section 1: Doncaster CCG Delivery Plan Highlights/Issues Section 2: Doncaster CCG NHS Constitution Indicator Performance Section 3: Provider Exception Report Section 4: Improvement and Assessment Framework Section 5: Looked After Children Report

Within Section 1 the report includes a highlight and issue summary of all twelve Delivery Plans, plus a focus on two of the twelve CCG Delivery Plans in depth each Month.

The key areas of change, both positive and negative, to note since the last report are:

NHS Doncaster Clinical Commissioning Group (CCG)  The two Delivery Plan focus areas this month are Learning Disability and Community and End of Life. The Learning Disabilities Delivery Plan update can be found on pages 6-8. The Community and End of Life Delivery Plan update can be found on pages 9-12.  91.25% of patients waiting on an 18 week Referral to Treatment pathway were waiting less than 18 weeks at the end of May 2017, which is a slight deterioration from April.  98.79% of patients waiting for a diagnostic test were waiting less than 6 weeks at the end of May, which is slightly below target but an increase on April’s performance.  A&E performance rose to 91.4% during May, though remained below the 95% target.  Two week wait cancer performance fell in April to 86.76%.  Two week wait breast symptomatic cancer performance fell to 84.44% during April.  62 day referral to treatment performance for cancer rose to 81.82% in April.  One Methicillin-Resistant Staphylococcus Aureus (MRSA) infection was reported for DCCG at Doncaster and Bassetlaw Teaching Hospitals Foundation Trust during April 2017.

Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT)  There was one 52 week breach during May 2017.  There were 4 breaches of the 28 day cancelled operations standard and a second operation cancelled for the same patient.

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)  IAPT Recovery Rate – the 50% target was missed for the 2nd time in the financial year at 48.10% during May.

Recommendation(s)

The Governing Body is asked to:  Note the key quality performance areas for attention.

Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report. Equality Neutral impact Sustainability Nil impact Financial As identified in the report. implications Legal Nil implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details. Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously N/A presented at Risk Risks are captured in the Executive Summary. analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework

Section 1: Delivery Plan Highlight & Exception Report Planned Care Measures Actions A large proportion of key actions have already been completed including the agreement of contract activity, Commissioning for Value policy. The remaining N/A 9 Completed 12 actions are all on‐track apart from one: Development of Shared Decision On Track 0 On Track 11 Making Strategy, including the review and enhanced use of patient decision Slightly Off 1 Slightly Off 0 aids. This action, previously two separate elements, has combined to focus on exploring the feasibility of developing the work stream through Patient Off Track 1 Off Track 1 Participation Groups. % of Actions On Track & 92% of patients waiting less than 18 weeks from referral to treatment across all % of Measures On Track Completed specialties failed to achieve target for May2017 with 90.6%, with a total of 5 specialties failing target. Detailed meetings are ongoing monthly with DBTHFT 0.0% 95.8% to understand the reasons and trajectories are in place within the Specialties to reach 92%.

Cancer Measures Actions The majority of the actions for Cancer are on track, including bisphosphonates implementation, prevention work, analysis of cancer waiting times data, N/A 19 Completed 4 ensuring all patients have access to a key worker and ensuring breast patients On Track 3 On Track 8 have access to a stratified follow up pathway. Actions slightly off track include Slightly Off 0 Slightly Off 3 implementing updated two week wait NICE guidance in primary care, straight to test pathways and stratified follow up pathways; with collaborative work Off Track 9 Off Track 0 continuing locally on colorectal follow up pathways. Three Cancer measures are on track, however a number of cancer measures are % of Actions On Track & off track including both two week wait national measures and two 62 day % of Measures On Track Completed referral to treatment measures that fell below the target of 85%. These indicators have ongoing pieces of work and a formal contract query around Two 25.0% 80.0% Week Wait has been issued to the Provider, along with a 62 day action plan submitted to NHS England from the Cancer Alliance.

Medicines Management Measures Actions All actions are on track with the exception of working with providers on N/A 6 Completed 0 formulary development programme and monitoring/adherence schedule which was deemed as slightly off track; the formulary development for Doncaster and On Track 0 On Track 8 Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) has yet to be agreed. Slightly Off 0 Slightly Off 1

Progress against the impact measures will be added once 17/18 data is Off Track 0 Off Track 0 available. % of Actions On Track & % of Measures On Track Completed NA 88.9%

Children's Measures Actions Most actions are on track including new models of care as part of Working Together, implementation of the local transformation plan and mapping of N/A 0 Completed 0 maternity provision against Better Births recommendations. Those off track are On Track 2 On Track 5 commissioning of a paediatric respiratory nurse and a responsive community Slightly Off 0 Slightly Off 0 provision which have been delayed due to the identification of cost pressures. Membership for the task and finish group has been agreed and there is a Off Track 3 Off Track 2 requirement to resolve the issues at pace. % of Actions On Track & Three of the five measures failed to hit the allocated trajectory. These were % of Measures On Track Completed expected reductions in Paediatric Assessments, Emergency Admissions in Asthma and Children admitted to Acute Mental Health Ward. Whilst reductions in URTI and LRTI emergency admissions are on track. 40.0% 71.4%

3 Learning Disabilities Measures Actions Three actions are on track however there are two off track actions: implementing an intermediate care model for step down and step up crisis N/A 8 Completed 0 management and Enhance acute liaison services. Care Quality Commission On Track 0 On Track 3 registration for the Extra Care facility at Danes Court is still awaited. At the last Slightly Off 0 Slightly Off 1 Strategic Contract meeting it was discussed that it should be up and running by middle of June and a review of LD Acute liaison to be undertaken by RDaSH Off Track 0 Off Track 1 taken in the summer of 2017, respectively. % of Actions On Track & Two impact measures are now off track, relating to QIPP, Reduce the amount of % of Measures On Track Completed inappropriate A&E attendances from frequent fliers and the associated cost of inappropriate A&E attendances. Work is ongoing for specific patients to keep 0.0% 60.0% them out of A&E.

Community & End of Life Measures Actions Actions are all on track with the exception of aligning patient pathways with the review of neurorehabilitation services, for which the outcome from the NHSE N/A 6 Completed 0 Y&H review of neurorehabilitation services shall ensure that local patient On Track 5 On Track 6 pathways are aligned during phase 1. In addition, local commissioned services Slightly Off 2 Slightly Off 1 are reviewed to improve and standardise the quality for patients with acquired brain injury during phase 2. Off Track 0 Off Track 0

There are six measures on track and two slightly off track. These are Friends and % of Actions On Track & Family Test (FFT) response rates and the proportion of people who die in their % of Measures On Track Completed usual place of residence (one breach). Response rates for FFT are monitored and discussed at RDaSH Clinical Quality and Review Group,, with appropriate 71.4% 85.7% actions undertaken.

Mental Health Measures Actions The majority of actions are on track including development of collaborative pathways to deliver physical health for people with mental health problems and N/A 7 Completed 0 development of the Crisis Café. The actions slightly off track are the On Track 1 On Track 9 development of community based model to improve perinatal mental health , Slightly Off 1 Slightly Off 2 Core 24/7 Mental Health Liaison development and transferring stable patients back to primary care. Off Track 0 Off Track 0

Meetings are being arranged with DBTHFT/RDaSH and led through the % of Actions On Track & Sustainability and Transformation Partnerships (STP) to identify and undo any % of Measures On Track Completed potential blockages. In addition a further meeting around piloting of patients to be transferred back to Primary Care, is arranged for late June. 50.0% 81.8% Of the two measures that can be reported, one is off track ‐ 'Expand capacity so that 53% of people begin a NICE recommended package of care within 2 weeks of referral'. At present, contracted target is 50%, which shall be increased to 53% to match rising capacity.

Care Homes Measures Actions All actions are on‐track. N/A 11 Completed 0 12 Work is underway by the Quality team to update the narrative against the On Track 0 On Track 13 actions and the measures will be rated once 17/18 data is available. Slightly Off 0 Slightly Off 0 Off Track 0 Off Track 0

% of Actions On Track & % of Measures On Track Completed NA 100.0%

4 Dementia Measures Actions All actions are on track including raising dementia awareness, monitoring and reporting against the dementia pathway, and evidence based dementia N/A 3 Completed 0 standards, and working with partners to deliver the Health Education England On Track 6 On Track 6 mandate for a fit for purpose workforce. Slightly Off 2 Slightly Off 0 Six impact measures are on track however two are currently off track: Off Track 0 Off Track 0 Reduction in Re‐admissions and Reduction of deaths within 3 days of admission to hospital; where the 2017/18 position is either slightly higher or equal to that % of Actions On Track & of 2016/17. Commissioners are working with providers to achieve 6 weeks from % of Measures On Track Completed referral to diagnosis by 2020. The Doncaster Admiral service is commissioned to be a point of contact on discharge from assessment and treatment services. 75.0% 100.0%

Primary Care Measures Actions Eight actions are on track, however actions currently off track include Practice Manager Development Programme, Second wave of the clinical pharmacist in N/A 0 Completed 0 practice scheme, Capital investment in infrastructure and Extra investment to On Track 1 On Track 8 support practices to adopt online consultation of the national specification. Slightly Off 3 Slightly Off 1 Many of the off track actions are reliant on national publication of programmes, guidance or funding. Specifically, regarding technology bids that are likely to fit Off Track 0 Off Track 3 with the criteria for the use of GP Forward View Online funding, have been put on hold; this applies to all the technology bids submitted for Doncaster. % of Actions On Track & % of Measures On Track Completed Apart from the one impact measure on track, all others are currently amber as further data is awaited in Q2 to make a full assessment. 25.0% 66.7%

Urgent Care Measures Actions The majority of actions are on track, including the early testing and implementation of the intermediate care model, agreeing revised delayed N/A 5 Completed 3 transfers of care reporting and work to support the digital care map. On Track 0 On Track 9 Slightly Off 0 Slightly Off 4 The actions slightly off track include ensuring the recommendations to improve consistency to the Unplanned Care Centre with Front Door Assessment and Off Track 3 Off Track 0 Streaming Service (FDASS) audit completed and initial results shared; the paramedic pathfinder implementation with rapid response currently being % of Actions On Track & tested and is successfully maintaining patients in the community; and review of % of Measures On Track Completed the Doncaster Urgent Care System , with a planning meeting for system wide perfect week arranged for 27th June with support from NHS Improvement. Key 0.0% 75.0% themes agreed as priorities for testing/implementing during Perfect week

3 of the 8 impact measures can currently be reported against, with A&E performance, 999 response times and FDASS streaming rated as red.

Intermediate Care Measures Actions Just one action, 'Develop Proof of concept for shared digital care record' is currently off track, however a project manager is identified, project team N/A 10 Completed 0 members and reps from providers confirmed and initial project plan drafted. On Track 0 On Track 6 Ready to launch and awaiting finalising a contract. All other actions are currently Slightly Off 0 Slightly Off 1 on track or are due to start at a later date. Off Track 0 Off Track 0 No impact measures can currently be assessed as 2017/18 data is awaited. % of Actions On Track & % of Measures On Track Completed NA 85.7%

5 Delivery Plan on a Page ‐ Learning Disabilities

Local Context and Rationale Health & Wellbeing Gap Care & Quality Gap Finance & Efficiency Gap

A Health Needs Assessment for people with a learning disability and /or ASD was conducted in 2011 which 15 people with complex care needs are receiving in‐patient identified that people from this cohort were dying (rehabilitation) care outside of Doncaster away from their families. The average price per bed day rate cost for locked rehabilitation is £408, rising from preventable cancers as they were not accessing 8 people have been placed in low or medium secure services. to £480 per day for medium secure. screening programmes. 1500 people are on LD Doncaster has a high number of independent and private sector Current cost to the CCG for locked rehab circa £2.7million registers but only 32% of people with a learning complex care provision which attracts commissioners from our of disability who are on a GP register are receiving an area, which placed a burden on local NHS service provision. annual health check during the year

Vision/ Objectives/Outcome (what will be different) Delivery of the core principles of Building the Right Support in Communities of People with a Learning Disability and / or ASD. Deliver Transforming Care Partnership plans with local government partners, enhancing community provision for people with learning disabilities and /or autism. Prevent people from going into crisis, support people to live as independently as possible in the community and prevention of the need for out of areas placements. Reduce cost pressures on spend for our of area placements

Programme focus areas

Population‐ all ages with LD, full spectrum but transforming care around specific pathways. NB gap re autism and ADHD Place Plan Cohort: Across all: Cohort A: Prevention & Early Help; Cohort B : Integrated Intermediate Health & Social Care; Cohort C: Enablement and Recovery Neighbourhood or geographical area (includes footprints wider than Doncaster): Doncaster, Sheffield, N Lincs, Rotherham; LA work only Doncaster popn

Stage of development/ Maturity of Programme

Live‐ early 2016

Key Milestones/Action Plan

Timescale Key Actions

 Reduce out of area placements – step down from locked rehabilitation ● Development of Enhanced Community Team From ● Enhanced primary care support for people with a learning disability including annual health check April 2017 ● Implement intermediate care model – step down and step‐up crisis management ● Enhancement acute liaison services

Impact / Benefits including finance and activity Reduce inpatient bed capacity by March 2019 to 10‐15 CCG commissioned beds per million population, and 20‐25 in NHS England commissioned beds per million population. Improve access to healthcare for people with learning disability so that by 2020 75% of people on a GP register are receiving an annual health check. Reduce premature mortality by improving access to health services, education and training of staff, and by making necessary reasonable adjustments for people with a learning disability. Remodelled provision of step down/up services supported by an enhanced community service focusing on patient case management and supporting individual need. This will deliver patient care within the local community and within the least intensive setting by ensuring timely intervention, identification of preventative care, avoidance of out of area care. Resourced through remodelling of existing commissioned inpatient and community capacity to provide timely and efficient patient interventions. Primary care baseline information will be collected and monitored: BP checks undertaken, BMI recorded (weight and height), Cholesterol, Waist Circumference, Smoking status, Diabetic check/diabetic eye screening undertaken and Cancer screening undertaken – breast, bowel and cervical (and numbers of eligible patients) Finance ‐ spend per locality etc

Leadership and Governance arrangements Lead Agency: CCG re Chief Officer role across STP and TCP footprint; locally lead is joint with LA, with focus on different elements of the pathway Supporting Governance Structure: Transforming Care Board across TCP footprint Local Programme exec board (LA led) inc accommodation/ residential care

Supporting Structure Critical Resources Programme management support Andrea/ Emma and Kerry Wright at DMBC

Key stakeholders, include all organisations affected by the change Police to a degree and then across all

Funding Assumptions Include any funding assumptions including release of resource Decommissioned 5 assessment and treatment unit beds; reinvested to support community provision Releasing funding from high cost placements into Doncaster ‐ will be reinvested back into LD Transforming care £570k N/R to spend end March 2017; another bid to be submitted

Dependencies with other transformation programmes

Choose from following list and list nature of dependency:

Prevention Starting Well Paediatrics Stronger Families? Primary Care Complex Dependencies Adult Health & Wellbeing

Intermediate Care Mental Health Learning Disability Population Health Work and Health Complex Dependencies

Other Key Dependencies Include nature of dependency Section 136‐ only 1 bed if not A&E; children to A&E Primary care education Complex funding arrangements combined with patients arriving from out of area to specialist units and becoming Doncaster’s responsibility to pick up

6 Learning Disabilities Delivery Plan Dashboard Impact Measure Progress Actions Progress Reduce inpatient capacity across Transforming Care Partnership to 24 patients by Reduce out of area (OOA) placements ‐ step down from locked N/A March 2018 (22.5 CCG commissioned beds per million population) rehabilitation

Improve access to healthcare for people with learning disability so that by 2020 75% N/A Development of Enhanced Community Team of people on a GP register are receiving an annual health check. Reduce premature mortality by improving access to health services, education and Enhanced primary care support for people with a learning disability N/A training of staff, and by making necessary reasonable adjustments for people with a including annual health check learning disability. Remodelled provision of step down/up services supported by an enhanced Implement intermediate care model ‐ step down and step up crisis N/A community service – service outcomes to be developed by Autumn 2017’ management

Primary care baseline information will be collected and monitored: BP checks undertaken, BMI recorded (weight and height), Cholesterol, Waist Circumference, N/A Enhance acute liaison services Smoking status, Diabetic check/diabetic eye screening undertaken and Cancer screening undertaken – breast, bowel and cervical (and numbers of eligible patients)

N/A Finance ‐ spend per locality etc

QIPP ‐ Reduce the amount of inappropriate A&E attendances from frequent fliers

QIPP ‐ Reduce the associated cost of inappropriate A&E attendances from frequent fliers

LD Measures

Reduce inpatients Annual Health checks

35 Information being sourced. 30 25 20 15 10 5 0 Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18

Target Reduce the amount of inpatients

Deaths Local Community provision

Information has been sourced and will be reported quarterly. Danes Court information will be developed along with outcome measure after initial review.

Primary Care information

Templates have been developed by the CCGs Data Quality Team in time for reporting from the start of April 2017. Information for this group of measures should be available around October 2017.

Impact on Finance:

Information is now being validated and anticpated to be availble in August.

7 Apr‐17 May‐17 Jun‐17 Period by: ACTIONS Indicator Slightly Off On Track On Track Performance

Danes Court is now on track after fully Reduce out of area (OOA) placements ‐ opening on 19.04.17. The Wider Mar‐19 Some significant discharges made in May step down from locked rehabilitation Update Reduction for OOA placements off track due to delay in Danes Transforming Care Partnerships (TCP) is now 2017. Current trajectory is on track for 9 by (Narrative) Court opening. Danes Court opened 20th April. looking at filling the remaining 3 beds 30.06.17. following step down from locked rehabilitation.

Indicator On Track On Track On Track Performance

Enhanced Community team beginning to Development of Enhanced Community Dec‐18 Enhanced Community team beginning to support community providers to prevent Team Update Enhanced Community team now fully recruited and will begin support community providers to prevent escalation. Formal contract meeting to be (Narrative) implementation in April 2017. escalation. arranged with RDaSH to discuss the full implementation.

Indicator On Track On Track On Track Performance

All practices have had their lists validated Enhanced primary care support for people All practices have had their lists validated for for 20161/17, practices with a low uptake of Mar‐19 with a learning disability including annual 20161/17, practices with a low uptake of annual health checks are being actively Update Permanent post now engaging in wider GP support to health check annual health checks are being actively managed by RDaSH. Primary Care Liaison is (Narrative) improve level of annual health checks across Doncaster. managed by Rotherham Doncaster and South to visit day centres to encourage the uptake Humber NHS Foundation Trust (RDaSH). of Annual Health check and access to screening services.

Indicator Off Track Off Track Off Track Performance

Still awaiting Care Quality Commission Still awaiting Care Quality Commission Implement intermediate care model ‐ step Dec‐17 registration for the Extra Care facility at registration for the Extra Care facility at down and step up crisis management Update Danes Court continuing to build Extra care crisis suite due to Danes Court. At the last Strategic Contract Danes Court. At the last Strategic Contract (Narrative) be completed by 10th May 2017. meeting it was discussed that it should be up meeting it was discussed that it should be and running by middle of June. up and running by middle of July.

Indicator On Track On Track Slightly Off Performance

Mar‐18 Enhance acute liaison services Review of LD Acute liaison to be undertaken Update Review of LD Acute liaison to be undertaken Review of LD Acute liaison to be undertaken by RDaSH. by RDaSH. This is to be undertaken in (Narrative) by RDaSH. summer 2017.

Key risks and messages Please insert any key risks for escalation, messages about future actions and progress/highlights.

8 DRAFT Delivery Plan on a Page ‐Community and EOL Jo Forrestall, Dr Lindsey Britten Local Context Health & Wellbeing Gap Care & Quality Gap Finance & Efficiency Gap Aging population and increasing complexity of Lack of true integration of health and care services Increasing number of avoidable non‐elective needs leading to under utilisation/or duplication in services admissions and attendances Supporting people in their own home as long as Navigation of services difficult for patients and their Variable access possible carers

Vision/ what will success look like? Improved communication and integration across Improved quality of community services provision The Health and social care workforce has the skills to all Health and Social Care stakeholders to increase Patient feels supported and maintains independence safely care for people outside acute care settings efficiency and prevent duplication longer All individuals, their families and carers are engaged People will have timely and appropriate access Improved patient experience of community services in their care and have choice if their place of death into community services and improved access to by providing continuity of care and holistic case specialist intervention management for their physical and mental health wellbeing

Actions March 2019 Continue the review of services included within the acute block contract (Dietetics ,Orthotics ,Podiatric surgery, MSK services, SALT) Continue to explore further opportunities within the community nursing model to transfer care and appropriate resources and ensure the Dec 2018 interface between core and specialist advice and support (Continence, Lymphoedema ,Parkinson's, community podiatry, wheelchair services) Influence the community nursing team and review the neighbourhood model for community based multi‐professional team in partnership March 2019 with MH teams. Evaluate Integrated community specialist palliative care team and interfaces and explore opportunities for further activity shift Dec 2017 Further increase the number of individuals within services to have undertaken GSF training across the Borough with a new focus on Care March 2018 Homes and Domiciliary care providers Falls, ensure that all services embed risk assessment documentation within core offer, and work with existing services to develop Rapid March 2018 Response Following the outcome from the NHSE Y&H review of neurorehabilitation services we will ensure that local patient pathways are aligned Phase 1 2018 during phase 1 and that local commissioned services are reviewed to improve and standardise the quality for patients with traumatic brain Phase 2 2019 injury during phase 2

Impact • Friends and Family Test ‐ Maintain the • Reduce non‐elective admissions for Acute and • Decrease the amount of deaths within 3 days of percentage of people recommending RDASH General specialities against 2016/17 baseline hospital admission against 2016/17 baseline Community Services above 85% • Reduce non‐elective urology admissions for • Increase the proportion of people who die in their • Friends and Family – increase the percentage of catheterisation against 2016/7 baseline usual place of residence against baseline responses against March 2017 baseline • Reduce the number of non‐elective admissions for • End of Life surveys (RDASH and DBTHFT) • Increase the percentage of patients rating the people with Parkinson's against 2016/17 baseline Experience of the quality of care in the last 3 • Reduce the length of stay for non‐elective months of life as outstanding excellent and good admissions for people with Parkinson's against the (baseline 2012 and 2013 data) 2016/17 baseline • Increase the proportion of people feeling • Increase the response time for the provision of supported to manage their condition based on community equipment CCG outcome indicators 2015/16 baseline • Decrease the amount of falls within the community

Enablers and links to other plans Primary Care Strategy development will support Care Home Strategy Digital care records Urgent Intermediate care review and winter testing of rapid community based teams and more proactive care Care Mental Health Learning Disability response for falls and use of bed base

9 NHS Doncaster CCG Community and End of Life Delivery Plan Impact Measure Progress Actions Progress Friends and Family Test ‐ Maintain the percentage of people recommending Continue to review the services included within the acute block Reduce non‐elective urology admissions for Rotherham Doncaster and South Humber NHS contract (Dietetics, Orthotics, Podiatric Surgery, MSK services, catheterisation against 2016/17 baseline Foundation Trust (RDASH) Community Services SALT). above 85%

Continue to explore further opportunities within the community nursing model to transfer care and appropriate resources and Friends and Family – increase the percentage of Reduce the number of non‐elective admissions for ensure the interface between core and specialist advice and responses against March 2017 baseline people with Parkinson's against 2016/17 baseline support (Continence, Lymphoedema, Parkinson's, community podiatry, wheelchair services)

Increase the percentage of patients rating the Reduce the length of stay for non‐elective Influence the community nursing team and review the Experience of the quality of care in the last 3 N/A admissions for people with Parkinson's against neighbourhood model for community based multi‐professional months of life as outstanding excellent and 2016/17 baseline team in partnership with MH teams. good (baseline 2012 and 2013 data)

Increase the proportion of people feeling Increase the response time for the provision of Evaluate Integrated community specialist palliative care team N/Asupported to manage their condition based on N/A community equipment and interfaces and explore opportunities for further activity shift CCG outcome indicators 2015/16 baseline

Further increase the number of individuals within services to Review End of Life surveys once received ‐ have undertaken Gold Standard Framework (GSF) training across N/ADoncaster and Bassetlaw Teaching Hospitals N/A Decrease the amount of falls within the community the Borough with a new focus on Care Homes and Domiciliary Foundation Trust (DBTHFT) and RDASH care providers

Falls, ensure that all services embed risk assessment Reduce non‐elective admissions for Acute and Decrease the number of patients who die within 3 N/A documentation within core offer, and work with existing General specialities against 2016/17 baseline days of an admission to hospital services to develop Rapid Response

Following the outcome from the NHSE Y&H review of neurorehabilitation services we will ensure that local patient Increase the proportion of people who die in their pathways are aligned during phase 1 and that local usual place of residence against baseline commissioned services are reviewed to improve and standardise the quality for patients with acquired brain injury during phase 2

Community Measures

Friends and Family Test ‐ Community

100% 5.0% 4.5% 4.0% 90% 3.5% 3.0% 80% 2.5% 2.0% 1.5% 70% 1.0% 0.5% 60% 0.0% May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17

FFT ‐ RDASH recommended FFT ‐ Yorkshire and Humber recommended FFT ‐ RDASH percentage responders FFT ‐ Yorkshire and Humber percentage responders

The percentage of people recommending RDASH community services has been rising since April 2016 throughout the year and is now higher than the Yorkshire and Humber regional average.

Experience South Yorkshire and Bassetlaw ‐ Quality of care in last 3 months of life England Average

SY& Bassetlaw Quality of care in last 3 months of life 2016 Weighted Percentage (2012 and 2013 April 2016 Weighted Percentage (2012 and 2013 combined) combined)

Outstanding Outstanding Excellent Excellent Good Good Fair Fair Poor Poor

10 Proportion of people feeling supported to manage their condition based on CCG outcome indicator Review End of Life surveys once received

70.0 End of Life survey results have been requested from DBTHFT and RDASH quarterly and the first results are anticipated to be available during August 2017. 69.0

68.0

67.0

66.0

65.0

64.0

63.0

62.0

61.0 2011/12 2012/13 2013/14 2014/15 2015/16

People feeling supported ‐ Doncaster People feeling supported ‐ England

Non elective admissions for general and acute specialties Non‐elective Urology admissions resulting in catheterisation or maintenance

3600 16

3500 14 3400 12 3300 10 3200 8 3100 6 3000 2900 4 2800 2

2700 0 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17

Non elective admissions for general and acute specialties Non elective Urology admissions resulting in catheterisation or maintenance

Reduce the number of non‐elective admissions for people with Parkinson's against 2016/17 baseline Reduce the length of stay for non‐elective admissions for people with Parkinson's against 2016/17 baseline

7 14

6 12

5 10

4 8

3 6

2 4

1 2

0 0 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17

Number of non‐elective admissions for patients with a primary diagnosis of Parkinson's Disease Average length of stay for patients with Parkinson's Disease

Increase the response time for the provision of community equipment Decrease the amount of falls within the community

Information is currently being sourced from the Local Authority. Information is currently being sourced.

Deaths within 3 days of admission to hospital Percentage of people dying in their preferred place of death ‐ Woodfield 24

1200 110%

1000 100%

800 90%

600 80%

400 70%

200 60%

0 50% 2009 2010 2011 2012 2013 2014 2015 2016 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17

Deaths in hospital within 3 days of admission Total deaths in Doncaster Percentage of Woodfield 24 patients dying in their chosen place

Impact on Finance:

To be confirmed

11 Apr‐17 May‐17 Jun‐17 Period by: ACTIONS Indicator On Track On Track On Track Performance

Continue to review the services included within the acute block Services are being reviewed and service Mar‐19 contract (Dietetics, Orthotics, Podiatric Surgery, MSK services, Speech and Language and orthotic specifications have Specialist Physiotherpay specifcations beng developed in Update specification developed. Podiatric surgery SALT). been drafted and are currently with DBTHFT for partnership. Awaiting performance data to complete (Narrative) agreed with Doncaster Bassetlaw Teaching comments. unpicking the block contract. Hospital Foundation Trust (DBTHFT).

Indicator On Track On Track On Track Performance

Continue to explore further opportunities within the community nursing model to transfer care and appropriate resources and Continence service specification is being Wheelchair services has been reviewed and performnace A revised Lymphoedema specification is now within Dec‐18 ensure the interface between core and specialist advice and implemented and the service is in the process of dashboard produced. The service is now undertaking Update contract. A meeting has been arranged to review support (Continence, Lymphoedema, Parkinson's, community reviewing all long term catheter patients and communications and engagement on patient eligibility, (Narrative) prescribing budgets in relation to community services podiatry, wheelchair services) where possible transferring to formulary appropriate use and returns. Also developing a local user and GPs. product. group for peer support.

Indicator On Track On Track On Track Performance

Influence the community nursing team and review the Rotherham Doncaster and South Humber NHS Mar‐19 neighbourhood model for community based multi‐professional Foundation Trust (RDaSH) are continuing to RDaSH are continuing to implement their transformation RDaSH are continuing to implement their transformation Update team in partnership with MH teams. implement their transformation plan and work plan and work is ongoing to develop pathways and work plan and work is ongoing to develop pathways and work (Narrative) is ongoing to develop pathways and work across across the 4 neighbourhoods. across the 4 neighbourhoods. the 4 neighbourhoods.

Indicator On Track On Track On Track Performance

Evaluate Integrated community specialist palliative care team Dec‐17 Stakeholder survey is being undertaken and Awaiting first performance data to finalise evaluation. Awaiting first performance data to finalise evaluation. and interfaces and explore opportunities for further activity shift Update findings will support the evaluation of the Stakeholder survey to be shared and discussed with Stakeholder survey to be shared and discussed with (Narrative) changes to the service model. RDaSH and findings will develop an action plan. RDaSH and findings will develop an action plan.

Indicator On Track On Track On Track Performance Further increase the number of individuals within services to have undertaken Gold Standard Framework (GSF) training across Mar‐18 A further 15 GP practices have completed the the Borough with a new focus on Care Homes and Domiciliary Update Links have been made to Care Home Strategy Links have been made to Care Home Strategy GSF training, almost 60% of practices have care providers (Narrative) implementation. implementation. completed.

Indicator On Track On Track On Track Performance

Falls, ensure that all services embed risk assessment Falls Assessment tool as been implemented in a Falls Assessment tool as been implemented in a range of Falls Assessment tool as been implemented in a range of Mar‐18 documentation within core offer, and work with existing services range of front line health, social care and Update front line health, social care and voluntary sector services front line health, social care and voluntary sector services to develop Rapid Response voluntary sector services and integrating the (Narrative) and integrating the pathway within Intermediate Care and integrating the pathway within Intermediate Care pathway within Intermediate Care review and review and Rapid Response. review and Rapid Response. Rapid Response.

Indicator Slightly Off Slightly Off Slightly Off Performance

Following the outcome from the NHSE Y&H review of neurorehabilitation services we will ensure that local patient The initial part of the review is now complete. Dec‐16 pathways are aligned during phase 1 and that local The review is now being taken through the STP process The review is now being taken through the STP process Specialised commissioning are currently setting onwards commissioned services are reviewed to improve and Update for a response on how the recommendations and for a response on how the recommendations and out proposals for discussion/agreement within standardise the quality for patients with acquired brain injury (Narrative) proposed changes will be implemented across South proposed changes will be implemented across South each Sustainability and Transformation Plans during phase 2 Yorkshire and Bassetlaw. Yorkshire and Bassetlaw. (STP) on how to progress.

Key Risks and Messages Please insert any key risks for escalation, messages about future actions and progress/highlights.

12 Section 2: NHS Constitution Indicators (NHS Doncaster)

Referral to Treatment Times (RTT)

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks

Commissioner May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Doncaster CCG 93.68% 93.21% 93.01% 92.41% 92.20% 91.87% 91.45% 90.43% 90.75% 90.93% 90.90% 91.27% 91.25%

Rightcare Peer Group 92.23% 91.59% 91.17% 90.78% 90.66% 90.73% 90.48% 89.66% 90.17% 90.40% 90.34% 90.24%

Doncaster and Bassetlaw Teaching Hospitals Foundation Trust 93.1% 92.8% 92.6% 92.0% 92.1% 91.7% 91.3% 90.1% 90.3% 90.5% 90.5% 90.4% 90.6% (DBTHFT)

England 91.89% 91.63% 91.37% 91.02% 90.76% 90.51% 90.57% 89.79% 90.02% 90.05% 90.65% 89.95%

Target 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

Patients on incomplete non-emergency pathways who have been waiting no more than 18 weeks

87% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Doncaster CCG Rightcare Peer Group Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) England Target

Performance for DCCG patients remains under target at 91.25% with 6 specialties failing with DBTHFT also failing to meet target at 90.6%.

DBTHFT have reviewed their reporting structure around referral to treatment times to improve accuracy and to allow greater visibility of longer waits from March 2017.

Key issues for underperformance during the month were theatre capacity and utilisation, cancellations at a specialty level, validation and patient tracking/management and also managing the demand on the anaesthetic workforce. The main areas of concern were Ophthalmology, General Surgery, ENT and Pain Management. Due to ongoing underperformance around the 18 weeks RTT target, the Surgical Care Group has been placed in internal Advanced Monitoring with bi-weekly meetings chaired by the Chief Operating Officer.

Internal weekly Patient Tracking List meetings take place with Care Groups in DBTHFT where Delivery Plans are discussed to bring performance levels back in line with commissioned activity and to meet RTT targets. Recovery Plans are in place and regularly reviewed and challenged with each Care Group. Performance is also discussed at the Care Group Accountability Meeting.

There have been improvements noted including dermatology improving from 85% to above 95% and orthopaedics performance improving to almost 91% from 88%.

Increases in the admin team have impacted positively on the RTT position as now the validation of patient pathways is monitored on a daily basis. The increase in waiting areas has required the appointment of receptionists which has enabled the timely out coming of all patients following clinic and has enabled patients to leave the department with a follow up appointment or pre- operation appointment as required. Booking in kiosks are also rolling out across the Ophthalmology service, which will further compliment the provision of a dedicated Ophthalmology reception team at the entrance to the clinic.

Patients waiting less than 6 weeks for a diagnostic test

Commissioner May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Doncaster CCG 99.52% 99.61% 99.36% 98.78% 98.83% 99.18% 99.32% 99.25% 98.16% 98.66% 96.89% 97.65% 98.79%

Rightcare Peer Group 98.30% 98.56% 99.03% 98.63% 98.80% 98.90% 98.75% 97.68% 97.77% 98.87% 98.69% 98.53%

DBTHFT 99.50% 99.58% 99.23% 98.96% 98.94% 99.19% 99.44% 99.31% 98.08% 98.93% 97.43% 97.54% 98.50%

England 98.57% 98.53% 98.64% 98.32% 98.52% 98.90% 98.92% 98.33% 98.27% 98.96% 98.94% 98.20%

Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

Patients waiting less than 6 weeks for a diagnostic test 100%

99%

98%

97%

96%

95% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Doncaster CCG Rightcare Peer Group DBTHFT England Standard

A key issue again relates to audiology capacity. Two locums commenced in post during April with another appointed; performance is expected to be delivered by the end of June. Endoscopy capacity has been secured through an external supplier to mitigate patient breaches, manage demand and reduce the waiting list.

A&E attendances under 4 hours from arrival to admission, transfer or discharge

Provider May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17

Doncaster & Bassetlaw Teaching NHS FT 93.12% 92.28% 92.78% 91.86% 94.13% 92.82% 90.73% 86.58% 84.96% 88.70% 92.70% 90.37% 91.40%

England 90.24% 90.55% 90.27% 90.97% 90.64% 89.05% 88.40% 86.20% 77.60% 87.60% 90.00% 90.50%

Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

A&E attendances under 4 hours from arrival to admission, transfer or discharge 100% 95% 90% 85% 80% 75% 70% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Doncaster & Bassetlaw Teaching NHS FT England Standard

Trust performance improved to 91.4% during May despite an increase in the total amount of patients attending and the Trust has maintained the planned trajectory for quarter 1. Bed pressures were experienced at Doncaster Royal Infirmary (DRI) after the May Day Bank Holiday so a system wide response was initiated which allowed flow to be maintained. A proactive plan was put in place to support the DRI site for the Spring Bank Holiday but flow through the system worked effectively. Medical workforce gaps remained the predominant cause of breaches.

The Trust has now received additional National capital monies to improve front door streaming services for both DRI and Bassetlaw District General Hospital.

The Urgent Care Network, are reviewing the actions for 4 hour access across the Sustainability and Transformation Partnership (STP) footprint with each stakeholder leading on system wide improvement. A system wide ‘perfect week’ is being planned for the 5th of September being supported by Emergency Care Improvement Programme (ECIP) which will ensure that movement of patients through the hospital and into community settings with full support and where appropriate is optimised.

Cancer

2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 94.01% 93.45% 93.80% 95.58% 95.70% 96.24% 96.10% 95.56% 93.88% 94.73% 94.70% 89.10% 86.43% 89.76% 92.0% 86.76%

Rightcare Peer 95.46% 95.38% 95.36% 95.24% 94.61% 94.73% 94.86% 95.32% 95.95% 96.48% 95.90% 95.21% 96.46% 95.62% 95.78% 94.17% Group

DBTHFT 93.1% 94.0% 93.42% 94.5% 94.4% 94.4% 94.61% 95.3% 94.3% 94.6% 94.71% 90.5% 86.5% 88.5% 88.96% 86.7%

England 94.04% 93.87% 93.67% 94.40% 93.97% 94.12% 94.15% 94.84% 95.10% 95.47% 95.13% 94.00% 95.43% 94.70% 94.73% 92.8%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 98% 96% 94% 92% 90% 88% 86% 84% Q1 Q2 Q3 Q4

Doncaster CCG Rightcare Peer Group DBTHFT England Target

Two week wait performance has not met target for four months running for both the Trust and CCG. A response to the Contract Query submitted to DBTHFT during May has been received with a proposed resolution action plan for this measure including improved forward planning of capacity to match demand and reduce hospital and patient cancellations, and the implementation of the Electronic Referrals System which is expected to have a positive effect on performance. The timeframes of these actions span from April through to September with performance expected to show improvement from July 2017. Specific tumour group trajectories have been provided by the Trust to the CCG which will be monitored alongside the action plan provided.

2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 96.97% 93.67% 94.10% 93.33% 97.62% 100% 95.90% 92.00% 100% 91.30% 95.50% 88.64% 93.48% 93.33% 92.00% 84.44%

Rightcare Peer 93.85% 95.24% 94.37% 95.96% 94.90% 95.73% 95.62% 98.13% 97.45% 96.94% 97.50% 95.97% 96.00% 95.42% 95.78% 94.83% Group

DBTHFT 95.8% 93.8% 94.22% 92.5% 97.9% 100% 96.51% 93.5% 100% 93.2% 96.09% 93.1% 93.8% 93.1% 93.31% 90.10%

England 92.06% 91.96% 91.87% 92.16% 92.19% 95.67% 93.35% 96.11% 96.10% 95.19% 95.79% 93.80% 93.80% 91.60% 92.93% 89.7%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

2 week wait for first outpatient appointment for patients referred urgently with breast symptoms 100% 98% 96% 94% 92% 90% 88% 86% Q1 Q2 Q3 Q4

Doncaster CCG Rightcare Peer Group DBTHFT England Target

Performance for the CCG failed to meet target in April due to a total of 7 breaches in April, 5 relating to 'Patient Choice', 1 breach was relating to Hospital Cancellations and the remaining breach were due to Capacity Issues.

31-day wait from diagnosis to first definitive treatment for all cancers

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 98.06% 97.24% 96.10% 98.06% 97.78% 98.47% 98.20% 99.24% 97.62% 98.36% 98.80% 95.59% 97.30% 99.33% 97.60% 99.28%

Rightcare Peer 98.50% 98.35% 98.13% 98.36% 97.68% 97.40% 97.81% 98.29% 97.19% 98.25% 97.92% 97.18% 98.30% 97.75% 97.76% 97.68% Group

DBTHFT 99.4% 98.6% 99.12% 100% 100% 99.3% 99.78% 99.1% 99.2% 100% 99.77% 99.2% 100% 98.7% 99.30% 98.6%

England 97.59% 97.58% 97.61% 97.71% 97.34% 97.27% 97.56% 97.31% 97.20% 97.86% 97.60% 96.50% 97.62% 97.90% 97.47% 97.4%

Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%

31-day wait from diagnosis to first definitive treatment for all cancers 101% 100% 99% 98% 97% 96% 95% 94% Q1 Q2 Q3 Q4

Doncaster CCG Rightcare Peer Group DBTHFT England Target

31 day wait for subsequent treatment where that treatment is surgery

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 100% 100% 97.00% 92.86% 100% 100% 95.70% 100% 100% 100% 100% 94.74% 100% 100% 98.20% 100.00%

Rightcare Peer Group 93.65% 96.98% 95.78% 98.34% 98.48% 97.60% 98.01% 98.91% 97.12% 96.59% 97.57% 97.32% 96.41% 96.68% 97.11% 95.74%

DBTHFT 100% 100% 100% 100% 100% 100% 95.00% 100% 100% 100% 100% 94.1% 100% 100% 97.73% 100%

England 94.75% 96.27% 95.29% 96.01% 95.73% 95.21% 95.67% 95.74% 94.60% 95.53% 95.38% 94.10% 95.79% 95.80% 95.39% 98.5%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

31 day wait for subsequent treatment where that treatment is surgery 100% 99% 98% 97% 96% 95% 94% 93% 92% 91% 90% Q1 Q2 Q3 Q4 Doncaster CCG Rightcare Peer Group DBTHFT England Target

31 day wait for subsequent treatment where that treatment is drug regimen

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr

Doncaster CCG 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Rightcare Peer 99.70% 99.71% 99.71% 100% 99.72% 99.71% 99.81% 99.40% 99.74% 99.68% 99.63% 99.74% 99.39% 100% 99.55% 100% Group

DBTHFT 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

England 99.51% 99.42% 99.40% 99.37% 99.35% 99.18% 99.32% 99.33% 99.50% 99.54% 99.48% 98.90% 99.32% 99.20% 99.18% 99.3%

Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

31 day wait for subsequent treatment where that treatment is drug regimen 100%

99%

98%

97% Q1 Q2 Q3 Q4

Doncaster CCG Rightcare Peer Group DBTHFT England Target

31 day wait for subsequent treatment where that treatment is radiotherapy

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 100.00% 100.00% 100.00% 95.56% 97.92% 96.15% 96.60% 97.44% 97.78% 96.55% 97.30% 100.00% 95.65% 86.96% 93.90% 96.77%

Rightcare Peer 98.88% 98.58% 98.80% 98.53% 98.65% 96.01% 97.74% 98.64% 98.53% 98.89% 98.58% 98.09% 98.62% 97.38% 97.93% 99.01% Group

England 97.44% 97.06% 97.20% 97.30% 96.55% 96.44% 96.88% 97.28% 97.80% 98.16% 97.80% 96.20% 97.82% 97.30% 97.14% 96.9%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

31 day wait for subsequent treatment where that treatment is radiotherapy 100% 99% 98% 97% 96% 95% 94% 93% 92% 91% 90% Q1 Q2 Q3 Q4 Doncaster CCG Rightcare Peer Group England Target

62-day wait from urgent GP referral to first definitive treatment for cancer

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 83.58% 81.54% 82.00% 81.16% 83.33% 75.00% 80.80% 72.88% 82.76% 77.55% 81.40% 71.43% 80.00% 78.43% 77.30% 81.82%

Rightcare Peer 83.08% 82.94% 83.93% 83.62% 82.50% 81.17% 82.61% 82.82% 83.03% 81.65% 82.51% 83.24% 83.98% 82.83% 83.66% 85.01% Group

DBTHFT 89.7% 86.0% 87.84% 86.6% 86.2% 84.7% 86.81% 81.0% 85.8% 80.8% 85.27% 85.2% 86.8% 85.8% 86.84% 82.6%

Sheffield Teaching Hospitals 71.47% 79.55% 77.15% 82.33% 83.05% 79.84% 81.87% 80.94% 75.36% 79.01% 79.13% 74.93% 82.04% 79.18% 79.06% 84.78% Foundation Trust (STHFT)

England 81.27% 82.46% 82.38% 82.11% 82.60% 81.33% 82.32% 80.93% 81.90% 82.86% 82.25% 79.40% 79.59% 82.70% 81.08% 82.6%

Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

62-day wait from urgent GP referral to first definitive treatment for cancer 90%

85%

80%

75%

70% Q1 Q2 Q3 Q4

Doncaster CCG Rightcare Peer Group DBTHFT Sheffield Teaching Hospitals Foundation Trust (STHFT) England Target

62 day waiting times from referral to treatment for people with Cancer missed the standard for Doncaster CCG again in April 2017.

There were a total of 12 breaches in April resulting in performance of 81.8% against the 85% target. 7 of the breaches were with DBTHFT as the treating provider and the remaining 5 were Sheffield Teaching Hospital as the Provider. 8 of the 12 breaches were for the Urological Tumour site with 4 for Head and Neck.

There were a total of 7 breaches for DBTHFT in April 2017, 6 breaches for the Urological tumour type of which all were due Capacity Issues. The remaining breach was for the Skin Tumour group where the breach is still being investigated.

Of the 5 breaches, 3 were due to Inter Trust Referrals (ITR) being received after breach date, 2 for Urology and 1 for Head and Neck. One breach was due to ITR being received late in the pathway for the Head and Neck Tumour site and the remaining breach for Sarcoma was due to patient choice.

62-day wait from referral from an NHS screening service to first definitive treatment for all cancers

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 100% 100% 97.20% 100% 81.82% 100% 92.50% 75.00% 100% 88.89% 87.50% 83.33% 87.50% 90.91% 84.60% 100%

Rightcare Peer 94.29% 95.00% 94.29% 90.00% 95.29% 95.31% 93.61% 96.91% 95.19% 96.67% 95.56% 93.48% 94.38% 92.83% 94.42% 95.51% Group

DBTHFT 100% 100% 97.87% 100% 87.0% 94.7% 92.78% 90.9% 83.3% 100% 95.00% 87.5% 90.0% 93.1% 87.95% 100%

STHFT 96.43% 85.71% 92.96% 84.85% 97.50% 100% 93.88% 92.59% 91.49% 100% 95.08% 91.84% 90.70% 97.50% 93.18% 100%

England 90.79% 92.06% 91.30% 92.46% 92.86% 91.86% 92.35% 91.35% 92.50% 93.51% 92.47% 90.60% 90.06% 92.80% 91.22% 93.20%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

62-day wait from referral from an NHS screening service to first definitive treatment for all cancers 100%

90%

80% Q1 Q2 Q3 Q4 Doncaster CCG Rightcare Peer Group DBTHFT STHFT England Target

62-day wait from referral from consultant upgrade to first definitive treatment for all cancers

Commissioner May-16 Jun-16 Q1 Jul-16 Aug-16 Sep-16 Q2 Oct-16 Nov-16 Dec-16 Q3 Jan-17 Feb-17 Mar-17 Q4 Apr-17

Doncaster CCG 70.59% 69.23% 77.40% 76.19% 76.92% 92.31% 82.40% 82.35% 85.00% 84.62% 84.20% 77.78% 73.33% 86.36% 83.00% 70.00%

Rightcare Peer 87.24% 90.10% 89.43% 89.84% 89.05% 84.48% 87.53% 85.71% 87.86% 89.05% 87.96% 85.31% 88.46% 83.77% 85.68% 90.00% Group

DBTHFT 75.0% 81.6% 80.99% 80.0% 84.4% 88.9% 85.71% 83.3% 91.9% 86.2% 88.68% 88.5% 81.5% N/A 89.42% 83.0%

STHFT 79.71% 69.62% 76.42% 65.63% 74.19% 84.91% 74.18% 89.66% 80.88% 89.66% 86.41% 82.35% 81.03% 68.60% 76.02% 73.08%

England 87.23% 89.95% 89.54% 88.57% 89.18% 87.81% 89.28% 87.97% 89.70% 90.10% 90.11% 87.00% 86.63% 88.50% 88.47% 88.3%

62-day wait from referral from consultant upgrade to first definitive treatment for all cancers 100% 95% 90% 85% 80% 75% 70% 65% 60% Q1 Q2 Q3 Q4

Doncaster CCG Rightcare Peer Group DBTHFT STHFT England

There were 6 breaches in April 2017 resulting in the performance of 70%, of which 4 were Sheffield Teaching

Hospital as the treatment provider and 2 were as Doncaster and Bassetlaw Teaching Hospitals as treatment provider with the following exception commentary:

Doncaster and Bassetlaw Teaching Hospitals There were breaches for Haematology and Gynaecology with the haematology breach being investigated by the trust and the Gynaecology breach due to capacity issues.

Sheffield Teaching Hospital 3 of the breaches were due to the ITR being received after breach date in the Lung, Upper GI and Lower GI tumour sites. The remaining breach was due to ITR being received late in the pathway for the Lung tumour site.

Yorkshire Ambulance Service (YAS) – Doncaster - The category A ambulance NHS Constitution measures have been replaced during Ambulance Response Programme pilot.

YAS is continuing to participate in NHS England’s Ambulance Response Programme (ARP) pilot. The next stage, Phase 2.2, has been developed by listening to feedback from ambulance staff, GPs, healthcare professionals (HCPs) and patients and was implemented from 20 October 2016.

This revised process will give four main options for ambulance responses:

. Cardiac arrest or peri-arrest (Purple response standard - within 8 minutes) . Life-threatening emergency (Amber response standard - within 19 minutes) . Serious but not life-threatening emergency (Yellow response standard - within 40 minutes) . Non-emergency (Green response standard - 1 to 4 hours)

November 16 December 16 January 17 February 17 March 17 April 17 May 17 June 17 Category 1 < 8min 59.3% 58.4% 59.5% 60.3% 64.6% 60.2% 60.4% 61.8% (contract target 75%) Category 2T < 72.9% 67.4% 66.7% 70.7% 74.9% 72.4% 68.4% 70.2% 19 min Category 2R < 78.9% 81.4% 83.3% 82.1% 82.2% 76.5% 81.1% 72.0% 19 min Category 3T < 69.4% 64.5% 63.8% 65.5% 77.8% 68.7% 77.4% 64.0% 40 min Category 3R < 79.2% 64.9% 74.9% 77.1% 85.0% 82.5% 83.2% 72.8% 40 min Category 4 < 76.4% 64.8% 72.8% 64.9% 67.0% 67.2% 65.5% 59.0% 90 min Category 4H (triage) < 90 96.6% 94.6% 98.2% 100% 100% 100% 98.7% 99.7% min

Section 3: Provider Exception Report

The following section of the report details performance by exception (those measures either rated Red, or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH. Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance as a whole for DBTHFT and Doncaster sites for RDASH, and does not simply relate to the service provided to NHS Doncaster CCG. The following includes a summary of provider measures and exceptions, which are those which are of concern either cumulatively for the year, quarter or in month.

Number of Indicators and percentage within each provider Green Red DBTHFT 17 (53%) 15 (47%) RDASH 35 (90%) 4 (10%) Other Commissioned Services 5 (38%) 8 (62%)

45 Total 40 35 30 25 20 Red 15 Green 10 Green Red 5 0 DBTHFT RDASH Other Commissioned Services

3.1 Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust: Exception Report

This section only includes those measures in the DBTHFT contract currently not meeting target, which are not covered by the constitution measures in Section 2.

Handovers (ambulance to A&E) – no person waiting over 60 minutes

Handovers waiting over 60 min Provider May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 DBTHFT 12 11 4 15 28 5 8 12 66 13 10 21 14 Target 0 0 0 0 0 0 0 0 0 0 0 0 0

Handovers over 60 min 80

0 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Handovers (ambulance to DBTHFT A&E) – numbers waiting over 60 min

Ambulance handovers over 60 minutes reduced during May 2017 to 14. Performance issues are picked up during weekly joint meetings with CCGs and providers. When compared to other hospitals in Yorkshire and the Humber, DRI falls joint 4th with 4 other Trusts for the length of time handovers take over 15 minutes, with 7 hospitals having longer handovers than DRI.

Cancelled operations

Cancelled operations (target less than 0.8%) Provider May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 DBTHFT 1.2% 1.4% 1.2% 1.1% 1.4% 1.5% 1.5% 1.8% 1.8% 1.3% 1.0% 1.1% 1.1% Target 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8%

Reduction in cancelled operations 2.0%

1.5%

1.0%

0.5%

0.0% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Reduction in Cancelled Operations Target

Performance was maintained at 1.1% during May 2017 which is 0.1% lower than during May 2016, though the target was not met at any point in 2016/17.

The most recent data published by NHS England for q4 2016-17 shows that DBTHFT 1.32% of operations cancelled in comparison to 1.2% at other large trusts and the England average of 1.06%.

Cancelled Operations - 28 day standard Provider May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 DBTHFT 2 2 1 3 3 1 1 6 1 2 0 0 4 Target 0 0 0 0 0 0 0 0 0 0 0 0 0

Cancelled operations - 28 day standard 7 6 5 4 3 2 1 0 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Cancelled operations - 28 day standard

Cancelled Operations - No urgent operation cancelled for a second time Provider May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 DBTHFT 0 0 0 0 0 3 0 0 0 0 0 0 1 Target 0 0 0 0 0 0 0 0 0 0 0 0 0

Cancelled operations - urgent operations cancelled for a second time 4

0 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Cancelled operations - urgent operations cancelled for a second time

All of the patients who had a cancelled operation have now been seen and their operation completed.

52 Week Waits – Incomplete Pathway

52 Week Waits – Incomplete Pathway Provider May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 DBTHFT 0 4 5 2 1 1 1 0 1 2 1 1 1 Target 0 0 0 0 0 0 0 0 0 0 0 0 0

52 Week Waits – Incomplete Pathway 6 5 4 3 2 1 0 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

52 Week Waits – Incomplete Pathway

One patient waited over 52 weeks in May 2017 from General Surgery. Some further diagnostics had been required and then a further delay had been experienced due to patient choice. An appointment has been scheduled during July 2017. Validation processes remain in place to identify any long waiters and work is progressing between DBTHFT and Northern Lincolnshire and Goole NHS Foundation Trust to develop training material (Right First Time) for staff around RTT measures. A baseline questionnaire to 100 staff received a 97% response rate to help highlight areas where increased awareness could be beneficial. This training will be made available across all staffing groups with a focus on key care groups.

Referral to diagnosis of Autism to be no more than 18 weeks for 95% of patients under 5

Referral to diagnosis of Autism to be no more than 18 weeks for 95% of patients under 5 May- Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Provider 16 DBTHFT 0.00% 0.00% 0.00% 0.00% 0.00% 25.00% 100.00% 100.00% 100.00% 100.00% 75.00% 75.00% 80.00% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

RTT for people with Autism 100% 80% 60% 40% 20% 0% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Referral to diagnosis of Autism to be no more than 18 weeks for 95% of patients <5

One of 5 patients did not meet the referral to diagnosis standard in 18 weeks in May. The service are currently short of a Psychologists, one recently started in June and another vacancy is out to advert, for which RDaSH are leading the recruitment. The waiting lists for General Development Assessments have significantly reduced over time with the service adding additional clinics at weekends to manage the demand.

Stroke: Proportion of patients directly admitted to a stroke unit under 1 hour (target 48%) and 4 hours (target 90%); Proportion of applicable patients receiving a joint health and social care plan on discharge (target 90%); and Percentage of applicable patients who are discharged who were given a named person to contact after discharge (target 95%)

Feb- Mar- Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 DBTHFT measure 17 17 Proportion of patients scanned within 1 hour 42.9% 52.5% 50.0% 53.8% 55.1% 51.5% 47.8% 56.0% 54.3% 52.9% 37.2% 43.8% of clock start (target 48%) Proportion of patients directly admitted to a 69.6% 70.0% 67.4% 71.2% 67.3% 71.1% 60.9% 66.0% 62.9% 49.0% 51.2% 53.1% stroke unit under 4 hours (target 90%) Proportion of applicable patients receiving a joint health 87.5% 77.1% 91.7% 90.0% 97.7% 92.1% 94.4% 85.0% 93.1% 73.0% 74.4% 85.2% and social care plan on discharge (target 90%) Percentage of applicable patients who are discharged who 79.2% 73.0% 82.5% 75.0% 95.5% 94.9% 97.2% 82.2% 79.4% 65.9% 74.4% 80.7% were given a named person to contact after discharge (target 95%)

Stroke measures 100.0%

80.0%

60.0%

40.0%

20.0%

0.0% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Proportion of patients scanned within 1 hour of clock start Proportion of patients directly admitted to a stroke unit under 4 hours Proportion of applicable patients receiving a joint health and social care plan on discharge Percentage of applicable patients who are discharged who were given a named person to contact after discharge

There was an unusually high number of discharges in the month (64) compared to a monthly average for the year of 48.

The stroke pathway is being process mapped to look at areas of potential improvement including working with Emergency Department and East Midlands Ambulance Service staff around identifying patients to increase direct access and movement to the Stroke Unit. These areas will include the Stroke Nurse’s role within the Emergency Department, pathways to radiology and computed tomography (CT), portering and patient flow, transfers from Bassetlaw and patients with initial presentation which mimics stroke. This will identify gaps within the service and opportunities to improve on current performance to admit to the stroke unit within 4 hours. In order to improve on the 4 hour to admission target, it should be recognised that it will be necessary to review and enhance the whole pathway for patients following stroke. Bed availability on admission is dependent on flow through the entire pathway.

With the wider pathway the entire rehabilitation pathway and all options currently available for onward referral from the Acute hospital will be reviewed to identify delays and gaps within this pathway, fully understand the current Early Supported Discharge

38 service provision, share options analysis for improvement with CCG colleagues and ensure links with Intermediate Care developments regarding community bed base and home first approach.

Infection Control

Cases of MRSA Apr- May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Provider 16 DBTHFT 0 0 1 1 0 0 0 1 0 0 0 0 1 Target 0 0 0 0 0 0 0 0 0 0 0 0 0

There has been a case of MRSA reported for DBTHFT for April 2017 who was also a DCCG patient.

Following a Post Infection Review it has been agreed that this was a contaminant.

3.2 Rotherham, Doncaster & South Humber NHS Foundation Trust

This section only includes those measures in the RDASH contract currently not meeting target, which are not covered by the constitution measures in Section 2.

Percentage of patients receiving a 12 month Section 117 review – adult services (target 95%)

Percentage of patients receiving a 12 month S117 review – adult services Provider May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 RDASH 94.3% 93.8% 94.2% 94.1% 95.0% 94.6% 94.2% 95.1% 93.0% 93.7% 92.1% 93.3% 92.9% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

S117 Reviews 100.0% 98.0% 96.0% 94.0% 92.0% 90.0% 88.0% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

S117 reviews Target

S117 Reviews 100.0% 98.0% 96.0% 94.0% 92.0% 90.0% 88.0% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

S117 reviews Target

The compliance percentage has fallen slightly 92.9% which relates to 40 breaches. RDASH have provided further details of these patients to the monthly meeting help between the CCG and the Trust. Work is underway to ensure that these patients receive a review where appropriate. In addition information around this area of work is being added to the Trusts new data warehouse which will allow reports to be produced more quickly and accurately; a further data validation meeting has been scheduled in July to progress this work.

Improving Access to Psychological Therapies (IAPT)

Locally reported data from RDASH is shown below; although nationally published data shows some underperformance within the timeframes of access to the IAPT service and around the percentage of people achieving recovery, locally performance has been shown to be meeting targets with the exception of the recovery rate in May 2017. The difference is due to some errors in national submissions which have been flagged with the national team.

IAPT Recovery Rate

Commissioner May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17

Doncaster CCG 46.30% 44.80% 47.00% 51.90% 53.80% 58.50% 49.70% 50.60% 54.50% 56.20% 59.00% 45.70% 48.10%

England 48.59% 48.89% 48.72% 48.55% 48.44% 48.60% 48.80% 48.80% 49.15% 49.89% 50.97%

Target 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

IAPT Recovery Rate 65% 60% 55% 50% 45% 40% 35% 30% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Doncaster CCG England Target

During May 2017 locally reported data has identified underperformance of 48.1% against the 50% target. An action plan is in place which has been agreed with the CCG with key actions around triage and follow up, Drug and Alcohol referrals as well as potential use of single point of access identified. The service are currently looking into the drop in April and May; this is reflective of the first quarter of 2016-17 and appears to be seasonable.

CAMHS: Percentage of referrals starting a treatment plan within 8 weeks/Non Urgent (target 98%)

CAMHS May- May- Commissioner Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 16 17 Percentage of referrals starting a treatment plan 87.3% 87.2% 97.5% 92.6% 94.7% 85.7% 93.9% 92.3% 94.7% 97.3% 95.6% 80.8% 90.7% within 8 weeks/Non Urgent Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

CAMHS 100.0%

50.0%

0.0% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Triaged referrals assessed percentage of referrals starting a within 4 weeks / Non Urgent treatment plan within 8 weeks / Non Urgent

May’s performance was below the 98% target at 90.7%. There were 4 service breaches out of the 43 non-urgent referrals relating to issues around capacity, patient choice and building work.

As previously reported last month the service is currently extending the weekend sessions as required. Staff are being transferred between clinical pathways and the service is exploring the use of appropriate agency staff to provide additional support with the current referral demands. In addition two staff are returning from Maternity Leave in the coming months.

3.3 Other Commissioned Services

3.3.1 FCMS: Out of Hours (OOH) Surgery face to face assessments triaged as emergency is less than 1 hour and as urgent under 2 hours; Visits face to face assessments triaged as urgent under 2 hours

Out of Hours 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17

Surgery < 1 hour Surgery < 2 hours Visits < 1 hour Visits < 2 hours Target

OOH Surgery breaches for Red Priority (1 hour): Performance rose to 80% in May with 1 breach caused by a clinician delay.

OOH Surgery breaches Amber Priority (2 hours): Performance fell slightly in May by 0.7% resulting from 43 breaches. The main reason remains clinician delays (21), 3 of which waited over 3 hours all on the same day due to increased demand within the service.

OOH Visit breaches Red Priority (1 hour): Although performance was 0% it was the result of the only patient accessing the service through this pathway breaching target and has been attributed to a reporting error.

OOH Visit breaches Amber Priority (2 hours): Performance rose to 93.75% during May due to one breach which failed to meet target by less than a minute.

Same Day Health Centre: face to face assessments triaged as emergency and seen under 1 hour and as urgent under 2 hours Same Day Health Centre 100%

80%

60%

40%

20%

0% May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Target SDHC < 1 hour SDHC < 2 hours

Red Priority (1 hour) breaches: There were 2 breaches during May both of which could be attributed to patient choice or the first available appointment.

Amber Priority (2 hour) breaches: There were 33 breaches during May resulting in a slight fall of performance to 79.1%. Twenty of these breaches could be patient choice or may have been the earliest available appointment, with 11 attributed to clinician delays. The service continues to ask staff to record on the system when a delay is due to patient choice so these can be identified.

A clinical review has taken place of all red and amber priority patients who weren’t seen in time and no harm came to these patients due to the delay.

3.3.2 Nursing / Care Homes / Domiciliary Care Providers

The information provided within this section is taken up to 30th June 2017. Since the last Governing body meeting there has been 0 new embargo’s against admissions / new care packages placed. There remains 1 home with restrictions in place.

3.3.3 Serious Case Reviews / Lesson Learnt Reviews

No new Serious Case Reviews or Lessons Learnt Reviews have been recommended or commissioned since the last Governing Body Report.

3.3.4 Domestic Homicide Reviews

There are currently 2 Domestic Homicide Reviews taking place within Doncaster. An independent chair has been commissioned for both reviews. The first draft of agency Individual Management Reviews / Summary Reports where presented to the DHR Panel on the 20th June 2017. Agencies are currently awaiting comments from the chair on the reports submitted to date.

3.3.5 Mixed Sex Accommodation

Breaches of Mixed Sex Accommodation

Commissioner May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17

Doncaster CCG 0 0 0 0 0 0 0 0 0 0 1 0 0

There were no mixed sex accommodation breaches reported for Doncaster CCG during May 2017.

3.3.6 Complaints and Concerns (DBTHFT)

Complaints and concerns 200 150 100 50 0 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

Complaints and concerns

Complaints resolution has improved this month and DBTHFT continue work to improve this further.

3.3.7 Serious Incidents (SI)

Serious Incidents 25 20 15 10 5 0 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 2016/17 Q1 2017/18

Serious Incidents

Please note that the above figures include incidents which may be subsequently de-logged as a SI.

Section 4: Improvement and Assessment Framework

NHS England replaced the CCG Assurance Framework with an Improvement and Assessment Framework which covers the following four domains: 1. Better Health: this section looks at how the CCG is contributing towards improving the health and wellbeing of its population, and bending the demand curve; 2. Better Care: this principally focuses on care redesign, performance of constitutional standards, and outcomes, including in important clinical areas; 3. Sustainability: this section looks at how the CCG is remaining in financial balance and securing good value for patients and the public from the money it spends; 4. Leadership: this domain assesses the quality of the CCG’s leadership, the quality of its plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest.

In July 2017 CCGs will be assigned a rating for each of the 6 clinical areas by independent panels and will also receive an overall assessment. The possible ratings are: Top Performing, Performing Well, Needs Improvement and Greatest Need for Improvement.

The following table shows the baseline assessment for Doncaster CCG published in June 2016. These are due to be updated in July 2017. Clinical Priority Area Overall rating Cancer Greatest Need for Improvement

Dementia Needs Improvement

Diabetes Performing Well

Learning Disabilities Needs Improvement

Maternity Needs Improvement

Mental Health Performing Well

Underpinning the domains are 60 indicators which are used to inform the ratings (Appendix 1).

According to data published by NHS England in June 2017 Doncaster CCG is in the lowest performing quartile in England for the following indicators:

Indicator Period DCCG Rank (out of 209 CCGs)

Injuries from falls in people aged 65 and over q3 16/17 2396 173

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions q3 16/17 1165 166

Cancers diagnosed at early stage 2015 48.6% 174

Anti‐microbial resistance: appropriate prescribing of antibiotics in primary care Feb‐17 1.21 178

Staff engagement index 2016 3.69 192

Out of area placements for acute mental health

inpatient care ‐ transformation q4 16/17 25% 192

Reliance on specialist inpatient care for people with a learning disability and/or autism q4 16/17 78 174

Dementia care planning and post‐diagnostic support 2015/16 76.5% 164

Emergency admissions for urgent care sensitive conditions q3 16/17 3274 184

Digital interactions between primary and secondary care q4 16/17 46.4% 207

The following work is being undertaken to address performance against these indicators:

Injuries from falls in people aged 65 and over As part of the system transformation of Intermediate Care a new rapid response service was launched on 23rd January. Ambulance staff will assess patients who have fallen and those who require short term health or social care support to stay at home will be referred to this service rather than conveyed to A&E.

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions DCCG is undertaking joint work with the DMBC Public Health Department and the Burns Practice to identify and address health inequalities. A Health and Well Being Workshop in Health Inequalities attended by all local stakeholders was held in October 2016. A Health Inequalities Working Group has been established and includes representatives from DCCG, DMBC, Health Watch and General Practice. Anti-microbial resistance: appropriate prescribing of antibiotics in primary care DCCG’s prescribing rate of antibacterial items per STAR-PU in 2016-17 was 2.43% lower than in 2015-16 and DCCG achieved the 2016-17 Quality Premium target for reducing antibacterial prescribing. The Medicines Management Delivery Plan aims continue this improvement in reducing anti-microbial resistance.

Cancers diagnosed at early stage The Cancer Delivery Plan aims to increase the proportion of cancers diagnosed at stages 1 or 2 to the national average by March 2018. The proportion increased from 37.8% in 2014 to 48.6% in 2015.

Out of area placements for acute mental health inpatient care – transformation There are currently a high number of specialised placements for people with complex mental health / forensic histories who are in secure rehabilitation / personality disorder units. DCCG is currently scoping work to repatriate these patients.

Reliance on specialist inpatient care for people with a learning disability and/or autism There are currently 13 people out of area in secure rehabilitation and DCCG has developed a transformation plan based on transferring these patients to community services. 7 of these patients were due to be transferred by 31st March.

Dementia care planning and post-diagnostic support The Doncaster Admiral Service provides all persons diagnosed with dementia living at home with a point of contact. These patients will have a care plan but this is not necessarily provided by the patient’s GP. In the summer of 2017 DCCG is going to the market to commission a comprehensive and holistic post diagnostic service. The Dementia Delivery Plan aims for 85% of people referred for an assessment to receive a diagnosis and commence NICE approved treatment within 10 weeks.

Emergency admissions for urgent care sensitive conditions The Urgent Care Delivery Plan aims to increase the proportion of patients streamed away from the Emergency Department at DRI to an average of 20% per month and also to reduce ambulance conveyances to DRI by 2.5% in 2017-18. The Doncaster Place Plan aims to reduce emergency admissions for older people with these conditions by developing out of hospital services and fostering community resilience to improve support and provide services closer to home.

Staff Engagement Index This indicator is derived from the results of the 2016 NHS Staff Survey for DBTHFT and RDaSH. DBTHFT’s overall Staff Engagement Score in 2016 is significantly worse than in 2015 and is in the lowest 20% of its benchmark group. To address this issue DBTHT have developed a Staff Survey Action Plan which contains five key elements: Communicating with staff Listening to staff Involving staff Supporting and engaging with managers A program of staff experience

Digital interactions between primary and secondary care Doncaster CCG’s IT Strategy aims to increase the number of Practices enabled for the Electronic Prescription Service version 2 (EPS2). The Planned Care Delivery Plan includes a review of the e-referral system and both the Access Policy and Contract KPI schedule include a requirement for DBTHFT to ensure that sufficient slots are available on the system to enable electronic booking to take place. Working in partnership with DBTHFT DCCG plans to implement electronic discharge messaging. A Doncaster Interoperability Group has been established chaired by the Chief Officer of DCCG. This Group includes representatives from primary and secondary health and also social care. The purpose of the Group is to lead the implementation of the local digital roadmap and also the integration of information across the Doncaster health and social care community.

Appendix 1 - Improvement and Assessment Framework dashboard.

Section 5: Looked After Children Report

Introduction

This paper intends to provide an update on the Looked After Children (LAC) Paper presented at Governing Body in March, Quality Patient Safety Committee and Corporate Parenting Board.

The Governing Body and Corporate Parenting Board requested an updated position of the quality of provision following the procurement of a new service to provide the Initial Health Assessments. This will also be shared and discussed with the Multi Agency Looked After Panel (MALAP).

Scott Practice was awarded the contract for completing the initial medical health assessment in January in partnership with GPs in Bentley Surgery. Best Practice in line with the Statutory Guidance for Looked After Children, initial assessments are required to be completed within 20 working days. Aligned with this the RDASH nurse LAC team are also inputting into the Initial Health Assessment (IHA) for all age children by providing an early holistic assessment prior to the IHA and medical assessment.

Performance

Performance has been collated since the new service commenced, however for Quarter One which is due for reporting in July the indicators have become more sophisticated to show how many days after the 20 day threshold the assessment has been completed and day of notification by social care, this will demonstrate the actual response time by the service.

For the reporting period of January to March there have been no outstanding assessments for the 29 children reported. There is still a delay in receiving the notifications and consent from social care, some are not being received until 14 -16 days of the child being in care therefore it is impossible to book and undertake an assessment within 20 working days.

The Children’s Commissioner, Designated and Named Nurse for LAC have met with the Head of Service for LAC in Doncaster Children’s Services Trust (DCST) to discuss the issues that are still apparent and also develop practice by encouraging the social worker to be present at the initial health assessment. The Trust are continually raising this with social work staff and looking at arrangements for late summer to support social workers to engage in the health assessment process.

Quality of Assessment

To develop the quality of assessment, analysis and reporting the Designated Doctor, Nurse and Named Nurse have held learning and development sessions with the GP’s completing the IHA’s to develop a consistent good standard, particularly focusing on the action plan and recommendations that arise from the assessment.

Moving forward it is intended that sessions will include peer reviewing of reports to develop reflective practice and shared learning. The Designated Nurse is exploring opportunities for the LAC Council to deliver some elements of the Respect Training to offer the Doctors a viewpoint from young people to inform their assessments and consultations.

The Designated Doctor also compiles a thorough monthly audit of a selection of IHA and considers areas of good practice and areas for development which informs training.

Progress on Recommendations and Objectives for 2017/18

1. Child and Adolescent Mental Health Services (CAMHS) Looked After Children analysis deep dive March 2017, this will inform future commissioning decision making.

Work has been initiated on the deep dive; the children’s commissioner has secured an independent consultant, who has begun this work. He has met with CCG commissioners and the CAMHs team to set the work plan. The next stage will be for the consultant to engage with relevant stakeholders as part of the mapping process, to shape the final recommendations.

2. DCST to improve timely communication of notifications and consent for children coming into care by 5 working days.

As described in the body of the report

3. Embed new IHA providers and holistic team working to achieve timely IHA that are of good quality.

As described in the body of the report

4. The voice of LAC and their carers needs to continue to be at the forefront of commissioning decisions and service development, as a commissioning organisation.

Still to be progressed, however on-going consultation and engagement happens with the LAC Nursing Team to provide responsive care through the services that are currently commissioned. Once the new GP service is embedded a satisfaction survey will be developed to seek views and hear the voice of children and young people.

5. CCG to hear the voice of the Looked After Child during patient stories in Governing Body.

Stories heard and discussed at the March Governing Body meeting on experience of health services as Looked after Children and prior coming into care, RDASH are also planning for these experiences to be heard at Board too.

6. CCG to consider opportunities for work experience for LAC.

Designated Nurse is liaising with the Lead Practitioner for LAC at The Hub (Doncaster College) together with Human Resources to understand what types of work experience would be benefitted from and how the CCG could support such placements.

Challenges to Progress

 Engaging the Social Workers to attend the IHA appointment (acknowledging they may have to prioritise Court).  Receiving timely notifications from DCST.  The capacity by the LAC Nursing team to respond in time to complete a holistic assessment before the IHA is booked in.

Enc E

Item 10

Finance Report

Meeting name Governing Body Meeting date 20 July 201 7

Title of paper Finance Report May 2017 (Month 2)

Executive / Hayley Tingle, Chief Finance Officer Clinical Lead(s) Author(s) Tracy Wyatt, Deputy Chief Finance Officer

Purpose of Paper - Executive Summary

This report sets out the financial position as at the end of May 2017.

The CCG is forecasting to achieve all of its financial targets for 2017/18 at this early stage in the year.

The report also outlines:

• The key risk areas identified for 2017/18 • A summary of the CCG Efficiency Savings for 2017/18 (Appendix 2) • A summary of the CCG’s Resource Allocation (Appendix 3) • A summary of the CCG’s Reserve position (Appendix 4)

Recommendation(s)

Members are asked to:

• Receive the report and note the financial position for May 2017 (Month 2).

Impact analysis Quality None identified impact Equality None identified impact Sustainability Nil impact Financial As highlighted within the report implications Legal None identified implications Management of Conflicts None Identified of Interest Consultation / Engagement N/A (internal departments, clinical, stakeholder & public/patient) Report previously None presented at The CCG identified a number of risks as part of the Financial planning for 2017/18. These included:

• Non delivery of parts of the Efficiency Savings programme • Over performance against the main acute contracts • Prescribing and High Cost Drugs Expenditure Risk • Individual Placements analysis A small contingency fund of £2.5m, which equates to 0.5% of the CCG’s allocation, has been set aside to mitigate against these risks, as required by the business rules. Should this not prove sufficient then the CCG will have to look at extending its efficiency programme further or potential other measures in collaboration with STP partners. Assurance 3.1, 3.2, 3.3, 3.4 Framework

NHS DONCASTER CCG

2017/18 FINANCE REPORT MONTH 2 – MAY 2017

1. Introduction

This report provides the financial position for NHS Doncaster CCG for 2017/18 as at the end of May 2017 (Month 2). The CCG is forecasting to achieve all of its financial targets for 2017/18 at this early stage in the year.

2. Current Position

The following table shows the CCG’s current and forecast position for the key financial targets and statutory duties -

Key Duty Target Month 2 Forecast Achieve annual target of £12,021k £2,010k £12,021k Financial surplus (£2,004k M2) Position NHSE In year reporting - breakeven B/E B/E QIPP Achievement (Plan £11,660k) TBD TBD 95% + invoices paid within 30 days 95.76% 98% (NHS) 95% + invoices paid within 30 days 96.67% 98% (non NHS) BPPC 95% + invoice values paid within 30 99.95% 98% days (NHS) 95% + invoice values paid within 30 98.49% 98% days (Non NHS) Cash 1.25% of monthly drawdown remaining 1.24% 1.11% Drawdown at period end Running Maintain spend within annual target of £961k £6,773k Costs £6,773k (£1,042k M2) Capital Expenditure not to exceed allocation N/A N/A Resources (N/A)

Key

Red Not achieving and at risk of not being met Amber Not achieving but could be recovered Green Achieving and on target to be met

The Month 2 position reflects a surplus of £2,010k which is in line with the target of £2,004k and the forecast is to achieve the £12,021k surplus for the year.

It should be noted that NHS England have now moved to in year reporting rather than cumulative surplus reporting. This is to bring CCG’s in line with provider

3 reporting and to avoid misinterpretation of CCG’s financial positions by showing large in year surpluses when these are in fact just historical cumulative surpluses.

For NHS Doncaster CCG our in year reporting position is to break even.

The current and forecast position is summarised in the Operating Cost Statement included at Appendix 1.

3. Key Messages and Risks

The largest financial risks identified as part of the Financial Planning process were around achievement of the ambitious efficiency plans, acute contract over performance, Prescribing, and increased Individual placements (including Continuing Healthcare, Specialist Placement and Section 117 packages).

The delivery of the efficiency programme remains the highest risk and although significant work has been undertaken and plans are in place this will need to be closely monitored and any mitigating action taken early to ensure the financial control is delivered.

Acute contract over performance remains a risk as the acute providers may undertake additional activity to meet RTT targets. Prescribing prices remain a risk as they are agreed nationally so are outside of the CCG’s control.

Individual Placements remain a concern as cases continue to step down from Specialised Services (NHS England) with no funding being transferred.

To help manage and offset the risks a small contingency fund of £2.5m was established as part of planning. This equates to 0.5% of the CCG’s allocation and is as in line with business rules.

4. Efficiency Savings Programme

The CCG has an ambitious efficiency plan equating to £11.6m.The main contracts with Doncaster and Bassetlaw Teaching Hospitals NHS FT and Rotherham, Doncaster and South Humber NHS FT were negotiated net of the agreed efficiency targets of £4.5m and £0.5m respectively. A full breakdown of the efficiency targets split by the relevant Delivery Plan is shown in Appendix 2. At this early stage in the year limited information is available to quantify the achievement so far. For the August Governing Body meeting a detailed analysis will be provided, where information is available, on the progress so far and any actions that may be required to bring the position back into line if required.

5. 1% Non Recurrent Headroom

The CCG has set aside £4.4m, (1% of the CCG’s recurrent allocation excluding delegated primary care), as per the business rules, for non-recurrent investment. In 2017/18 the CCG has had to ring-fence 50% of this funding to provide funds to insulate the wider health economy from financial risk. As per 2016/17 this funding is

4 unlikely to be able to be utilised. The remaining 50% has been utilised to balance the overall financial plan for 2017/18.

6. Further Allocations

The CCG has not received any new allocations so far this year.

7. Capital Resource

The CCG has not yet received any capital funding in 2017/18.

8. Better Care Fund

The detailed utilisation of the Better Care Fund has not yet been agreed due to significant delays in the guidance publication by NHSE. The guidance has now been published (early July) and the plan is now being prepared for agreement by the CCG and Local Authority by mid-August.

The overall funding for 2017/18 has increased due to the introduction of the Improved Better Care Fund, which has provided an additional £8m to be utilised in key areas such as meeting Adult Social Care needs, reducing the pressure on the NHS, including Delayed Transfers of Care, and supporting the local social care provider market. A summary of the 2017/18 budget is shown below.

Source 2017/18 £m BCF funding provided by Doncaster CCG 15. 168 BCF revenue funding from Doncaster MBC 7. 166 BCF capital funding from Doncaster MBC 2.118 Original BCF (2 years announced) 24.452 Improved BCF announced 2015 1.333 Improved BCF announced 2017 7.046 Total Improved BCF (3 years announced) 8.379 Total 32.831

9. Conclusion and Recommendations

Members are asked to receive and note the Finance Report for May 2017 (Month 2).

NHS DONCASTER CLINICAL COMMISSIONING GROUP Appendix 1 2017/18 FINANCE REPORT MAY 2017

Opening Budget FORECAST YEAR TO DATE Variance OPERATING COST STATEMENT Recurrent Non Rec Total Recurrent Non Rec Total Forecast Variance Recurrent Non Rec Total (Under)/ Budget Budget Budget Budget Budget Budget Outturn (Under)/ Over Budget Budget Budget YTD Actual Over £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

Baseline Allocation -445,139 -445,139 -445,139 0 -445,139 -445,139 0 Co-Commissioning -42,534 -42,534 -42,534 0 -42,534 -42,534 0 HRG4+ 4,024 4,024 4,024 4,024 4,024 0 IR Rule Chnages -362 -362 -362 -362 -362 0 In year drawdown of prior year surplus -438 -438 -438 -438 -438 0 Historic Drawdown -12,021 -12,021 -12021 -12,021 -12,021 0 Running Cost Allowance -6,773 0 -6,773 -6773 0 -6,773 -6,773 0 Initial Allocation -494,446 -8,797 -503,243 -494,446 -8,797 -503,243 -503,243 0

In year changes 0 0 0 0 0 0 0 0 TOTAL ALLOCATIONS -494,446 -8,797 -503,243 -494,446 -8,797 -503,243 -503,243 0 -81,578 -81,578 0

Acute Contracts - DBHFT 186,163 1,186 187,349 186,434 793 187,227 187,227 0 31,205 0 31,205 31,205 1 Acute Contracts - Other NHS 34,741 4,848 39,589 36,153 4,033 40,185 40,185 0 5,626 0 5,626 5,309 -317 Acute Contracts - Other Providers Non NHS 4,443 125 4,568 4,530 0 4,530 4,530 0 755 0 755 756 1 Acute Contracts - Urgent Care 5,843 0 5,843 5,843 0 5,843 5,843 0 974 0 974 973 0 Acute - Non Contract Activity 2,574 0 2,574 2,574 0 2,574 2,574 0 429 0 429 429 0 Total Acute Services 233,764 6,159 239,923 235,534 4,826 240,359 240,359 0 38,988 0 38,988 38,672 -315

Mental Health Contracts - RDaSH FT 34,864 0 34,864 34,764 123 34,887 34,768 -119 5,728 0 5,728 5,728 1 Mental Health Contracts - Other NHS 1,094 0 1,094 1,167 0 1,167 1,167 0 80 0 80 60 -21 Mental Health Contracts - Other Providers 17,435 0 17,435 17,338 0 17,338 17,338 0 2,890 0 2,890 3,250 361 Mental Health - Non Contract Activity 60660 66 0 10 1 0-1 Total Mental Health Services 53,399 0 53,399 53,275 123 53,398 53,279 -119 8,699 0 8,699 9,038 339

Community Contracts - RDaSH FT 30,857 0 30,857 30,880 2 30,883 31,002 119 5,074 0 5,074 5,074 0 Community Contracts - Other NHS 395 438 833 369 -88 281 281 0 -27 0 -27 -27 0 Community Contracts - Other Providers 10,977 0 10,977 10,980 0 10,980 10,980 0 1,830 0 1,830 1,822 -8 Total Community Services 42,229 438 42,667 42,229 -86 42,143 42,262 119 6,877 0 6,877 6,869 -8

Prescribing 63,565 0 63,565 63,565 0 63,565 63,565 0 10,594 0 10,594 10,594 0 Oxygen Services 614 0 614 614 0 614 614 0 102 0 102 113 10 Other Primary Care Services 4,176 0 4,176 4,176 0 4,176 4,176 0 643 0 643 635 -9 GPIT 802 0 802 802 0 802 802 0 134 0 134 132 -2 Delegated Co-Commissioning 41,992 0 41,992 41,992 0 41,992 41,992 0 6,969 0 6,969 7,033 64 Primary Care Services 111,149 0 111,149 111,149 0 111,149 111,149 0 18,443 0 18,443 18,506 63

Continuing Healthcare 29,664 0 29,664 29,664 0 29,664 29,664 0 4,944 0 4,944 4,939 -5 Continuing Healthcare Services 29,664 0 29,664 29,664 0 29,664 29,664 0 4,944 0 4,944 4,939 -5

Medicines Management 518 518 518 0 518 518 0 86 0 86 87 1 Safeguarding 39 3939 0 39 39 0 6 0 6 60 Mental Health Assessments 0 00000000000 NHS Property Services Recharge 2,404 2,404 2,404 0 2,404 2,404 0 401 0 401 401 0 Corporate non running costs 2,961 0 2,961 2,961 0 2,961 2,961 0 493 0 493 494 1

Chief Pharmacist 88 88 88 0 88 88 0 15 0 15 13 -2 Admin & Business Support 879 879 879 0 879 879 0 60 0 60 50 -10 Contract Management 535 535 535 0 535 535 0 89 0 89 81 -8 Finance 717 717 717 0 717 717 0 119 0 119 107 -12 Corporate Costs & Services 397 397 397 0 397 397 0 66 0 66 85 18 Human Resources 82 82 82 0 82 82 0 14 0 14 15 1 Health & Safety 11 1111 0 11 11 0 2 0 2 20 Patient & Public Involvement 112 112 112 0 112 112 0 19 0 19 11 -8 Communications & PR 5 55055010121 Performance 833 833 833 0 833 833 0 139 0 139 128 -11 Quality Assurance 628 628 628 0 628 628 0 105 0 105 96 -9 Primary Care Support 193 193 193 0 193 193 0 32 0 32 25 -8 Strategy & Development 803 803 803 0 803 803 0 134 0 134 117 -17 Governing Body 1,491 1,491 1,491 0 1,491 1,491 0 248 0 248 231 -18 Corporate Running Costs 6,773 0 6,773 6,773 0 6,773 6,773 0 1,042 0 1,042 961 -81

Total Corporate Costs 9,734 0 9,734 9,734 0 9,734 9,734 0 1,535 0 1,535 1,455 -80

1% Non Recurrent Headroom Reserve 2,226 2,226 2,226 2,226 2,226 0 0 0 0 0 0 Contingency Reserve 0.5% 2,460 2,460 2,460 0 2,460 2,460 0 0 0 0 0 0 Total Reserves 2,460 2,226 4,686 2,460 2,226 4,686 4,686 0 0 0 0 0 0

TOTAL APPLICATION OF FUNDS 482,399 8,823 491,222 484,045 7,177 491,222 491,222 0 79,574 0 79,574 79,568 -6

SURPLUS 1% REQUIREMENT* 12,021 12,021 0 -12,021 2,004 0 -2,004

TOTAL 503,243 503,243 491,222 -12,021 81,578 79,568 -2,010

* This reflects the historical cumulative surplus NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 2

Savings / Efficiency Programme 2017/18

Annual YTD Forecast Delivery Plan Scheme Contract Plan £'000 £'000 £'000 Childrens & Maternity Paediatric transformation plan Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 470

Community & End of Life Community QIPP Rotherham, Doncaster and South Humber NHS FT 222 37 222

Continuing Healthcare/Care Homes Continued Management of cases and adherence to access criteria N/A 2,500

Intermediate Care/Urgent Care Impact of Intermediate Care redesign Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 946

Mental Health & LD LD frequent flyers Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 11 Mental Health & LD Mental Health QIPP Rotherham, Doncaster and South Humber NHS FT 278 46 278

Planned Care Reduction in Gp referrals 6% Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 963 Planned Care Reduction in acupuncture activity (NICE guidance) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 96 Planned Care Procedures of Limited Clinical Value Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 1,529 Planned Care Procedures of Limited Clinical Value (other providers) Other Acute providers 1,300 Planned Care Use of biosimilars (FY impact) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 296 49 296

Prescribing Review of formulary links to Right Care N/A 1,270 Prescribing Wastage, Optimise Rx, formulary reviews etc N/A 1,264

Urgent Care Urgent care signposting & paramedic pathfinder Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 515

Totals 11,660 132 796

Notes Information is not yet available to support the DBH schemes or prescribing due to timing of data In future months each scheme will be RAG rated in line with the delivery plan performance Schemes will also be broken down into further detail NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 3

SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 2 MAY 2017

Recurrent Non Recurrent Total £000's £000's £000's Baseline Allocation -445,139 -445,139 Co-Commissioning -42,534 -42,534 HRG4+ 4,024 4,024 IR Rule Chnages -362 -362 In year drawdown of prior year surplus -438 -438 Historic Drawdown -12,021 -12,021 Running Cost Allowance -6,773 0 -6,773 Total Resources Available at Plan Stage -494,446 -8,797 -503,243

Adjustments to the Resource Limit:

Month 01 April No adjustments 0 0 0 0 0 0

Month 02 May No adjustments 0 0 0 0 0 0 Revised Resources available as at Month 2 May 2017 -494,446 -8,797 -503,243 NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 4 SUMMARY OF RESERVES AS AT MONTH 2 MAY 2017

RESERVES Recurrent Non Total Recurrent £000's £000's £000's

RISK RESERVES AND CONTINGENCIES 1% Non Recurrent Headroom Initial Plan 0 2,226 2,226 Budget Transfers No transfers as at Month 2 - funding uncommitted and 0 ringfenced as per NHSE Guidance

0 2,226 2,226

0.5% Contingency Initial Plan 2,460 0 2,460 Budget Transfers No transfers as at Month 2 0 2,460 0 2,460

2,460 2,226 4,686 Cross Check to Operating Cost Statement 2,460 2,226 4,686 Enc F

Item 11

Corporate Assurance Report Quarter 1 2017/2018

Meeting name Governing Body Meeting date 20 July 2017

Governing Body Assurance Framework Title of paper End of Quarter 1 Report 2017/18

Executive / Sarah Atkins Whatley, Chief of Corporate Services Clinical Lead(s) Sarah Atkins Whatley, Chief of Corporate Services Author(s) Assurance Framework Risk Leads

Purpose of Paper - Executive Summary

This report presents the position of the Governing Body Assurance Framework as at the end of the Quarter. Updated text is shown in blue .

The table below summarises the position:

Start of End of End of End of End of

year Q1 Q2 Q3 Q4 Number of risks 12 12

Start of End of End of End of End of

year Q1 Q2 Q3 Q4 TOLERATE 6 6 Risk treatment TREAT 6 6

Start of End of End of End of End of Score Risk rating year Q1 Q2 Q3 Q4 1 to 5 Low 0 0 6 to 11 Medium 6 8 12 to 15 High 5 4 16 to 20 Very High 1 0 25 Extreme 0 0 TOTAL 12 12

Recommendation(s)

CONSIDER and APPROVE the 2017/18 Quarter 1 position of the Assurance Framework.

Impact analysis Risk 2.1 on the Assurance Framework highlights risks associated with Quality impact quality impact. Our approach to health inequalities is integrated within our Equality commissioning activities, and all areas aim to have a positive impact on impact health inequalities. Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of None identified Interest Consultation / Engagement (internal Consultation with Assurance Framework Lead Officers departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Captured throughout the Assurance Framework analysis Assurance All Assurance Framework risks Framework

NHS Doncaster CCG Governing Body Assurance Framework

Last updated: 30 June 2017

Corporate Objectives (COs)

CO 1 Ensure an effective, well led, and well governed organisation.

Commission high quality, continually improving, cost effective healthcare which meets CO 2 the needs of the Doncaster population.

CO 3 Ensure that the healthcare system in Doncaster is sustainable.

Work collaboratively with partners to improve health and reduce inequalities in well CO 4 governed and accountable partnerships.

Likelihood 1 2 3 4 5 Risk Matrix Almost Rare Unlikely Possible Likely certain (1) Negligible 1 2 3 4 5 (2) Minor 2 4 6 8 10 (3) Moderate 3 6 9 12 15 (4) Major 4 8 12 16 20

Consequence (5) Extreme 5 10 15 20 25

1-5 Low 6-10 Medium 12-15 High 16-20 Very High 25 Extreme

The risk appetite under which risks can be tolerated is a score of 11 or below.

Risks scored at or in excess of a score of 16 must be escalated to the Governing Body. NHS Doncaster CCG Governing Body Assurance Framework Summary Last updated: 30 June 2017

Current Number of Ref Principal risk Treatment 12 score risks Organisational change: If we do we not have the right skill mix and resource within the organisation, 1.1 supported by our Organisational Development Strategy, we may not achieve both our local commissioning 9 TREAT strategy and our wider collaborative commissioning commitments. Quality impact: Financial resource reductions could potentially affect our ability to commission for 2.1 8 TOLERATE TOLERATE 6 continually improving quality. Risk Urgent Care: If we fail to commission effective, resilient and sustainable urgent & emergency care services, treatment 2.2 the quality of care delivered to patients and the achievement of associated quality and performance targets 12 TREAT TREAT 6 could be adversely affected. Primary Care: If we fail to commission effective, resilient and sustainable primary medical care services, the quality of care delivered to patients and the achievement of associated quality and performance targets 2.3 8 TOLERATE could be adversely affected, and the full vision contained within the Place Plan could potentially be adversely affected. Provider Workforce: Providers in Doncaster may not have access to a sufficiently skilled workforce to meet Number of 2.4 12 TREAT Score Rating the outcomes identified in our commissioning intentions. risks Transformation: If our transformation delivery plans are not sufficiently ambitious to respond to the 3.1 expected growth in activity and reduction in financial allocation, we could fail to deliver the efficiency 10 TOLERATE 1 to 5 Low 0 savings required to maintain financial balance across the local health system. Efficiencies: If we do not achieve the quality and efficiency savings within our Delivery Plans and maximise 3.2 efficiency opportunities presented by areas such as Prescribing and RightCare, we may be forced to 12 TREAT 6 to 11 Medium 8 consider decommissioning services from elsewhere in order to achieve the required savings. System affordability: If the overall Doncaster healthcare system is not affordable given the impact of 3.3 external controls on CCG allocations leading to increasingly limited financial resource, this may require the 15 TREAT 12 to 15 High 4 CCG to undertake greater prioritisation of resource to meet the identified needs of our population. Control total: If we do not meet our CCG control total due to the impact of external controls on CCG allocations and/or the impact of unpredicted in-year cost pressures, then we will be in breach of our 3.4 10 TOLERATE 16 to 20 Very High 0 statutory duties to commission efficiently, effectively and to achieve value for money, and we may not be able to commission all the services which we have identified that our population needs. Dual partnership focus: We have dual areas of partnership commissioning focus - our local focus on Doncaster as a place delivering the ambition described in the Doncaster Place Plan, and our collaborative commissioning commitments within areas such as the South Yorkshire & Bassetlaw Sustainability & 4.1 8 TOLERATE 25 Extreme 0 Transformation Plan. If these dual areas of focus dilute our local system leadership as CCG as resource is aligned both locally and across a wider collaborative footprint, this could potentially impact upon our organisational independence of decision making. Engagement & prevention: If, across the Doncaster Place Plan footprint, we do not achieve cultural change away from a more dependant medicalised model of healthcare towards greater self-care, prevention, 4.2 8 TREAT TOTAL 12 patient engagement & empowerment, and building on the existing strengths within communities, we may not deliver the vision contained within the Place Plan, or the efficiencies. STP non-delivery: If the South Yorkshire & Bassetlaw Sustainability & Transformation Plan does not deliver 4.3 the expected savings, greater savings will need to be identified at a Place level, and we may not be able to 8 TOLERATE commission all the services which we have identified that our population needs. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 1: Ensure an effective, well led, and well governed organisation. Committee: Executive Committee Executive Lead: Chief of Corporate Services Clinical / Lay Lead: Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Organisational change: If we do we not have the right skill mix and resource within Uncontrolled risk: 3 4 12 the organisation, supported by our Organisational Development Strategy, we may not Current risk: 3 3 9 achieve both our local commissioning strategy and our wider collaborative Target risk: 3 2 6 1.1 commissioning commitments. Outcome: TREAT

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 3 3 Date reviewed: 30 June 2017 Likelihood 2 3 Next review due: 30 September 2017 Total 6 9 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Organisational Development (OD) Strategy Governing Body approval of OD Strategy - December 2016 (minutes) XX Yes Sponsors for each of the 6 domains within the OD Strategy Governing Body approval of OD Strategy - December 2016 (minutes) X Yes External partner for OD support Tender documentation / Partner appointment X Yes 360 Stakeholder Survey 360 Stakeholder Survey Report 2017 X Yes Annual Review with NHS England Annual Review Letter - reported to Governing Body XX Yes Quality of Leadership assessment Outcome: www.nhs.uk/service-search/scorecard/results/1175 X No Reporting of key OD metrics Corporate Assurance Report received by Governing Body quarterly X Yes Staff Survey (nationally administered) Staff Survey Report - http://www.nhsstaffsurveys.com/Page/1056/Home/NHS-Staff-Survey-2016/ X Yes Business Continuity Plans at team level Corporate Assurance Report received by Governing Body quarterly X Yes Executive Committee - responsibility for deploying organisational resource Executive Committee minutes (also reported to Governing Body) XX Yes Colleague Engagement Group (CEG) & Staff Briefs - involving staff in readiness for the future Colleague Engagement Group minutes; Staff Brief presentations XX Yes Organisational Development / Learning & Development budget Budget monitoring reports X Yes Personal Development Reviews (PDRs) PDR Training Needs Analysis XX Yes Corporate Assurance Report received by Governing Body on a quarterly basis (Governing Body minutes); Robust governance infrastructure as a basis for future developments - Constitution, Standing 1617-DCCG-08-R - Information Governance Toolkit Internal Audit Report - Orders, Governance Meeting Structure, Risk Management, Information Governance, Health significant assurance; X Yes & Safety, Emergency Preparedness and Mandatory & Statutory training 1617-DCCG-07-R - Conflicts of Interest Internal Audit Report - full compliance; Head of Internal Audit Report

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A A plan for maximising staff development opportunities in an evolving NHS architecture and Development of a framework / plan. 31/12/2017 succession planning for potential skills/capacity gaps

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: The Audit Committee undertook a Deep Dive on this risk during Quarter 1, and resulting additional controls were added. A gap in control regarding support to staff to maximise development opportunities in an evolving NHS architecture alongside a need for succession planning for potential skills/capacity gaps was identified, and an action added. The likelihood of the risk has increased slightly due to the fast- paced work on integration which will require assessment of skills and capacity needs. We have committed to a piece of work with the Local Authority on the capacity and capability of both organisations and where our functions may be best integrated. We are also developing internal CCG Team Effectiveness audits. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 2: Commission high quality, continually improving, cost effective healthcare Committee: Quality & Patient Safety Committee which meets the needs of the Doncaster population. Executive Lead: Chief Nurse Clinical / Lay Lead: Locality Lead with Quality lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Quality impact: Financial resource reductions could potentially affect our ability to Uncontrolled risk: 4 4 16 commission for continually improving quality. Current risk: 4 2 8 Target risk: 4 2 8 2.1 Outcome: TOLERATE

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 2 2 Next review due: 30 September 2017 Total 8 8 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Quality & Patient Safety Committee minutes; Quality & Patient Safety Committee Quality and Patient Safety Committee Internal Audit Report 1516DCCG02R – XXX Yes significant assurance Quality & Performance Reports monthly to Governing Body Governing Body minutes X Yes National oversight and benchmarking of key quality performance targets NHS England Quarterly Review meetings; benchmarking data X Yes Contractual provider quality monitoring reports including CCG oversight of the quality impact of Clinical Quality Review Group minutes; X Yes provider Cost Improvement Programmes Quality of Care in Care Homes Internal Audit Report 1617-DCCG-02-R Provider Care Quality Commission (CQC) ratings CQC website XX Yes Incident Management Group oversees Serious Incident Reporting Incident Management Group minutes X Yes Quality Surveillance Group across South Yorkshire & Bassetlaw area Quality Surveillance Group minutes X Yes Prescribing Sub Group; Area Prescribing Committee Prescribing Sub Group & Area Prescribing Committee minutes X Yes Quality & Safety Team Quality & Safety Directorate structure Yes Safeguarding Boards - Children's and Vulnerable Adults Safeguarding Board minutes XX Yes Quality Accounts from our main providers - reviewed by Chief Nurse Quality Accounts publically published XX Yes

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: An additional control was added regarding Quality Accounts from our main providers. The risk score remains the same. In the near future, we will need to review the contracting assurance governance structure for the newly emerging Accountable Care Partnership (ACP) and Primary Care Doncaster Federation and the associated Quality Frameworks. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 2: Commission high quality, continually improving, cost effective healthcare Committee: Executive Committee which meets the needs of the Doncaster population. Executive Lead: Chief of Strategy & Delivery Clinical / Lay Lead: Locality Lead with Urgent Care lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Urgent Care: If we fail to commission effective, resilient and sustainable urgent & Uncontrolled risk: 4 4 16 emergency care services, the quality of care delivered to patients and the achievement of Current risk: 4 3 12 associated quality and performance targets could be adversely affected. Target risk: 4 2 8 2.2 Outcome: TREAT

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 3 3 Next review due: 30 September 2017 Total 12 12 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Urgent Care Delivery Plan - including national 9 point plan which covers wider determinants Delivery Plan received by Governing Body March 2017 (minutes) XX Yes A&E Delivery Board jointly with NHS Bassetlaw CCG Minutes of A&E Delivery Board X Yes Contracts with providers for the delivery of urgent care services Signed contracts XX Yes Quality & Performance monitoring reporting Quality & Performance Reports monthly at Governing Body (minutes) X Yes System Resilience Group and underpinning weekly operational surge group Minutes of System Resilience Group X Yes Urgent Care system e.g. Same Day Health Centre, Urgent Care Centre, A&E front-door triage Quality assurance visits to services X No Patient experience report to Engagement & Experience Committee January Patient experience analysis in A&E X Yes 2017

Gaps in control: Actions being taken to address gaps: Due date Remediation plan developed and monitored through A&E Delivery Board. National expectation A&E 4-hour wait performance Complete that the target will be back on track by April 2017. Maintain commissioning oversight through the A&E Delivery Board on the national outcomes A&E 4-hour wait performance in line with national trajectory 31/03/2018 required of 90% by September 2017 and 95% by March 2018.

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: The action to remediate against the A&E target is being tracked through the monthly Quality & Performance Report at Governing Body, and in May reached 91.4% against a 95% standard within the contract. However the Trust maintained the planned NHS Improvement trajectory of 90%. A national programme, "Action on A&E", has been launched which aims to review urgent care across the system. All Place areas are expected to work through 9 key elements to improve 4 hour access. The outcomes are expected that England achieves 90% by September 2017 and that Trusts are achieving 95% by March 2018. Original action closed and new action opened. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 2: Commission high quality, continually improving, cost effective healthcare Committee: Primary Care Commissioning Committee which meets the needs of the Doncaster population. Executive Lead: Chief of Strategy & Delivery Clinical / Lay Lead: Lay Member - Primary Care Commissioning

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Primary Care: If we fail to commission effective, resilient and sustainable primary Uncontrolled risk: 4 4 16 medical care services, the quality of care delivered to patients and the achievement of Current risk: 4 2 8 associated quality and performance targets could be adversely affected, and the full Target risk: 4 2 8 2.3 vision contained within the Place Plan could potentially be adversely affected. Outcome: TOLERATE

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 3 2 Next review due: 30 September 2017 Total 12 8 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Primary Care Delivery Plan Delivery Plan received by Governing Body March 2017 (minutes) XX Yes Minutes of Primary Care Commissioning Committee; Primary Care Commissioning Committee XXX Yes Primary Care Co Commissioning Internal Audit Report 1617DCCG04R GP 5 Year Forward View Plan Submitted to NHS England as part of annual planning submission X Yes Delegation from NHS England for commissioning primary medical care services - supports better Delegation Agreement XX Yes integration of primary medical care commissioning with the wider CCG commissioning strategy Quarterly reporting from Primary Care Commissioning Committee to Governing Body Governing Body minutes X Yes National oversight and benchmarking of key quality performance targets NHS England Quarterly Review meetings; benchmarking data X Yes Quality Performance Reporting on Primary Care to Quality & Patient Safety Committee Quality & Patient Safety Committee minutes X Yes Primary Care Doncaster Federation Formal establishment of Primary Care Doncaster X Yes

Gaps in control: Actions being taken to address gaps: Due date Development of Federations in Doncaster are at an early stage and may not be fully set up to Support from commissioned Strategic Partner - EY. Action ongoing. State of Readiness Report Complete respond to and take their place within the Doncaster Place Plan being developed. None. None. N/A

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: Primary Care Doncaster has been established as a Federation and has elected individuals both to the Board and to the Chair position, and recruited a Chief Executive Officer. Due to this additonal local control to support primary care sustainability and foster working together, the gap in control has been closed and the risk likelihood reduced. A risk on the Risk Register covers the specific risk of General Practices closing at short notice. An additional primary care Risk Register risk focusses on preparation and readiness for future Primary Care Policy requirements – the risk that the Primary Care Delivery Plan implementation is not effectively delivered for national ‘must do’s’ such as extended GP Practice hours with lack of continuity from the CCG and Provider perspective with regards to the national delivery plan. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Provider Workforce: Providers in Doncaster may not have access to a sufficiently Uncontrolled risk: 4 4 16 skilled workforce to meet the outcomes identified in our commissioning intentions. Current risk: 4 3 12 Target risk: 4 2 8 2.4 Outcome: TREAT

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 3 3 Next review due: 30 September 2017 Total 12 12 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Doncaster Place Plan - a vision of an Accountable Care System with providers working in All statutory organisations have supported the vision in the Place plan XX Yes partnership together Strategic Partner appointed to support implementation of the Place Plan Contract for Strategic Partner - EY XX Yes Team Doncaster - working together to improve the economic climate in Doncaster, attract and Minutes of Team Doncaster - Chief Officer & Chair representation X Yes retain new workforces, and train our own staff from within Doncaster Joint Commissioning Partnership with Doncaster Council - including the Better Care Fund Minutes of Joint Commissioning Partnership X Yes 2-year outcome based contracts - giving providers greater flexibility to innovate Contracts with Providers X Yes Local Digital Roadmap describing a vision of paperfree at the point of care by 2020 and Minutes of Doncaster Interoperability Group X Yes interoperability to support better provider integration and cross-working

Chief Officer engagement within Team Doncaster; Partnership engagement with Health Education England and Doncaster College on provider Chief of Partnership Commissioning & Primary Care engagement with South X Yes workforce needs Yorkshire & Bassetlaw Primary Care Workforce Group supporting the GP 5 Year Forward View within the Sustainability & Transformation Plan

Place Plan State of Readiness Report and recommended next steps State of Readiness Report received by Governing Body - June 2017 X Yes

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date An understanding of the partnerships' state of readiness for implementing the Place Plan. EY developing a State of Readiness Report. Expected to be ready by the middle of Quarter 1. Complete

Education & training programmes which meet the needs of the future health and social care Collective piece of work across providers and education establishments to design education & 31/12/2017 workforce. training programmes which meet the needs of the future health & social care workforce.

Risk updates: The State of Readiness Report for implementing the Place Plan has been received by the Governing Body, and support has been given for the recommended workstreams to move through Phase 2 in partnership with the other partners to the Place Plan. A gap has been identified in the education/training programmes available to develop the health & social care workforce of the future, and an associated action has been added to respond to this gap. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Governing Body Executive Lead: Chief Officer Clinical / Lay Lead: Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Transformation: If our transformation delivery plans are not sufficiently ambitious to Uncontrolled risk: 5 5 25 respond to the expected growth in activity and reduction in financial allocation, we could Current risk: 5 2 10 fail to deliver the efficiency savings required to maintain financial balance across the local Target risk: 5 2 10 3.1 health system. Outcome: TOLERATE

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 5 5 Date reviewed: 30 June 2017 Likelihood 4 2 Next review due: 30 September 2017 Total 20 10 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Governing Body support of Sustainability & Transformation Plan - November South Yorkshire & Bassetlaw Sustainability & Transformation Plan X Yes 2016 Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability & Collaborative Partnership Board minutes X Yes Transformation Plan - Chief Officer representation Doncaster Place Plan Governing Body support of Doncaster Place Plan - October 2016 X Yes Governing Body approval of CCG Commissioning & Contracting Intentions - CCG Commissioning & Contracting Intentions X Yes November 2016 Governing Body approval of CCG Delivery Plans - March 2017; Mental Health Payment by Results Data Quality Internal Audit Report Delivery Plans for each of the 12 areas in the Commissioning & Contracting Intentions XXX Yes 1516DCCG05R – significant assurance Monthly reporting to Governing Body on CCG Delivery Plan progress. Operational planning templates 2017-2019 submitted to NHS England alongside a planning NHS England submission X Yes narrative setting out plans to deliver agreed activity reductions, standards and targets. Our Plans includes ambitious targets and trajectories reflecting the priorities of the Membership, Governing Body, service users, and other stakeholders. The Plan was subject to review & NHS England Quarterly Review meetings XX Yes challenge by NHS England at key stages in its development. Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes) X Yes

NHS England Improvement & Assessment Framework - a continuous risk-based process, with meetings as required, informed by performance indicators and a wide range of other sources of NHS England Improvement & Assessment Framework Reports XX Yes insight, leading to a formal assessment against the 4 domains of assurance at the year end.

Internal assessment of national potential Right Care opportunities and tracking of progress Right Care tracker document X Yes against these Health & Wellbeing Board - local collaborative work to improve health outcomes and address Health & Wellbeing Board minutes - Chair & Chief Officer representation X Yes health inequalities; Health & Wellbeing Board challenge of CCG plans

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date Regular reporting to Governing Body on delivery of our CCG Delivery Plans. Developing a template for reporting to Governing Body - tested in March 2017. Complete Assurance that our transformation plans are sufficiently ambitious to achieve the necessary Regular Governing Body challenge of the ambition described in our transformation plans - Ongoing savings action is ongoing.

Risk updates: Regular reporting to Governing Body on delivery of our CCG Delivery Plans has commenced, with 2 Delivery Plan areas covered in May 2017 (Primary Care and Planned Care), and 2 covered in June 2017 (Children's Services and Intermediate Care). A forward programme of reporting has been agreed, meaning that each Delivery Plan will be featured in an extended Spotlight Report to the Governing Body every 6 months. This action has been completed and an additional corresponding assurance added. The implementation of our Delivery Plans is being tracked through the monthly Quality & Performance Report to Governing Body, and currently our the Delivery Plans are largely on track to deliver the quality and efficiency ambitions, however this will be closely monitored during the next Quarter to enable the Governing Body to reassess whether the level of ambition is sufficient to deliver the outcomes in the plans. NHS England has assessed our plans are robust and appropriately ambitious, and therefore the likelihood of the risk has been reduced. Regular Governing Body challenge will continue as further performance data emerges, and the risk likelihood may be increased again should our current ambition not achieve our forecast quality & efficiency outcomes. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Governing Body Executive Lead: Chief Officer Clinical / Lay Lead: Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Efficiencies: If we do not achieve the quality and efficiency savings within our Delivery Uncontrolled risk: 4 4 16 Plans and maximise efficiency opportunities presented by areas such as Prescribing and Current risk: 4 3 12 RightCare, we may be forced to consider decommissioning services from elsewhere in Target risk: 4 2 10 3.2 order to achieve the required savings. Outcome: TREAT

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 3 3 Next review due: 30 September 2017 Total 12 12 0 0 0

Internal assessment of national potential Right Care opportunities and tracking of progress against Right Care tracker document X Yes Prescribing Reports to Prescribing Sub Group (minutes); Prescribing analysis Medicines Management Internal Audit Report 1415DCCG04R – Significant XXX Yes Assurance Governing Body support of Sustainability & Transformation Plan - November South Yorkshire & Bassetlaw Sustainability & Transformation Plan X Yes 2016 Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability & Collaborative Partnership Board minutes X Yes Transformation Plan - Chief Officer representation Doncaster Place Plan Governing Body support of Doncaster Place Plan - October 2016 X Yes CCG Commissioning & Contracting Intentions Governing Body approval of CCG Commissioning & Contracting Intentions - X Yes Delivery Plans for each of the 12 areas in the Commissioning & Contracting Intentions Governing Body approval of CCG Delivery Plans - March 2017 X Yes Operational planning templates 2017-2019 submitted to NHS England alongside a planning NHS England submission X Yes narrative setting out plans to deliver agreed activity reductions, standards and targets. Our Plans includes ambitious targets and trajectories reflecting the priorities of the Membership, Governing Body, service users, and other stakeholders. The Plan was subject to review & NHS England Quarterly Review meetings XX Yes challenge by NHS England at key stages in its development. NHS England Improvement & Assessment Framework - a continuous risk-based process, with meetings as required, informed by performance indicators and a wide range of other sources of NHS England Improvement & Assessment Framework Reports XX Yes insight, leading to a formal assessment against the 4 domains of assurance at the year end.

Procurement Strategy Governing Body approval of Strategy - May 2014 (minutes) X Yes Deep Dive with CCG Leads on Delivery Plans Action notes from meetings. X Yes

Gaps in control: Actions being taken to address gaps: Due date Monitoring of prescribing; prescribing incentive scheme; Commissioning for Value Framework Prescribing costs - at a primary care level and at a secondary care level. Ongoing limiting to NICE guidance. Action ongoing

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: The wording of the risk has been expanded to reflect the risks of non-delivery of our 12 Delivery Plans - which align to the efficiency savings. Monitoring of progress on Delivery Plans is ongoing, including Deep Dive meetings with CCG Leads on Delivery Plans - this has been added as an additional control. Further performance on Delivery Plans (which include efficiencies) will be reported to Governing Body when figures are available. No other change to risk. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Governing Body Executive Lead: Chief Officer Clinical / Lay Lead: Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total System affordability: If the overall Doncaster healthcare system is not affordable given Uncontrolled risk: 5 4 20 the impact of external controls on CCG allocations leading to increasingly limited Current risk: 5 3 15 financial resource, this may require the CCG to undertake greater prioritisation of Target risk: 5 2 10 3.3 resource to meet the identified needs of our population. Outcome: TREAT

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 5 5 Date reviewed: 30 June 2017 Likelihood 3 3 Next review due: 30 September 2017 Total 15 15 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? South Yorkshire & Bassetlaw Sustainability & Transformation Plan Governing Body support of Sustainability & Transformation Plan - November X Yes Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability & Collaborative Partnership Board minutes X Yes Transformation Plan - Chief Officer representation Doncaster Place Plan Governing Body support of Doncaster Place Plan - October 2016 X Yes CCG Commissioning & Contracting Intentions Governing Body approval of CCG Commissioning & Contracting Intentions - X Yes Delivery Plans for each of the 12 areas in the Commissioning & Contracting Intentions Governing Body approval of CCG Delivery Plans - March 2017 X Yes Operational planning templates 2017-2019 submitted to NHS England alongside a planning NHS England submission X Yes narrative setting out plans to deliver agreed activity reductions, standards and targets. Our Plans includes ambitious targets and trajectories reflecting the priorities of the Membership, Governing Body, service users, and other stakeholders. The Plan was subject to review & NHS England Quarterly Review meetings XX Yes challenge by NHS England at key stages in its development. Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes) X Yes Partnership working across Team Doncaster. Team Doncaster minutes X Yes Working Together Partnership Board - collaborative decision making on Hyper Acute Stroke Working Together Partnership Board minutes - received by Governing Body X Yes Unit services and Children's Surgery & Anaesthesia

Gaps in control: Actions being taken to address gaps: Due date NHS Doncaster CCG does not have any control over financial allocations from NHS England / the Department of Health, which have been reducing over the past few years. A move from deprivation-based allocations to age-based allocations adversely affected NHS Doncaster Limited controls - national allocations. Ongoing dialogue with NHS England. Ongoing CCG's allocations, and these have continued to decrease year-on-year. The CCG allocations affect the resources which we have available to commission local healthcare services, and pump-prime transformation work.

If local providers arae unable to develop an effective Accountable Care Partnership to respond to Integrated Commissioning (CCG and Doncaster Council) commissioning (starting with testing Support from commissioned Strategic Partner - EY. Action ongoing. State of Readiness 30/06/2017 the model with Intermediate Care services), then there is a risk that we not achieve the vision Report being developed. set out in the Doncaster Place Plan, which may adversely affect system sustainability.

Gaps in assurance: Actions being taken to address gaps: Due date There is national funding available for first wave Sustainability & Transformation Plan areas, but Governance arrangements are being developed collaboratively across the Sustainability & Ongoing this has not yet been allocated. Transformation Plan footprint, but are at an early stage. CCG additional funding is contingent upon the delivery of organisational control totals by Limited controls - national allocations. Ongoing dialogue with NHS England. Ongoing providers across the Sustainability & Transformation Plan footprint.

Risk updates: A Memorandum of Understanding (MOU) for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan (STP) is under development and will be received by Governing Bodies and Boards during Quarter 2 of 2017/18. The actions are ongoing. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Audit Committee Executive Lead: Chief Finance Officer Clinical / Lay Lead: Locality Lead with Finance lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Control total: If we do not meet our CCG control total due to the impact of external Uncontrolled risk: 5 5 25 controls on CCG allocations and/or the impact of unpredicted in-year cost pressures, then Current risk: 5 2 10 we will be in breach of our statutory duties to commission efficiently, effectively and to Target risk: 5 2 10 3.4 achieve value for money, and we may not be able to commission all the services which Outcome: TOLERATE we have identified that our population needs. Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 5 5 Date reviewed: 30 June 2017 Likelihood 2 2 Next review due: 30 September 2017 Total 10 10 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Financial Strategy Governing Body approval of Strategy - November 2016 (minutes) XX Yes Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes) X Yes Finance Report to Governing Body on a monthly basis Governing Body minutes X Yes Standing Financial Instructions, Standing Orders, & Scheme of Delegation On website. Last approved by Governing Body in March 2017 X Yes Minutes of FPIG meetings; Finance, Performance & Information Group (FPIG) meetings with Providers X Yes Data Quality Internal Audit Report 1516DCCG08R – significant assurance Internal Audit Plan 2017/18; Counter Fraud Workplan 2017/18; Internal Audits Head of Internal Audit Opinion; XX Yes 1617-DCCG-09-R – Budgetary Control & Key Financial Systems Internal Audit Report - significant assurance Annual Audit Letter 2015-16; External Audit XX Yes ISA260 Report to those charged with Governance

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: No change to risk - at this early stage in the year we are forecasting to achieve our control total. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 4: Work collaboratively with partners to improve health and reduce inequalities Committee: Executive Committee in well governed and accountable partnerships. Executive Lead: Chief of Strategy & Delivery Clinical / Lay Lead: Locality Lead with Planning lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Dual partnership focus: We have dual areas of partnership commissioning focus - our Uncontrolled risk: 4 3 12 local focus on Doncaster as a place delivering the ambition described in the Doncaster Current risk: 4 2 8 Place Plan, and our collaborative commissioning commitments within areas such as the Target risk: 4 2 8 4.1 South Yorkshire & Bassetlaw Sustainability & Transformation Plan. If these dual areas of Outcome: TOLERATE focus dilute our local system leadership as CCG as resource is aligned both locally and across a wider collaborative footprint, this could potentially impact upon our Start End of End of End of End of organisational independence of decision making. Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 2 2 Next review due: 30 September 2017 Total 8 8 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Governing Body approval for establishment of Joint Committees, and the level of delegation to Governing Body minutes X Yes joint Committees. South Yorkshire & Bassetlaw Sustainability & Transformation Plan - Collaborative Partnership Governing Body support of Sustainability & Transformation Plan - November Board for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan - Chief Officer X Yes 2016; Collaborative Partnership Board minutes representation. Working Together Partnership Board - collaborative decision making on Hyper Acute Stroke Unit Working Together Partnership Board minutes - received by Governing Body X Yes services and Children's Surgery & Anaesthesia. Represented by Chief Officer. Governing Body support of Doncaster Place Plan - October 2016; Doncaster Place Plan - represented on collaborative partnership by Chair & Chief Officer X Yes Collaborative Partnership minutes received by Executive Committee Strategic Partner appointed to support implementation of the Place Plan Contract for Strategic Partner - EY XX Yes Partnership working across Team Doncaster. Team Doncaster minutes X Yes Section 75 agreement with Doncaster Council Signed Section 75 agreement X Yes Colleague Engagement Group (CEG) & Staff Briefs - involving staff in readiness for the future Colleague Engagement Group minutes; Staff Brief presentations XX Yes External partner for OD support - ensuring organisational readiness for change Tender documentation / Partner appointment X Yes Signed MOU; Memorandum of Understanding (MOU) for Continuing Health hosting arrangements by NHS Continuing Healthcare Payments Certification 1516DCCG04R Internal Audit X Yes Doncaster CCG. Report – significant assurance

Standards of Business Conduct & Conflicts of Interest Policy - including business case and Policy - on website; X Yes procurement requirements 1617-DCCG-07-R - Conflicts of Interest Internal Audit Report - full compliance

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: Work is progressing well across all areas of partnership working, with development of a draft Memorandum of Understanding for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan, a State of Readiness Report on the Doncaster Place Plan, and the formal establishment of a Working Together Joint Committee of CCGs from April 2017. A Joint Committee across the commissioning functions in Doncaster Council and NHS Doncaster CCG is being proposed and will be worked up further in Quarter 2. Currently, the resource of the organisation is being balanced to support effective input into these separate partnerships. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 4: Work collaboratively with partners to improve health and reduce inequalities Committee: Engagement & Experience Committee in well governed and accountable partnerships. Executive Lead: Chief of Corporate Services & Chief of Strategy & Delivery Clinical / Lay Lead: Locality Leads with lead for engagement

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total Engagement & prevention: If, across the Doncaster Place Plan footprint, we do not Uncontrolled risk: 4 3 12 achieve cultural change away from a more dependant medicalised model of healthcare Current risk: 4 2 8 towards greater self-care, prevention, patient engagement & empowerment, and building Target risk: 4 2 8 4.2 on the existing strengths within communities, we may not deliver the vision contained Outcome: TREAT within the Place Plan, or the efficiencies. Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 2 2 Next review due: 30 September 2017 Total 8 8 0 0 0

Key controls to mitigate risk/threat: Sources of Assurance: Internal External Positive Rec'd? Communication, Engagement & Experience Strategy Governring Body approval of Strategy - December 2014 X Yes Governring Body approval of Strategy - January 2017; Equality & Diversity Strategy - incorporating our approach to health inequalities and our equality Public Sector Equality Duty Internal Audit Report 1516/DCCG/09/R – XXX Yes objectives significant assurance Engagement & Experience Committee Minutes of Engagement & Experience Committee X Yes Doncaster Inclusion & Fairness Forum - CCG membership Notes from Inclusion & Fairness Forum X Yes Strong relationship with Healthwatch Doncaster, who also sit on our Governing Body Governing Body minutes, written agreement for co-working X Yes Health & Wellbeing Board - local collaborative work to improve health outcomes and address Health & Wellbeing Board minutes - Chair & Chief Officer representation X Yes health inequalities; Health & Wellbeing Board challenge of CCG plans Cross-Doncaster Communication & Engagement Group, chaired by NHS Doncaster CCG, Notes from meeting X Yes supporting public engagement in the Place Plan Commissioning of Healthwatch Doncaster to lead public engagement on the Sustainability & Report from engagement X No Transformation Plan

Gaps in control: Actions being taken to address gaps: Due date None. N/A N/A Communication, Engagement & Experience Strategy needs to be updated in accordance with Update the Communication, Engagement & Experience Strategy 30/09/2017 new statutory guidance from NHS England.

Gaps in assurance: Actions being taken to address gaps: Due date None. N/A N/A

Risk updates: Working with CCGs and a range of other stakeholders, NHS England has developed refreshed statutory guidance on involvement. Team members across all Directorates in the CCG have been briefed on the new guidance, and the principles in the guidance are reflected in the newly refreshed engagement principles of the CCG. These are being incorporated within a revised Communication, Engagement & Experience Strategy. An action to refresh the Communication, Engagement & Experience Strategy has been added to this risk, but has not affected the overall risk score. NHS Doncaster CCG Governing Body Assurance Framework Last updated: 30 June 2017

Objective 4: Work collaboratively with partners to improve health and reduce inequalities Committee: Governing Body in well governed and accountable partnerships. Executive Lead: Chief Officer Clinical / Lay Lead: Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total STP non-delivery: If the South Yorkshire & Bassetlaw Sustainability & Transformation Uncontrolled risk: 4 3 12 Plan does not deliver the expected savings, greater savings will need to be identified at a Current risk: 4 2 8 Place level, and we may not be able to commission all the services which we have Target risk: 4 2 8 4.3 identified that our population needs. Outcome: TOLERATE

Start End of End of End of End of Score history: of year Q1 Q2 Q3 Q4 Consequence 4 4 Date reviewed: 30 June 2017 Likelihood 2 2 Next review due: 30 September 2017 Total 8 8 0 0 0

Gaps in control: Actions being taken to address gaps: Due date Chief Officer represents NHS Doncaster CCG on the STP Collaborative Partnership Board and The Sustainability & Transformation Plan is at an early stage, and only high-level indicative engages the Governing Body in the direction of travel and any expected commissioning and Ongoing savings have been identified. financial impact.

Gaps in assurance: Actions being taken to address gaps: Due date As above. As above. As above

Risk updates: The Chief Officer represents NHS Doncaster CCG on the STP Collaborative Partnership Board and engages the Governing Body in the direction of travel and any expected commissioning and financial impact. In the last Quarter a collective decision has been made on Children's Surgery & Anaesthesia, and a decision is pending for Hyper Acute Stroke Services. An Acute Hospital Services Review is underway. A draft Memorandum of Understanding for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan has been developed, and South Yorkshire & Bassetlaw has been announced as a first wave Accountable Care System. Enc G

Item 12

Chair & Chief Officer Report

Meeting name Governing Body Meeting date 20 July 2017

Title of paper Chair and Chief Officer Report

Executive / Dr David Crichton, Clinical Chair Clinical Lead(s) Mrs Jackie Pederson, Chief Officer Author(s) Mrs Sarah Atkins Whatley, Chief of Corporate Services

Purpose of Paper - Executive Summary

The purpose of this report is to update the Governing Body on issues relating to the activity of the CCG of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. This month the paper includes updates on the following areas:

• Place Plan • Locality Elections • Senior leadership changes • Annual Audit Letter • All Party Parliamentary Group on Cancer recognition • Walk All Over Cancer campaign • Colleague Engagement Group • Strategy & Organisational Development Forum update

Recommendation(s)

The Governing Body is asked to:

• Support the suspension of Locality Lead elections for a period of 6 months, and agree to consult Member Practices upon the proposed suspension. • Note the report.

Impact analysis Quality impact Neutral Equality Neutral impact Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of Paper is for information. No relevant interests. Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Nil analysis Assurance 1.1 Framework

Chair and Chief Officer Report July 2017

1. Place Plan

We and Doncaster Council are committed to a more integrated approach to commissioning Health and Social Care across Doncaster. This commitment is described within the Doncaster Place Plan , which is currently overseen by the Joint Commissioning Coordination Committee (JCCC) and the wider Health and Social Care Transformation Governance Group (HSCTG). A number of priority areas have been identified where an integrated approach will complement the design and inform the development of the Neighbourhood model. Six of these areas have been categorised as “high priority” due to them being more ready/more urgent and can be progressed faster. These areas will be used to test the emerging operating model and the operating arrangements; involving a good range of providers to test the design of the contracting model/s required to deliver the services. The six agreed areas of immediate focus are: • Urgent & Emergency Care (developed specification exists, contracting model to be determined) • Complex Lives • Intermediate Care • Starting Well (1001 days) • Vulnerable Adolescents (Tier 4 Specialist Services) • Dermatology

2. Locality Elections

In Summer 2016, Member Practice Engagement was undertaken to explore the future role of commissioning Localities. At that time Member Practices agreed to retain 5 commissioning Localities, and requested only minor “housekeeping” changes alongside enacting cross-Doncaster Membership Engagement sessions periodically throughout the year. However it was noted that as the NHS landscape evolved, the consultation exercise may need to be repeated.

The Next Steps on the NHS Five Year Forward View (NHS England 2017) advocates new care models where commissioners and providers across the NHS and local government need to work closely together to improve the health and wellbeing of their local population and make best use of available funding.

In response to this, the past 6 months have seen significant changes proposed to the provider and commissioner landscape in Doncaster. The Doncaster Place Plan and the State of Readiness Report from Ernst & Young proposes integrated provision through an Accountable Care Partnership (ACP), and integrated commissioning between NHS Doncaster CCG and Doncaster Council. We have also seen the emergence of the new Primary Care Doncaster GP Federation which is taking its place amongst other health providers in Doncaster. Finally, South Yorkshire &

Bassetlaw has been named as a first wave area to become an Accountable Care System (ACS), which will have implications on CCG commissioning activities.

In light of these changes, Member Practices have been questioning their future role within clinical commissioning. This topic was discussed at the cross-Doncaster Membership Engagement session on 29 June 2017. At that meeting, it was agreed that the Governing Body should propose a range of options for future member engagement to Member Practices. These options are currently under discussion for future consultation with Member Practices.

In light of potential changes to the Locality structure, it is recommended that Locality Lead elections are suspended for 6 months to allow a period of time for this consultation. This mirrors the election suspension last year when we undertook a similar consultation with Member Practices.

The table below demonstrates the impact which this would have upon the forward election schedule:

Locality Locality Dr Seddon Dr Barbour January 2016 North West South East (Lead B) (Lead B) Dr Oakford Dr Wagstaff November 2016 North East South West (Lead A) (Lead A) Dr Tupper Dr Pieri January 2017 Central (Lead A) North West (Lead A)

July 2017 Dr Singh Dr Bradley South East North East January 2018 (Lead A) (Lead B) January 2018 Dr Britten Vacancy South West Central July 2018 (Lead B) (Lead B) July 2018 Dr Seddon Dr Barbour North West South East January 2019 (Lead B) (Lead B) January 2019 Vacancy Dr Wagstaff North East South West July 2019 (Lead A) (Lead A) July 2019 Dr Tupper Dr Pieri Central North West January 2020 (Lead A) (Lead A) January 2020 South East (Lead A) North East (Lead B) July 2020 July 2020 South West (Lead B) Central (Lead B) January 2021

Governing Body members are asked to approve the suspension of Locality Lead elections for a period of 6 months, and agree to consult Member Practices upon the proposed suspension.

3. Senior leadership changes

There have been some senior leadership changes within the organisation. Laura Sherburn has now left the organisation to take up her secondment as Chief Executive Officer of Primary Care Doncaster, the GP Federation.

This has triggered some changes to the Strategy & Delivery Directorate, and from 1 July 2017: o The Primary Care Team joined the Directorate o The Communication & Engagement Team joined the Directorate o The Heads of Commissioning are now reporting to the Deputy Chief of Strategy & Delivery

The Chief of Corporate Services leaves the organisation in mid-August, at which point the Governance and Corporate Services Team will move under Lisa Devanney whose role as been re-titled as Associate Director of HR & Corporate Services.

The organisational structure below provides a summary of this structure.

Associate Director of HR & Corporate Services’ Team: Chief Officer • Corporate Governance – including Risk Management, Information Governance,

Health, Safety & Security, Emergency Planning, and Headquarters management • Human Resources & Organisational

Development Associate Director of • Equality & Diversity HR & Corporate Services • Secretariat and corporate support function

Director of Strategy & Chief Finance Officer Chief Nurse Delivery

Chief Finance Officer’s Team: Chief Nurse’s Team: Chief of Strategy & Delivery’s Team: • Financial Strategy • Quality & Safety • Strategic Plan • Financial management and control • Safeguarding children and vulnerable • Delivery Plans • Financial reporting adults • System transformation • Financial governance • Medicines Management • Commissioning in partnership • Contracting • Serious Incident management • Performance management • External Audit • Contractual quality • Business Intelligence & Information • Internal Audit • Clinical governance and assurance Technology • Counter Fraud • Continuing Healthcare (including • Primary Care Commissioning Previously Unassessed Periods of • Communications, Engagement and Care) Experience • Personal Health Budgets

4. Annual Audit Letter

The Annual Audit Letter from our External Auditors, KPMG, which appended to this report, summarises the key issues arising from the 2016/17 audit at NHS Doncaster CCG.

Although this letter is addressed to the Members of the Governing Body of the CCG, it is also intended to communicate these issues to external stakeholders, such as members of the public.

Our External Auditors issued an unqualified opinion on the CCG’s accounts on 26 May 2017, meaning they believe the accounts give a true and fair view of the financial affairs of the CCG and of the income and expenditure recorded during the year. There were no significant matters which were required to be reported to ‘those charged with governance’.

Our External Auditors are required to report to us if they are not satisfied that the CCG has made proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Based on the findings of our work, there was nothing to report.

5. All Party Parliamentary Group on Cancer recognition

The All Party Parliamentary Group on Cancer has recognised NHS Doncaster CCG as one of the most improved CCGs as measured by annual one-year cancer survival rates. Dr Crichton attended a reception in London to collect our certificate.

6. Walk All Over Cancer campaign

Cancer is one of our 12 Delivery Plan areas as a CCG and we supported the Cancer Research UK “ Walk all over Cancer ” 10,000 steps a day campaign for June.

The distance travelled by the CCG across the whole campaign is equivalent to walking from the Pena Palace in Sintra, Portugal to the Winter Palace in Saint Petersburg, Russia – whilst visiting every capital city on the way. That’s just over 4000 miles! By the end of the journey, the CCG had walked 8,146,976 steps.

The top 3 walkers for the month of June were:

1. Dr Nabeel Alsindi who achieved 566,698 steps overall! 2. Dr Pat Barbour who achieved 537,091 steps overall! 3. Dr David Crichton who achieved 523,945 steps overall!

Congratulations to all participants for raising awareness of such an important issue, and to Luke Boulby, Communications Apprentice, for all his hard work on the campaign.

7. Doncaster Health & Social Care Cup

On Saturday 8 July 2017 the inaugural Doncaster Health & Social Care Cup was played, where teams of 5-a-side footballers from Health and Social Care organisations across Doncaster played friendly matches.

The Cup was organised by Club Doncaster Foundation, and won by Primary Care Doncaster, the new GP Federation in Doncaster.

The teams are hoping that this will become an annual event.

8. Colleague Engagement Group (CEG)

Our Colleague Engagement Group (CEG) continue to work towards achieving the national Workplace Wellbeing Charter. The Staff Survey results have been made available to all staff and we have used CEG to gather views on the key findings and combined this with feedback from the OD focus groups. The themes that have emerged are around: o Being involved in decisions about your area of work o Understanding how your work makes a difference and feeling valued o Being able to influence through a number of communication mechanisms o Resilience and increasing effectiveness

9. Strategy & Organisational Development Forum update

At our Strategy & Organisational Development Forum at the beginning of the month, members received a presentation from Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust on their strategic vision, and debated the draft South Yorkshire & Bassetlaw Accountable Care System Memorandum of Understanding.

10. Recommendations

The Governing Body is asked to:

• Support the suspension of Locality Lead elections for a period of 6 months, and agree to consult Member Practices upon the proposed suspension.

• Note the report.

10 Annual Audit Letter 2016-17

NHS Doncaster Clinical Commissioning Group

July 2017 Contents

Page The contacts at KPMG in connection with this report are: Introduction 3

Clare Partridge Headlines 6 Engagement Lead KPMG LLP (UK) Appendices Tel: + 44 113 2313922 [email protected] A. Summary of our reports issued 10

James Boyle Manager KPMG LLP (UK)

Tel: + 44 161 246 4604 [email protected]

Louise Stables Assistant Manager KPMG LLP (UK)

Tel: + 44 113 231 4747 [email protected] This report is addressed to NHS Doncaster CCG (the CCG) and has been prepared for the sole use of the CCG. We take no responsibility to any member of staff acting in their individual capacities, or to third parties.

External auditors do not act as a substitute for the audited body’s own responsibility for putting in place proper arrangements to ensure that public business is conducted in accordance with the law and proper standards, and that public money is safeguarded and properly accounted for, and used economically, efficiently and effectively.

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Document Classification: KPMG Confidential Introduction Introduction

Background This Annual Audit Letter (the letter) summarises the key issues arising from our 2016-17 audit at NHS Doncaster Clinical Commissioning Group (the CCG). Although this letter is addressed to the Members of the Governing Body of the CCG, it is also intended to communicate these issues to external stakeholders, such as members of the public. It is the responsibility of the CCG to publish this letter on the CCG’s website. In the letter we highlight areas of good performance and also provide recommendations to help the CCG improve performance where appropriate. We have reported all the issues in this letter to the CCG during the year and we have provided a list of our reports in Appendix A. Scope of our audit The statutory responsibilities and powers of appointed auditors are set out in the Local Audit and Accountability Act 2014. Our main responsibility is to carry out an audit that meets the requirements of the National Audit Office’s Code of Audit Practice (the Code) which requires us to report on:

Financial Statements We provide an opinion on the CCG’s financial statements.That is whether we believe the financial statements give a true and fair view of the including the regularity financial affairs of the CCG and of the income and expenditure recorded during the year. opinion and Governance We are also required to: Statement — form a view on the regularity of the CCG’s income and expenditure i.e. that the expenditure and income included in the CCG’s financial statements has been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them; — report by exception if the CCG has not complied with the requirements of NHS England in the preparation of its Governance Statement; and — examine and report on the consistency of the schedules or returns prepared by the CCG for consolidation into the Whole of Government Accounts (WGA) with our other work.

Value for Money We conclude on the arrangements in place for securing economy, efficiency and effectiveness (value for money) in the CCG’s use of resources. arrangements

Document Classification: KPMG Confidential Introduction (cont.)

Adding value from the External Audit service We have added value to the CCG from our service throughout the year through our: — attendance at meetings with members of the Governing Body and Audit Committee to present our audit findings, broaden our knowledge of the CCG and provide insight into sector developments and examples of best practice; — proactive and pragmatic approach to issues arising in the production of the financial statements to ensure that our opinion is delivered on time; — incorporation of data analytics into our programme of work to, for example, identify high risk journals for testing; — strong and effective working relationship with Internal Audit to maximise assurance to the Audit Committee, avoid duplication and provide value for money. Fees Our fee for 2016-17 was £69,800 (2015-16: £67,500) excluding VAT. Our fees are set nationally by Public Sector Audit Appointments Ltd and the 2016-17 fee was above the fee agreed at the start of the year with the CCG’s Audit Committee. The additional £2,300 fee is due to the additional local substantive work we were required to complete around GP co-commissioning, which included review and consideration of GP practice list sizes and associated spend. We were required to undertake this additional work as we obtained and reviewed the ISAE 3402 Type 2 Service Auditor Report on the Exeter/NHAIS system and determined that we are unable to rely on the controls in operation at Capita due to the adverse opinion given by the service auditor. The additional fee is currently subject to approval by the PSAA.

Acknowledgement We would like to take this opportunity to thank the officers of the CCG for their continued support throughout the year.

Document Classification: KPMG Confidential Headlines Headlines

This section summarises the key messages from our work during 2016-17.

Financial We issued an unqualified opinion on the CCG’s accounts on 26 May 2017. This means that we believe the accounts give a true and fair view of the Statements audit financial affairs of the CCG and of the income and expenditure recorded during the year. opinion There were no significant matters which we were required to report to ‘those charged with governance’

Financial We are required to apply the concept of materiality in planning and performing our audit. We are required to plan our audit to determine with statements audit reasonable confidence whether or not the financial statements are free from material misstatement. An omission or misstatement is regarded as work undertaken material if it would reasonably influence the user of financial statements. Our materiality for the audit was £7m (2015/16: £7m). We identified the following risks of material misstatement in the financial statements as part of our External Audit Plan 2016/17: Accounting for co-commissioning - as this was year one of this new responsibility for Doncaster CCG and given the national problems with service auditor reports in this area, accounting for the accuracy, completeness and existence of this new and material area of expenditure presented a risk of material misstatement in 2016/17. We have understood and tested the CCG’s in-year processes, systems and controls associated with the commissioning of GP services. We have substantively tested the expenditure included within the CCG’s financial statements for the commissioning of GP services, including consideration of list sizes and associated spend, for accuracy, completeness and existence. We did not identify any issues as part of our work.

Regularity Opinion We are required to form a view on the regularity of the CCG’s income and expenditure i.e. that the expenditure and income included in the CCG’s financial statements has been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them. We reviewed the CCG’s expenditure and income and in our opinion, in all material respects, it has been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Document Classification: KPMG Confidential Headlines (cont.)

Governance We confirmed that the CCG complied with NHS England requirements in the preparation of the CCG’s Governance Statement. Statement No significant adjustments were required to the Governance Statement.

Whole of We issued an unqualified Auditor Statement on the Consolidation Schedules prepared by the CCG for consolidation into the Whole of Government Government Accounts with no exceptions. Accounts

Value for Money We are required to report to you if we are not satisfied that the CCG has made proper arrangements to secure economy, efficiency and effectiveness (VFM) conclusion in its use of resources. Based on the findings of our work, we have nothing to report.

VFM conclusion risk We undertook a risk assessment as part of our VFM audit work to identify the key areas impacting on our VFM conclusion and considered the areas arrangements you have put in place to mitigate these risks. Our work identified the following significant risks: Medium Term Financial Planning - medium term financial planning continues to be a key issue for the CCG and the sector in general. The CCG has budgeted for a balanced plan in 2017/18 but this is predicated on assumptions relating to the achievement of efficiency savings. The CCG recognises the opportunities to make the required savings in areas including planned care, prescribing and demand management schemes. The CCG is aware that cash releasing efficiency savings are required and whilst they are working towards building elements of these savings into key contracts, they are aware that certain identified efficiency savings need to be developed further to determine their achievability. Furthermore, the CCG recognises the risks relating to HRG4+ on their medium term financial planning and are currently working to understand the methodology associated with this and the how it will impact on the CCG going forward. We have considered the arrangements that the CCG has in place to identify and deliver recurrent cost improvements going forward. We have reviewed how the CCG’s financial plans are developed and managed to ensure delivery of the CCG’s QIPP programme. We have considered how the CCG is working with key stakeholders to help ensure the achievability of its financial plans, including the impact of HRG4+ on the CCG’s financial plans. The CCG has submitted a balanced plan for the 17/18 and 18/19 financial years. In order to achieve their financial plan in 17/18, the CCG has a QIPP target of £11.6m, which includes the adverse impact of £3m on the CCG’s allocation due to moving to HRG4+. The CCG has identified a number of recurrent schemes to achieve its QIPP target in 17/18. We have not identified any issues as part of our work which would lead us to issue a non-standard VFM conclusion.

Document Classification: KPMG Confidential Headlines (cont.)

Recommendations We are pleased to report that there are no recommendations arising from our 2016-17 audit work. The CCG has been good at implementing agreed audit recommendations from prior years. There were no recommendations arising from our prior year audit work.

Public Interest We have a responsibility to consider whether there is a need to issue a public interest report or whether there are any issues which require referral to Reporting the Secretary of State. We did not issue a report in the public interest or refer any matters to the Secretary of State in 2016-17.

Document Classification: KPMG Confidential Appendices Appendix A Summary of our reports issued

2017 The Audit Plan set out our approach to the Audit Plan audit of the CCG’s Financial Statements January (January 2017) (including the Governance Statement) and our VFM conclusion work. February

March The External Audit Findings Memorandum provides details of the results of our audit April External Audit for 2016-17 including key issues and Findings recommendations raised as a result of May Memorandum our observations. Audit Report The Audit Report provides our audit opinion for the year, the Value for Money (May 2017) We also provided the mandatory auditing (May 2017) conclusion, and our Audit Certificate. June standards declarations as part of this report. July Annual Audit Letter This Annual Audit Letter provides a August summary of the results of our audit for (July 2017) 2016-17. September

October

November

December

Document Classification: KPMG Confidential The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavour to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the particular situation.

KPMG LLP is multi-disciplinary practice authorised and regulated by the Solicitors Regulation Authority. For full details of our professional regulation please refer to ‘Regulatory Information’ at www.kpmg.com/uk

The KPMG name and logo are registered trademarks or trademarks of KPMG International. | Create Graphics: CRT061249A

Document Classification: KPMG Confidential Verbal

Item 13

Locality Feedback

Enc H

Item 14

Receipt of Minutes

Minutes of the Quality & Patient Safety Committee Held on Thursday 4th May 2017 at 9.30am Boardroom, Sovereign House

Formal Committee Committee Members Present Members Present: Dr Emyr Jones (Chair) Secondary Care Doctor Member Mr Andrew Russell Chief Nurse Mrs Suzannah Cookson Deputy Chief Nurse, Designated Nurse Safeguarding Children & LAC Mr Ian Boldy Designated Nurse Safeguarding Adults, DCCG Dr Jeremy Bradley GP Representative, DCCG Mrs Wendy Feirn Senior Nurse, Quality & Patient Safety Mrs Chris Quinn Patient Experience Manager Mrs Gill Bradley Deputy Head of Medicines Management Mrs Jenny Rayner Senior Officer for Quality Mrs Zara Head Primary Care Quality Nurse Mrs Andrea Stothard Quality & Patient Safety Manager Mrs Leah Denman Named Nurse for Safeguarding Adults. Dr Lindsay Britten DP Representative, DCCG Mrs Michaela Hunter CHC Team Leader, DCCG

Formal Committee None Members in Attendance:

In attendance: Mrs Lesley Twigg Minutes Mr Gareth Jones Observer

Action

1. Welcome and Apologies

Dr Jones welcomed everyone to the meeting. Apologies for absence were received from:

• Mrs Andrea lbbeson, Named Nurse for Children's Safeguarding • Mr Mark Randerson, Head of Medicines Management • Mr Victor Joseph, Assistant Director of Public Health, DMBC • Mrs Karen Tooley, Lead Nurse for Care Home Strategy Implementation

2. Declarations of Interest

The Chair 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 NHS Doncaster Clinical Commissioning Group (CCG).

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Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk

The meeting was noted as quorate.

Declarations of interest from today’s meeting:

Agenda item 5.2: Dr Jones asked that the minutes reflect that in his role of National Summary Care Records Lead he had recently addressed RDaSH consultants.

3. Minutes and Actions of the Previous Meeting – Enclosure A & B

The minutes of the meeting held on 2nd March 2017 were approved as a true record with the following amendments:

• Page 1: Amend DP to GP on Dr Britten’s title LT • Page 10: Safeguarding Children’s Update – Replace ‘Children’s Trust’ with

Safeguarding Children’s Board for both entries in paragraph 1

Refer to the Committee action log for all actions updates.

4. Matters Arising not on the Agenda

The Committee went through the action log for the meeting. All updates will be recorded on the action log.

There were no other matters arising raised by Committee members.

5. QUALITY

5.1 DBHfT Quality Report – Enclosure C

Mrs Cookson asked that the report provided was taken as read but highlighted the following from the report:

The information in the report relates to the ACQRG meeting held April 2017.

The Business Intelligence Report shows that there are no fluctuations in quality with the Trust leading the way for the work being done on mortality reviews and development of the end to end pathway.

The Royal College review of maternity and paediatric services has been

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received but will not be shared wider until Mr Singh, Medical Director returns from annual leave and has shared the findings / recommendations with staff. The Trust will share the recommendations of the report with the CCG. Mrs Cookson added that the Trust are currently recruiting more midwives. Dr Jones asked about the Executive Lead and Mrs Cookson responded that this will be Mr Singh and Mrs Hardy, adding that a meeting will be arranged with Mr Singh, Mrs Hardy and Mr Russell; this will be a closed session to discuss the full report. Mrs Cookson informed the committee that the report did not contain anything that the Trust hasn’t identified internally and that they are already addressing a lot of the issues. This work includes work on their governance structures. It is envisaged that a full action plan would be presented to the CQRG meeting and managed through the meeting structures. Mr Russell added that any further quality issues will be identified via Serious Incidents and Complaints and any concerns raised via the ACQRG and Strategic Contract meetings.

Dr Jones asked the committee if they had any further questions for Mrs Cookson, nothing further asked.

5.2 RDaSH Quality Report – Enclosure D

Mrs Cookson asked that the report provided was taken as read but highlighted the following from the report: The CQRG meeting planned for 3 rd May 2017 had been cancelled due to the number of bank holidays and apologies received, there were also clashes with the Trust’s Quality meeting which had been re-arranged due to bank holidays.

Mrs Cookson drew the committee’s attention to the update on the 12 Week Magnolia Lodge plan stating that there is new leadership in place in Magnolia Lodge, the pathway has been reviewed and Standard Operating Practices (SOPs) reviewed and updated. Dr Jones asked if Magnolia Lodge patients were from a specific age group; Mr Russell replied that it is a rehabilitation unit for neurological patients of all ages with Mrs Cookson adding that the complexity of patients in the unit has increased. Dr Jones asked if there had been any SI’s with Mrs Cookson stating that there had been and Mr Russell adding that during the SI investigations issues had been identified but that the Trust are now taking action to address those issues and have an on-going action plan which will be longer than 12 weeks and that the Trust Board have regular updates on the actions being taken in Magnolia Lodge adding that the Trust have ambitious plans in place to improve service and quality. Dr Jones said that it was good to see the work being done. Mr Russell added that there are ongoing discussions in relation to Rehabilitation pathways that are within the CCG and NHS England’s sphere of responsibility. Dr Jones asked the committee if they had any further questions for Mrs Cookson, nothing further asked.

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5.3 FCMS Quality Update – Verbal

Mr Russell updated that there had not been an FCMS Quality meeting since the last committee meeting, the next meeting with FCMS will be 24 th May 2017 and he will provide a written report at the next Quality & Patient Safety meeting on 6 th July 2017.

Mr Russell updated the committee that the last Bank Holiday weekend had been really challenging across the health community with DRI ED having a surge of patients, Dr Jones asked if there were any concerns to highlight to this committee; Mr Russell responded that there wasn’t.

Dr Jones asked the committee if they had any further questions for Mr Russell, nothing further asked.

5.4 Care Home Report – Enclosure E

Mr Boldy and Mrs Denman gave a brief update on the Care Home Report.

Mr Boldy updated that Mrs Tooley was now in post and will be the CCG lead to implement the Care Home strategy and that the Clinical Lead is Dr Nick Tupper who has taken over as chair of the Care Home Implementation Board (CHIB).

The focus is now on setting the scene and to identify priorities which are being informed by the national report. The next CHIB on 12th May 2017 will discuss the Vanguard areas and identify quick wins that can be implemented adding

that there is further finance available from NHS England for the next phase of care home work. If appropriate NHS Doncaster are prepared and would apply for this. Mrs Denman drew the committee’s attention to the map on page 5 of the report which highlights CQC ratings across Yorkshire for Care Homes and that Doncaster is the only area that is green with the rest being amber and red. This RAG rating relates to a national piece of work undertaken by Independent Age that looked at the number of care homes that fell below an acceptable threshold when inspected by CQC. The number of care homes in Doncaster that fell below this level was under 20% and as such they graded Doncaster Green. Mr Russell said that it would be beneficial to go back over the last 2 years and look at the same data to see how Doncaster’s performance

percentage has increased and to compare how far we have come; this was agreed as a good idea and Mr Boldy and Mrs Denman will take this forward. Dr Britten said that the data is surprising as this work has felt like an uphill struggle but that the data shows we are doing better.

The full Independent Age care home report highlighting Doncaster performance can be accessed here.

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Mrs Denman and Mr Boldy to look at CQC Action 020 / 04.05.17: LD / IB performance data from the last two years to see how Doncaster’s performance percentage has increased and to compare how far we have come; once work is complete this is to be brought back to this committee. Mrs Denman informed the committee that Sandrock House has recently received Gold Standard status which is great news and will encourage other care homes; Mr Boldy added that where care homes in the borough have closed this has not been down to quality and safety issues but have been a financial decision by the care home. Dr Jones asked about feedback from the Vanguard areas; Mr Boldy said that the reason that Mrs Tooley had sent her apologies today was that she had received significant amounts of data from the Vanguard areas and is working through this today. Dr Jones asked if all the Vanguard areas were achieving; Mr Boldy responded that there was a sense that the vanguard areas were m Mr Russell said that Mrs Philbin from Sheffield CCG is working with NHS England on care homes adding that it is acknowledged that Doncaster may be ahead of other South Yorkshire and North of England in some areas and we will be able to contribute to this group and also take shared learning into our work in Doncaster. Dr Jones said it sounds as if there is good collaboration across the patch;

Mr Boldy shared that the CCG had been approached by Leeds CCG on the back of the previously discussed report and we were sharing information and our approach with them. Dr Jones said that he would raise this at Governing Body to highlight the CQC data and that Doncaster is the only Yorkshire area that is registered as ‘green’.

Action 021 / 04.05.17: Dr Jones to highlight the CQC Care Home data with Governing Body to highlight that Doncaster is the only Yorkshire area that is EJ rated green.

Mrs Denman informed the committee that procurement for the CAP Pathway will go back out to tender as the first tender exercise did not identify sufficient applicants. This may have been due to a number of factors and that a second procurement process would hopefully be more successful.

Dr Bradley said that there was very little communications to GPs regarding

CAP beds; Mr Boldy said there would be more communications once a new provider was in place and that work is being done to identify the gaps. Mr Boldy reaffirmed his offer to discuss CAP beds with individual practices as necessary. Dr Jones asked that Mrs Denman provide an update at a future meeting once the procurement is complete and a provider is in place; Mrs Denman agreed.

Action 022 / 04.05.17: Mrs Denman to provide an update at a future meeting once the CAP Bed procurement is complete and a provider is in place. LD

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Mrs Denman updated the Local Authority are now using the Care Home Quality Monitoring tool that had previously been in pilot form. This information is used within the Integrated Quality and Risk process between the LA and CCG.

Embargo Update

Old Rectory: The embargo on the Old Rectory has now been lifted.

Avondale: This is an out of area care home in Nottinghamshire and has now closed.

Amethyst: Has now closed.

Dr Jones asked if there had been any significant patient concerns regarding any of the above care homes; Mrs Denman said there wasn’t.

Dr Jones asked the committee if they had any further questions for Mrs Denman or Mr Boldy, nothing further asked.

5.5 Individual Placements Report – Enclosure F

Mr Boldy asked that the report is as read. Mr Boldy provided the following highlights:

Case Management staff are being ‘paired up’ to share the challenge of the Case Manager role adding that this does not diminish effectiveness. Dr Jones said that it would be good to see the outcome of this in a future update.

A ‘Duty’ role has been created and this is covered by a Band 6 Nurse on a weekly basis, this is working really well.

The number of outstanding reviews is on track with 351 outstanding; Mr Russell asked when this will be reduced and Mr Boldy confirmed that this will be the end of the 2017-18 financial / performance year.

The 28 Day Timescale has mostly been successful with a couple of planned exceptions and some degree of challenge from DMBC as this challenges the organisation of Social Workers and Reviewing Officers.

Mr Boldy updated that he met with the Local Authority and they are working through a number of issues and developing relationships and in essence embedding actions. Dr Jones said that it would be good to see some data on the new ways of working with Mr Russell adding that CHC team within the CCG feels ‘settled’ and more cohesive as a team and the progress made has been good to see. Dr Jones thanked Mr Boldy and said that the report was very good.

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Mr Russell updated that Mr Evans has started work this week in the Quality Team and will undertake Care Treatment Reviews for Specialised Placements and will help reduce the pressure from Mr Booth.

Dr Jones asked the committee if they had any further questions for Mr Boldy or Mr Russell, nothing further asked.

5.6 Section 117 Exception Reporting & Work Plan – Verbal

Mr Russell updated that the Section 117 meeting has now been in place for 3 years and the meeting is held monthly adding that there is some disappointment in Local Authority attendance at this meeting this month but

acknowledged that DMBC are currently out to advert to recruit 30 senior posts. Mr Russell added that he had met with Mrs Karen Johnson and had highlighted risk of not achieving actions but added that he is not overly concerned at present.

Mr Russell updated that he will provide a written report for the next meeting in July 2017.

Dr Jones asked the committee if they had any further questions for Mr Russell, nothing further asked

5.7 Medicines Management Report – Enclosure H

Mrs Bradley introduced this report and highlighted the following:

Pregabalin: Decision made for brand prescribing to be discussed with and facilitated where possible across Doncaster Primary Care, there are potential cost savings but there are also risks including using a single supplier, and therefore the activity has been added to the CCG risk register. Mrs Bradley advised that a number of other CCG’s had already undertaken this piece of work.

Blueteq: Four areas now live – rheumatology, ophthalmology, dermatology and gastroenterology.

Collaboration with DBHfT Dietetic Team: Revision of current guidelines on prescribing Gluten Free products was discussed at MMG and decision made to defer this until results from the DH public consultation are known.

Management of children and young people with depression CAMHs Audit: Mr Steve Davies, Chief Pharmacist RDASH FT has reviewed the audit undertaken; the audit was based on local SOPs and NICE guidelines and on reflection it appears that the methodology used in the audit has led to results which appear to be more concerning than after further scrutiny. This has already been fed-back within RDASH FT. Mrs Bradley added that further

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scrutiny had provided a higher level of assurance; however an action plan was still required to be devised and implemented. Mr Russell asked if a future audit was planned and whether the audit tool will be changed; Mrs Bradley confirmed that it would.

Orthopaedic Venous Thrombo Embolism (VTE) Prophylaxis: Mrs Bradley updated that she will be following this debate through attendance at the DBTH Drug & Therapeutics Committee meetings where clinicians are relooking at the evidence of using aspirin for low risk patients. Mrs Stothard updated that there had been an SI on VTE recently.

Dr Jones asked the committee if they had any further questions for Mrs Bradley, nothing further asked.

5.8 Primary Care Quality Report – Enclosure I

Mrs Head asked that the report provided was taken as read but highlighted the following:

Complaints received by NHS England cannot be shared with the CCG. Dr Jones asked if they were unable to share the data or won’t share it; Mrs Head said it was a technical issue so that they can’t. Mr Russell said that he would raise this at the next Quality Leads meeting and if necessary escalate to the Quality Surveillance Group.

Action 023 / 2017: Mrs Cookson/Mrs Stothard to raise the issue that NHS SC/AS England cannot share complaints data with CCGs at the next Quality Leads meeting.

Mrs Head updated that they are now getting trend data from the National Reporting and Learning System (NRLS) with Mrs Cookson adding that this had been a really good piece of work with Mr Russell commenting that this has been done in a systematic way and improved learning across the patch.

Mrs Head informed the committee that Mr Empson will attend the next committee meeting in July 2017 to demonstrate the Primary Care matrix. The committee discussed GP involvement with this work and asked that Mrs Head raise how we can get GPs involved and address the potential conflict this may bring at the next Primary Care Committee. Action 024 / 2017: Mrs Head to raise with the Primary Care Committee how GPs can be involved and how to address the potential conflict. ZH

Data on GPs reporting to Child Protection Conferences is looking more positive, Mrs Cookson updated that further work is being done to look at compliance. Doncaster Children’s Trust is undertaking some work to look at the process to ensure social workers get the information in a timelier manner.

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Mrs Head updated that the FGM Reporting process for GPs to register is very complex but that support is being provided by the CCG where needed. All practices are willing to register but need to ensure that their Caldicott Guardian is registered correctly first. Mr Russell said it was good that all practices want to register and highlighted to the committee that there were no care gaps and this was about data recording.

Mrs Head updated the committee that West End Practice has achieved a rating of ‘Good’ in their recent CQC inspection. Mrs Cookson asked that the minutes reflect the work that Mrs Head has done working and supporting the practice to get to this point, Dr Jones and Mr Russell agreed and thanked Mrs Head. Mrs Bradley said that previously this practice had been one of the highest prescribers in the area adding that it will be interesting to see if this now decreases; Mrs Head said that this is an area that she had worked with them on and feels that they have made a really good start.

Dr Jones thanked Mrs Head for the update and asked that now she has been in post for 9 months acknowledging that this was a new role with a steep learning curve if she could provide a report at the next meeting in July 2017 with her impression on how Primary Care now looks in Doncaster. Mrs Cookson added that the investment in Mrs Head’s role has paid off and also thanked her for the work done.

Action 025 / 2017: Mrs Head to provide a report at the July 2017 documenting ZH her impression on how Primary Care in Doncaster now looks and feels. Dr Jones asked the committee if they had any further questions for Mrs Head, nothing further asked.

5.9 RDaSH Q4 CQUIN Attainment – Enclosure J

Mrs Stothard asked the committee to note that RDaSH have achieved all CQUINs, this is the first year that the Trust has achieved across the board adding that the Trust had provided good quality timely evidence. Dr Jones asked that Mrs Stothard pass on this committee’s congratulations to the Trust.

Action 026 / 2017: Mrs Stothard to pass the committee’s congratulations to RDaSH regarding their 2016-17 CQUIN Attainment. AS

Dr Jones asked the committee if they had any further questions for Mrs Stothard, nothing further asked.

DBTHfT Q3 CQUIN Attainment and Q4 Forecast – Enclosure K

Mrs Stothard updated the committee that the Trust had achieved Q3 and that evidence to support Q4 attainment is awaited. The forecast is achieved except for Sepsis, Mr Russell added that Sepsis has not been achieved but Serious

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Incidents regarding Sepsis have not increased. Mrs Stothard informed the committee that there is an increase in the Sepsis CQUIN for 2017-18 and that she will keep an eye on this.

Dr Jones asked the committee if they had any further questions for Mrs Stothard, nothing further asked.

5.10 Serious Incident (SI) Report – Enclosure L

Mrs Stothard asked that the committee take the report as read but highlighted the following:

The Trust have implemented a review process where they meet and decide if the incident should be recorded on STEIS as an SI with Mrs Cookson adding that the work at the front end is paying off. Mrs Stothard updated that access to Pressure Ulcer equipment is an issue but that overall Pressure Ulcers are reducing. Dr Jones agreed and said that you can see the strategy working on the wards.

Mrs Stothard updated that NHS England and NHS Information are reviewing NRLS and challenges are being received regarding incidents; Dr Jones said that receiving challenges was a good thing and enables us to be assured that the process is followed. Mr Russell said that there may have been a concern about the Key Objective within the Trust to reduce SI’s and that this should be a reduction in harm and not simply a reduction in the number of SI’s reported; Mrs Cookson agreed and said that this was the same for Maternity Services. The view was that there was still good reporting and that episodes of Harmful care were reducing. Mrs Stothard updated that the Trust has a Patient Safety team in place but at present there is some sickness absence within the team but she will continue to monitor this.

Dr Jones asked the committee if they had any further questions for Mrs Stothard, nothing further asked.

5.11 Q4 Complaints, Enquiries, Challenges & Concerns – Enclosure M

Mrs Quinn asked that the committee take the report as read but highlighted the following:

There are a lot of repeat complaints regarding PUPOC and the PUPOC process. Mr Boldy updated that there are discussions regarding the next stage of feedback on MDT and DST, this has been a real challenge but is valued by the team. Dr Jones asked if this leads to lessons learnt and changes to practice; Mr Boldy responded that for CHC it does. Dr Britten asked if asking for feedback on the quality of decisions to patients was the right thing to do. Mr Russell responded that the Quality of the Decision was something that Audit would look at and that the experience of the process was something that we

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needed to explore and gain patient and family views on. Mr Russell suggested that a report of ‘what has been done differently as a result of feedback’ could be presented at the next meeting. Mr Boldy agreed this approach and said that he, Mrs Quinn and Mrs Hunter would meet to do this piece of work.

Action 027 / 2017: Mr Boldy to meet with Mrs Quinn and Mrs Hunter to pull IB / CQ together a report on what has been done differently as a result of feedback for / MH the next meeting on 6 th July 2017.

Dr Jones asked the committee if they had any further questions for Mrs Quinn, nothing further asked.

Complaints and Concerns Annual Report 2016-17 – Enclosure N

Mrs Quinn asked that the committee take the report as read but highlighted the following:

There has been a 25% increase in complaints from last year; Dr Jones asked if there was anything unexpected. Mrs Quinn responded that work is being done now and this will reflect in the current months data adding that complaints are slightly down for this quarter.

Mrs Quinn updated that her contact details are now held on the survey so that members of the public can contact her direct if they have a query / question / issue. Dr Jones said that it was reassuring that there is a good robust process in place adding that the report that Mrs Quinn provided shows that the process is working.

Mrs Bradley queried the entries on the table at Appendix A as the top half of the table refers to Pharmacy/Medicine Management but the bottom half of the table refers to Prescribing and asked if the same language should be used. Mrs Quinn said that she will amend this so that both entries are titled the same. Mr Russell said that he is assured that there is a robust process in place and that it is open and transparent and this is down to the work that Mrs Quinn and Mrs Ross have undertaken; Dr Jones agreed and expressed his thanks to both ladies.

Action 028 / 2017: Mrs Quinn to amend the table at Appendix A of the report CQ so that it reads the same on both the upper and lower tables.

Dr Jones asked the committee if they had any further questions for Mrs Quinn, nothing further asked.

6. PATIENT SAFETY

6.1 IPC Update – Enclosure O

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Mrs Feirn asked that the committee take the report as read but highlighted the following:

MRSA

DBTHfT have their first case this year of MRSA.

C.Difficile

There will be some changes for 2017-18 whereby if a patient is discharged from hospital within 72 hours of being admitted any CD infection stays with the community and is not allocated to the acute trust. Mr Russell asked if the RCA process will change; Mrs Feirn responded that this will stay as it is currently and will be realigned if needed with Dr Jones adding that the changes will have a financial implication for the Trusts.

Public Health Commissioned Service

The contract is up next year and Public Health are reviewing what will happen; Mr Russell added that Mr Joseph is fully engaged with us regarding this and discussions are taking place. Dr Jones asked that this committee were kept up to date with this work; Mr Russell added that Governing Body touched on IPC recently and noted that there have been significant reductions with Dr Jones stating that this clearly demonstrates that management actions improve clinical outcomes.

Gram Negative Blood Stream Infections

Mrs Feirn updated that CCG’s have responsibility to collect this data and nationally everyone is worrying about how this will be done adding that she had attended national meetings and everyone has concerns regarding resource to do this as the data has 36 points to be considered and documented.

There will be a conference in June 2017 and the first half of the day will be dedicated to covering the process for data collection. Dr Jones said that it sounds as if this will be a huge job; Mrs Feirn agreed and said that 86% is attributed to Urosepsis and links to hydration adding that East Midland had done work on this and we can use this. Dr Jones asked that future updates come to Q & PSC; Mrs Feirn said that she will include as part of her future reports for the committee.

Dr Jones asked the committee if they had any further questions for Mrs Feirn, nothing further asked.

6.2 Q3 Safeguarding Adults and Children’s Report – Enclosure P

Mrs Cookson asked that the committee take the report as read but highlighted

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the following:

Work is being undertaken on the Place Plan and to align safeguarding streams across the health partnership adding that the Chief Executives for both RDaSH and DBTHfT have engaged and are keen to take this forward. Mrs Feirn asked if the Safeguarding Teams are aware of this work and Mrs Cookson confirmed that they were and that she had attended the Safeguarding Spring Conference rd on 3 May 2017, this news was received very positively. Mrs Cookson said that it would be good to have a GPs perspective on safeguarding and Mr Russell suggested using locality meetings to discuss this with Dr Britten adding that it would be good to determine how often a GP raises a safeguarding concern. Mrs Cookson said she would discuss this with Dr Britten outside of this meeting. SC / LB Action 029 / 2017: Mrs Cookson and Dr Britten to discuss GP involvement in the safeguarding review.

Mr Boldy updated that there was not a lot to add regarding adults but that there are two domestic homicide reviews which are on-going.

Dr Jones said that the report was very good and it was excellent to see the

inter-agency partnership working.

Dr Jones asked the committee if they had any further questions for Mrs Cookson or Mr Boldy, nothing further asked.

6.3 Caldicott Log – Verbal

Mr Russell updated that there has not been any Caldicott queries received.

6.4 Caldicott Work Plan – Enclosure Q

Mr Russell asked that the Work Plan was noted and approved and that the plan will come to the committee by exception. The committee approved this approach.

Dr Jones asked the committee if they had any further questions for Mr Russell, nothing further asked.

6.5 CQC Update - Verbal

Mr Russell updated that there was nothing to update on this agenda item.

6.6 Quality & Safety Work Plan – Verbal

Mr Russell updated that Mrs Rayner had drafted the plan based on the Quality Team Time Out which had been very positive and really helpful adding that

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there was further work to be done on the plan and that this will come to the next meeting in July 2017.

Dr Jones asked the committee if they had any further questions for Mr Russell, nothing further asked.

7. Any Other Business

Terms of Reference – Enclosure R

The group agreed that the following amendments to be made to the ToR:

• Mrs Tooley to be added to the attendance section of the ToR • Mrs Stothard’s job title to be amended • Mrs Cookson and Mrs Head to discuss 7.2 on the ToR and provide an update to Mrs Twigg

Once amended the ToR are to be sent to Mrs Atkins-Whatley and then go to Governing Body for approval.

Action 030 / 2017: Mrs Twigg to discuss with Mrs Cookson and Mrs Head regarding 7.2 on the ToR and then update as discussed and send to Mrs LT / SC Atkins-Whatley for the ToR to go to the next Governing Body meeting for / ZH approval.

Intellectual Property Policy – Enclosure S

Mrs Atkins-Whatley had asked that Quality & Patient Safety Committee approve the policy. Following discussion that it was probably more appropriate for the policy to be approved by the Audit Committee it was agreed that Mr Russell would discuss this with Mrs Atkins-Whatley but that the minutes reflect that this committee had no objections to the updated policy.

Action 031 / 2017: Mr Russell to discuss who should approve the Intellectual AR Property policy with Mrs Atkins-Whatley.

Post meeting Note: This was put to the Audit Committee for approval.

Boardpad

Mrs Twigg informed the committee that as part of the CCGs Paperlight project that she had been asked that in future rather than agenda packs being issued in paper format to committee members that those committee members that have iPad’s are given access to Boardpad and they will use this for future committee meetings. The committee agreed this approach.

LT / All

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Action 032 / 2017: Mrs Twigg to arrange the move to Boardpad and send committee members further information on this.

Surveillance Policy – Verbal

Mr Russell updated that Mrs Feirn had reviewed this policy due to provider involvement in IPC and that this is not needed. The committee agreed this approach.

8. Minutes and Information • Medicines Management Group – Enc T • Incident Management Group – Enc U • Area Prescribing Committee – Enc V • Safeguarding Assurance Group – Enc W

9. Date and Time of Next Meeting

Thursday 6th July 2017 at 09.30 - 11.30 in the Boardroom, Sovereign House

FUTURE MEETING DATES

DATE TIME VENUE

Thursday 7 th September 2017 0930 - 1130 Boardroom, Sovereign House

Thursday 2 nd November 2017 0930 - 1130 Boardroom, Sovereign House

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Minutes of the Primary Care Commissioning Committee Held on Thursday 13 April 2017 commencing at 12.30pm In the Boardroom, Sovereign House

Voting Mrs Linda Tully – Lay Member (Chair) Members Mrs Sarah Whittle – Lay Member (Vice Chair) Present: Mrs Jackie Pederson – Chief Officer Mrs Hayley Tingle – Chief Finance Officer Mrs Laura Sherburn – Chief of Partnerships Commissioning and Primary Care

Non-Voting Dr Pat Barbour – Locality Lead, South East Locality Members Dr Niki Seddon – Locality Lead, North West Locality Present: Mrs Carolyn Ogle – Primary Care Contract Manager, NHS England

Formal Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term attendees Conditions present Mrs Suzannah Cookson – Deputy Chief Nurse (non- Mrs Kayleigh Wastnage - Primary Care Support Manager voting): In Mrs Jayne Satterthwaite PA to Chair & Chief Officer - (Taking Minutes) attendance: Mr David Gibbons – Local Medical Committee (Attending on behalf of Dr Eggitt) Mrs Lee Eddell – NHS England (Attending on behalf of Mr Ogle) Mr Andrew Goodall – Healthwatch (Attending on behalf of Mrs Hilditch)

ACTION

1. Welcome and Introductions

Mrs Tully welcomed everyone to the Primary Care Commissioning Committee meeting.

There were no members of the public in attendance at the meeting and 4 members of NHS Doncaster CCG staff observing the meeting.

2. Apologies

Apologies were received from:

• Dr Dean Eggitt – Medical Secretary, Doncaster Local Medical Committee

• Dr Rupert Suckling – Director of Public Health • Mrs Debbie Hilditch, Health watch Doncaster Representative • Mr Ian Carpenter, Head of Communications & Engagement

3. Declarations of Interest The Chair reminded committee members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.

Declarations declared by members of the committee are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk

The meeting was noted as quorate.

Declarations of interest from sub-committee/working groups:

None declared.

Declarations of interest from today’s meeting:

None declared.

4. Minutes of the Previous Meeting held on 9 March 2017

The minutes of the meeting held on 9 March 2017 were agreed as an accurate record.

5. Matters Arising

Review of Terms of Reference

Mrs Tully confirmed that the Terms of Reference had been amended and that she had forwarded them to Mrs Atkins Whatley, Chief of Corporate Services.

Tier 3 Colposcopy Service

Dr Alsindi reported that he would meet with Mrs Burns upon her Dr Alsindi return from annual leave.

Application for Ransome Practice Branch Closure

Mrs Wastnage informed the Primary Care Commissioning Committee that NHS Doncaster CCG, NHS Property Services and

NHS England have met with the practice regarding their application. There are no financial implications for the practice. NHS Property

Services require 3 months-notice of vacation of the property. When vacated a decision is required whether to sell or offer the property to

other stakeholders for their use. In the meantime NHS Doncaster CCG is responsible for the costs of the building. Local intelligence has indicated that buildings usually take up to 4 months to sell. Rotherham Doncaster and South Humber Foundation Trust (RDaSH) currently use the building. Mrs Eddell informed the Committee that

the NHS Property Services Constitution states that such properties should be offered to the Local Authority.

Mrs Tully queried if RDaSH has not officially been given notice, does the CCG remain responsible for costs. Mrs Tingle reported that it is

not clearly defined within the contract as it is on a block contract Mrs Tingle arrangement but would speak to Mr Emmerson regarding the arrangement of a contract variation. Mrs Wastnage reported that NHS Property Services has started discussions with RDaSH to give notice to vacate.

There remains more work to be undertaken with the practice and approval for a public consultation is in process. The stakeholder process will be via the Overview and Scrutiny Panel.

The Primary Care Commissioning Committee supported the closure of the practice and gave approval for the practice to progress to consultation within due process.

Primary Care Commissioning Committee Action Tracker

The Primary Care Commissioning Committee Action Tracker was noted by the Primary Care Commissioning Committee.

6. Primary Care Estates Planning

Mrs Sherburn gave a presentation to the Primary Care Commissioning Committee on the Strategic Approach to Primary Care Estate in Doncaster as follows:

• A workshop has recently been held with key stakeholders

regarding the Primary Care Estates planning. • The current dimensions of Primary Care estate in Doncaster include the following: o Estates & Technology Transformation Fund (ETTF) o LIFT utilisation o 6 facet-survey o Housing developments o Doncaster Place Plan o Sustainability & Transformation Plan • The presentation included a map showing the location of upcoming housing developments, against the location of practices, and also depicting the current patient/GP ratio and patient experience rating of each practice. There are 15,000 new houses being built over the

next 10 years.

Proposed Strategic Principles: • Areas will be prioritised where there is planned population growth and/or current estate is not fit for purpose to meet population health need • Before supporting any capital development, we need to ensure full

utilisation of current LIFT estate where appropriate/relevant • There is an expectation that the terms of lease are fully explored before extra investment is requested • New capital developments will only be possible by rationalising

existing estate. Providers across the system will be required to work in partnership to support this. • Once prioritised, there will need to be a consistent set of questions asked of each proposal; these should include: o Can we work with housing developers & Doncaster Metropolitan

Borough Council (DMBC) to make provision/space for health estate? o Have all possible funding streams been explored? o What is the revenue impact and how quickly can this be confirmed? o Can the revenue impact be mitigated by the whole system; additional revenue will require disinvestment elsewhere by the CCG, need collective ownership of this?

• Next steps - Apply the above principles to all current known developments/bids. • Explore options to get the right capacity & capability to create a Primary Care Estates Strategy for Doncaster. • Present back to Primary Care Commissioning Committee in May 2017 for decision on how to take findings forward.

The Primary Care Committee highlighted the following points:

• It was queried if Public Health was in attendance at the workshop. Mrs Sherburn confirmed that there were no attendees from Public Health. • Consideration should be given to branch surgeries. • It cannot be assumed that moving from one building to another will be cost neutral, as new capital will incur new revenue costs. To make this feasible, partners will need to work collaboratively to optimise the estate, potentially sharing some functions, for example reception/waiting areas etc. • Patient engagement will need to be initiated from the beginning and consideration given to how this may be done. Patients may have differing opinions and ideas. • Each proposal will require a consistent set of questions. Each development must include health and the Local Authority and

housing developers will need to consult with the CGG on future developments in the future. • CCG resources are limited and if we agree to fund increased

revenue costs for a proposal, it may be necessary to dis-invest in services elsewhere to balance the books. • Cohort 2 of the ETTF is currently massively over-subscribed. An Estates Strategy for Doncaster will need to be developed.

Mrs Tully requested that Primary Care Estates Planning be included Mrs on the forward planner. Satterthwaite

7. GPFV Implementation Plan – progress update

Mrs Sherburn stated the progress update was for noting by the Primary Care Commissioning Committee and explained that it provides an update against each of the areas of the Doncaster GP Forward View Delivery Plan, which was submitted in December 2016 to NHS England. A great deal of work had been undertaken to date with good engagement from General Practice noted. Mrs Sherburn reported that the update will be presented at the next Local Medical Committee (LMC) meeting.

Dr Seddon acknowledged the hard work undertaken by Mrs Sherburn and the Primary Care Team

Primary Care Commissioning Committee noted the GPFV Implementation Plan progress update.

8. Doncaster -wide June event – Agenda planning

Mrs Sherburn informed the Primary Care Commissioning Committee that the next Doncaster-wide Primary Care event is scheduled to take place on 29 June 2017 at Castle Park Rugby Club and, as an agenda has not yet been agreed, it would be a good opportunity for the Committee to advise on items for discussion. The Committee

suggested the following items for inclusion on the agenda:

• Hold workshop sessions. • Look at areas in the GP Forward View such as the increase in General Practice access hours. • A formal slot for discussions regarding Federations. • A general update on the Primary Care Strategic model. • Conditions of limited clinical value. • Sustainability & Transformation Plan (STP) and Doncaster Place Plan.

Mrs Sherburn thanked the Committee for their contribution.

9. Application for list closure – Dunsville Practice

Mrs Wastnage informed the Primary Care Commissioning Committee that in January 2017 NHS Doncaster CCG became 5 aware that Dunsville Medical Centre had informally closed their list to new patient registrations on advice of Doncaster’s Local Medical

Committee (LMC). The Practice has been asked to keep a record of each patient that is refused registration, their reason for wanting to register with the Practice, and inform NHS Doncaster CCG of each time this occurs. The Practice also has a contractual obligation to write to each patient denied registration detailing the reasons why.

The Practice’s situation was reviewed again at the beginning of March 2017. As the situation was no different the Practice completed a formal application to close their patient list for a period of 12 months.

Dunsville Medical Centre is a PMS practice situated in the North East locality of Doncaster. The Practice has recently reduced from 3 GP partners to 2 GP partners, 1 of these partners is on long term sickness and has been since October 2016, there is no anticipated return date for the partner. The Practice has also seen a steady increase in its list size over the last year with a total of 74 new patients.

Within the Practice area there are 8 other GP practices, 4 of which are within a 2 mile radiance of Dunsville Medical Centre:

• Hatfield Health Centre, Hatfield (1.2m) • Kingthorne Group Practice branch site, Kirk Sandall (1.8m) • St Vincent Medical Practice, Hollybush branch site, Edenthorpe

(1.9m) • Field Road Surgery, Barnby Dun branch site (2.0m) • The Village Practice, Armthorpe (2.9m) • White House Farm Medical Practice, Armthorpe (2.9m) • Thorne Moor Medical Practice, Thorne (5.4m) • Northfield Surgery, Thorne (5.4m)

All 8 practices and the LMC have been offered the chance to express comments or views. The LMC replied in support of the list closure. The Village Practice offered support to Dunsville Medical Centre stating that they have capacity to support the practice and would be happy with the practice offering the option of registration at The Village Practice for their patients that reside within the DN3 area.

NHS England’s List Closure Policy requires the Practice and the CCG to meet and discuss any possible support or changes that would help keep the patient list open. It should be noted that there are currently no closed lists in South Yorkshire & Bassetlaw. The

CCG is obliged to make a decision within 21 days of receipt of an application, unless a longer time period is agreed with the Practice.

If approval is granted then a closure notice is issued as soon as possible following the decision with a copy to the LMC and to any persons who have been consulted as part of the process. The notice will set out that the practice can only register immediate family members of registered patients while closed and set out the time

6 frames for the process as outlined in the policy. The Practice must close on the date specified in the notice and remain closed for the time specified, unless it is agreed to reopen earlier.

If the decision is made to reject the application the CCG must make the Practice aware as soon as possible which should include why the proposal was rejected. Details of the dispute and appeal process and timeframes for making a further application should also be provided at this time with a copy sent to the LMC. If the application is rejected no further applications can be made for three months. If the decision is appealed, then this three month period starts after the final appeal decision. However a further application can be made if there is a change in circumstances which affects the Practices ability to deliver services.

If the Practice wants to extend the closure period it has to apply at least 8 weeks before the notice is due to expire. The CCG must acknowledge the extension notice within 7 days, discuss with the LMC and affected parties and reach a decision within 14 days of receipt. Following a decision the same process is applied as for the initial application. If the extension is rejected, the practice list remains closed for the original time period.

If a practice list is closed patients can only be assigned to the Practice in the following circumstances:

• If most or all providers of essential services in the area have

closed lists • If NHS England’s assessment panel says that a patient must be assigned to the practice and this decision hasn’t been overturned by NHSLA • The CCG/NHS England has discussed with the practice taking on a particular patient and agreed additional support.

Mrs Wastnage requested that the Primary Care Commissioning Committee consider the details contained within the Executive

Summary together with the Application to Close Practice List of Patients, make a decision whether to approve or reject Dunsville Medical Centre’s Application to Close Practice List of Patients for a period of 12 months and make a decision whether to approve or reject the request to continue to register Care Home/Nursing Home patients during the Closed List Period if approved.

Mrs Sherburn highlighted that the practice would welcome a conversation regarding funding for recruitment or peer support, and that the CCG should undertake to meet with the practice. Dr Seddon reported that, currently, it can be difficult to recruit GPs locally. Mrs Pederson suggested that a practice ‘buddy’ system would provide a means of support to the practice.

Mr Goodall highlighted that patients access Healthwatch to source an alternative practice if they are not accepted by their first choice

and may be of help in this instance.

Mrs Whittle stated that she would welcome an action plan from the practice detailing its intentions.

The Primary Care Commissioning Committee considered the detail in the Executive Summary together with the application to Close

Practice List of Patients and approved Dunsville Medical Centre’s application to close the Practice List of Patients for a period of 12 months and approved the request to continue to register Care Home/Nursing Home patients during the Closed List Period.

Mrs Mrs Tully requested that an update regarding the list closure of Satterthwaite Dunsville Practice be added to the Forward Planner for January 2018.

10. Rent Reimbursement – Burns Practice

Mrs Wastnage explained that it is the responsibility of each GP Practice to provide suitable accommodation for the provision of the primary care services they are contracted to provide. In return for providing such accommodation the GP Practice is entitled to have their rent reimbursed by the commissioner.

The Burns Practice Cantley site is owned by the GP partners and as such is owner occupied. In the case of owner-occupied premises the rent that is reimbursed is known as a “notional rent payment”. NHS England, or CCG if fully delegated pays the current market rental

value of the practice premises. The Premises Directions set out how the current market rental is to be assessed; the District Valuer assesses the level of notional rent.

As no actual lease exists the Premises Directions make certain

assumptions as to the terms of the notional lease for which rent is to be assessed. This is because different levels of rent will be payable depending on the terms of the lease; for instance a tenant will pay more rent for a lease where the landlord is liable for maintenance and repair than would be the case for a lease where the tenant is

liable. Rent abatements apply to owner/occupiers, notional rent may be abated (i.e. the notional rent amount may be reduced) if ‘NHS money’ is introduced to improve the premises, the calculation of the abatement is detailed in the directions. Additionally, if the practice receives reimbursement for the total building area and rental income

from other organisations using the premises, the rent received should be abated from the reimbursement, i.e. no double payment. If the other provider’s services are not NHS services, the practice must charge a rent to the provider. If other NHS services are being provided from the premises, there is no requirement to charge a rent

for this and the practice may receive full rent.

The Burns Practice was awarded £520,350 from the Primary Care

Infrastructure Fund towards the cost of an extension at the Cantley site; this represented 66% of the total cost of £788,408. As required

by the NHS Premises Directions 2013 the District Valuer was requested to complete a “Before” and an “After” valuation in order that the necessary abatement can be applied. Prior to the extension being built the current market rent of the property was £34,000pa, after the extension was completed the current market rent is

£103,000pa. In terms of abatement, the previous market rent is subtracted from the current market rent to give the current market rent value of the premises improvement - £71,000. The Burns Practice contributed 34% towards the cost of the improvement; therefore they are entitled to 34% of the current market rent for the

improvement which is £24,140 + 10% towards landlord costs totalling £26,554. The rental reimbursement per annum will therefore be £60,554. The period of abatement will be for 15 years as the contribution by the NHS was in excess of £250,000+VAT.

Within the practice there are three rooms used for NHS services not provided by the practice, the value of those rooms for rental purposes is £3,425pa. The Burns Practice do not charge rent to those services that use these rooms.

Mrs Wastnage requested that the Primary Care Commissioning Committee note the increased rental reimbursement from £33,000 to £60,554, consider the budgetary implications and make a decision whether to approve or decline to pay the increased notional rent.

Mrs Eddell informed the Committee that this is part of an historical scheme which was approved at the time and was transferred upon delegation to the CCG.

Dr Barbour stated that it would helpful if clarity could be sought on

the practice boundaries. Mrs Wastnage agreed to investigate this Mrs Wastnage further.

The Primary Care Commissioning Committee approved the payment of the increased notional rent with the proviso that the further clarity is sought on the practice boundaries. The Committee acknowledged that further conversations are needed to discuss how this may be approached more effectively in the future.

11. GMS Contract Changes 2017/2018

Mrs Tingle highlighted that it was agreed at the last Primary Care Commissioning Committee meeting that a narrative would be provided regarding the implications of the review of the GMS contracts. The guidance is still awaited.

Key Changes to the 2017/18 GP Contract

The following will be included in the core contract requirement for all

GP contracts from 1 April 2017.

• Identification & Management of Patients with Frailty • National Diabetes Audit • NHS Digital Workforce Census • Data Collection • Registration of Prisoners • Access to Healthcare

The breakdown of the 1 April 2017 uplift to be applied to GP Contract is as follows:

• MPIG reinvestment is the redistribution of the phased deduction of MPIG from GMS contracts. • Seniority reinvestment is the redistribution of the phased deduction of seniority from GMS/PMS contracts. • Elements of the deal relate to additional pension administration levy costs, workforce survey administration, overseas visitors cost recovery, non-recurrent additional patient records workload, and other increased business expenses. • Enhanced Services reinvestment is the reinvestment of the Avoiding Unplanned Admissions DES, which ceased on 31 March 2017 and is now part of the core contract for all practices in relation to frail patients. • 5. Inflation uplift of 1% on pay, along with an appropriate uplift to expenses (not specified).

The estimated impact of applying the above uplift to NHS Doncaster CCG GP contracts is £600k.

Carr Hill Formula

The Carr Hill Formula is the weighting index used to assess practices registered populations in terms of age, sex, deprivation. Negotiations on changes to the Carr Hill Formula are commencing, and the earliest start date for changes will be 1 April 2018.

Quality and Outcomes Framework (QOF)

The price per QOF point will be increasing from 1 April 2017 from £165.18 to £171.20, an increase of 3.6%. The estimated impact of this change is £162k.

Directed Enhanced Services (DES)

The Learning Disability DES price change from 1 April 2017 of 20.69% is estimated to have an impact of £10k. The Extended Hours DES is to remain unchanged until 1 October 2017.

The Avoiding Unplanned Admission DES ceased on 31 March 2017. Funding has transferred into core contract to fund the new contractual requirement relating to Identification and Management of 10

Patients with Frailty. The estimated impact of transferring the DES into core contract is £21k, which is included within the £600k cost pressure highlighted above for core contract changes.

Other Changes

Other changes cover:

• GP retention scheme updated. • GP sickness leave updated and classed as mandatory. • CCG’s to reimburse practices directly for Care Quality Commission (CQC) fees. Awaiting confirmation of guidance and process. Estimated cost pressure of £225k. • Amendments to NHS England Public Health for Vaccinations and Immunisations. • NHS England agreed to make payments to practices for indemnity inflation in 2016/17 and 2017/18. NHS England funding 2016/17 directly and 2017/18 a cost pressure for CCG’s. Awaiting further guidance relating to 2017/18 price per patient and process.

Mrs Sherburn queried if a decision has been reached on the uplift in respect of the Local Enhanced Services (LES). Mrs Tingle reported that these will be subject to 1% uplift in line with the GMS contract.

Dr Barbour raised the GP sickness element and asked if it applied to any GP. Mrs Eddell confirmed that it does not apply to locums only permanent GPs who would be eligible after a sickness period of 2 weeks.

The Primary Care Commissioning Committee noted the 2017/2018 GP Contract changes for Primary Care Delegated Medical Contracts, and the estimated financial impact of £997k.

12. Financial Planning – Primary Care budgets 2017/2018

Mrs Tingle explained that the report is a high level summary and outlines the 2017/2018 financial plans for Primary Care, including delegated Medical Contracts and is for noting and the agreement of the Committee.

NHS Doncaster CCG assumed responsibility for managing the Primary Medical Care Budget from NHS England with effect from 1 April 2016, adding to the current CCG responsibility for Enhanced Services, Out of Hours Contract, Oxygen and GP IT.

The total 2017/18 Primary Care Financial plans total £47,584,000, including £41,992,000 relating to Delegated Medical Contract and £5,592,000 relating to Other Primary Care budgets which cover oxygen, enhanced services, out of hours and GP IT. Areas of concern relate to Delegated Medical Contracts premises and the impact of the 2017/18 GP contract negotiations.

The Primary Care Commissioning Committee noted and agreed the Primary Care budgets for 2017/2018.

13. Primary Care Commissioning Committee Forward Planner

Mrs Tully highlighted that the Primary Care Commissioning Committee Forward Planner is for noting by the Committee. It contributes to forming the agendas for future meetings however cannot be exact.

The Primary Care Commissioning Committee noted the Forward Planner.

14. Quality Update

Mrs Cookson presented the Quality update for noting by the Committee however wished to highlight the following point:

• Complaints received by NHS England cannot yet be shared with the CCG. The Primary Care Quality Nurse has been in discussion with NHS England and was informed that this has been the case since a new system (CRM) was implemented in 2015. Reporting is done by the national complaints team who are looking to establish

a dashboard per CCG and the first draft of these has been released to the regional complaints leads. There were some issues identified and they are working on a further draft but it is not clear when this is expected to be released.

Dr Barbour raised GP reporting to Child Protection Conferences and queried if the reports should be completed by GPs or if any competent person could complete. Mrs Cookson responded it would be the lead clinician who knows the family best.

15. Receipt of Minutes

The following minutes were received and noted by the Primary Care Commissioning Committee:

• Primary Care Delivery Group – Draft Minutes of the meeting held on 10 March 2017. • Provider Engagement Group – Draft minutes of the meeting held on 22 February 2017.

16. Any Other Business

Disposal of Patient Records

Dr Barbour raised the guidance relating to the shredding of patients 12

records held in General Practice and requested clarity on procedures for Doncaster practices.

Mrs Tully stated that the guidance recommends that the contents within the Lloyd George envelope are scanned and held electronically then disposed of through appropriate confidential shredding. The Lloyd George envelope must be retained.

Dr Barbour requested that this information be circulated to Practice Mrs Sherburn Managers and the LMC for information.

Primary Care Website

Dr Alsindi reported that the Primary Care Website is now in operation. It was suggested that the presentation from today’s meeting regarding Primary Care Estates planning is uploaded. The Public Primary Care Commissioning Committee papers are uploaded

onto the NHS Doncaster CCG website.

Standing Agenda Item

Mrs Tully suggested that a standing agenda item be added to future Mrs agendas in respect of any potential risks which may be identified Satterthwaite when discussing business items.

17. Date and Time of Next Meeting

Thursday 11 May 2017, Boardroom, Sovereign House at 12.30pm

Executive Committee Held on Wednesday 3rd May 2017 commencing at 9am In Dr David Crichton’s Office, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Formal Members Mrs Jackie Pederson – Chief Officer (Chair) Present: Dr David Crichton – Chairman Mrs Sarah Atkins Whatley – Chief of Corporate Services Mr Andrew Russell, Chief Nurse Mr Anthony Fitzgerald – Chief of Strategy & Delivery Mrs Hayley Tingle – Chief Finance Officer Mrs Laura Sherburn – Chief of Partnerships Commissioning

Formal Attendees Mrs Lisa Devanney Present: Mr Ian Carpenter – Communications and Engagement Manager

In attendance: Mrs Jayne Satterthwaite – PA to Chair and Chief Officer (Item 5) Mr Gareth Jones – Corporate Governance Manager (Item 5) Mrs Gill Bradley - Deputy Head of Medicines Management (Item 8)

Miss Lindsay Moore – Senior Corporate Services Support Officer (Taking Minutes)

ACTION 1. Apologies

There were no apologies received for this meeting

2. Declarations of Interest

The Chair reminded committee members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.

The meeting was noted as quorate. Declarations of interest from sub-committee/working groups:

None declared.

Declarations of interest from today’s meeting:

Dr Crichton declared an interest in Item 8 from a non- financial professional perspective. It was agreed that Dr Crichton remain in the room and be involved in the discussions but not in the decision making.

3. Minutes from the Meeting held on 5 April 2017

The minutes from the Executive Committee meeting held on 5

April 2017 were agreed as a correct record subject to the following amendment:

Page 8, Paragraph 3 should read ‘Dr Crichton commented that patients are now also being discharged from Hospital with Pre- emptive medications.

Page 13’ ‘NHS Doncaster CCG agreed that diabetes would not be taken forward as a priority area and therefore will not require its own delivery plan’ The committee agreed that this should read; ‘NHS Doncaster CCG agreed that diabetes would not be taken forward as a priority area but will still have its own delivery plan’

4. Matters Arising

There were no matters arising raised at this meeting

5. Admin Specification

Mrs Satterthwaite and Mr Jones advised that a review has been undertaken on the Administrative Support Team Specification. The specification has been presented and well received at an Administration Team Meeting held on 10 th April. At this meeting the Administration team agreed the team values and functions

which can be offered within the current administration capacity. A gap of 1wte administration post has also been identified which is linked to a member of staff being on Maternity Leave.

The following changes have been made to the specification; • Receptionist responsibilities • Core administration functions including the aims to achieve a ‘paperlight’ organisation • Meeting management and the list of meetings associated

for each team • Cover arrangements for reception and meetings • Members of the team supported by administration

Mrs Satterthwaite and Mr Jones highlighted the following key points to the committee; • Consideration to be given to any Band 4 Support Officer within each team to provide support to Task and Finish Groups / local work stream meetings or project work • Cover for meetings in case of absence will only be provided for those meetings that form part of the

Governance Structure or may be part of a legal request such as Freedom of Information. • Support for Task and Finish Groups or local meetings must be covered within the team either by the Chair or Band 4 Support, taking actions notes where necessary.

• The agreement of 6 – 8 meetings is deemed an acceptable amount of meetings per person that require formal minutes and may need to be covered in case of absence

Mrs Satterthwaite advised that there have been a lot of requests made recently for meeting cover and reception cover due to Annual Leave and Sickness and this takes up a lot of Administration Team time. The Corporate Administration Team seeks to cover their own meetings within the team and do not often ask for cover from the wider Administration Teams.

The Executive Committee were asked to review the meeting list and advise on whether all the meetings listed require administration support and cover. Consideration is also needed to Band 4 staff within each directorate providing meeting support to Task and Finish Groups. Mr Jones advised that the Finance directorate have devised a system of ensuring meeting cover for their teams and this system is working well and is being looked at as a way forward for the wider Administration Team.

Mr Fitzgerald advised that a review of meetings in the Strategy & Development Directorate has taken place and Lucy McGibbon is working on this. Mr Jones and Mrs Satterthwaite agreed to meet Mrs Satterthwaite with Lucy to look at the work that has been done around this. /Mr Jones

A meeting has also been planned to discuss how the Dementia work will be taken forward once Mr Goddard leaves the CCG on 19 th May. Mr Jones and Mrs Satterthwaite are welcome to attend this meeting.

The Committee agreed that it may be useful to look at a ‘revolving’ administration support duty for Partnership meetings in a similar way to the A&E Delivery Board meetings are arranged.

The Committee noted that there is currently a member of the team on Maternity Leave and as such her duties have been

covered by the Corporate Administration Team. It was noted that there is more resource in the Corporate Office than other teams and it was suggested that the colleague could support other areas in the Organisation to distribute resources more effectively.

The Committee agreed that an 8am start time for reception would be beneficial as some meetings start at 8am and there is often no one to greet visitors and allow them access to the meeting venues. It was noted that some partners who regularly

attend meetings are aware of the access code for the building.

Mrs Devanney suggested giving consideration / a trial period to some meetings being recorded and subsequently transcribed via an audio system.

All The Committee thanked the Admin Team for their work around this and agreed to send any subsequent changes required to Mrs Satterthwaite and Mr Jones.

The Administration team have put forward some ideas on how to become paperlight such as secure printing, black and white Mrs printing by default and wider use of Boardpad. An update on the Satterthwaite ‘Paperlight’ project will be presented to a future meeting of the / Mr Jones Executive Committee.

6. PEG Business Case

Mr Fitzgerald advised that further work around this is required and subsequently this item is deferred to a future meeting.

7. Infertility policy

Mr Fitzgerald informed the Committee that in 2013 following transfer of commissioning responsibility for specialist fertility services from the YH Specialised Commissioning Group to local CCGs, a Yorkshire & Humber wide fertility policy was developed to encourage consistent access thresholds. This policy could be adapted locally by individual CCGs to suit their needs, and the number of cycles offered for the different age groups could also be set locally.

A review of the current policy and latest NICE guidance was carried out virtually by a panel of local commissioners and provider experts in Autumn 2016. Minimal changes were made to the Policy and those that were made, were to reflect the changes in NICE guidelines, and also to make certain wording clearer to patients. These changes have been agreed via NHS

Doncaster CCG Clinical Reference Group in March 2017.

There is still variance across the region in terms of the number of cycles available to patients ranging from 1 to 3 funded cycles, Doncaster offer 2 cycles at present.

Based on the figures and evidence provided in the report the Executive Committee agreed the changes within the policy and to maintain the provision of two funded cycles at present.

It was also agreed to commit to continued discussions with South Yorkshire & Bassetlaw CCGs in moving towards a unified provision of treatment cycles.

8. Minor Ailments Scheme Review

Mrs Bradley and Mrs Sherburn informed the Committee that NHS Doncaster CCG currently commissions a Minor Ailments Service from Community Pharmacies. The aim of the service is to offer an alternative to a GP appointment for conditions that do not need to be seen by the GP, and support a culture change in patient behaviour that encourages Self Care.

The last review of the service was carried out in 2015 which led to the formulary and accreditation requirements being revised.

There is now a need to review this service again to ensure it is performing at its optimum potential, and supports the principles of preventative, responsive, and proactive care in the community. One of the national initiatives under the GPFV is Active Signposting in general practice which supports patients to choose the best service for them.

Under the current arrangements, the formulary items can only be recompensed under the Minor Ailments scheme if they are used for the specified indications, even though their licence may cover other conditions. Of the total 79 pharmacies in Doncaster that are signed up to the service 52 are actively offering the service.

From the data obtained the following conclusions can be documented; • The current service costs c. £36K per annum, treating c. 4000 patients • Main area of spend (over 50%) is headlice treatment for children • 91% of patients would have gone to their GP if this hadn’t been available • Technically therefore the service has saved 3640 GP/GPN appointments per year • There is a perception that the scheme is only for patients that don’t pay for their prescriptions, limiting utilisation

• There is wide variation in the number of claims per pharmacy; this could also mirror variation in understanding/awareness of the scheme in general practice • Given the above, there is potential to optimise the scheme further, or go in the opposite direction and restrict it going forward.

A robust discussion was held around the following 2 options;

Option 1: Optimising the scheme This option is based on the premise that the Minor Ailments scheme fundamentally supports the national & local strategic direction of travel and therefore is a necessary element of the primary care system. This is consistent with initiatives elsewhere, and also supports the national policy direction of encouraging more integration of pharmacy and general practice in general terms. In order to optimise the scheme and make it more effective, there are a few things we could explore:

1. Refresh the list of providers, develop patient and provider resource/literature, rebrand and promote the service to all patient/public and stakeholders. 2. Review the scope of the scheme to consider: a. Expand to include additional indications; possibly supported by introduction of Patient Group Directives delivered by approved pharmacists b. Allow each drug on the formulary to be used for any indication it is licensed for (allowing opportunistic dispensing and potentially avoiding re-directing the patient to the GP in more circumstances)

The financial impact of the above actions will not be possible to forecast, but if they are successful, there will be increased expenditure. There are funding streams available through the GP Forward View to support Active Signposting, on a non-recurrent basis over the next two years that could be used to mitigate increased expenditure, and allow us to test the concept that an optimised scheme would be “invest-to-save”.

Option 2: Restricting the scheme

It will always be difficult to definitively prove the impact of the minor ailments scheme, and it could be argued that the investment over the past two years has been deployed on services of limited clinical value. From this perspective, there is an option to actively restrict the current scheme, for example to those exempt from prescription charges, or decommission it altogether. There could also be an exploration of the scope of the service and whether or not the list of conditions should be limited based on clinical value, as opposed to the current state

which recognises and accepts patient’s requests and aims to meet that demand away from general practice.

The Committee agreed that the scheme should continue for a further 12 months and that is should be available to people who do not pay for prescriptions. It was agreed to promote this to General Practice via signposting training that is about to be undertaken. The performance, costs and activity can then be re looked at and a decision made as to the future of the service in 12 months time.

9. Delivery Plan Reporting

Mr Fitzgerald presented the Delivery plans and supporting documents to the Committee and explained how they are produced, populated and monitored. It has been agreed that 2 delivery plan areas will be presented to each Governing Body meeting and an exception report will be produced for those areas

not put forward as the main focus areas. There will also be a patient story linked to the areas of focus at each Governing Body Meeting. The areas of focus for May 2017 Governing Body are Planned Care and Primary Care and the St Vincent’s’ practice are looking at the Patient Story for this area.

The Committee agreed with the approach for Governing Body and that it would be useful for the Delivery Plans and Exception Reports to also come to Executive Committee prior to Governing Mr Fitzgerald Body.

10. Ernst Young Phase 1 Report

Mr Fitzgerald presented the two EY reports to the Committee and advised that they will eventually be merged into one report. Both reports give a fair and relatively accurate reflection of our current position; however some alterations to the language used will be required.

The Committee agreed that the report needs to be as balanced as possible with regard to Health and Local Authority content and provider coverage. It was recommended that Urgent Care and Emergency Care need to be added as a priority area of

opportunity specifically focussing on implementing a new contractual model from April 2018 (or earlier). EY have produced presentation slides for the Strategy and Organisational Development Forum on 4 th May and these are being reviewed in respect of content and language used.

Mr Fitzgerald informed the committee that the reports are very draft and are not to be shared at the current time.

11. Bring Forward Agenda

The Committee agreed the following:

Strategy & Organisational Development Forum

June Mrs Atkins • Confidentiality Training Whatley

• RDaSH Plans Mrs Smith / Mr Ahulwalia

Governing Body

June • EY Report Update

12. Items to Note/Receipt of Minutes

The Executive Committee noted the receipt of the following minutes:

• System Resilience Group – Draft minutes from the meeting held on 23 March 2017.

13. Any Other Business

Mr Fitzgerald is attending a meeting at 12:00 today around the

current situation within A&E.

th Mr Goddard and Mrs Grimwood leave the CCG on 19 May and handover meetings are scheduled and taking place.

Mr Fitzgerald has met with the Local Authority regarding the integration of Business Intelligence Teams and a joint time out is being scheduled.

There are two new starters within the Strategy and Development Team due to commence employment in June and July. A further advert for a Band 7 post has been sent out.

14. Date and Time of Next Meeting

Wednesday 7 June 2017 at 9am, Dr Crichton’s Office, Sovereign House

South Yorkshire and Bassetlaw Sustainability and Transformation Partnership

Collaborative Partnership Board

12 May 2017, The Birch/Elm Room, Oak House, Rotherham

Decision Summary

Minute Item Action reference 41/17 Minutes of the previous meeting held 7 April 2017

The following amendment was required at 39/17, Bassetlaw JA paragraph, 2nd line, Barnsley should be altered to read Bassetlaw.

43/17 National Update

SYB Memorandum Of Understanding a) That Will Cleary-Gray would collate all feedback and comments regarding the draft and bring revised MOU to the th WC-G next Collaborative Partnership Board Meeting on 9 June. b) That members should forward any further feedback to Will Cleary-Gray. ALL

44/17 Finance update

Stroke Business Case  A short note to members will be circulated that identifies the process that was used concerning the submission of the three JC capital bids e.g. how they got from the list to being submitted to

the Department of Health in the timescales involved.

The following additional comments were made by members:

 It is important that the revised figures regarding the Stroke

blueprint and analysis are shared with stakeholders to inform JC understanding of potential changes and impact.

46/17 Update on Programme Activity: a. Workforce

Members noted the connection with the Workforce Framework paper previously presented to the Collaborative Partnership Board and Tim TG/PH Gilpin and Peter Hall would support a discussion at a future Collaborative Partnership Board Meeting.

47/17 b. Proposed Joint Infrastructure and the DWP Initiative Kevan Taylor informed members there would be a presentation and KT proposal regarding the DWP initiative at the next Collaborative 1

Partnership Board meeting in June.

49/17 d. Cancer

The Chair advised members that the Cancer Alliance Board agreed a shared inter provider transfer (IPT) policy at the May Cancer Alliance Board meeting and has advised the Collaborative Partnership Board at this meeting that the policy had been signed off and was ready to be sent out to partners. After discussion members agreed that the Clinical Reference Group would finalise any outstanding clinical issues CRG within 6 weeks, which will need to be agreed to ensure we are able to successfully operationalise the policy. CPB

51/17 Findings from conversations with the public and staff on the SYB STP

 all future Board reports will be circulated as a single PDF as JA well as the combined ‘Master All’ document.

Helen Stevens added that her work stream will be looking at a SYB HS STP website, branding and narrative and a report will be brought to the next Collaborative Partnership Board meeting.

55/17 Update on Organisational Development

The Collaborative Partnership Board agreed:  4/5 senior people should be nominated as enablers from each ‘place’ on the Board. ALL

 Social Kinetic will circulate a questionnaire for Board members and those nominated as enablers to complete, this will be ‘live’ for 2 Social Kinetic

weeks.

 Social Kinetic will then analyse the data received back from the Social Kinetic questionnaires.

 A wider team event should be arranged e.g. a one day workshop, 10am to 4pm for approximately 80-100 people should be arranged Social Kinetic for the whole Collaborative Partnership Board and Team to attend.

South Yorkshire and Bassetlaw Sustainability and Transformation Partnership

Collaborative Partnership Board

Minutes of the meeting of 12 May 2017, The Birch & Elm Room, Rotherham

Name Organisation Designation Present Apologies Deputy for STP Lead/Chair & CEO, South Yorkshire and Sir Andrew Cash Sheffield Teaching  Bassetlaw STP Hospitals NHS F T Rob South West Yorkshire Adrian Berry Deputy Chief Executive  Webster Partnership NHS FT CEO Adrian England Healthwatch Barnsley Chair  Nottinghamshire County Anthony Ainsley Macdonnell, Service Director  Council May CEO Locality Director North Alison Knowles NHS England  of England, Academic Unit of Ben Jackson Primary Medical Care, Senior Clinical Teacher  Sheffield University Voluntary Action Catherine Burn  Representative NHS Rotherham Clinical Chris Edwards Accountable Officer  Commissioning Group The Rotherham NHS Louise Chris Holt  Foundation Trust Barnett Working Together Des Breen Medical Director  Partnership Vanguard John Greg Fell Sheffield City Council Director of Public Health  Mothersole CEO Deputy Director of Frances Cunning Public Health England  Health and Wellbeing South Yorkshire and Assc. Director of Helen Stevens  Bassetlaw STP Comms & Engagement NHS Bassetlaw Clinical Interim Accountable Idris Griffiths  Commissioning Group Officer NHS Doncaster Clinical Jackie Pederson Accountable Officer,  Commissioning Group South Yorkshire and Corp Admin, Exec PA, Jane Anthony  Bassetlaw STP Business Mgr Working Together Janette Watkins Director  Partnership Vanguard Voluntary Action Janet Wheatley Chief Executive  Rotherham South Yorkshire and Interim Director of Jeremy Cook  Bassetlaw STP Finance John Mothersole Sheffield City Council Chief Executive  First Hour Sheffield Children’s John Somers Hospital NHS Chief Executive  Foundation Trust Director of Public Julia Burrows Barnsley Council  Health 3

Sheffield Clinical Julia Newton Chief Finance Officer   Commissioning Group Rotherham, Doncaster Kathryn Singh and South Humber NHS Chief Executive  FT Sheffield Health and Kevan Taylor Chief Executive  Social Care NHS FT NHS Barnsley Clinical Lesley Smith Accountable Officer  Commissioning Group The Rotherham NHS Louise Barnett Chief Executive  Foundation Trust NHS Sheffield Clinical Maddy Ruff Accountable Officer  Commissioning Group NHS Sheffield Clinical Director of Maddy Matt Powels  Commissioning Group Commissioning  Ruff NHS England Matthew Groom Specialised Assistant Director  Commissioning Yorkshire Ambulance Associate Director of Matthew Sandford  Service NHS Trust Planning & Dev Health Education Mike Curtis Local Director  England Bassetlaw District Neil Taylor Chief Executive  Council Nottinghamshire Chief Operating Paul Smeeton Healthcare NHS  Executive Foundation Trust Barnsley Hospital NHS Richard Jenkins Interim Chief Executive  Foundation Trust Doncaster and Richard Parker Bassetlaw Teaching Chief Executive  Hospitals NHS F T The Yorkshire and Richard Stubbs Humber Academic Acting Chief Executive  Health Science Network South West Yorkshire Rob Webster Chief Executive  Partnership NHS FT Doncaster Metropolitan Rupert Suckling Director of Public Health  Borough Council South West Yorkshire District Service Director, Adrian Sean Raynor  Partnership NHS FT Barnsley and Wakefield Berry Rotherham Metropolitan Sharon Kemp Chief Executive  Borough Council Steve Shore Healthwatch Doncaster Chair  South Yorkshire and Sustainability & Will Cleary-Gray  Bassetlaw STP Transformation Director

Minute Item Action reference 40/17 Welcome and introductions

The Chair welcomed members and noted apologies for absence.

41/17 Minutes of the previous meeting held 7 April 2017

The following amendment was required at 39/17, Bassetlaw JA 4

paragraph, 2nd line, Barnsley should be altered to read Bassetlaw.

Subject to the above amendment the minutes of the meeting were accepted as a true and accurate record and would be published.

42/17 Matters arising

All matters arising would be picked up as part of the agenda.

43/17 National Update

South Yorkshire and Bassetlaw Memorandum Of Understanding

Will Cleary-Gray updated members on the progress of the Memorandum of Understanding (MoU). The MoU is not a legal contract, nor does it serve to replace the legal framework or responsibilities of our statutory organisations. It is an agreement that sets out the framework within which our partner organisations will come together to establish how we will develop as an Accountable Care System.

A draft was shared with Collaborative Partnership Board members attending the South Yorkshire and Bassetlaw Sustainability and Transformation Partnership (SYB STP) timeout on 28 April 2017. Feedback from the timeout was incorporated into the draft MoU and those present at that meeting agreed the revised document should be shared with statutory organisations. The draft was circulated with an accompanying letter from Sir Andrew Cash in which he outlined the context of the MoU, the document being a first draft and requested their feedback which would be incorporated into the document. ALL

The draft MoU has also been shared with NHS Improvement and NHS England and with the Five Year Forward View Team.

Will Cleary-Gray will collate all further feedback and comments regarding the draft and bring a revised MoU to the next Collaborative WC-G Partnership Board meeting on 9th June 2017.

The following comments were made by members:  A sentence should be added to the document regarding stakeholders because as provider groups start to develop and emerge they will also be part of the stakeholder agreement and as such should be invited as and when they develop.  This is a helpful and very well written document, this is a social movement of working together.  ‘Parties to’ and ‘partners in’ is a useful way to make a distinction between the various stakeholders and how they may wish to be reflected in the MOU.  Clarify ‘partners’ and ‘parties’: ‘partners’ provide support for the direction of travel, ‘parties’ are organisations that will be signing the MoU.  Yorkshire Ambulance Service is a Trust therefore the word ‘Foundation’ should be removed when referring to this service.  In the glossary it may be helpful to have an explanation of both ‘horizontal’ and ‘vertical’ parties.

Will Cleary-Gray agreed to incorporate the above comments into the WC-G draft. 5

The Chair urged members to forward any further feedback direct the ALL Will Cleary-Gray.

The Collaborative Partnership Board noted the Memorandum of Understanding.

44/17 Finance update

Indicative Budget 2017-18

Jeremy Cook presented his finance report to the meeting drawing attention to the following issues:

Capital Capital bids had been submitted to the Department of Health under very tight deadlines.

STP had submitted 3 bids but as yet has not received any feedback on them from the Department of Health.

STP Budget 17/18 Jeremy Cook added the STP budget for 2017-18 had not yet been worked up as notification of funding from NHS England and NHS Improvement. The Chair advised members she would update them from a national meeting held in London on 2nd May 2017 that both she and Will Cleary-Gray attended.

Financial modeling Jeremy Cook advised members that a simplified version of the financial plan was being developed. The Finance Steering Group meeting on 23rd May 2017 will receive a presentation regarding the progress.

Hyper acute stroke services business case Jeremy Cook informed members that there is a difference between the blueprint and analysis figures in terms of the way forward for the hyper acute stroke services business case.

Will Cleary-Gray advised members that the team has been working through the revised flows with Yorkshire Ambulance Service to establish clarity. The reviewed flows would be shared with stakeholders.

Jeremy responded to comments from members as follows:  There was some urgency around the capital bids as the submission deadline was tight. In future it is expected that such urgent items are channelled through the new Executive Sub Group. The Executive Steering Group is not formed at the moment and Terms of Reference are being taken to the Financial Oversight Committee today and the Executive Steering Group on Tuesday, 16th May and will circulated thereafter.  A short note to members will be circulated that identifies the process that was used concerning the submission of the three JC capital bids e.g. how they got from the list to being submitted to the Department of Health in the timescales involved. 6

The following additional comments were made by members:  We must ensure we are aware of the national parameters of bids and their criteria so we can adapt our cases to fit.  It is important that the revised figures regarding the Stroke blueprint and analysis are shared with stakeholders to inform JC understanding of potential changes and impact.

The Chair thanked Jeremy Cook for the information provided.

45/17 Summary update to the Collaborative Partnership Board The Chair gave members an update on recent national discussions. The Chair and Will Cleary-Gray attended the STP National meeting with Chairs and CE’s present from the other 8 STP systems on 2nd May 2017.

The Chair informed members that discussion had taken regarding:  Working with the Centre,  Understanding support offer from the Centre including transformational funding,  Understanding how the 9 Accountable Care Systems (ACS) will work together and share information as an emerging ACS.

The Chair conveyed the following key items that she took away from the meeting:

 The timeline for developing a Memorandum of Understanding which was ending in June.  The national priorities.  The focus on delivery and transformation.

The Chair added that she was awaiting the outcomes from the national ACS meeting which would provide detail and clarity regarding the above discussions and areas where we work with the Centre and other emerging ACS.

Will Cleary-Gray presented the remaining summary report updates to the Collaborative Partnership Board.

The Collaborative Partnership Board received the report and welcomed the updates provided from each of the STP work streams that they would use to inform local discussions.

46/17 Update on Programme Activity: a. Workforce The Chair welcomed Linda Crofts, Head of Learning & Development, Sheffield Teaching Hospitals to the meeting. Linda Crofts was also supporting the STP workforce work-stream.

Linda Crofts added that it is important to acknowledge that developing the workforce is an opportunity as well as a challenge to achieving successful transformational change.

Linda Crofts informed members she was here today to talk through work developing the Excellence Centre and to seek the support of colleagues in the Partnership. At the moment the Excellence Centre is looking to strengthen their Employer Forum. 7

Linda Crofts gave her presentation to Board members.

Linda Crofts responded to comments from members as follows:  We should recognise our unregistered workforce is vital to transformational change  We have a good infrastructure in South Yorkshire, we need to bring together the Excellence Centre and Faculty for Advanced Practice.  South Yorkshire has developed good partnerships regarding the development of its workforce, it needs to build on the successes and relationships it already has. Such partnerships are not as well developed in other areas and it would be detrimental to the collaborations already built up if we were to replicate the model to include other areas.

Members made the following additional comments  We should understand the resources we have in our different organisations and note that we could work better if we are better connected.  We should ensure there is no duplication i.e. we should change our mindset and create a culture of coming together, noting the potential to focus on learning and development and pool our resources.  Healthcare systems need to understand different skill sets are required outside hospitals. We need to bridge the skill gap to ensure staff are developed and able to respond to take care of people outside of hospitals.  If trained well, some staff bands can potentially free up higher grades so they are able to undertake additional training when required.

 We must factor in a consistent approach across South

Yorkshire in order that sectors and roles within it are not

destabilized.

 Social care is keeping people out of hospital. ‘Place’ relates to

60% of what is going on in STP and therefore we should start

discussions with social care teams and their representatives.

Collaborative Partnership Board members thanked Linda Crofts for

attending this meeting and for her presentation.

Members noted the connection with the Workforce Framework paper TG/PH/BC previously presented to the Collaborative Partnership Board and Tim

Gilpin and Peter Hall would support a discussion at a future Collaborative Partnership Board Meeting.

47/17 b. Proposed Department of Work and Pensions (DWP) initiative Kevan Taylor informed members there would be a presentation and KT proposal regarding the DWP initiative at the next Collaborative Partnership Board meeting in June.

48/17 c. Urgent Care The Chair welcomed Rachel Gillott, Programme Director Urgent and Emergency Care, SYB STP to the meeting.

Rachel Gillott gave her presentation to Board members.

Members were informed that Urgent Care is a big area of work and what this work area is still looking at is identifying two or three major items they want to progress.

49/17 d. Cancer The Chair highlighted that the draft Memorandum of Understanding articulates a move towards a new performance management framework for Cancer. One which will require a clear Inter Provider Trust policy to support the safe and timely transfer of patients between providers:

“We will work to deliver the 62 day referral to treatment standard at system level as a single measure across our provider organisations. This will create capacity to focus not only on the headline target but also enable us to focus on measures which hold the greatest significance to people affected by cancer such as quality of life, whilst also working to improve inter provider transfers within 38 days”.

The Chair added the challenges for this work area being:  62 days target from referral to treatment - there are clear time pressures in terms of expectation of the achievement of 62 day performance, with a significant national focus. The explicit timeframes within which 62 day performance must be met include 70% of provider organisations must meet the target by July with 100% of provider organisations and Cancer Alliances by September 2017.  A 38 day transfer protocol  What constitutes transfer?  As part of current conversations it is expected that providers will be expected to sign up to a local IPT policy as a requirement to access the Sustainability element of the STF.  We are also aware that any Cancer Transformation funding will also be released based on progress towards recovery of 62 day performance as an SYB&ND system.

There has been a significant amount of work, over 18 months to the shared IPT policy. This has been a hugely challenging process in which we have asked organisations and individuals to shift focus from local organisational performance towards a ‘new world’ acceptance of collective responsibility for shared performance in line with the future aspirations of the Cancer Alliance and STP. Reporting the 62 days as a whole system takes away any focus on grey areas that damage relationships and allows us to get the pathway right for patients. In considering the work to date, the current national focus and the emerging MOU, the Cancer Alliance board agreed the shared Inter provider transfer (IPT) policy at the May Cancer Alliance Board meeting and require the support of the Collaborative Partnership Board to progress.

Members responded with the following comments:  Bearing in mind governance protocol the policy should go back to the Clinical Reference Group (CRG) to sign off before us.  We could sign up to the overall policy, dotting the i’s and crossing the t’s is down to implementation and at the CRG.  The policy needs any issues resolved before we sign it off e.g. exactly what defines a referral. If it can’t be resolved by the CRG within a specific time then it should go externally to be 9

resolved and then come back here for signing off in 6 weeks time.

50/17 e. Mental Health & Learning Disabilities Unfortunately, due to constraints on time Kathryn Singh and Jackie Pederson were unable to give their presentation. However, they suggested that members read the section of Paper D which provided up-to-date information.

51/17 Findings from conversations with the public and staff on the SYB STP Helen Stevens presented her report to the Collaborative Partnership Board. The report consisted of 3 elements:  an overarching report,  a summary report of community responses about the South Yorkshire and Bassetlaw Sustainability and Transformation Plan(SYB STP),  an analytical report on the current views of the SYB STP.

Helen Stevens reported that there had been good engagement in this process and took this opportunity to thank Healthwatch and the voluntary sector for their assistance which has helped to inform this report.

Helen Stevens agreed that:  the information contained in this report can now go into the public domain,  all future Board reports will be circulated as a single PDF as JA well as the combined ‘Master All’ document.

Helen Stevens added that her work stream will be looking at a SYB STP website, branding and narrative and a report will be brought to HS the next Collaborative Partnership Board meeting.

The Collaborative Partnership Board noted this report.

52/17 Independent Review of Hospital Services Unfortunately, due to constraints upon time this item was not discussed and members were referred to the written update.

53/17 Review of Commissioning Unfortunately, due to constraints upon time this item was not discussed.

54/17 Hyper Acute Stroke Services and Children’s Services Unfortunately, due to constraints upon time this item was not discussed, however, there was a comprehensive report circulated on this subject.

55/17 Update on Organisational Development The Chair welcomed Grace Doherty and Claire Cater from Social Kinetic to the meeting.

Grace Doherty and Claire Cater gave their presentation to the meeting. The presentation summarised the work embarked upon so far with Social Kinetic.

The next phase for Social Kinetic would be to focus on human factors and they outlined the next phase of their programme for Board members consideration.

The Collaborative Partnership Board agreed:  4/5 senior people should be nominated as enablers from each ‘place’ on the Board. ALL  Social Kinetic will circulate a questionnaire for Board members and those nominated as enablers to complete, this will be ‘live’ for 2 Social Kinetic weeks.  Social Kinetic will then analyse the data received back from the questionnaires. Social Kinetic  A wider team event should be arranged e.g. a one day workshop, 10am to 4pm for approximately 80-100 people should be arranged Social Kinetic for the whole Collaborative Partnership Board and Team to attend.

The Chair and Collaborative Board members thank Social Kinetic for their presentation and their attendance at this meeting.

56/17 Any Other Business There was no other business brought before the meeting.

57/17 Date and Time of Next Meeting The next meeting will take place on 9 June 2017 at 9.30am to 11.30am.

Verbal

Item 15

Any Other Business

Verbal

Item 16

Date & Time of Next Meeting

Thursday 17 August 2017 at 1pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ