Via Microsoft Teams Basildon & Brentwood CCG Governing Body

Via Microsoft Teams

Basildon & Brentwood CCG Governing Body meeting in Public 26 November 2020 – 1400 - 1600 Agenda

Objective Papers Lead Time Page No. GENERAL BUSINESS 1. Welcome and apologies for For Noting Dr ‘Boye Tayo, Chair absence 1400

2. Declarations of interest & For Noting Attached Dr ‘Boye Tayo, Chair Review of Register of Interests

3. Minutes of the meeting held For Attached Dr ‘Boye Tayo, Chair 24/09/20 Approval 1405

4. Matters arising & Action Log For Noting/ Attached Dr ‘Boye Tayo, Chair agreement

5. Questions from the Public For noting Verbal Dr ‘Boye Tayo, Chair 1410

6. Patient Story – Care Home For noting Presentation Geraldine Rodgers, 1415 Deputy Chief Nurse

SYSTEM ITEMS 7. Board Assurance Framework For Noting Attached David Triggs, Head of 1420 Corporate Governance

8 Covid 19 Central Incident For noting Attached Anthony McKeever, 1425 Management Team Update Joint AO

9 Appointments to Joint Executive For noting Verbal Anthony McKeever, 1430 Team Joint AO

10 EPUT Quality Account For noting Attached at Geraldine Rodgers, Response (included as part of Item 14 Deputy Chief Nurse Item 14) 1435 11 SEND Update Report (included For noting Attached at Geraldine Rodgers, as part of Item 14) Item 14 Deputy Chief Nurse

PLACE ITEMS 12 Chair’s Report For Noting Attached Dr Boye Tayo 1440 Chair 13 Alliance Director Report For Noting To follow William Guy, 1450 Alliance Director 14 Chief Nurse/Quality Report For Noting Attached Geraldine Rodgers, 1500 including: Deputy Chief Nurse (a) EPUT Quality Account (b) SEND update

15 Finance Update For Noting Attached Dee Davey, Interim CFO 1510 Via Microsoft Teams 16 Performance Report For Noting Attached Emma Timpson, 1520 Director of Planning, Performance & Demand Management

17 BB CCG Exception Reports For Noting 1530 a) Audit Committee Attached Chair AuditCommittee b) F&P To follow Chair F&P c) CEG Attached Chair CEG d) PS&Q Attached Chair PSQC

AOB 18 AOB 1540

DATE OF NEXT MEETING 19 28 January 2021

Quoracy: BBCCG Gov Body – 9 Governing Body Members, including 5 clinicians

Minutes of Virtual Board Meeting in Public 24 September 2020 Part 1 - By Teams – Draft v1

1 Introduction

Name Role

Dr Adegboyega Tayo Chair, GP Board Member, SEMC Locality Member Anthony McKeever Interim Joint Accountable Officer (from 2:35pm) William Guy Director of Strategy and Transformation Teresa Kearney MBE Chief Nurse Emma Timpson Director of Planning, Performance, & Demand Management Dee Davey Interim Chief Finance Officer (from 3pm) Dr Arv Guniyangodage GP Board Member, Brentwood Locality Dr Ken Wrixon GP Board Member, Brentwood Locality Member Dr Olugbenga Odutola GP Board Member, Arterial Locality Member Dr Nimit Dabas GP Board Member, Arterial Locality Member Dr Sooraj Natarajan GP Board Member, Brentwood Locality Dr Femi Salako GP Board Member, SEMC Locality Member Dr Vishal Sharma GP Board Member, Partnership BIC Locality Member Dr Anita Pereira GP Board Member, Partnership BIC Locality Member Dr Julia Hale Consultant for Secondary Care Nick Spenceley Lay Member for Audit and Governance Katherine Kirk MBE Deputy Chair, Lay Member, Chair Governance Committee Gill Jones Lay Member PPI

1.1.1 In attendance

Name Role

David Triggs Head of Corporate Governance Marion Barritt Administrator (Minutes)

1.1.2 Apologies Name Role Maggie Pacini Consultant in Public Health – Essex County Council (ECC) Cllr Stephen Hillier Essex County Council (ECC)

1.1 Welcome and apologies The Chair welcomed everyone to the meeting in public Apologies were noted as above. The Chair reminded everyone of the protocols for MS Teams video calls including staying on mute unless speaking and using the ‘raise your hand’ symbol when wishing to speak.

2. Declarations of Interest Katherine Kirk declared a direct conflict of interest in Item 13 Chair’s Report as this referred to an extension of her contract. She would step out of the meeting during this item. There were no other declarations of interest other than those already on the Register of Interest.

3. Minutes of previous meeting RESOLVED: That the minutes of the meeting held on 30 July 2020 be agreed as an accurate record.

4. Matters arising and Action log The action log was updated and attached to the minutes.

5. Board Assurance Framework (BAF) Head of Corporate Governance presented his report and informed members that this re- affirmed approval of the new BAF. It was noted that the Board approved revised Corporate Objectives at the public meeting on 30 July and endorsed the proposed BAF. At the Board meeting (held in common with other CCGs) on 27 August the Board approved the new risk appetite statement. It was agreed that the next step in embedding the BAF was to ensure that training was made available to Executives leads and risk owners .

RESOLVED: that members of the Board note progress in developing the new Board Assurance Framework.

6. Patient Story (video) The Chief Nurse apologised that it was not possible to show the planned video due to technical issues.

SYSTEM ITEMS

7. Mid & South Essex (MSE) / Covid 19 Incident Management Team (CIMT) Reports CIMT Briefing The Interim Joint Accountable Officer (JAO) presented a report outlining details of the management of the COVID 19 incident covering the governance of the incident and key decisions made by the incident management team and various workstreams that would otherwise have come to CCG Boards for approval or discussion.

The JAO confirmed that with the incidence of Covid increasing across the country preparations were being put in place to manage a second wave whilst Managing winter pressures and supporting the local health system to restore cancer services and maximise elective activity.

RESOLVED: That the Interim Joint Accountable Officer’s CIMT update be noted.

8. Joint Executive Team (JET) The Interim JAO presented a paper setting out the Joint Executive Team (JET) structure as approved by the CCG Board (meeting in Common) held on 10 September 2020. It was noted that the agreed structure was in line with the CCG Constitution . The agreed Joint Executive Team structure consisted of the following posts: • Chief Finance Officer • Executive Director of Nursing & Quality • Executive Director of Integrated Service Delivery • 4 x NHS Alliance Directors one for each place in the Health & Care Partnership: Basildon & Brentwood, Mid Essex, South East Essex and Thurrock. During discussion of the paper a concern was raised around the levels of support in place for staff The Interim JAO assured members that Human Resources and EPUT colleagues had arrangements in place to support staff during this difficult time. Some of these processes were outlined in the People Pandemic Policy.

RESOLVED: That the Interim Joint Accountable Officer’s report was noted.

9. Continuing Healthcare Reset (CHC) The Chief Nurse appraised the Board of the work undertaken during the Covid 19 pandemic and the system reset currently taking place. It was noted that as part of the Government’s response to the Covid-19 pandemic Continuing Healthcare (CHC) assessments were deferred and Covid-19 Hospital Discharge Service Requirements were put in place. ix of the CCG’s CHC nurses were redeployed to Brentwood Community Hospital (BCH) to support the discharge process. The Board noted the approach that Mid and South Essex NHS Funded Care Teams had taken to ensure the CHC restart and adherence to the latest Hospital Discharge Guidance are in place to continue to support a timely and appropriate transfer of patients from Acute and Community Hospital settings, back into the community. In response to a concern the Chief Nurse assured members that there were established models to manage the expected second wave but this would be reviewed if and when the situation demanded it.

RESOLVED: That Board Members noted the CHC reset programme.

10. Sexual Violence and Domestic Abuse Strategy This strategy had been developed by the local authority in conjunction with police and other health partners. This strategy was the first of its kind and pulled together all the services provided under one umbrella. The CCG commissioned some of the services that support this programme.

This has been through governance processes and was being presented to health for approval.

RESOLVED: That Board Members approved the Sexual Violence and Domestic Abuse Strategy.

11. Mental Health Investment Alfie Bandakpara-Taylor, Head of Mental Health & LD Commissioning joined the meeting to present this item. There were two papers for approval and these represented critical parts of improvement to support funding of the Mental Health Investment Standard. It was noted that the Mental Health Five Year Forward View and the NHS Long Term Plan (LTP) set out an ambitious transformation plan for mental health. The NHS’s Long-Term Plan reaffirms the commitment to putting mental health care on a level footing with physical health services. Within MSE significant progress had been made towards delivering this ambition through a strong partnership approach.

Although delayed as a result of the response to Covid the NHSE Chief Executive letter calls on systems to reset programmes and ensure the mental health investments continue to be made. The paper emphasised that the long-term plan ambitions were key to managing any surge and winter pressures. The paper focussed on the three remaining ‘do it once’ system transformation projects seeking approval for investment into:

. Expanding the Specialist Perinatal Mental Health Service . Adult Eating Disorder Services in south Essex to meet the level of the Mid Essex. . Improving therapeutic support in adult mental health Inpatient Care

The second paper was seeking approval for a business case that would support the ambition in the NHSE Long Term Plan. The Business Case aimed: i. To describe the development of an appropriately resourced Integrated Primary and Community Care Mental Health transformation programme to deliver a new model of care that is inclusive, community based and designed with and for Primary Care Networks and make the case for recurrent investment; ii. To consider the different starting points for each Place, the presenting demographics and geographies, the multiplicity of stakeholders and networks and the competing priorities as the PCNs, ICPs and ICS develop in the context of improving the experience and health outcomes of people with SMI. iii. To set out the rationale and evidence base that will inform the development of the MSE bid for the LTP Community Mental Health Transformation Funding later in the year. It was noted that the new offer would look to address some of the issues faced under the current Service Offer. The new offer would comprise • Mental Health integrated offer within the Primary Care Network (PCN) - working as part of or with the enhanced primary care and social care teams. • Wrap around support offer –The integrated team will be supported by wider Place services such as Recovery Colleges, Wellbeing Hubs, Advocacy etc. • Interface with secondary care – formally managed to safely support discharges to primary care and navigate those requiring more specialist care.

• Managing complex needs – a high quality therapeutic offer for those with complex presentations.

The report outlined the proposed investment for each CCG with BBCCG investment for 2020-21 at £352,000 with indicative annual costs of £1.5m. Dr Ken Wrixon explained that the first paper concerning Perinatal, Eating Disorder, Inpatient Therapeutic Offer aimed to provide a bridge between primary and secondary care and ease the pressure on GPs. A meeting had taken place with representatives from PROVIDE who provide this service had taken place to discuss how to improve engagement processes. The ambition was to get the service up and running in the whole area by the end of 2021. The Chair expressed concern about recruiting the workforce but was assured that PROVIDE were confident they could recruit the staff required

RESOLVED: a) That the following business cases be approved as outlined in the first Board paper • Perinatal Business Case • Eating Disorders Business Case • Inpatient care co-production proposal

b) That the business case for development of the Integrated Primary and Community Care Mental Health service offer in Mid Essex, Thurrock and Basildon & Brentwood, to support circa.9100 adults1 and older adults per year, who have severe mental illnesses by 2022-23, as outlined in the second Board paper be approved.

12. EPRR Core standards Director of Strategy and Transformation & Interim Deputy AO informed members the CCG was required to publish our Core Standards statement to deliver EPRR guidelines. A question was raised around the stock piling of PPE medication. Assurance was given that the provision of PPE had improved nationally. Medication had the added complication of Brexit in January 2021 however work was underway for stock piling of drugs for this winter. The EU planning would be brought back to Board.

RESOLVED: that members of the Board approved the Core Standards Statement.

1 Based on 2018-19 and 2019-20 GP referrals into secondary care

PLACE ITEMS

13. Chair’s Report [Katherine Kirk, Lay Member declared an interest and left the meeting whilst the Board considered the extension of her contract].

The Chair reminded everyone that the CCG’s AGM would take place at 4:00pm following this meeting.

The Chair presented his report and highlighted two key items: • Board Assurance Framework (BAF) • Joint Executive Team (JET) He further informed members that Teresa Kearney, Chief Nurse would be retiring in October 2020 following a long and commendable career. He thanked Teresa for her professionalism as Chief Nurse and her contribution as a Board Member. Dr Sooraj Natarajan, Chair of the Patient Safety and Quality Committee echoed those thanks and added Teresa’s professionalism with regard to patient safety and quality. The Board wished her a long and happy retirement. The Chair introduced the proposed extension of the term of office of Katherine Kirk from 30 September 2020 to March 2021. The Board supported this extension.

RESOLVED: that the Chair’s report be noted and the extension of Katherine Kirk’s role to 31 March 2021 be approved.

14 Finance Report – Month 5 2020/21 The Interim Chief Finance Officer presented her report with key highlights as follows:

Change to arrangements for this financial year which had been in place to speed up decision making and cash flow. Reconciliation of budgets had proved difficult due to the complexity of reporting. The Interim Chief Finance Officer thanked Natalie Brodie, Deputy Chief Finance Officer and the Finance Team for their excellent work in challenging circumstances. She informed members that there had been an increasing number of queries from regulators and the need to squeeze financial arrangements as the team prepared for the second half of the year. It was noted that the allocation for Covid costs had been received for the second half of the year. Compliance/ measurement against the Mental Health Investment Standard had been complicated by restraints around the organisation. The Interim CFO asked the Board to approve the Budget Virements as set out in the schedule. RESOLVED: that the Board noted the Finance Report and approved the Budget Virements.

15. Quality Report The Chief Nurse appraised the Board of the reset services currently underway across the system. • Safeguarding adults’ alerts had been raised. • There were two unexplained deaths that had raised a concern, however following investigation it was accepted that they were actually expected deaths. • Reset of Continuing Healthcare (CHC) was focusing on completing the backlog of assessments. • Primary care had faced a challenging time with the introduction of telephone triage. • There was a backlog of Learning Disability (LD) and Severe Mental Illness (SMI) health checks. • Screening programmes were behind. • Maternity: The CCG lead on Local Maternity and Neonatal Services (LMNS) and this service was currently focusing on Black, Asian and Minority Ethnic (BAME) inequalities. Focus was on four main areas which were detailed in the report. • Special Educational Needs and Disability (SEND): The Chief Nurse highlighted the most recent challenges including those children who had not returned to school and had challenges of aerosol generating procedures. There were currently nine children who were too high risk to return to school and a wrap around service was provided to support them. Three children were waiting for the ’Fit’ test in order to be able to return to school. • Essex Partnership University Trust (EPUT) had now launched a 111 crisis line. • There had been several hospital admissions in respect of Covid. William Guy, Interim Deputy AO informed members that there had been an upsurge in cases of measles due to a low take up of immunisation in children. He was working with the Director of Performance to gather data to share with primary care networks (PCNs). This issue would be discussed at Clinical Executive Group (CEG).

RESOLVED: that the Board noted the Quality Report.

16. Performance Report Director of Performance, Planning and Demand Management presented her report. Phase three planning to restart services had been submitted with the aim of recovery to 90% of elective capacity, day cases and outpatient procedures compared to pre-Covid levels by October. There remained significant challenges with a high number of patients waiting a long time. The CCG was working to mitigate on how to bridge that gap. Utilising the private sector, confirmation was awaited to see if that would continue post December 2020. MSE Foundation Trust had been working on waiting list initiatives by undertaking procedures at weekends. Further discussion was required around priority within the financial envelope. There would be an update at the Finance & Performance meeting in common.

In relation to cancer backlog and as a result of Covid there would be an increase in the number of patients waiting 62 days or more. Endoscopy performance remained challenging and the CCG was working with NHS Regional offices to agree a recovery plan. There had been a reduction in Increased Access to Psychological Therapy (IAPT) services and a drop in dementia which was in part due to the number of deaths. A concern was raised that as hospital appointments were delayed or cancelled patients were going back to GP surgeries. The Director of Performance, Planning and Demand Management responded that work was ongoing on with MSE and directly with the Analytical team to understand the plans that were in place. The reporting lines would be reporting back to the F&P Committee in Common which would be shared with our local F&P. The outcome of discussions would be brought to this Board.

RESOLVED: That Members of the Board noted the Performance report.

5. Assurance Reports 5.1 Report from the Audit Committee 3 June 2020 This was presented by Nick Spenceley, Chair of Audit. RESOLVED: That Members of the Board noted the report.

5.2 Report from the Clinical Executive Group (CEG) The report was presented by Dr Femi Salako, Chair of CEG. RESOLVED: That Members of the Board noted the report.

5.3 Report from the Finance & Performance Committee (F&P) The report was presented by the Chair of F&P who informed members that the 18 August 2020 meeting was not quorate and therefore had be held as a virtual meeting. It was however quorate at the F & P Committee meeting in Common on 19 August.

RESOLVED: That Members of the Board noted the report.

5.4 Report from the Patient Safety & Quality Committee (PSQC) The report was presented by Dr Sooraj Natarajan, Interim Chair of PSQC. RESOLVED: That Members of the Board noted the report.

6. ITEMS FOR INFORMATION 6.1 Minutes of Committees Members of the Board noted the approved minutes of committee meetings which had been uploaded to the CCG web site. https://basildonandbrentwoodccg.nhs.uk/

8 7 Any Other Business All papers from this meeting were available on the CCG website.

8 Date of next meeting The next Board meeting in public is 28 November 2020.

Questions from the Public There were no questions from the public.

Dr Adegboyega Tayo CCG Chair

9 Agenda Item 7

Board Assurance Framework

CCG Board 26 November 2020

Purpose of Report: To present the Board Assurance Framework Process and risk registers.

Recommendations and The CCG Board are asked to DISCUSS and NOTE the new Board decision/actions: Assurance Framework.

Executive Summary The new BAF process, introduced in August has continued to develop. (including financial impact): With much change across the mid and south Essex CCGs the process is yet to become embedded, although there is good engagement with staff to complete and update the risk registers.

The accompanying documentation has been provided for information and review by Board Members, in conjunction with the Board agenda items providing assurance over the management of risks:

- Strategic Objectives Dashboard – This document highlights where key risks sit across the strategic objectives of the CCG. Key risks can impact on more than one strategic objective.

- Board Assurance Framework – This document is a short reference to the risks across the CCGs and is filtered to show where red rated risks and red rated delivery plans exist across key workstreams.

- Plan Risk and Delivery Register. This document provides the full detail of the risk registers for each workstream across the CCGs and should be used to interrogate where Board Members have concerns that may have been highlighted on the BAF.

The BAF is a bi-monthly process whereby the relevant committees receive and review their associated risks before the overview risks are reported to the public Board meeting; the months in-between will be used to update the BAF document itself. The risk registers have been presented to both the Finance & Performance and Patient Safety & Quality Committees. Further governance arrangements are being established and consequently the CCGs are identifying other committees that should receive extracts of the risk registers going forward.

There is further work to be undertaken on the framework to align the document to the Delivery Plans across the system, ensure the full document is update and reflects all workstreams as well as fine tuning the report to the Board to maximise its effectiveness.

Written by/Presented by: Nicola Adams, Associate Director of Corporate Governance (TCCG)/ David Triggs, Head of Corporate Governance (BBCCG)

Executive Director Anthony McKeever, Interim Joint Accountable Officer Sponsor:

Cover paper for use during COVID-19 pandemic across Mid and South Essex Non-Officer/Board CCG Chair Sponsor: Audit Committee Chair.

Fit with CCG Strategic ALL Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this Finance and Performance Committee November 2020 document). Patient Quality and Safety November 2020

Reports Submitted to Board only: Date signed-off by Executive Team. 19/11/2020 (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) 

Has the Equality/Quality/Privacy Impact Assessment  been carried out and issues addressed?

Details of Stakeholder, Patient None & Public Engagement:

Risks / Link to BAF: N/A BAF Ref:

Conflicts of Interest: N/A

Escalation: None. To the Board To another Committee To the BAF/CRR

Cover paper for use during COVID-19 pandemic across Mid and South Essex Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership Clinical Commissioning Groups

MSE Strategic Objectives Dashboard 19/11/2020

No. Distilled Strategic Objectives Risk Rating Delivery Overview of risks and delivery No. Distilled Strategic Objectives Risk Rating Delivery Overview of risks and delivery

Key risk ratings were identified as surge capacity (Acute & ITU Beds), CHC 1 Ensure services are organised to respond to and meet COVID 19 Ensure services are organised to respond to and meet COVID 19 rrequirements.equirements. 4633824 6 3 3 8 2 Recovery and Reset and Infection & prevention control. Delivery risks related to CHC Recovery and Reset.

2 Improve access to services for patients in line with NHS Plan Improve access to services for patients in line with NHS Plan rrequirements.equirements. 15 19 6 13 24 3 Key risks related to Funded Nursing Care and Continuing Healthcare and SEND.

Make a step change in addressing inequalities and quality priorMake a step change in addressing inequalities and quality priorities to deliver outcomes in accordance with ities to deliver outcomes in accordance 3 12 16 6 7 21 6 Key risks highlighted related to CHC, SEND and Infection Prevention and Control. constitutional standards.with constitutional standards.

No key risks were highlighted, management were confident that risks were 4 Achieve key statutory financial duties including delivery of tAchieve key statutory financial duties including delivery of thhe system financial control total.e system financial control total. 11500605 0 0 6 0 adequately managed.

Transform and strengthen Community and Primary Care Services; dTransform and strengthen Community and Primary Care Services; developing and strengthening PCNs to bring eveloping and strengthening PCNs to 5 21 17 2 14 25 1 Key risk highlighted was in relation to SEND. care closer to home and avoid hospital admissions.bring care closer to home and avoid hospital admissions.

Strengthen partnership working across MSE and within localitieStrengthen partnership working across MSE and within localities to deliver a broad range of VFM Integrated s to deliver a broad range of VFM Key risk ratings were identified as surge capacity (Acute & ITU Beds), CHC and 6 22 17 5 13 27 4 Services strengthening prevention and early intervention.Integrated Services strengthening prevention and early intervention. FNC (including recovery and reset), SEND and Infection Prevention and Control.

Expand and embed an increased range of digitally delivered servExpand and embed an increased range of digitally delivered services to support better access, efficient services ices to support better access, efficient 7 13 17 2 10 20 2 Key risk ratings were identified CHC and FNC (including recovery and reset). and self‐care.services and self‐care.

Address workforce challenges within the system and support our Address workforce challenges within the system and support our staff to deliver the vision across the health andstaff to deliver the vision across the Key risk ratings were identified CHC and FNC (including recovery and reset and 8 66433734 3 3 7 3 care partnership for mid and south Essex.health and care partnership for mid and south Essex. repatriation of cases / staff).

Achieve system and organisational transformation to streamline Achieve system and organisational transformation to streamline decision making, improve VFM and better decision making, improve VFM and Key risk ratings were identified CHC and FNC (including recovery and reset and 9 55636736 3 6 7 3 support new commissioning models.better support new commissioning models. repatriation of cases / staff).

Page 1 of 1 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

Plan Risk & Delivery Updated: Wednesday 18th November

Risk Owner / Risk Target Risk Strategic Residual Residual Project Work‐stream BAF ID Workstream Area Responsible Risks to delivery of objective (Blockers) Impact Milestone Deadline Enablers Likelihood Risk Rating Score / Objectives Likelihood Risk Score Delivery Officer Rating Appetite Complete from MSE perspective. Patient Safety & Harm, Reputational Damage, Covid Care COVC01 Surge Capacity: ITU and Acute Beds 1, 6 Rachel Hearn 53 15 None Identified 3 5 Acute Hospital Demand Regional Beds under review. Terry Huff/Simon Covid Care COVC03 Targeted services for high risk patients 1, 6 00 ‐ ‐ 01/08/2020 ‐ 0 0 Williams

Patient Safety & Harm, Patient Experience, To achieve cancer performance in accordance with Backlog deadline Partnership Working, People Cancer Care CANC01 2 Karen Wesson Inequality, Acute Hospital Demand, Service 53 15 35 Constitutional Standards. 31st March 2021 Resources Delivery

Partnership Working, People Cancer Care CANC02 Harm Review for Cancer 2 Karen Wesson Patient Safety & Harm 5 4 20 31st March 2021 45 Resources, Comms & Engagement

To achieve disgnostic (DM01) performance in Patient Safety & Harm, Patient Experience, Acute Planned Care PLAC01 2 Karen Wesson 53 15 01/12/2020 People Resources 3 5 accordance with Constitutional Standards Hospital Demand, Inequality, Service Delivery

To achieve the Constitutional Standard for referral Patient Safety & Harm, Service Delivery, Patient Waiting List triaged Partnership Working, People Planned Care PLAC02 2 Karen Wesson 55 25 55 to treatment (RTT). Experience, Acute Hospital Demand by October 2020 Resources, Comms & Engagement

Patient Safety & Harm, Acute Hospital Demand, None Identified Partnership Working, Finance, Finance, Patient Experience, Reputational Planned Care PLAC06 Service Provision of high risk medicines. 3 (awaiting JET 45 20 01/09/2020 People Resources, IT 54 Damage, Inequality, Claims & Complaints, Service appointment) Infrastructure, Legal Delivery

Finance, Patient Experience, Acute Hospital Planned Care PLAC08 CHC ‐ Repatriation 8, 9 Tricia D'Orsi 44 16 01/12/2020 People Resources 4 4 Demand, Patient Safety & Harm 01/12/2020 Finance, Patient Experience, Reputational People Resources, Partnership Planned Care PLAC09 CHC ‐ Recovery & Reset 1, 3, 6, 7, 8, 9 Tricia D'Orsi Damage, Claims & Complaints, Patient Safety & 44 16 NHSE expectation of 44 Working Harm, Inequality clearing all backlog 31/03/2021 01/12/2020 Finance, Reputational Damage, Patient CHC ‐ Funded Nursing Care (FNC) and Continuing People Resources, Partnership Planned Care PLAC10 2, 3, 6, 7, 8, 9 Tricia D'Orsi Experience, Claims & Complaints, Patient Safety & 44 16 NHSE expectation of 44 Healthcare (CHC) Working Harm clearing all backlog 31/03/2021 December 2020 ‐ for Ageing Well AGEW07 Palliative and End of Life Care 5 Karen Wesson Patient Experience 4 4 16 structure and None Identified 4 4 measures The CCG will continue to work in partnership with Tricia D'Orsi Children, Young education and care to become fully compliantwith Reputational Damage, Patient Safety & Harm, Partnership Working, People CYP03 2, 3, 5, 6 44 16 ################## 44 People the Children and Families Act 2014 in relation to SEND SRO at Patient Experience, Inequality, Regulator Penalties Resources Special Education Needs and Disability (SEND). place

Governance and Patient Safety & Harm, Safeguarding, Patient Partnership Working, Comms & GOSD11 Infection Prevention and Control 1, 3, 6 Rachel Hearn 53 15 01/12/2020 35 Statutory Duties Experience, Reputational Damage Engagement

Patient Safety & Harm, Patient Experience, Governance and Partnership Working, IT GOSD12 Acute / Provider Quality Assurance 3 Rachel Hearn Inequality, Claims & Complaints, Reputational 44 16 30/11/2020 44 Statutory Duties Infrastructure Damage Governance and Patient Safety & Harm, Patient Experience, Claims People Resources, Partnership GOSD13 Management of Serious Incidents 3 Rachel Hearn 34 12 01/01/2021 43 Statutory Duties & Complaints, Reputational Damage Working Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

Risk Owner / Description (Actions Planned to support delivery) Success Measures Strategic Locality Senior System/Place Risks to delivery of objective Enablers Current Workstream Area Workstream Objective System/Place Clinical Lead (Controls) Milestone Deadline (Assurance ‐ 2nd line of Trend Assurance ‐ 3rd line of defence Governance / reporting route Plan

October 2020 Update Acute: MSEFT: Confirmed addtional capacity for COVID Surge. Located at Basildon site, these beds are able to serve all levels of need. There are agreed triggers and transfer pathways to allow safe movement of Ensure services are organised to patients from Broomfield and Southend sites as required. respond to and meet COVID‐19 Workforce requirements. HR continue to support the recruitment of staff to ensure safe staffing Sufficient surge capacity across all sites, orientation of all ITU staff continues. Complete from MSE created Delay and mitigate the spread of Region: perspective. Patient Safety & Harm, Reputational Covid Care Surge Capacity: ITU and Acute Beds COVID‐19 and ensure that everyone 1, 6 System/Place ALL Rachel Hearn James Currell 5420 Additional beds have been identified within the region, we are None Identified 3 15 5 A↔None Identified. Damage, Acute Hospital Demand

affected by it receives the very best COVC01 awating updated plans from the Critical Care Network (CCN), re access Regional Beds under Acute / Community Occupancy possible NHS treatment. and criteria for mutal aid. review. Levels, DTOC, Length of Stay Create and maintain sufficient surge Collate clear triggers for each site for the management of resurge in next 2‐3 weeks (staff, beds, kit and transfer). capacity: ITU (Critical Care), Acute Beds Work continues to with the MSE group and CCN.

Rational for high risk score: Although demand modelling and capacity has been undertaken, due to the evolving pandemic we may need to continue to revist modelling based based on demand.

Community Beds:

Additional bed capacity established, EPUT community integrated discharge offer in place, Howe Green (ECC) and Priory (SBC) running Covid discharge sites, redeployed staff to support SUHFT and BCH Ensure services are organised to discharge processes, CCG CHC staff supporting Priory discharge respond to and meet COVID‐19 support. requirements. Task Group established to support reset position utilising assisted Sufficient surge capacity created Delay and mitigate the spread of technology and opportunities for collaborative market management Deputy Chief and work plan developed. Covid Care Surge Capacity: Community Beds COVID‐19 and ensure that everyone 1, 6 System/Place ALL James Wilson 0 0 A Nurses

affected by it receives the very best COVC02 Considering opportunities for pooled resource and function for PCN Acute / Community Occupancy possible NHS treatment. integrated discharge approach. Levels, DTOC, Length of Stay Create and maintain sufficient surge capacity: Enhancing EPUT Care Home Support Team to support care homes IS Beds (including Care Homes) during Ciovid‐19 and beyond.

Whzan equipment being rolled out across HCP.

Falls pilot in place, including Raizer chairs in care homes, iStumble app, SWIFT response to care homes includes support to avoid long lies.

Ensure services are organised to respond to and meet COVID‐19 requirements.

Delay and mitigate the spread of COVID‐19 and ensure that everyone CYP Shielded: Risk assessment process being completed for children

Service Delivery Terry affected by it receives the very best Caroline and young people due to return to school. Actively working with ECC Covid Care Targeted services for high risk patients 1, 6 System/Place Huff/Simon 0 01 August 2020 0 R possible NHS treatment. McCarron and SBC Education stakeholders. Shielding flow chart has been

COVC03 Williams SHIELDED (AND VULNERABLE) developed by designated clinical officers. PATIENTS: Create, deliver and maintain targeted services (several pathways) to address the needs of Shielded (and Vulnerable) Patients

Ensure services are organised to respond to and meet COVID‐19 requirements. Understand the emerging learning of the impact of Covid‐19 lockdown Delay and mitigate the spread of on children and young people and influence CCG reset workstreams. Plans to address increased COVID‐19 and ensure that everyone Designated Lessons learned shared and Commissioning Forum / Covid Care 1, 2, 6 Place/System ALL Chief Nurse Sharon Connell Staffing, HR, OD 3412 SET Designated nurses reviewing evidence. 01 December 2020 People Resources, Finance 4 12 4 A↔None Identified safeguarding risks affected by it receives the very best professionals feedback to reset workstreams Committee COVC04

possible NHS treatment 18/08/2020 Assess information feedback once children return to school in Safeguarding: to ensure that increased September. safeguarding risks (arising from the COVID lockdown) are picked up and managed appropriately.

Regular bulletin has been distributed to patient and community reference groups throughout COVID‐19. Ensure services are organised to CCG comms and engagement teams have captured insight respond to and meet COVID‐19 linked to experiences during COVID‐19 via virtual views survey requirements. which closed at the end of June. Report will be collated and GB meetings held in public, shared on the website. Delay and mitigate the spread of regular communications and Covid19 ‐ Communications and Communication Commissioning Forum / Covid Care COVID‐19 and ensure that everyone 1, 6 System/Place ALL Claire Hankey Staffing, HR, OD 326 Comms & Engagement engagement provided to Completed 1 33 G↓None Identified Engagement Plan Leads Explore innovative ways of keeping people engaged and Committee

affected by it receives the very best COVC05 patient and community involved in decision making during the ongoing pandemic. AS July 20 possible NHS treatment. reference groups. working with colleagues to agree a consistent approach across PUBLIC ENGAGEMENT: mid and south Essex. Note: nationally we were told to hold Organise local facilities to encourage this work and prioritise the handling of the pandemic public engagement with services Corporate governance and communications teams working July 20 together to make July Governing Body public

October 2020 Update Demand (2ww) MacMillan GP are working with practices to encourage referrals to return to pre‐COVID‐19 levels Patient videos have been developed to encourage confidence to get systems investigated Hospital tightening up processes to ensure patients are seen within the 2week timeframe. Maintaining access to rapid, early 2 week wait To achieve cancer performance in David Walker / Patient Safety & Harm, Patient Finance & Performance diagnostics cancer surgery and other 31, 62 and 104 day Backlog deadline Partnership Working, People 31 day standards Cancer Care accordance with Constitutional 2 System ALL Karen Wesson Donald Karen Hull Experience, Inequality, Acute 5525 3 15 5 A↔None Identified. Committee, Clinical Forum / treatments. Capacity and flow across system including use of IS and TIer 2 services 31st March 2021 Resources 62 day standards

Standards. CANC01 McGeachy Hospital Demand, Service Delivery Committee is being used (Tier 2 supporting diagnostic pathway) 104 day waiting patients Chemotherapy at Home now operational to support treatments Backlog recovery plan in place to return at a minimum to pre‐COVID‐ 19 numbers (181 for 62 day).

104 ‐ Harm review and recovery plan to get to zero 104 day waiting patients by 31 March 2020, acknowledgement that maybe some unavoidable patients but these will be minimal and mitigated as far as practical.

Working to reduce those patients October 2020 Update David Walker / waiting for their cancer treatment MSEFT have developed a protocol for managing Cancer Harm Reviews Finance & Performance Donald (draft awaiting Cancer Alliance sign off) over 62 days (to 181 Pre‐COVID19 by Karen Flitton / Partnership Working, People Committee, Clinical Forum / Cancer Care Harm Review for Cancer 2 System ALL Karen Wesson McGeachy / Patient Safety & Harm 5525 Panels have been established to process the harm reviews 31st March 2021 4 20 5 A ↓ None Identified. March 2021) and over 104 days (zero Paula Saunders Resources, Comms & Engagement Committee, Commissioning

CANC02 Catherine Data transparency for tracking backlog and ongoing management for by March 2021). Forum / Committee O'Doherty the reduction in Cancer Harm Reviews in development (as at September 2020)

Page 1 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

Constitutional Standards PLAC01 Inequality, Service Delivery plan for endoscopy and wider diagnostics (incl. non‐obstetric Committee

referral. 14/08/2020 ultrasound) that will maximise use of the Independent Sector and Tier 2 capacity.

October 2020 Update Reduce 52week waiting patients MSEFT have a plan to treat the longest waiting patients (52 Reduce backlog for patients waiting Patient Safety & Harm, Service In line with trajectory Commissioning Forum / To achieve the Constitutional Standard James Buschor week waiting patients ‐ 951 by March 2021) Waiting List triaged by Partnership Working, People Planned Care Intiital focus of highly challenged 2 System ALL Karen Wesson Delivery, Patient Experience, Acute 5525 maximising use of capacity 5 25 5 R ↔ None Identified Committee, Finance & for referral to treatment (RTT). / Emily Hughes Plans to manage the clinically urgent and prioritisation in line October 2020 Resources, Comms & Engagement

specialties (T&O, Ophthalmology, PLAC02 Hospital Demand available. Performance Committee

14/08/2020 with Regional/national asks ‐ for waiting list to be triaged by Urology, Endoscopy, Skin). end Oct 2020

Ensure that Primary Care maximise the use of: October 2020 Increased utilisation of Advice ‐ Advice and Guidance to support Performance will be reported via CCG (Place) leads to ensure and Guidance at Place use of the virtual access to support Patient Safety & Harm, Patient that Advice and Guidance utilisation is maximised in primary People Resources, Comms & Increase use of Tier 2 providers Commissioning Forum / Planned Care Support demand into the Acute. 2 System ALL Karen Wesson CCG Chairs Emma Timpson 4312 2 8 4 G↓None Identified advice/management prior to referral Experience, Acute Hospital Demand care. Engagement, Partnership Working and impact seen in onward Committee PLAC03

‐ Utilisation of the Tier 2 provider 14/08/2020 Utilisation of Tier 2 services is monitored to ensure optimised acute referrals where Tier 2 services (planned and diagnostic) to across Place. service provided reduce the demand to the acute

All NHS acute and community hospitals should ensure all admitted patients are assessed daily for discharge, against each of the Reasons to Reside; and that every patient who does not need to be in a hospital bed is included in a complete and timely Community: EPUT community integrated discharge offer in Hospital Discharge List, to enable the place community Discharge Service to achieve safe and appropriate same Discharge to assess Covid function in place as part of the day discharge. incident response. Sustain the Hospital Discharge Service, In place Planned Care Hospital Discharge working across secondary care and 2, 6 Place/System James Wilson Matt Gillam 0 Additional bed capacity established, EPUT community 0 G

community providers in partnership PLAC04 integrated discharge offer in place, Howe Green (ECC) and July 2020 with Social Care. Includes daily 14/08/2020 Priory (SBC) running Covid discharge sites, redeployed staff to reviews of all patients in a hospital support SUHFT and BCH discharge processes, CCG CHC staff bed on the Hospital Discharge List; supporting Priory discharge support. prompt and safe discharges when clinically and in line with infection control requirements with the planning of ongoing care needs arranged in people´s own homes; and making full use of available hospice care ALSO IN UNPLANNED

October 2020 Update October 2020 Shortages are a national issue that the CCG has little control Adequately over. In addition, the issues relation to the supply of nutrition managed. To facilitate adequate access to Zafiat Quadry / via FK have improved and are being managed. None Identified Patient Safety & Harm, Finance, Management of Shortages. Current no TCCG ‐ Internal audit of Medicines The provision of medicines and medicines and nutrition products Prescribing lead Denise Regular engagement with regional and national groups and Clinical Forum / Committee, Planned Care 5Place/SystemALL (awaiting JET Claims & Complaints, Patient 4312 03 January 2021 None Identified No adverse effects on patient adverse effects on 2 8 3 G ↔ management workplan (substantial nutrition products for our patients. through engagement with community Board Members Rabbette / regular communication around drug shortages. Quality Committee PLAC05 appointment) Experience, Inequality care (Serious Incidents). patient care. assurance)

pharmacy and other suppliers 14/08/2020 Paula Wilkinson Pro‐active management of potential shortages, advising GPs. Engagement with patients through CRG. 0 SI's related to There is still a small potential risk in relation to EU Exit, which shortages is being considered and managed.

October 2020 Update October 2020 Current arrangements for Warfarin and DMARDS is unstable Effective Shared Care Ineffective (GP Practice presribing and pharmacy giving notice, returning To work with other stakeholders to Zafiat Quadry / Patient Safety & Harm, Acute arrangements with GPs and performance and None Identified Hospital Demand, Finance, Patient patients to acute hospital). Partnership Working, Finance, ensure adequate access to and Prescribing lead Denise Acute, actively engaging. worsening. NHSE highlighted unsafe service. Clinical Forum / Committee, Planned Care Service Provision of high risk medicines. 3Place/SystemALL (awaiting JET Experience, Reputational Damage, 4312 Engagement with acute trust and primary care to agree shared 01 September 2020 People Resources, IT Infrastructure, 5 20 4 R↑ monitoring of high risk medicines e.g. Board Members Rabbette / (2017) Quality Committee

PLAC06 appointment) Inequality, Claims & Complaints, care protocols to support DMARDS and Warfarin. This is on‐ Legal

Warfarin and DMARDs 14/08/2020 Paula Wilkinson Having a successful service to No service to Service Delivery going and proving difficult. manage anti‐coag. manage anti‐coag There are varying services across the system, which has (December 20) highlighted a need to review and re‐design services.

October 2020 Update There has generally been a pause on completing retrospective CHC claims during the COVID‐19 pandemic, which has had an impact on clearing backlogs. Furthermore, the potential for staff to continue in their redeployment to the front line means less capacity to complete CPR the work. A further spike in coronavirus could impact this further. Southend To review and process Retrospective CHC Leads at Logs of claims are held at each CCG and staff continue to work through Level of Retrospective Claims Quality Committee, Finance & Planned Care CHC ‐ Retrospective Claims 3, 4 Place ALL Tricia D'Orsi Finance, Reputational Damage 4312 01 December 2020 People Resources Thurrock 3 12 4 A↔None identified. Continuing Healthcare claims. Place the process in accordance with national guidance. reducing. Performance Committee PLAC07 Weekly meetings of the CHC Leads across MSE continue to co‐ordinate Mid 14/08/2020 responses and review issues identified. BB There continues to be historic claims being managed by ArdenGemCSU that are not yet completed. A further spike in Covid‐19 could impact on this. Weekly meetings of the CHC Leads across MSE continue to co‐ordinate responses and reviews issues identified.

October 2020 Update A high number of CHC staff were redeployed to work on the front line, which has had a consequental effect on capacity within the team. This is compounded by normal attrition within CHC which has increased the number of current vacancies. Returning staff to the CHC teams will have a reciprocal effect on capacity within the hospitals within which Finance, Patient Experience, Acute Repatriation ‐ return to business as CHC Leads at they were working, which in turn may also affect acute hospital Staff numbers within the CHC Quality Committee, Finance & Planned Care CHC ‐ Repatriation 8, 9 Place Tricia D'Orsi Hospital Demand, Patient Safety & 4312 01 December 2020 People Resources 4 16 4 R↑None Identified usual returning staff to the CHC team. Place pathways. Teams per establishment Performance Committee

PLAC08 Harm In the meantime, staff continue to work in accordance with policy and 14/08/2020 national guidance. Weekly meetings of the CHC Leads across MSE continue to co‐ordinate responses and review issues identified. Redeployed staff have now returned to their substansive posts in CHC. Staff continue to work in accordance with the National guidance.

Page 2 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

October 2020 Update Normal CHC business was on hold during the initial phases of the pandemic and consequently a backlog of work was created. In addition, patients were placed in a more expedient manner that now need to be reviewed in accordance with the national CHC guidance to determine needs and adjust care accordingly. Recovery and Reset ‐ Returning CHC There is a need for routine staff swabbing and for PPE for staff who will be required to visits patients to assess, although there continues to business as usual, recovering the to be access issues during COVID whereby care homes are not giving backlog of work and reviewing cases access for assessments. allocated at CHC during the pandemic Current COVID funding ends on 31st August, but continues for those 01/12/2020 BBCCG to determine current needs of Finance, Patient Experience, awarded until they are assessed, which could lead to inequalities MCCG patients. In particular: CHC Leads at Reputational Damage, Claims & depending on timeliness of assessments, which could also lead to People Resources, Partnership NHSE reporting against trajectory ‐ Quality Committee, Finance & Planned Care CHC ‐ Recovery & Reset 1, 3, 6, 7, 8, 9 Place/System ALL Tricia D'Orsi 4416 NHSE expectation of Trajectory of clearing backlog CPR 4 16 4 R↑ * Clear COVID discharges backlog Place Complaints, Patient Safety & Harm, claims and complaints and financial pressures. Working from September 2020 Performance Committee PLAC09 Inequality In the meantime, staff continue to work in accordance with policy and clearing all backlog SCCG

* Clear outstanding CHC referrals 14/08/2020 31/03/2021 TCCG during and prior to COVID national guidance. * Clear backlog of local resolution and Weekly meetings of the CHC leads across MSE continue to co‐ordinate responses and review issues identified. appeals Normal CHC business resumed along side the new D2A 6 week * Maintain case management funding. Backlog of deferred assessments is being undertaken with additional funding for staff for CCG's and LA's. There is a need for rountine staff swabbing and for PPE to visit patients and assess. Current COVID funding ends 31st Aug but continues for those awarded until they have been assessed, which could lead to inequalities depending on timeliness of assessments, which could also lead to claims and complaints and financial pressures.

October 2020 Update There is currently a backlog in undertaking the 3 month and annual reviews that were due during the COVID‐19 pandemic. There remains a capacity issue in undertaking new assessments and reviews that now become due as staff continue to be redeployed. There is a risk of retrospective claims if current assessments are not undertaken robustly. There is also an increased financial risk where FNC/CHC Reviews ‐ to undertake patients become unwell or their need increases and packages then 01/12/2020 BBCCG business as usual review of patients to need to be backdated. Finance, Reputational Damage, There continues to be some staffing issues due to the pandemic that is MCCG CHC ‐ Funded Nursing Care (FNC) and determine whether they are eligible CHC Leads at People Resources, Partnership NHSE reporting against trajectory ‐ Quality Committee, Finance & Planned Care 2, 3, 6, 7, 8, 9 Place/System ALL Tricia D'Orsi Patient Experience, Claims & 4312 also reflected within Social Care. NHSE expectation of Trajectory of clearing backlog CPR 4 16 4 R↑ Continuing Healthcare (CHC) for CHC, place accordingly and Place Working from September 2020 Performance Committee PLAC10 Complaints, Patient Safety & Harm In the meantime, staff continue to work in accordance with policy and clearing all backlog SCCG

undertake 3 month and annual 14/08/2020 national guidance. 31/03/2021 TCCG reviews. Weekly meetings of the CHC teams across MSE continue to co‐ ordinate responses and review issues identified. Currently having difficulty accessing care homes to complete reviews because of the COVID‐19 pandemic. In some areas there is currently a backlog of the 3 month and annual reviews that were due during COVID‐19 pandemic. This will remain while the backlog is being addressed. Some difficult in accessing care homes to complet reviews because of the Covid‐19 risks.

To ensure that we have adequate October 2020 Update arrangements for transporting Patient Safety & Harm, Service Quality Committee, Finance & Planned Care Patient Transport Service (PTS) 1, 2 System ALL Karen Wesson Emily Hughes 339 Current PTS is able to meet demand within the COVID guidance. N/A None Identified To meet demand levels Compliant 1 33 G ↔ None Required patients in line with current COVID‐19 Delivery, Inequality Performance Committee

PLAC11 The procurment for PTS service has been delayed as a result of COVID. requirements.

Acute: Develop plans and policies to support creation of an effective and flexible workforce that meets the needs of patients within the configuration of the new MSE trust. Support the merger of the three Planned Care / Secondary Care workforce Plan former Hospital Trusts into a single 2, 3, 8 System ALL Jacky Dixon Mark Tebbs 0 Risk currently under review 0 A Unplanned Care

MSE way of working PLAC12 Improve recruitment procedures, 14/08/2020 learning from processes during COVID 19, so ensuring adequate staffing Explore and implement new and more efficient ways of working.

October 2020 Update Stroke care and model for the Health and Care Partnership (H&CP) is disparate, the system has agreed to develop an Intermediate Care Strategy incorporating Stroke care and model for our population this will inform future service offer. Review model for Stroke Services Need also to ensure oversight and that quality of services are Brian Houston Commissioning Forum / following community bed changes ‐ sustained or improved. and Biju Patient Safety & Harm, Service People Resources, Comms & Committee, Finance & Unplanned Care Prioritisation of Stroke Services develop a system plan for the H&CP 2 System ALL Karen Wesson Hannah Evans 4416 SSNAP 3 12 4 G↓None Identified Kuriakose Delivery Engagement, Partnership Working Performance Committee,

for Stroke UNPC01 Stroke services have remained on a 'green' ward. Patients

14/08/2020 (Stroke Lead) Quality Committee Oversee performance for stroke care. with Covid have had virtual stroke input. All services have remained including thrombolysis, thrombectomy and all diagnostics. Stroke bed numbers were reduced due to ward changes but there was no impact as admissions had reduced. The bed base has reduced in two acute trusts but this is not impacting on the delivery of the service.

Strengthen 111 capacity and sustain appropriate Ambulance services 'hear October 2020 Update and treat' and 'see and treat' models. Established Think111 Programme Board and sub‐group Increase availability of booked Donald Patient Safety & Harm, Service Commissioning Forum / structures. IT Infrastructure, Partnership Direct booking into ED and Unplanned Care NHS111 Capacity appointments and open up new 2 System ALL Emily Hughes McGeachy / Nicola Goodey Delivery, Patient Experience, Acute 5315 01 December 2020 2 10 5 G↓None Identified Committee, Finance & Working Hospital Demand Clear objectives and project plan in place to deliver secondary SDEC from NHS 111. secondary care dispositions (SDEC, hot UNPC02 Chris Patridge Performance Committee

14/08/2020 care dispositions objectives. specialty clinic, frailty services) that New model to be in place by 1 December 2020 allow patients to avoid ED, where clinically appropriate

Provide local support to the new national NHS communications campaign encouraging people who Communication Communications Campaign in place and overseen by Think111 Commissioning Forum / Unplanned Care Urgent Care Communications Campaign should be seeking emergency or 2, 5 Place/System ALL Claire Hankey Acute Hospital Demand 326 01 November 2020 Comms & Engagement 2 65 G↓None Identified Leads Programme. Committee

urgent care to contact their GP, go UNPC03 online to NHS111 or call 999 if 14/08/2020 necessary

Sustain the Hospital Discharge Service, working across secondary care and All NHS acute and community hospitals Community: EPUT community integrated discharge offer in community providers in partnership should ensure all admitted patients are place with Social Care. Includes daily assessed daily for discharge, against reviews of all patients in a hospital each of the Reasons to Reside; and that Discharge to assess Covid function in place as part of the bed on the Hospital Discharge List; every patient who does not need to be incident response. prompt and safe discharges when Unplanned Care in a hospital bed is included in a 2, 6 Place/System James Wilson Matt Gillam 0 0 A clinically and in line with infection

complete and timely Hospital Discharge UNPC04 Additional bed capacity established, EPUT community

control requirements with the 14/08/2020 List, to enable the community integrated discharge offer in place, Howe Green (ECC) and planning of ongoing care needs Discharge Service to achieve safe and Priory (SBC) running Covid discharge sites, redeployed staff to arranged in people´s own homes; and appropriate same day discharge support SUHFT and BCH discharge processes, CCG CHC staff making full use of available hospice (SIMON STEVENS' LETTER) supporting Priory discharge support. care ALSO IN PLANNED

Page 3 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

October 2020 Update Ambulance performance (handover As part of the Winter Plan and Surge management Ambulance Staffing, HR, OD, Service Delivery, People Resources, Partnership Finance & Performance Unplanned Care Ambulance Services delays , conveyances vs hear / see & 2 System/Place ALL James Wilson James Buschor 4312 Handovers and improvement to turnaround (handover) time 3 12 4 G None Identified Acute Hospital Demand Working Committee

treat UNPC05 will be reviewed and where targeted action required support 14/08/2020 (local and regional) will be initiated.

100% GP practices able to Complete work on implementing * IT Audit currently underway. undertake video consultations. digital and video consultations, so that * Video Consultation SOP drafted ready to be circulated Unplanned Care Video Consultations all patients and practices benefit. 5, 7 System/Place ALL Peter King Jenni Speller Staffing, HR, OD 339 through primary care. 01 December 2020 IT Infrastructure Pilot underway 3 9 3 A↔None Identified 100% care homes able to have

Linked to Digital within Organisational UNPC06 * Digital tablets pilot to commence with 5 care homes in SEE

14/08/2020 video consultations with Preparedness and be upscaled in Autumn 2020. practices.

October 2020 Establishing a single clinical lead to drive performance with a local delivery, but under a standard specification. Introduction of single point of access, hear & treat and see & treat October 2020 11% Reduction in admissions protocols. Objective includes the 2 hour response and 2 day Baseline data of over 65's by 2022, in line Ageing Well and Unplanned reablement. awaited To develop the urgent community with the connect programme Care Workstream of Urgent Community Response response (2 hour response) in line Patient Safety & Harm, Service Operational Reset Group. (Admission Avoidance) Gerdalize Du Project plan/detailed action plan in place and in progress. Ageing Well with national requirements. To retain 2, 3, 5, 6, 9 System/Place ALL Dan Doherty Delivery, Acute Hospital Demand, 3412 31 March 2021 People Resources 2hr Response 3 9 6 A ↓ JAMES BUSHOR? (NICE Guidelines (NG74), Long‐Term Toit Inequality The Newton work is essential to this project and funding has

local delivery, but with a standardised AGEW01 Quality.

Plan) 01/04/2019 not yet been approved to progress this. specification of service. 2 day Re‐ablement (target for 2024) ‐ ref Connect Finance & Performance. Buy‐in from Providers and CCGs. Business case funding has Programme been approved. Newton instructed for the transformation work.

Currently the CCGs are ahead of the national plan.

To deliver the key outcomes of the October 2020 Update DES (i.e. Medication Reviews, Ward Following / compliant with the PCN DES for enhanced care in rounds, spotting deterioration, care homes. Performance against DES Enhanced Health in Care Homes advance care planning etc.) To ensure Gerdalize Du Service Delivery, Patient Safety & Care home support under COVID is still being provided to measures. 2, 3, 5, 6, 7, Harm, Acute Hospital Demand, Ageing Well (National DES) that the PCN support to bring Place/System ALL Tricia D'Orsi Toit / Geraldine 339 support. 31 March 2021 Comms & Engagement 3 9 3 A↔None Identified. 8, 9 Patient Experience, Inequality,

(including the clinical care home hubs) together services (MDT) to support AGEW02 Rogers Regulator Penalties Roll out of Whzan across care home footprint. Not sure where this is care better care homes is effective to 01/08/2020 reported? manage patients at home and avoid Need to bottom out how Place performance feeds back to unnecessary admissions. system. Improving the recognition of carers Gerdalize Du and the support they require. Toit October 2020 Update Offer to Carers Operational Reset steering Ageing Well (eventually may become the 2, 3 Place/System ALL Dan Doherty 111 Pro‐active working in preparation for the NHSE Anticipatory 31 March 2021 None Identified None Identified N/A 1 11 G ↔ (Long Term Plan) group

Anticipatory Care Framework in the AGEW03 Place Carers Care Framwork publication in 2021. future). 01/08/2020 Leads To ensure that we have effective October 2020 Update BBCCG methods of dementia diagnosis to Gerdalize Du Action Plan in place. Working with Practices and PCNs. MCCG CCG Boards achieve the 67% National target to Toit On‐going and embedded in normal practice. Ageing Well Dementia 2, 3, 5, 6 Place/System ALL Dan Doherty Patient Safety & Harm 339 31 March 2021 None Identified Achieve 67% Diagnosis Rate CPR 2 66 A↔ Quality Committees deliver care for dementia patients. Identifying any gaps on registers.

AGEW04 SCCG Performance

01/08/2020 Irene Lewsey TCCG Pilot use of PCN Memory Clinics Need to identify where performance is reported.

Map progress against exisiting October 2020 Update dementia strategy to inform the Patient Experience, Acute Hospital Operational Reset Steering Gerdalize Du Mapped the current dementia service delivery across the Ageing Well Dementia development of the Greater Essex 2, 3, 5, 6 System/Place ALL Dan Doherty Demand, Patient Safety & Harm, 339 31 March 2021 None Identified Identification of action areas TBA 2 66 G ↔ Group Toit Safeguarding system, gap analysisis now complete and is feeding into the

Dementia Strategy or Ageing Well AGEW05 Place Alliance Boards

01/07/2020 strategy discussions. Strategy in 2021. Optimisation of the non‐elective October 2020 Update pathways for people with frailty. Patient Safety & Harm, Acute Suite of KPIs relating to the Gerdalize Du HCP instructed Newton to support the transformation. People Resources, Information Ageing Well The Connect Programme * Admission avoidance 2, 3, 5, 6, 9 System ALL Dan Doherty Hospital Demand, Service Delivery, 4312 31 March 2021 connect programme TBA 3 12 4 A↔Benefits Realisation Group Governance Toit Inequality Programme of work in place.

* Community Flow AGEW06 deliverables. Senior partnership buy‐in, sponsors identified. * Discharge

Increase the number of patients on the EOL register by Five Key areas of work identified for October 2020 Update 0.6% to enable and empower Palliative and End of Life Care Develop governance strucutre to oversee the programme of our patients to plan their care 24/7 model of care, protocols&clinical Lynne Smith / work. for their last months of life as guidelines, training and education, December 2020 ‐ for Finance & Performance Eleanor Develop agreed measures to monitor delivery. well as their preferred place of Ageing Well Palliative and End of Life Care bereavement, clinical outcomes. 5 Place ALL Karen Wesson Patient Experience 4416 structure and None Identified 4 16 4 A↔ Committee, Clinical Forum / Sherwin / Develop and agree measures to capture patient and carer death.

AGEW07 measures Committee

01/10/2020 Emma Branch experience. Identify the 1% of the SEE population Measure impact and number of patients on the EOL register Reduce NEL admissions and ED that should be registered as end of should be 1% of the population. attendances as patients are Life managed more effectively in the community

October 2020 Update Adults and Older Adults: 24‐7 MH Crisis Response Service via 111 MH option has been in operation since 01.04. Public‐facing comms are now being progressed so that the public is aware of the service and how to access. Plans are being progressed to mitigate expected surge in demand especially with sub crisis needs High level system data is being shared but there is still some Demand Management Adult Community Crisis Care: 24/7 work to further improve recording, coding so that the data can Adult Crisis Resolution (via NHS111) Service Delivery, Reputational October 2020 Commissioning Forum / Damage, Patient Safety & Harm, be validated to enable its use in informing reset both at Patient Experience MH Urgent and Emergency Care ‐ MH and Home Treatment Teams Awaiting data as Committee, Quality Mental Health 1, 2, 3, 7 System/Place ALL Nigel Leonard Jane Itangata Finance, Acute Hospital Demand, 4312 system and place. In Place People Resources 2 8 4 G ↔ None identified as yet. 24/7 Crisis service is new and operating in line with best practice. Patient Experience, Regulator Committee, Finance &

MENH01 Service using bank staff until a full compliment can be OAP mitigation Including providing a crisis alternative embedding Performance Committee Penalties recruited. offer. All age access: (Currently under review.) Discussions to explore a longer term single access point via 111 when it becomes mandatory have commenced and a proposal will be submitted end June for governance. An initial meeting between CYP and ADULT MH commissioners, EPUT and NELFT to scope process took place on 15.05 NHSE are happy with approach and will be sighted on proposal.

October 2020 Update Improving the therapeutic offer in Reviewing all OAPs to support repatratiation back into local Inpatient Care to support treatment MH Urgent and Emergency Care ‐ systems. Working with Local Authority Colleagues to define Commissioning Forum / and discharge pathways. To align MH Reputational Damage, Regulator Clinical Review of Standards, OAPs, the MH accommodation and community support offer to meet People Resources, Estates, July 2020 None identified as yet, but Committee, Quality Mental Health accommodation and community offer 2 System Nigel Leonard Jane Itangata Penalties, Finance, Patient 4416 01 December 2020 Zero OAP 3 12 4 A↔ Partnership Working, Legal Acute therapeutic including 72hr follow Experience needs more appropriately. Data awaited monitored by NHSE. Committee, Finance &

to align with needs. To have a robust MENH02 up standard COVID‐19 has impacted significantly on this area, maintaining Performance Committee gatekeeping function in the home social distancing reduces capacity and therefore increases treatment teams. requirement for OAPs.

Page 4 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

Objectives Specific Responsible Op Lead (Blockers) Score (Gap in control) Performance Rating BAF ID PM3 Ref Inherent (Assurance ‐ 1st line of defence) defence) Risk Area Likelihood Likelihood / Appetite Officer (SRO) Risk Rating Risk (Impact) Work‐stream Inherent Risk Project Delivery System Delivery Date Risk Added Target Risk Score * EWMHS Procurement (Contract award Sept 2021) October 2020 Update * Implement Mental Health Support * Completion of EWMHS Aptiligen Report (commissioned by * Procurement for the EWMHS Service has initiated and on * EWMHS procurement * Procurement on Teams in line with national target award ‐ September 2021. procurement CCF) ‐ Review of service and plan for delivery. track. (TCCG Lead) * MHST Wave one ‐ * Delivery on 3 functionalities commissioning arrangements * MHST ‐ Wave 2 services have gone live in September and * MHSTs training * Deliver Transformation Plan CMH Complete. Wave 4 ‐ of MHSTs (Direct Care, Whole (February 2019) ‐ Acceptable Mental Health quarter 3 report submitted to NHSE. delayed 'Open Up Reach Out' January 2022 School Approach and Parental progress, recommendations for Deliver the ambition for Children's Leads, Sarah * MHST ‐ Wave 4 ‐ implementation plan approved by NHSE * OURO on track * Triple P Online Service(TCCG+) * Trans Plan ‐ January Training) improvement on commissioning and Mental Health in line with the NHS Garner Inequality, Patient Experience, and DfE, engagement with schools has initiated. 2021. * Triple P c1000 Clinical Forum / Committee, Children, Young * Implement the enhanced Crisis 1, 2, 3, 5, 6, * OURO ‐ Delivery Key service arrangements, Long Term Plan and 'Tranformation of System/Place ALL Tricia D'Orsi Reputational Damage, Regulator 4312 * Co‐production has begun with the plans to develop a film * Triple P ‐ February Finance, Partnership Working users 3 12 4 A↔ Finance & Performance People Community Support Service 7, 8 Objectives for 20/21 implementation of recommentions Children and Young Peoples Mental CYP01 Childrens Penalties resource for CYP and their families and schools. 2021. * ECCSS being Committee * Develop and implement 18‐25 year * Take up of Triple P in progress. Health Provision' (Green Paper). Commissioners * TPOL business case has been approved to extend the * CCSS ‐ January 2021 rolled out old Offer for young people * Level of Access of ECCSS (Place) programme to Jan '22 with 30 places for staff training for ASD * 18‐25 ‐ Summer 2021 * 18‐25 on track *Integrate Physical and mental health * Improve Access ‐ * Take up of 18‐25 offer ECC SEND inspection ‐ need for secured. * Access not Services March 2021 * Access Target 34% improvement * New trajectory and action plan has been developed with achieving *Improve access to CYP MH services * Eating Disorders ‐ * Fully compliant with Thurrock / Southend SEND Provider and Lead Commissioner, expectation is that MSE will * ED on track in line with NHS targets. March 2021 concordant model. Inspection ‐ praised. be compliant by March 2021. * Deliver fully compliant Specialist Eating Disorder Service for CYP.

October 2020 Update * Integrated Primary and Community Developing an integrated priamary and community care offer Care Mental Health Offer for PCNs in PCNs. % SMI Health Checks Undertaken Community MH SMI (incl. EIP, IPS & * Annual SMI Healthchecks Providing wrap around MH support offer. EIP (at level 3) Commissioning Forum / Acute Hospital Demand, Service IPS (CCG targets awaited) October 2020 physical health, eating disorders, MH * Stabilise and bolster community Place Mental Managing the interface between secondary and primary care. People Resources, Finance, Committee, Quality Mental Health 2, 3, 5, 6, 7 Place ALL Nigel Leonard Delivery, Patient Experience, 339 31 March 2022 Access for integrated offer Data awaited as a 3 9 3 A↔None as yet. rehabilitation, personality disorder mental health services for adults and Managing complex need. Partnership Working Health Leads Inequality (awaited) Committee, Finance &

MENH03 result of COVID diagnosis) older adults Work is in place to explore a system‐wide consistent offer, Performance Committee * Recruitment of Staff taking into account locality nuances. Metrics currently being reviewed * Partnership Working Currently awaiting allocation of transformation funds (application submission 18/11, results expected in Feb '21).

* Finalise suicide prevention October 2020 Update transformation funding for Wave 1, 2 Work being undertaken to enhance the offer for Primary Care Quality Committee, Patient Safety & Harm, Acute Reduction in suicide rates MH Urgent and Emergency Care ‐ and 3 for 2020/21 and zero tolerance for suicide within Secondary Care. Both Partnership Working, People NHSE Assurance Meetings ‐ Commissioning Forum / Mental Health 1, 2, 3, 6 System Nigel Leonard Jane Itangata Hospital Demand, Service Delivery, 4312 01 March 2021 TBA 2 8 4 A↔ Suicide Reduction and Bereavement * Finalise suicide bereavement inpatient and out of hospital protocols in place. Resources Patient Experience satisfactory (Nov 2020). Committee, Finance &

MENH04 Metrics currently under review transformation funding for Wave 1 Implementing wave 3 transformation fund programme and Performance Committee and 2 for 2020/21 therefore providing assurance to NHSE. October 2020 Update There are many avenues of support for staff both from a system perspective and more locally for IAPT services where all staff are being fast tracked. BB Mental Health First Aiders. Ensure enhanced psychological Staff sickness rates CPR IAPT. Mental Health MSE MH support for staff support is available for all NHS staff 3, 5, 8 System/Place Nigel Leonard Jane Itangata Staffing, HR, OD 339 31 March 2021 None Identified MCCG 2 63 G ↔ None as yet. Remuneration Committee Wellbeing seminars.

who need it. MENH05 Required from HR SCCG Support via line management. TCCG Employee Assistance Programme. Occupational Health. National funding was successful to support a more centralised NHSE offer. October 2020 Update Increase activity for self‐ Each Place has a slightly different approach to dealing with referrals. inequalities. Continue to take account of Increased activity other than Undertaking reviews to identify those inequalities so that they inequalities in access to mental health that requiring action under MH Quality Committee, Patient Experience, Inequality, can be addressed. services, and also address all the Mental Health Partnership Working, Comms & Act. Commissioning Forum / Mental Health MH Inequalities 2, 3, 5, 6 System/Place Nigel Leonard Patient Safety & Harm, Service 3412 All Providers have undertaken BME assessments, CCG to 01 December 2020 To be identified 4 12 3 A↔None as yet. issues that impact on inequalities Engagement Reduction in application of MH Leads Delivery Committee, Clinical Forum /

MENH06 ensure that appropriate action plans are being put in place and generally as well as a focus on the Act. Committee delivered to address inequalities. needs of BAME communities. Three workshops held to identify 3 key areas to focus Metrics under review pending programmes of work (culture, wider social determinants, data and baseline assessments process/service delivery). * Delivery of IAPT and IAPT LTC Service * Prepare for increased demand due IAPT Waiting Times (75% to October 2020 Update to COVID first treatment within 6 weeks, Managing the IAPT LTC offer to ensure parity of esteem, so * Address IAPT Workforce issues, 95% within 18 weeks, less than Quality Committee, Patient Safety & Harm, Acute that people with physical health problems are also supported MH Integrated Primary and Community especially future demand resulting 1, 2, 3, 5, 6, Mental Health 10% waiting 90 days or more Commissioning Forum / Mental Health Place/System Nigel Leonard Hospital Demand, Patient 339 with their Mental Health problems. 31 March 2021 People Resources, Finance Currently awaited 3 9 3 A↔NHSE Assurance Meetings. Care ‐ IAPT Long Term Conditions (LTC) from COVID to second treatment) 7, 8 Leads Experience, Service Delivery Committee, Finance &

MENH07 Each Place has an integrated IAPT LTC Offer. * Deploy digital solutions Performance Committee Availability of trainee places. * Expansion and replacement of Access Target (22%) Service review as part of health inequalities assessments. trainees Recovery Target (50%) * Meet IAPT referral to treatment and recovery standards * Liaison with Acute Hospitals to October 2020 Update provide a divert for MH needs that Meeting KPIs Ensuring that all three MH liaision continue to run at Core 24 Currently awaited, Quality Committee, have not physical health needs. Patient Safety & Harm, Patient e.g. 4 hrs response, None as yet. MH Urgent and Emergency Care ‐ standard. link to Commissioning Forum / Mental Health * Alcohol liaison service 3, 5, 7 System Nigel Leonard Jane Itangata Experience, Acute Hospital Demand, 339 31 March 2021 People Resources appropriate care plans, 2 63 G ↔ NHSE Assurance meetings to be held Mental Health Liaison Service Ensuring we continue to embed the alcohol liaison integration. performance Service Delivery Committee, Finance &

* Street Triage (in partnership with MENH08 continuity of care outside of regarding transformation funds. Ensure S136 protocols continue being observed. reporting Performance Committee Police) diverting non‐medical activity hospital. Continue to recruit to all vacancies. from the Acute * Rough Sleeping MH Urgent and Emergency Care ‐ MH * Problem Gambling Mental Health 3, 5, 8 System/Place Nigel Leonard Jane Itangata 0 Awaiting national direction. 0 A Workstreams * Secure Care * Provider Collaboratives MENH09 October 2020 Update Implementing new transformation programme, developing care pathways to support that. Quality Committee, Improving treatment pathways in Patient Safety & Harm, Patient MH Urgent and Emergency Care ‐ Meeting with EPUT to manage delivery and improvements in Reduced length of stay Commissioning Forum / Mental Health inpatients to support quick recovery 2, 3 System Nigel Leonard Jane Itangata Experience, Reputational Damage, 4312 31 March 2021 None Identified Awaiting data 3 12 4 A↔None as yet Inpatients (therapeutic offer) inpatient services. Regulator Penalties Improved patient experience Committee, Finance &

and reduced length of stay. MENH10 Plan established and requires further development to Performance Committee implement associated actions, although there was a pause during COVID. Providers to make direct and regular contact with all women receiving Maternity Direct is a secure platform which saves all the antenatal and postnatal care, information shared in the individual woman’s record Women explaining how to access maternity receive the App via e referral. Providing health Information for services for scheduled and unscheduled Karen Berry, women. COVID triage questions prior to face to face Maternity Services care, emphasising the importance of 2, 3 System Teresa Kearney Children's 0 0 A appointments – standardised across the 3 sites. Real time chat

sharing any concerns so that the MATS01 Leads for non‐urgent questions, support and advice. Developed a maternity team can advise and reassure Covid 19 video for women's information, available via women of the best and safest place to Facebook and the Maternity App. receive care. (SIMON STEVENS´ LETTER)

All three Obstetric units across the MSE have appropriate Ensure obstetric units have appropriate staffing levels which include anaesthetic cover, confirmed by Karen Berry, staffing levels including anaesthetic the CD for Women's Health across the MSE. Short term Maternity Services 2, 3 System Teresa Kearney Children's 0 0 A cover. sickness actioned real time. Birth rate plus exercise

MATS02 Leads (SIMON STEVENS´ LETTER) undertaken at each site to ensure sufficient staffing levels. Subsequent establishment uplift was made.

Page 5 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

* Develop intergrated pathways of care for CYP Long Term Conditions (e.g. asthma, diabetes. sickle cell October 2020 Update Disease) Childrens Child Health App being launched 13/11 and full * CYP LTC ‐ January *Develop and implement integrated * Admission rates: campaign planned for 16/11. 2021 models of care to promote Asthma Integration: to deliver integrated Meetings held with the Hosptial Trust to explore the delivery * Child Health App ‐ None as yet. prevention, self care and early Diabetes Commissioning Forum / Children, Young services for children and young people Children's Service Delivery, Inequality, Acute of Children's clinics within Primary Care. Delivered People Resources, Finance, intervention. 2, 3, 5, 6, 7 System/Place ALL Tricia D'Orsi 3412 Sickle Cell TBC 3 9 3 A↔ Committee, Clinical Forum / People in alignment with the NHS Long Term Leads Hospital Demand Six hospital consultants identified to support the programme. * Transitions ‐ March Partnership Working Potenital work from Newton * To review and implement services CYP02 * Outpatient Referrals Committee Plan and develop a 0‐25 year offer. Launched campaign on safer sleeping and a health resource for 2021 Europe. which plan and coordinate transitions * A&E attendance 0‐4 yrs COVID‐19 for Children and families. * OOH ‐ Review based on need rather than age. * Uptake of Child Health App Electronic Referral System Children's group has been December 2020 * Reduce the demand and referrals to established. UEC pathways and Secondary Care Outpatients by delivering care closer to home. * Work to rectify areas of significant concern identified by CQC and Ofsted * Re‐inspections due Report. 18mths following initial * Transforming care agenda ‐ to October 2020 Update inspection. Southend ‐ Spring 2021, Thurrock ‐ deliver the ambitions of and meet Neurodevelopmental pathway January 2022. Essex ‐ * Re‐inspection Opinion * Awaiting ECC SEND inspection ‐ need for national targets for Children and * Provider reset group have agreed to develop a resource Autumn 2022. * Admissions to Tier 4 Beds Inspections improvement Young People with LD and Autism. pack and a universal referral approach across MSE. The CCG will continue to work in * Transforming Care for Children with ASD/LD * TBC Thurrock / Southend SEND *Deliver CETRs for those CYP at risk of * QB test event has been confirmed with UCL and partners. partnership with education and care to Tricia D'Orsi trajectories (monthly) * Completion rate for CETR Inspection ‐ praised., ECC SEND admission and monitor and maintain Reputational Damage, Patient Safety * Bosa Autism Assessment is being shared across partners. * CETRs ‐ in place Children, Young become fully compliantwith the Children's Partnership Working, People pre‐admission * TBC inspection ‐ Areas of significant mechanisms for identification( Risk 2, 3, 5, 6 System/Place ALL & Harm, Patient Experience, 4416 * Pan‐Essex Neurological group has completed a mapping montored monthly 90% 4 16 4 R ↔ Quality Committee People Children and Families Act 2014 in SEND SRO at Leads Resources * LD Register (Primary Care) concern. register) CYP03 Inequality, Regulator Penalties exercise to understand the variation across the Essex County CETR before admission relation to Special Education Needs and place * Completion of LD Annual * TBC Southend SEND ‐ Areas of *To ensure CYP age 14+ with LD are footprint. target. Disability (SEND). Healthchecks (Primary Care) * TBC significant concern. on the GP register and recieve annual * LD Healthcheck implemention plans in place and being * LD Register metrics < 25yrs March 2021 * Autism waiting lists for Thurrock SEND ‐ Areas of significant health checks progressed. * Neuro ‐ Review March diagnosis * TBC concern for the Local Authority. * Implement new * Progress continues through the Children's Partnership 2021 neurodevelopmental pathway working Boards on the deliver of the WSOA. * Autism WT ‐ March with system partners 2021 (NHSE/I metrics *Reduce the waiting times for CYP expected. Autism Diagnosis. SEE Place: SUHFT to have system in place and complete backlog of Initial Health Assessments (IHAs) for Looked After Children Joy Edwards, SEE ‐ Joy October 2020 Update HCP: Working with Safeguarding CPR Included in SEND report as not Edwards Workshop event has been planned for November to look at a No of children IHAs completed To meet the needs of CYP who are Clinical Network and Children’s Reputational Damage, Safeguarding, Southend performing. Quality Committee, Children, Young Pan‐Essex model. An update has been given to HEF within the statutory looked after reducing the health Commissioners ensure capacity to 2, 3, 6, 7 System/Place ALL Tricia D'Orsi Patient Safety & Harm, Regulator 3412 01 December 2020 People Resources, IT Infrastructure Thurrock 3 9 3 A ↓ Commissioning Forum / People Helen Farmer (Safeguarding Board). framework timescale of 20 inequalities and improving outcomes. undertake IHAs is available across CYP04 Penalties Mid Social Care Inspection Frameworks Committee A data collection and mapping exercise has been completed days Southend, Essex and Thurrock. BB also confirm not performing. LAC Designate for the IHAs. Review the current commissioning Leads arrangements across the 7 Essex CCGs working with partners to propose an effective model for delivery and monitoring arrangements.

* Delivering the assessment and arrangement for packages of care for * Childrens Continuing Care continuing care needs. Assessment Waiting time * Supporting CYP with AGPs returning * All children will have access to school (awaiting final guidance) to appropriate care for AGP * Providing and co‐ordination of FIT October 2020 Update * Completing the testing and provision of PPE for PHB CCGs and Little Havens have agreed to develop one contract to Children, Young Patient Safety & Harm, Finance, procurement of payroll and Commissioning Forum / Children's Continuing Care holders. 2, 3, 6 System/Place ALL Tricia D'Orsi Caroline Lowe 339 capture all service provision to capture best use of resource. None Identified TBC 2 63 G↓ People Service Delivery support for PHBs Committee * Re‐procurement of payroll and CYP05 New model development has been drafted. * New model of care for support for PHBs Continuing Care Services for Children have commenced. children with palliative and * Leading on End of Life respite end of life conditions (liaising with local areas where * Deliver specification for necessary) Specialist Healthcare Tasks * CCG lead for Specialist Healthcare Tasks (for ESS educational needs).

Primary Care Programme Board providing system oversight to Development of PCNs and Clinical PCN development. Directors in line with national Place based PCN development plans. guidance, following the PCN maturity Reputational Damage, Service Named primary care leads in each Place supporting PCN 01/10/2020 review of 19/20 baseline Primary and Primary Care People Resources, Partnership Annual progress against the Commissioning Forum / PCN Development matrix. Further developing 2, 3, 5, 6 Place/System ALL William Guy Delivery, Acute Hospital Demand, 3412 development requirements. development plans undertaken, all at 2 66 A↔None Identified. Community Care Leads Working maturity matrix. Committee

collaboration and partnership working PRCC01 Patient Experience, Inequality Maturity assessments being undertaken to support and funding. foundation stage. linking PCNs with emerging ICPs at development plans. Place and in the wider HCP. National funding available for PCN develpment. Developing clinician involvement in ICPs and the wider HCP.

Ensuring national service requirements for PCNs are delivered Reputational Damage, Patient Safety Primary Care Programme Board providing system oversight to BBCCG in accordance with set criteria and & Harm, Claims & Complaints, PCN development. Services to be ready to CPRCCG Primary and PCN Implementation of National Primary Care People Resources, Partnership Delivery of contractual Commissioning Forum / timescales. 2, 3, 5, 6, 7 Place/System ALL William Guy Service Delivery, Acute Hospital 339 Named primary care leads in each Place supporting PCN deliver from 1st MCCG 2 63 G ↔ None Identified. Community Care Service Requirements Leads Working, Information Governance requirements. Committee

* Enhanced Care in Care Home DES PRCC02 Demand, Patient Experience, development requirements. October. SCCG * Early Diagnosis for Cancer Inequality Local contract monitoring (CCG or NHSE) to ensure delivery. TCCG * Medication Reviews October 2020 Updated plans Primary Care Programme Board providing system oversight to submitted to region PCN development. by 9th November Named primary care leads in each Place supporting PCN 2020. development requirements. Overseen through the workforce hub. Aggregate local plan October 2020 Assisting PCNs in developing skill‐ Primary Care Assessed by NHS England. and amounts for in‐ Recruitment of additional BBCCG Primary and PCN Additional Roles Re‐imbursement mixed services to meet the needs of Leads Acute Hospital Demand, Patient Recruitment commenced in 2019/20. year redistribution People Resources, Partnership staff. CPRCCG Commissioning Forum / 2, 5, 6, 8 Place/System ALL William Guy 236 2 44 G ↔ None Identified. Community Care Scheme the population through employing Experience, Service Delivery All 20/21 Workforce Plans submitted by 31st August agreed by 30th Working, Human Resources MCCG Committee staff with additional roles. PRCC03 Kathryn Perry Plans shared with region by 9th September 2020 and all plans November 2020 Utilsation of ARRS funding. SCCG agreed. TCCG Updated 2020/21 workforce plans and workforce intentions Updated CCG 22/23 and 23/24 received from all 28 PCN’s aggregation tool Recruitment support offer provided through Essex Primary submitted to region Care Careers by 30th November Underspend collated 2020 Supporting Practices to remain resilient (safe, secure, on‐going, open) and ensure compliance with regulator Named primary care leads in each Place supporting Practices. requirements in accordance with their Some system funding available for Practice resilience. BBCCG NHS Contract. For example: CCG approach varies across MSE, but support available to Services to be back up Reputational Damage, Patient Safety CPRCCG Primary and * Face‐to‐face Services Primary Care & Harm, Service Delivery, Acute Practices where needed. and running by People Resources, Estates, Comms & Appointments in line with Commissioning Forum / GP Individual Practice Resilience 1, 3 Place ALL William Guy 339 MCCG 4 12 3 A↔None Identified. Community Care * COVID‐ Compliant Leads Hospital Demand, Patient Practice level quality and risks assessed. October 2020 (Simon Engagement previous year activity levels Committee

PRCC04 SCCG * PPE Experience, Inequality GP Practice dashboards (staffing, CQC rating, list sizes etc). Stevens letter). TCCG * Deliver Simon Stevens asks. There are currently some local concerns about getting back to * Childhood Vaccs and Imms a 'new normal' and the delivery of face‐to‐face services. * IT Infrastructure * Quality

Page 6 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

To develop processes within the CCGs to enable the offer of Primary Care Commissioning delegated from NHSE System‐wide group reviewing how this can be delivered across BBCCG so that there is a consistent (or Mid and South Essex. CPR ‐ complete NHSE feedback on previous Primary and Primary Care Reputational Damage, Regulator Formal delegated authority for Commissioning Forum / Primary Care Commissioning system) approach to the delivery of 9 System/Place ALL William Guy 248 Local discussion between CCGs and NHSE. 01 November 2020 None Identified MCCG 3 63 A↔application that have been denied ‐ Community Care Leads Penalties all CCGs. Committee

the function. PRCC05 Currently being delivered by SEE and (Joint) MCCG. SCCG ‐ complete actions to implement. Currently BBCCG and Thurrock CCG Action plans in place for those not currently delegated. TCCG are not delegated and MCCG has joint delegation.

Primary and

Primary Care Estates 6 Kerry Harding? 0 0 Community Care PRCC0

October 2020 Delivery of a system wide workforce programme in line with 31 March 2021 central requirements. Coordinate retention initiatives to support GP and general GP Fellowships to practice staff recruitment and retention through programmes commence 1st such as International GP recruitment, GP retention, student December 2020 placements and apprentices. Support PCN's with development of workforce plans and Mentoring recruitment of additional roles. Primary and Primary Care Workforce Development Recruitment and retention of roles Service Delivery, Acute Hospital Programme to People Resources, Partnership 8 Place/System ALL Tricia D'Orsi Kathryn Perry 339 Fellowship programme developed and advertised for newly Currently being determined TBA 2 66 A↔ Community Care Plan within Primary Care Demand, Patient Experience commence 31st Working, Human Resources

PRCC07 qualified GP's and GPN's. 10 GP fellows to commence December 2020 programme . GP Mentoring programme developed in conjuction with Essex CPD Courses live 15th LMC November 2020 GP Coaching proposal provided through RCGP developed and agreed . Practice Managers CPD investment plans for nurses and AHP's developed and courses commence by approved. 15th December 2020 Practice Managers workshops commissioned. Primary Care Premises Schemes SEE Place: St Luke's Primary and SEE Place: Shoebury House 2, 5 Place Kerry Harding Jenni Speller 0 0 A Community Care SPEAK WITH KERRY HARDING RE:

SEE Place: LGD PRCC08 ESTATES

c.90% of consultations with patients as face‐to‐face GP Practices should continue to triage appointments to managing patient contacts and to use online DoctorLink in the process of being rolled out across MSE ‐ 118 more than 85% of consultation so that patients can be Contract management controls of practices as of w/c 29.06.20 utilising online consultations and consultations remotely. 95% of directed to the most appropriate Jenni Speller, supplier. Digital Mark Barker, 100% of practices supported to undertake video consultations. practices now having video Peter to provide Commissioning Forum / Online Consultations member of the practice team straight 5, 7 System/Place ALL Taz Syed Kelly Marie‐ Staffing, HR, OD 339 01 August 2020 People Resources, IT Infrastructure 3 9 3 A↔ Transformation Peter King consultation capability live and from RH Committee away, demand can be prioritised DITR01 Jenner Jointly owned issues log between

14/08/2020 Project also dependent on Practice adaption and functionality the remaining few percent in based on clinical need and greater CCG and supplier. of softward. the process of implementation convenience for patients can be or procurement of a solution. maintained. 100% of practices enabled

Acute: Outpatients Full digitisation and streamlining of the outpatient pathway Improve operational infrastructure using digital communication tools Redesign of patient pathways to support the reduction of face to face Referral streaming of new outpatient attendances referrals is important to ensure they Consider and review Outpatient operational and management models are being managed in the most in order to standardise processes across the Trust appropriate setting, and this should Manage outpatients (particularly those with LTC) from an ICS First phase specialities Digital perspective Conversion of out patient Commissioning Forum / be coupled with Advice and Guidance 5, 7 System/Place ALL Karen Wesson Taz Syed Emily Hughes Staffing, HR, OD 339 completed by the end People Resources TBC 3 9 3 A↔None Identified. Transformation Digital Referral Management Lighthouse Development Centre ‐ service not yet accepting referrals referrals into appointments. Committee provision, so that patients can avoid DITR02 see MSE 2020.0032 above. of August 2020 an outpatient referral if their primary 14/08/2020 care service can access specialist Reduction in clinical estates footprint across the three main hospital advice (usually via phone, video too). sites due to reduced need for F2F consultations and relocation of remaining F2F outpatient clinics offsite

Consolidate the administrative resource supporting outpatient services to enable centralised management and allocation

Trusts should use remote appointments ‐ including video As above consultations ‐ as a default to triage their elective backlog. They should First phase specialities Reduction in face to face Digital Need patients to be able to utilise this. Commissioning Forum / Remote Appointments implement a ‘patient initiated follow 2, 6, 7 System ALL Karen Hull Taz Syed Emily Hughes Staffing, HR, OD 339 completed by the end IT Infrastructure attendances to <25% across all TBC 3 9 6 A↔None Identified. Transformation Committee up’ approach for suitable DITR03 of August 2020 outpatient consultations.

14/08/2020 Procurement expertise ‐ a number of procurements have been appointments ‐ providing patients the pushed back to Q4 due to Covid means of self‐accessing services if required. 01/05/2020 * Enabling Shared Care Records for Nightingale Hospitals * Enabling Shared Care Records with Primary Care. TBC National requirement to implemente * CYP: Implementation of the electronic red book for children. Oct 2020 Digital shared care records to enable * Move catheter care passport onto a shared record / S1 so Commissioning Forum / Implement Shared Care Records 5, 6, 7 System ALL Peter King Taz Syed Alix McCourt Regulator Penalties 339 IT Infrastructure % Take Up / Implementation TBC 3 9 6 G ↔ None Identified. Transformation interoperability between providers of that patients are discharged with a TWOC booked with the Dec 2020 Committee DITR04

services. 14/08/2020 community nursing team. * Ability to share information in relation to medication, allergies etc linked to GP Connect . September 2020

Digital To roll out eclipse live to all Practices Roll out of Eclipse Live 5, 6, 7 System ALL Terry Huff Taz Syed Peter King Finance 339 Objective and risk currently under review. 0 A Transformation as per expectation. DITR05 14/08/2020

Digital Ensure all GP practice es enable Milestone plan on track prior to Covid‐19 now being reset and Level of GP Practices sharing Commissioning Forum / GP Connect ‐ Ambulance 5, 6, 7 System ALL Peter King Taz Syed Nick Hammond Staffing, HR, OD 339 01 September 2020 People Resources TBC 2 66 G ↔ None Identified. Transformation sharing preferences for GP Connect. due to implementation by September 2020 preferences for GP Connect Committee DITR06 14/08/2020

Digital Commissioning Forum / GP Connect ‐ NHS 111/Direct Booking 5, 6, 7 System ALL Peter King Taz Syed Nick Hammond Staffing, HR, OD 326 Working with EEAST to get to go live stage. In Place IT Infrastructure GP Connect rolle dout In Place 1 33 G↓None Identified. Transformation Committee DITR07 14/08/2020

MID does not have an ordercoms system in place. Digital Supporting MSE to deliver community IT Infrastructure, Finance, People Deliver Community Commissioning Forum / Community Phlebotomy 5, 6, 7 System Mid Peter King Taz Syed Alix McCourt Service Delivery 236 MCCG considering a single phlebotomy solution timescale 18‐ 01/08/2022 3 63 A↔None Identified. Transformation phlebotomy service. Resources Phlemotomy Committee DITR08 24 months. 14/08/2020

Digital Ensuring identified sites are equipped All sites equipped to deliver Commissioning Forum / Community Bed Management 5, 6, 7 System ALL Peter King Taz Syed Alix McCourt Staffing, HR, OD 339 Project Completed. In Place IT Infrastructure In Place 1 33 G ↔ None Identified. Transformation with IT services to deliver care. community bed management Committee DITR09 14/08/2020

Digital Equipping clinical pharmacists with IT Clinical Pharmacists with IT Commissioning Forum / Clinical Pharmacists 5, 6, 7 System ALL Peter King Taz Syed Darren Tidy Staffing, HR, OD 339 Project Completed. In Place IT Infrastructure In Place 1 33 G ↔ None Identified. Transformation services across the HCP. services. Committee DITR10 14/08/2020

Page 7 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

required. 14/08/2020 * Requesting / Setting up staff briefings, board meetings etc using broadcast accounts.

Digital Replacing N3 with HSCN in all NHS Commissioning Forum / HSCN 5, 6, 7 System ALL Peter King Taz Syed IT Leads Staffing, HR, OD 339 Project Completed. In Place IT Infrastructure Roll out of HSCN In Place 1 33 G ↔ None Identified. Transformation premises. Committee DITR12 14/08/2020

* Internet connectivity survey being undertaken with care All GPs are able to undertake a Virtual Consultations/Appointments homes. video consultation. What % of GP consultations now * SOP being reviewed to cover all aspects of virtual Digital Primary Care Commissioning Forum / Virtual Consultations undertaken remotely? And what % of 5, 6, 7 System ALL Peter King Taz Syed Staffing, HR, OD 339 consultations. 01 December 2020 IT Infrastructure, Finance TBC 3 9 3 A↔None Identified. Transformation Leads All care homes wishing to Committee practices now have video consultation DITR13 * Digital pilot due to commence to include telehealth

14/08/2020 participate being able to capability live solution, digital stethoscope and tablets to support virtual receive a video consultation. consultations with care homes and GP practice.

Windows 10 project on track and estate identified to ensure Digital Windows 7 replacement on all NHS Commissioning Forum / Windows 10 7 System ALL Peter King Taz Syed IT Leads Staffing, HR, OD 339 this work can continue during social distancing restrictions. 01 January 2021 People Resources Roll out of Windows 10 TBC 3 9 3 A↔None Identified. Transformation devices. Committee DITR14 Project would be severely impacted by a second wave of covid. 14/08/2020

SEE Place: IT enablement of new building, GP Practice move, Digital IT enablement of new building (St Commissioning Forum / decommissioning of old building – 5, 6, 7 Place SEE Peter King Taz Syed Darren Tidy Staffing, HR, OD 339 On track plans to relocate within the next month. 01 September 2020 People Resources, Finance Relocated to new site on‐going 1 33 A↔None Identified. Transformation Lukes) Committee including network infrastructure, Wi‐ DITR15 Fi, PCs, Printers etc. 14/08/2020

Digital SEE Place: Enabling BTUH ICE reports People Resources, Partnership Commissioning Forum / ICE BTUH 5, 6, 7 Place SEE Peter King Taz Syed Darren Tidy Staffing, HR, OD 339 Delivery plan currently being developed. 01 January 2021 SEE GPs access to ICE reports TBC 3 9 3 A↔None Identified. Transformation to be viewed by SEE GP practices. Working Committee DITR16 14/08/2020

SEE Place: Reducing the cost of mobile Digital Working with EE to agree standard tarifs and reduce mobile People Resources, Partnership Reduction in mobile phone Commissioning Forum / Contract Rationalisation phone devices across South East 4 Place SEE Peter King Taz Syed Darren Tidy Staffing, HR, OD 339 01 December 2020 TBC 3 9 6 A↔None Identified. Transformation phone costs. Working costs Committee Essex. DITR17 14/08/2020

Digital Enabling EPUT to send discharge EPUT led project which ceased during the Covid response, Ability to send discharge Commissioning Forum / Mental Health Discharge Letters 5, 6, 7 Place SEE Peter King Taz Syed Darren Tidy Service Delivery 339 TBC People Resources TBC 3 9 3 A↔None Identified. Transformation letters electronically to GP practice awaiting re‐start. letters Committee DITR18 14/08/2020 Working with pilot practices to identify appropriate digital stethoscope. ECC PH Team to undertake literature review. Digital Piloting digital stethoscopes in 5 GP Reduction in unnecessary Commissioning Forum / Digital stethoscopes 5, 6, 7 Place/System SEE Peter King Taz Syed Michelle Angell Staffing, HR, OD 339 JCT support in place to link to specialists at MSEFT. S1 expert 01 October 2020 People Resources TBC 2 63 A↔None Identified. Transformation practices. referrals for CHD/lung Committee DITR19 working with supplier to identify appropriate mechanism to 14/08/2020 share sound. Digital first bid currently being developed requesting Peter Digital additional resources to support the HCP Digital strategy and to Partnership Working, People Commissioning Forum / Primary Care Digitalisation 5, 6, 7 Place/System SEE King/William Taz Syed Jenni Speller Staffing, HR, OD 339 01 March 2021 3 9 3 A↔None Identified. Transformation embed programmes of work already in place to ensure that Resources Committee DITR20 Guy

14/08/2020 the system can continue to move at pace with this agenda. Surgery Pods in all participating practices. IPC guidance under development. Mobilisation plan to be Digital SEE Place: Surgery pod roll out across Increase in clinical Commissioning Forum / Surgery Pods 5, 6, 7 Place SEE Peter King Taz Syed Michelle Angell Staffing, HR, OD 339 developed. 23 out of the 42 practices will receive surgery pods 01 October 2020 IT Infrastructure TBC 2 63 A ↓ None Identified. Transformation SEE GP practice appointment time as basic Committee DITR21 as part of phase 1.

14/08/2020 tests undertaken prior to consultation.

October 2020 Update SFLG agenda, national guidance and FAQs. Ovesight at CIMT, SFLG and F&P (in common and CCGs). Proposed system operating budget. Revised plan submitted to NHSE. In progress, Finance, Patient Experience, Patient Increasing financial governance post crisis. Monthly Reporting of financial Control of Income and Expenditure Achieving the Financial Envelope Monthly, and as at currently a gap in Finance & Performance Finance 4 System/Place ALL CFOs CCG Chairs DCFOs Safety & Harm, Reputational 4416 Mths 5‐6 now funded to break‐even. Partnership Working position, both by organisation 3 12 4 A↔None Identified.

across the System across the system. FIN01 31/3/21 meeting the Committee Damage, Service Delivery Mth 7‐12 plan deficit/gap understood. and HCP.

01/08/2020 target. Feedback from NHSE and agreed size and drivers of financial gap. Size of financial gap shared with all organisations within the HCP. Potential impact of Wave 2 of the pandemic under review.

October 2020 Update Return to new normal including CIP/QIPP workstream. In progress, SLFG commissioned external report to review and capture new currently a gap in pathway/clinical practice emerging from Covid‐19 crisis. Monthly Reporting of financial meeting the Control of Income and Expenditure To achieve System Savings ‐ Finance, Service Delivery, Monthly, and as at Finance & Performance Finance 4 System/Place ALL CFOs CCG Chairs DCFOs 4416 Increasing financial governance post crisis. Partnership Working position equating to breakeven target. 3 12 8 A↔None Identified. Reputational Damage

across the System CIP/QIPP/Management Costs FIN02 31/3/21 Committee Set‐up of system‐wide benefits (previously Newton work). against budget, or better System CIP/QIPP Set‐up of benefits realisation group. benefits part‐year Establishment of a system efficiency group looking at Pan‐ 20/21. Essex efficiency opportunities.

October 2020 Update There is a new process for setting system budgets with Control of Income and Expenditure difficulty navigating the governance processes across multiple Revised budget approved ‐ Finance & Performance Finance To set system Operating Budgets. 4 System/Place ALL CFOs CCG Chairs DCFOs Finance 4 3 12 End October 2020 Partnership Working In progress 3 12 8 A↔None Identified.

across the System FIN03 organisations. both via NHSE, and locally Committee Process of setting the system budgets have been provisionally agreed at SFLG.

* Financial Balance * Productivity +1.1% Per Annum October 2020 Update * Reduce Growth in Demand This is not a significant risk for this financial year as NHSE are Monthly Reporting of financial Achievement of finance statutory Regulator Penalties, Monthly, and as at Finance & Performance Finance * Reduce unjustified variation in 4 System/Place ALL CFOs CCG Chairs DCFOs 339 measuring system financial performance against the envelope None Identified position equating to breakeven TBC 2 6 8 A↔None Identified.

duties (NHS 5 Tests) FIN04 Reputational Damage 31/3/21 Committee performance rather than by individual organisations. Whilst this is a against budget, or better * Better use of assets and capital statutory duty, the risk lies in achieving the financial envelope. investment to drive transformation

To achieve the requirements of the Finance & Performance Finance Mental Health Investment Standard Place holder, to be completed.

Mental Health Investment Standard FIN05 Committee

Page 8 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

GOSD01 Delivery training. from major incidents. In COVID exercise (April) Exercise Hodges (Regional & local exercises) October 2020 Update Policies, procedures and training in place and up to date. Patient Safety & Harm, Governance and Emergency Preparedness, Resilience To achieve compliance with NHSE Jackie King, System resilience and business continuity tested regularly. Achievement of EPRR Core 9 System/Place ALL Karen Wesson Reputational Damage, Service 5315 In place None Identified Compliant 1 55 G ↔ Audit Committee Statutory Duties and Response Core Standards for EPRR EPRR Leads EPRR Core Standards compliance across each CCG. Standards

GOSD02 Delivery Exercised and training updated regularly. All CCGs remain compliant. Review ways of working at CCG and system level as part of the COVID October 2020 Update Governance and reset process. Modern and effective ways of working 9 Place/System ALL Tom Wilson DAOs Service Delivery 3 3 9 This work is now complete and forms part of the CCG Complete None Identified N/A N/A 1 33 G ↔ Remuneration Committee Statutory Duties

GOSD03 restructure process. Remove at next iteration. Return to Office / Working from home reset. October 2020 Update To manage the CCGs workforce during There are significant measure across MSE to ensure staff Staff sickness rates Governance and times of uncertainty and in Service Delivery, Claims & Wellbeing and staff deployment has been reviewed follow People Resources, Comms & Workforce 8 System/Place ALL Mark Tebbs DAOs 4312 Januray 2021 TBC 3 12 4 A↔ Remuneration Committee Statutory Duties preparation for closer / matrix Complaints COVID measure and is now stable. Engagement, Human Resources

GOSD04 Required from HR working across MSE. There is further work to be undertaken as part of the MSE re‐ structure. October 2020 Update Complaints processes follow the Complaints Regulations. Governance and To comply with the statutory Complaints Claims & Complaints, Regulator Complaint acknowledgement Complaints 8, 9 Place ALL DAOs 339 Teams in place to manage and respond to complaints. N/A None Identified Met 2 66 G ↔ Audit Committee Statutory Duties requirement to manage complaints. Leads Penalties within 3 days

GOSD05 Response metrics monitored and reported to the Quality and Audit Committees. October 2020 Update Communications being managed across the MSE CCGs. Governance and To fulfil the statutory requirement to Communication Regulator Penalties, Claims & Co‐ordinated approach to all communications where Good' PPI Assessment status Quality Committee, Audit Communications and engagement 9 System/Place ALL Claire Hankey 4312 N/A None Identified Compliant 1 44 G ↔ Statutory Duties engage with the public and patients. Leads Complaints appropriate. from NHSE Committee GOSD06 Each CCG completing the PPI assessment for NHSE with satisfactory outcomes. To comply with all legislation October 2020 Update associated with the protection of data Reputational Damage, Claims & Established team to manage IG across the CCGs. Governance and Satisfactory Status for DPST Information Governance for example the Data Protection Act, 9 System/Place ALL Iain Gear IG Champions Complaints, Service Delivery, 4312 Policies and procedures in place and up to date. 31 March 2020 People Resources Compliant 2 8 4 G ↔ Audit Committee Statutory Duties return

General Data Protection Regulations, GOSD07 Regulator Penalties Internal Audit confirmation of good processes in place. Freedom of (Information Act) etc. Annual confirmation of meeting the DSPT requirements.

October 2020 Update HCP structures in place for the scrutiny and oversight of EDI. To deliver compliane with the Local compliance within CCGs with the Equality Act, WRES and Equalities Act, Public Sector Equality Inequality, Claims & Complaints, EDS2. This is on‐going work that requires updating. Commissioning Forum / Governance and duty and to ensure that the CCGs have People Resources, Finance, Equality, Diversity and Inclusion 3, 9 System/Place ALL Mark Tebbs Sunil Gupta EDI Leads Reputational Damage, Staffing, 4416 SRO designated for MSE system. 01 December 2020 TBA TBA 3 12 4 A↔ Committee, Remuneration Statutory Duties equality for all in everything the do Partnership Working

GOSD08 HR, OD Clinical Fellow working alongside leads to develop EDI. Committee both as an employer and Applied for funding to support Clinical Fellow in baselining commissioner of services. inequalities. Established Health Inequalities Oversight Group across HCP.

October 2020 Update Each 'place' has a designated lead for safeguarding children Completion rate for WSOA for Southend and Essex and complaince with statutory responsibilities. October 2020 safeguarding reviews. raised actions for improvement. Attendance and partnership working with members of the To work with Designated WSOA for Thurrock raised actions Ensuring the statutory safeguarding Patient Safety & Harm, Children's Safeguarding Boards. Essex, Southend Governance and Statutory Safeguarding Children Jane Foster‐ Safeguarding Partnership Working, People Zero Serious Case Reviews for improvement for the Local function is met to keep 'at risk 9Place/SystemALL Safeguarding, Claims & 5315 CCGs currently working towards delivery of the written 01 December 2020 and Thurrock SBs 2 10 5 A↔ Quality Committee Statutory Duties Responsibility Taylor Leads for Resources ambition. Authority.

patients' safe. GOSD09 Complaints, Regulator Penalties statement of action from the OFSTED reports into SEND for to identify the childrens Southend, Essex and Thurrock. metrics. Embdding learning from Review of MASA arrangements ‐ Moving to a JET and the transition to an ICS will challenge how existing SCR. recommendations to implement. the system currently operates and who will undertake the safeguarding roles going forward. October 2020 Update Each 'place' has a designated lead for safeguarding adults and compliance with statutory responsibilities. October 2020 Attendance and partnership working with members of the No of Safeguarding Adult To work with None as yet. Ensuring the statutory safeguarding Designated Patient Safety & Harm, Adults Safeguarding Boards. Reviews Essex, Southend Governance and Statutory Safeguarding Adults Jane Foster‐ Partnership Working, People function is met to keep 'at risk 9Place/SystemALL Safeguarding Safeguarding, Claims & 5315 Moving to a JET and the transition to an ICS will challenge how 01 December 2020 and Thurrock SBs 2 10 5 A↔ Quality Committee Statutory Duties Responsibility Taylor Resources Review of MASA arrangements ‐

patients' safe. GOSD10 Leads for adults Complaints, Regulator Penalties the system currently operates and who will undertake the No of domestic homicide to identify the recommendations to implement. safeguarding roles going forward. reviews. metrics. Challenges arising from the COVID‐19 pandemic may increase workload as incidences of domestic violance has and continues to escalate. October 2020 Update Rating reflecting current position with COVID‐19 management and risk. Commissioning IPC Team in place linked to all Provider IPC Infection Incidence: October 2020 leads. MRSA (0 tolerance) 11 IPC Provider progammes in place with delivery monitored by Cdiff (y/e ceiling) within tolerance Our patients are protected from commissioning IPC Team and reported through commissioning Coronavirus (Outbreaks) 8 avoidable infections by robust frameworks. implementation of published Infection Patient Safety & Harm, MSE have reported outbreaks of COVID‐19 which have been Managed outbreaks, nationally July 2020 Governance and Prevention & Control guidelines by all Safeguarding, Patient managed in line with the national framework for outbreak Partnership Working, Comms & Infection Prevention and Control 1, 3, 6 System/Place ALL Rachel Hearn Chris Patridge 5420 01 December 2020 set ceiling breach avoided, All 3 15 5 A↔CQC reviewed MSE assurance Quality Committee Statutory Duties involved in delivering patient care. Experience, Reputational management of COVID‐19 . Engagement

GOSD11 nosocomial infections framework and were satisfied. Infections may include, but are not Damage Reporting to the Quality Committee in Common and CCG investigated, all learning limited to: MRSA, Cdiff, iGAS, Boards. implemented. Coronavirus. Noted increase in healthcare acquired infections ‐ Good collaborative working YTD: Clostridioides difficile ‐ 130 cases across 5 CCG's, noted between Providers and that Southend hospital is reporting higher numbers that this Specialist Teams. time last year YTD: MRSA‐ 12 cases reported across the 5 CCG's with reviews ongoing, to date no avoidable MRSA infections have been identified.

Page 9 of 10 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

October 2020 update Acute and Community Performance. Whilst community peformance is more stable there have been a number of issues raised within Acute Providers. Contract management processes were paused during the first phase of the pandemic. CQRG and quality performance mangement processes have Provider CQC reports. CQC report into Maternity services Ensuring the care provision for Patient Safety & Harm, Patient now restarted. at BTUH ‐ Inadequate (August 2020) Governance and residents is safe, effective, good Place Chief Experience, Inequality, Claims & Contract / Quality leads continue to meet with Providers to Partnership Working, IT Acute / Provider Quality Assurance 3 System/Place ALL Rachel Hearn 4416 30 November 2020 Cancer and RTT Harm Reviews Data awaited. 4 16 4 R ↔ Quality Committee Statutory Duties quality and value for money as Nurses Complaints, Reputational address quality issues. Infrastructure

GOSD12 completed and learning shared Awaiting outcomes from further defined within the NHS Constitution. Damage Complaints processes feeding into leads. across the system. inspections in September. NHSE, CQC, CCG and Providers now meeting in joint monthly meetings to manage quality issues. Consideration presently being applied to the system quality framework for system ownership. Issues currently arising from CQC, a risk will be added to reflect this in mid‐November, when the report is published. Additional issues exist within Acute Hospital data quality.

October 2020 Update Oversight of hospital serious incidents Rating reflecting the role of the CCG as oversight and ensuring to ensure they are managed lessons are learnt. appropriately. There is no longer a backlog of COVID Serious Incidents, Review of all serious incidents and Patient Safety & Harm, Patient recognised by NHSE. Governance and working closely with Providers to Place Chief Experience, Claims & Following the SI National Framework. People Resources, Partnership October 2020 Management of Serious Incidents 3 System/Place ALL Rachel Hearn 339 01 January 2021 Volume of outstanding SIs. 4 12 3 R ↔ None as yet. Quality Committee Statutory Duties determine their closure and Nurses Complaints, Reputational Contract management proceses in place to oversee SI Working 189 Acute SIs O/S implement required actions. GOSD13 Damage management. Ensuring that learning from serious Joint Committee SI Administrators in place to support system incidents is disseminated across the work. HCP system. Presently, in trial for new Patient Safety Framework that may be issued in the future. Governance and Controlled Drugs Responsible Officer 4 0 0 R Statutory Duties GOSD1

Page 10 of 10 Agenda Item 8 Basildon and Brentwood CCG Board Meeting, 26 November 2020 Central Incident Management Team Update

Purpose of Report: To provide the Board with a summary of the management of the COVID19 incident.

Recommendations and The Board is asked to note the content of the report decision/actions:

Executive Summary This paper gives CCG Boards a summary overview of the management (including financial impact): of COVID19 incident covering the governance of the incident and the main decisions made by the incident management team and various workstreams that would otherwise have come to CCG Boards for approval or discussion.

Some specific issues such as the proposed changes to intermediate care beds are dealt with as specific, separate papers and not covered in this paper. Similarly issues such as flu vaccination planning that are not directly managed in the CIMT governance framework are not covered here.

Written by: Tom Wilson, Interim Programme Director, M&SE JC Team

Executive Director Anthony McKeever, Interim Joint Accountable Officer Sponsor:

Non-Officer/Board N/A Sponsor:

Fit with CCG Strategic Yes Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A – Information Item document).

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) X

Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed? Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: BAF Ref:

Conflicts of Interest: N/A

Escalation: N/A To the Board To another Committee To the BAF/CRR COVID 19 Central Incident Management Team update Incident Management

1. The CCG Incident Management room and the overall incident management structure established in March remains in place.

2. NHS Chief Executive Sir Simon Stevens announced that the health service in England returned to its highest level of emergency preparedness, Incident Level 4, from 5 November. This means the NHS moved from a regionally managed but nationally supported incident under Level 3, returning for the time being to one that is co-ordinated nationally. The full guidance can be found at https://www.england.nhs.uk/coronavirus/wp- content/uploads/sites/52/2020/11/KW_Level_4-letter_4Nov.pdf

CIMT decisions

3. A review of decisions taken since the last Board report (September) and up to 18 November shows that there are no decisions that should be brought to the attention of the CCG Board that have not otherwise been reported either from CIMT or from any of the individual workstreams.

Community Beds 4. During the initial phase of COVID-19 it was necessary to rapidly complete an options appraisal and agree a plan to expand community inpatient facilities across the Mid and South Essex Healthcare Partnership (MSE HCP) following initial modelling predications on community care demands.

5. After a review of options, the decision was made by the Central Incident Team (CIMT) to create two central facilities to manage the anticipated demand for phase 1 of the COVID-19 outbreak. A key driver around the decision to create the two central facilities from six previous units was the availability of staffing resources and the ability to source additional equipment and consumables within reasonable timescales, as well as the need to continue to achieve compliance of the 2m bed space Health Technical Memoranda regulation when additional beds were added to facilities.

6. Following this initial rapid change in the model of community intermediate care (IMC) and stroke beds in the MSE HCP further modelling of the demand for community beds over the winter period was carried out by Newton Europe, a piece of work commissioned by the MSE system. Following this an options appraisal was undertaken by the HCP on the potential locations of beds for winter 2020, recognising the usual demands of winter whilst also operating in a level 3 incident (since increased to Level 4).

7. In October a decision was made by System Leaders Executive Group to move the majority of beds back to their previous locations with some slight changes to the configuration and number of beds. All community beds had to move out of Braintree Community Hospital as the site was needed by Mid and South Essex Foundation Trust to restart their elective work. The changes reflected the want and ask of local leaders to have local beds in place to support care closer to home. The current configuration of community IMC and stroke beds is set out below:

Place: Location: Name of unit/service: Number of beds: Type of Bed: Cumberledge Intermediate 14 IMC South East Essex Rochford Hospital 22 Care Centre (CICC) 8 Stroke Thurrock Community South West Essex Mayfield 24 Hospital IMC Brentwood Community South West Essex Thorndon Ward 48 Hospital IMC Mid Essex Halstead Hospital Halstead 20 IMC Mid Essex Maldon St Peters 16 Stroke TOTAL 130

8. Work has now commenced on the longer-term plans for community IMC and stroke beds (post April 2021), informed by the work undertaken to date. This will include: • Development of a system strategy for Intermediate Care and Stroke • Development of communication and engagement strategy to ensure engagement in the future model • Development of the case for change for the future model of care for the system ensuring safe and effective outcomes for our population

Data and Intelligence

9. A key deliverable for the data and intelligence workstream has been to deliver an effective model of how infections, illness and deaths from coronavirus may occur to model and manage capacity and demand and generate a daily dashboard across all system partners giving both an update on the modelling estimate and a daily view of capacity across community and hospital services. The metrics used in the dashboard since early summer have been reviewed and a revised dashboard is now in use and available to Board members.

10. The summary of the most recent report at the time of writing (18 November) is:

• Covid-19 demand for Critical care ventilated (ICU) beds has seen an increased from 24/10. On average for the month of November to date (at 17/11) there were 15 patients (range: 9 to 25) with demand at both Basildon and Southend sites.

• Demand for other Covid-19 beds (Level 1 & 2) increased from 25/10 with an average November to date of 120 patients (range: 99 to 141) as at 17/11. Majority of patients (average 77) at Basildon but demand has been increasing at other two sites particularly at Southend.

• Number of positive tests increased across local authorities from 27/09. • Number of daily hospital fatalities was <=3 to 19/10 and now <=8 since 20/10. Note lag in reporting with data shown from 12/11 likely to change.

• For East of England the R0 rate is between 1.1 and 1.4 with growth rate per day for new infections between 2% and 5% (as at 13/11).

• Bed occupancy November to date 16/11, for acute is an average of 79% ranging between 71% & 84% and for community the average is 78% ranging between 67% & 88%.

• The average number of patients who are medically optimised waiting discharge for November to date 16/11 is 72 ranging between 89 and 44.

• The average number of patients with a length of stay over 21 days for November to date (16/11) is 153 ranging between 142 and 168.

11. Full details of numbers of tests, cases, hospitalisations and deaths can be found on publicly accessible websites at https://coronavirus.data.gov.uk/

Recommendation

The Board is asked to note the content of the report. Agenda Item 12

Chair’s Report

Basildon & Brentwood CCG Board Meeting in Public 26 November 2020

Purpose of Report: The Purpose of this paper is to summarise matters that the Chair wishes to bring to the attention of the Board and that require approval.

Recommendations and i. The Board is asked to note the Chair’s update decision/actions: ii. The Board is invited to approve the following:

Item 5: Joint Executive Team appointments. To endorse the decision taken under emergency powers. Item 6: Constitution: The Board is asked to confirm the approach of making limited changes to the constitution to support primary care delegation pending a new single mse constitution in 2021.

Executive Summary 1. Board Meetings in Public (including financial impact): This is the third public meeting held on Teams since the first Covid Lockdown in March/ April 2020. Public meetings will continue to be held using Microsoft Teams or other video technology for the foreseeable future. Below is a summary of the items considered at the Part 2 Board meetings held on 22 October 2020. 2. Part 2 Board meetings 24 September and 22 October 2020 The Board met on 24 September and 22 October and discussed the following:

24 September: • Approval of Anthony McKeever as Joint Accountable Officer for the CCG; • Noting the planning for winter 20/21 and the second wave of Covid 19 • An update from the Interim Chief Finance Officer • An update from the Chief Nurse

22 October: • Approval of the Mid and South Essex CCG statement in response to the Essex Partnership University NHS Foundation Trust (EPUT) Quality Accounts • A discussion paper around proposals to develop Joint Committee decision making • A summary of the Phase 3 submission to NHS England responding to guidance on planning for the remainder of 2020/21. • A progress report on the application to NHS England to take on primary care delegation • An update from the Interim Chief Finance Officer • Arrangements for cover following retirement of the Chief Nurse.

3. Joint Accountable Officer (JAO) A recruitment process for the substantive Joint AO has been put in place during the summer and this culminated with interviews being held during September and a recommendation to appoint Anthony McKeever. This recommendation was approved by the CCG Board in September and was subsequently ratified by NHS England.

4. Board Membership

4.1 The Board is invited to note that Rachel Hearn has been appointed as the Executive Director of Nursing and Quality for Mid and South Essex and will take on the voting role of Chief Nurse on the CCG Board. I would like to welcome Rachel and note that she will also take on the role of Caldicott Guardian. Owing to the difficulty of attending multiple meetings at the same or similar times Rachel has asked that Geraldine as Deputy Chief Nurse be invited to continue to deputise for Rachel at some CCG meetings.

4.2 The Board is invited to note that William Guy has been appointed as Alliance Director for this CCG. William has been a voting member of the CCG Board in the role of Chief Operating Officer. It is proposed that William continues to hold a voting role on the Board and that an amendment be made to the Constitution to reflect the fact that his job title has changed.

4.3 Elections for the SEMC Locality. These elections will be taking place during November/ December with the view to the new three year term starting from 1 January 2021.

5. Emergency Decisions

5.1 JET appointments. I would like the Board to note that as Chair together with the Joint AO Anthony Mckeever, the Chair of Remuneration Committee Katherine Kirk and the Chair of Audit, Nick Spenceley we used the powers held under the emergency provisions to sign off a recommendation from the Remuneration Committee to approve the salary of the four Alliance Directors and the Executive Director of Nursing and Quality. Recommendation: That the decision taken under emergency powers be ratified.

6. Primary Care Delegation: Changes to CCG Constitution

As part of the proposal to submit an application to take on primary care delegation from NHS England with effect from 1 April 2021 the CCG is required to submit aments to the Constitution to NHS England that recognise these changes.

The standard wording within the Constitution and the terms of reference for the Primary Care Committee are dictated by NHS England. As part of the changes NHS England has also asked the CCG to make corrections/ housekeeping changes. As schedule of the proposed changes are attached as appendix 1 to this paper.

It is proposed that following appointments made to the Joint Executive Team it makes sense to use this opportunity to update the list of Executive members within the Constitution.

The Board will be aware that, subject to approval by the CCG Membership, the CCG will be considering an application to merge and form one CCG for Mid and South Essex (mse) to take effect from 1 April 2022. With this in mind the CCG will need to consider the submission of a revised Constitution to NHS England during 2021. It is for this reason that the changes proposed here are limited to changes required to enable primary care delegation and other housekeeping changes/ corrections.

Recommendation: i. The Board is asked to confirm the approach of making limited changes to the constitution as part of the application to take on primary care delegation pending a new single mse constitution being adopted during 2021. ii. The Board is asked to note the track changes proposed to the Constitution set out in appendix 2.

Written by/Presented by: Dr ‘Boye Tayo, Chair

Executive Director William Guy, Alliance Director Sponsor:

Non-Officer/Board Dr ‘Boye Tayo, Chair Sponsor:

Fit with CCG Strategic N/A Objectives? Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). N/A

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) 

Has the Equality/Quality/Privacy Impact Assessment  been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF:

Conflicts of Interest: None

Escalation: To the Board N/A To another Committee N/A To the BAF/CRR N/A Chair’s Report November 2020: Appendix 1 Proposed Changes to BBCCG Constitution & Corporate Governance Manual (Comprising Standing Orders, Scheme of Reservation & Delegation and Standing Financial Instructions) to enable Primary Care Delegation.

Proposed Change Reference in Reason documents 1 Vice Chair to Deputy Chair (various changes Required by throughout Const & NHSE Corporate Gov Man 2 Definition of Chief Operating Officer Section 8 Definitions For updating page 6 and clarity 3 Definition of Deputy Chair refined Section 8 Definitions for clarity page 7 4 Para 17.7 – include reference to Procurement Page 15 For accuracy Cttee and new Primary Care Commissioning Committee (PCCC) 5 Para 18.1 – include after Chief Operating Officer Page 15/16 For updating (Alliance Director or other place based Executive and clarity Lead) & add after Chief Nurse a new bullet – other officers appointed to the JET (non-voting) 6 Para 19.2 proceedings of GB – final bullet Para 19.2 page 19 For clarify amended to “in the absence of Chair, the Deputy Chair will Chair the meeting. 7 Para 35.1 Reference to para 6 rather than 14.6 – Para 35.1 page 37 For accuracy in hindsight this should refer to 14.5 & 14.6. 8 Para 41 insert reference to Primary Care New para 41 page For Commissioning Committee (PCCC) 41 delegation of PC functions 9 Update to schedule 8 to include Procurement Schedule 8 For accuracy Cttee and new Primary Care Commissioning Committee (PCCC) 10 Para 42 insert reference to the terms of reference New para 42 page For of Audit, Remuneration Committee and PCCC 41 delegation of being laid out as part of schedule 11. PC functions 11 Para 49 – updated listed of CCG membership by Para 49 pages 44 to Correction to locality 48 current list for accuracy 12 Para 59 – insert new Schedule 11 including the Para 59 page 73 to For terms of reference of the Audit Committee, 86 delegation of Remuneration Committee and PCCC PC functions

13 Other minor corrections various Correction to current list for accuracy 14 Section C – Scheme of Reservation and Section C page 24 For Delegation insert ref to Primary Care delegation of Commissioning Committee against “Approval of PC functions primary care decisions relating to delegated responsibilities from NHS England to the CCG”. 12 Other minor corrections – e.g. Quality & Patient Section C - Page 27 For accuracy changed to “Patient and Quality” Chair's Report: Appendix 2

Constitution

Version 5.0 Status V 4.0 Amended by NHS England Sept 2017 Ratified By and Date V 5.0 CCG Board 30 January 2020 NHS England – 07 September 2017 CCG Membership October 2019 NHS England Date tbc Date Effective 12 September 2017 tbc Review period Annually Date of Next Formal Review November 2017 Target Audience All CCG Board members, CCG officers, member practices and their staff, population served by the CCG commissioned services are of the highest 1 Foreword quality, making most effective use of resources and bringing care closer to home. This Constitution sets out the terms on which the Clinical Commissioning Group through its appointed and/or co-opted Governing Body / 4 Chair Statement Board (the Governing Body) shall implement all The group will promote good governance and statutory obligations including but not limited to proper stewardship of public resources in commissioning of secondary health and other pursuance of its goals and in meeting its services in the Locality. This Constitution shall statutory duties Good corporate governance also contain the main governance rules of the arrangements are critical to achieving the Clinical Commissioning group and its CCGs objectives. Governing Body.

Each Member has agreed to the terms of this Constitution with the intention that by no later 5 Accountable Officer Statement than April 2013 a formal statutory Clinical The CCG operates an integrated approach to Commissioning Group shall have been the management of its business and services. established along similar terms of reference in This includes corporate, financial, clinical, accordance with, and subject to, any relevant information and research governance legislation pertaining to govern and regulate the principles. In accordance with section same. 14L(2)(b) of the 2006 Act (inserted by section of Each Member by its signature to this 25 of the 2012 Act), the group will at all times Constitution shall agree that it is a member of observe “such generally accepted principles of good governance” in the way it conducts its the Clinical Commissioning Group and will adhere to, and work in accordance with its business. These include: terms. a) The highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship 2 Aims and Values of public funds, the management of the organisation and the conduct of its The NHS belongs to the people (NHS Constitution, March 2010) business; Basildon and Brentwood CCG supports the b) The Good Governance Standard for founding principles and values of the NHS. It Public Services (CIPFA) will conduct its core commissioning activity c) The standards of behaviour published under the ethos of the NHS for patients, for by the Committee on Standards in clinicians, for citizens. Public Life (1995) known as the ‘Nolan Principles’ The CCG aims to deliver, in partnership with its d) The seven key principles of the NHS patients, a local health service that continually Constitution; improves to meet today’s demand and e) The Equality Act 2010. tomorrow’s need.

3 Mission

The practices of the CCG will work closely together to improve patient care, where the needs of patients should be at the very heart of clinical decision making. Members will work together with stakeholders to ensure that

NHS Basildon and Brentwood CCG Constitution v4.0 Page 1 of 67 CONTENTS

1 Foreword ...... 1 2 Aims and Values ...... 1 3 Mission ...... 1 4 Chair Statement ...... 1 5 Accountable Officer Statement ...... 1 6 Statutory Framework ...... 4 7 Background ...... 4 8 Definitions ...... 5 9 Interpretation ...... 8 10 Commencement and duration ...... 8 11 Name ...... 9 12 Locality ...... 9 13 Principal purpose ...... 9 14 Membership ...... 9 15 Accountability of the CCG ...... 10 16 Functions and general duties ...... 11 17 Decision making: the governing structure ...... 14 18 Members of the governing body of the CCG ...... 15 19 Governance of the Governing Body (Board) ...... 18 20 Role of the Governing Body ...... 22 21 The ChairmanChair and Vice ChairmanChair ...... 24 22 Accountable officer (Chief Officer / Chief Clinical Officer) ...... 25 23 GP Members ...... 26 24 Lay Members ...... 26 25 Secondary care specialist and Board nurse ...... 26 26 Chief Operating Officer & Chief Finance Officer ...... 27 27 Accountability and rules of engagement with Member Practices ...... 27 28 Devolved commissioning structures ...... 28 29 Joint working with other CCGs ...... 28 30 Conflict of interest ...... 33 31 Declaration of conflict of interest ...... 34 32 Failure to disclose conflict of interest ...... 36

NHS Basildon and Brentwood CCG Constitution v54.0 Page 2 of 67

33 Transparency in procuring services ...... 36 34 Transparency, ways of working and standing orders ...... 36 35 Termination of membership of the clinical commissioning group ...... 37 36 Public and patient involvement in commissioning of health services ...... 38 37 Responsibilities to external bodies and agencies ...... 38 38 Employment, remuneration and expenses ...... 39 39 Audit Committee ...... 40 40 Remuneration Committee ...... 40 41 STP Joint Committee ...... 41 42 Dispute resolution ...... 42 43 Confidentiality ...... 42 44 Variation ...... 42 45 Notices ...... 42 46 Distribution ...... 43 47 Schedule 1 - list of member practices of the Clinical Commissioning Group ...... 44 48 Schedule 2 – appointment of General Practitioners to serve as members of the Governing Body of Basildon and Brentwood Clinical Commissioning Group ...... 53 49 Schedule 3 – proxy form ...... 56 50 Schedule 4 – devolved commissioning structures ...... 58 51 Schedule 5 – member, governing body member, committee and sub-committee member and employee declaration form: financial and other interests ...... 62 52 Schedule 6 – dispute resolution procedures ...... 66 53 Schedule 7 – approval of standing financial instructions, standing orders and scheme of delegation ...... 69 54 Schedule 8 – Clinical Commissioning Group Committee Structure ...... 70 55 Schedule 9 – Basildon and Brentwood NHS CCG etiquette protocols ...... 71 56 Schedule 10 – NHS constitution ...... 72

NHS Basildon and Brentwood CCG Constitution v54.0 Page 3 of 67 6 STATUTORY FRAMEWORK

Clinical commissioning groups were established under the Health and Social Care Act 2012 (“the 2012 Act”).1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (“the 2006 Act”).2 The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision.3

The NHS Commissioning Board (otherwise known as NHS England) is responsible for determining applications from prospective groups to be established as clinical commissioning groups4 and undertakes an annual assessment of each established group.5 It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.6 Approval is required from NHS England

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.7

7 Background

From 1st April 2013, NHS Basildon and Brentwood CCG has operated as a statutory body, authorised by NHS England under the auspices of the 2012 Act. This constitution has been set out to establish how statutory obligations will be met by the CCG

1 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act 4 See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act 5 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 6 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 7 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued

NHS Basildon and Brentwood CCG Constitution v54.0 Page 4 of 67 8 Definitions

The 2006 Act means the National Health Service Act 2006

The 2012 Act means the Health and Social Care Act 2012 Accountable Officer means an individual who is appointed by the NHS Commissioning Board and who may be a member or employee of the CCG or of anybody who is a Member of the CCG and whose duties and responsibilities are set out in paragraph 14 herein. This post may also referred to as the Chief Officer where the role is undertaken by the CCG’s most senior manager or the Chief Clinical Officer where the role is undertaken by the Clinical Leader.

Any Qualified means the Any Qualified Provider principle to be applied by the Provider (AQP) Governing Body when engaging in the commissioning of health care services.

Board means the appointed and/or elected members of the CCG having the duties and responsibilities as set out in this constitution. The Board is also referred to as the Governing Body.

Budget means the financial resources delegated to the Governing Body for the purposes of commissioning and all relevant and related services and functions including, but not limited to, the responsibilities as set out in paragraph 14 herein and any relevant legislation

Business Day means 9.00am until 5.00pm (other than a Saturday or Sunday or a Bank or Public Holiday).

Chair of the may be any member of the governing body other than the governing body Accountable Officer, Chief Finance Officer, Secondary Care Specialist Doctor, Registered Nurse (Board Nurse) or the Lay Member with the lead role in overseeing key elements of financial management and audit. The Chair of the governing body may also be the Clinical Leader of the CCG.

Chief Finance is the CCG’s most senior employee with a professional qualification Officer in accountancy, who has the experience to lead the financial management of the CCG and is a member of the governing body.

Chief Finance and describes circumstances where a CCG has a Chief Clinical Officer Operating Officer (hence a clinician who undertakes the accountable officer role) and they decide to appoint a single individual to undertake the combined roles of the Chief Operating Officer and Chief Finance Officer.

Chief Officer means an individual who is appointed by the NHS Commissioning Board and who may be a member or employee of the CCG or of anybody who is a Member of the CCG and whose duties and responsibilities are set out in paragraph 5 herein. This post is also known as the Accountable Officer, but is referred to as the Chief

NHS Basildon and Brentwood CCG Constitution v54.0 Page 5 of 67 Officer when the role is undertaken by the CCG’s most senior manager.

Chief Operating means the officer responsible for the day to day management of Officer the CCG at a ‘Place’ level. It is the CCG’s most senior manager in circumstances when the CCG has a Chief Clinical Officer (i.e. its clinical leader undertakes the Accountable Officer role) At Basildon and Brentwood CCG the role is known as Alliance Director.

Clinical means the NHS Basildon and Brentwood CCG formed in Commissioning accordance with and approved by the NHS Commissioning Board. Group

Clinical Leader is the individual, recognised by the CCG as the leading clinician who represents the clinical voice of its members. This individual will be invited to be the CCG’s member of the NHS Commissioning Assembly. They will either be the Chair of the governing body or undertake the role of Accountable Officer. In circumstances where a CCG chooses to appoint a clinician to the Chair of the governing body and nominate a clinician for the role of the Accountable Officer (to be appointed by the NHS Commissioning Board), then the CCG should identify one of them to be known as the Clinical Leader. This will be recorded in minutes of a Board meeting where appointed posts of the CCG are confirmed.

Commencement means the date of commencement of this Constitution being TBC Date once approved by NHS England

Conflict of Interest means any conflict of interest as set out in paragraphs 30 & 3123.

Constitution means this Constitution as amended from time to time in accordance with its terms and all schedules to it.

Governing Body means the body who ensures that the CCG has appropriate arrangements in place to exercise their functions effectively, efficiently and economically and in accordance with the generally accepted principles of good governance and the constitution of the CCG. The governing body is also referred to as ‘the Board’.

Locality means the locality groups of Basildon and Brentwood that together constitute the CCG as described in Schedule 4.

Local Medical means the South Essex Local Medical Committee. Committee

Member means the Members of the CCG (which may change from time to time), being a GP Practice or primary care services provider holding a contract for the provision of primary medical services i.e. General Medical Services, Personal Medical Services or Alternative Personal Medical Services contract.

NHS means the body corporate as identified in the Health and Social Commissioning Care Act 2012 Board / NHS England

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Observer means a non-voting appointed/co-opted Member of the Governing Body.

Performers List means a medical performers list prepared and published by NHS Performers List Regulations 2004, as amended.

Provider means any company, partnership, voluntary organisation, social enterprise, charity or organisation which may from time to time enter or seek to enter or have entered into arrangements to provide secondary medical services or social care services or any other goods and services by virtue of being commissioned by the CCG.

QIPP Means Quality, Innovation, Productivity and Prevention (QIPP). The QIPP agenda is a key part of the NHS reforms, helping to ensure that value for money is further enhanced while quality is maintained or improved.

Deputy Chair Vice Means the Deputy Chair vice chairmanChair of the CCG, ChairmanChair appointed to deputise for the Chair in the event of the Chair being unable or unavailable to actbut may also be referred to at the ‘deputy chair’. STP Sustainability and Transformation Partnership

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9 Interpretation

In this agreement:

9.1 Unless otherwise stated, words or expressions contained in this constitution shall bear the same meaning as in the Health and Social Care Act 2012.

9.2 Words importing the masculine gender only shall include the feminine gender; words importing the singular shall import the plural and vice-versa.

9.3 References to any person shall include natural persons and partnerships, firms and other incorporated bodies and all other legal persons of whatever kind and however constituted and their successors, permitted assigns or transferees;

9.4 References to any statute, enactment, order, regulation or other similar instrument shall be construed as a reference to the statute, enactment, order, regulation or instrument as amended by any subsequent enactment, modification, order, regulation or instrument as subsequently amended or re-enacted;

9.5 Headings are included in this Agreement for ease of reference only and shall not affect the interpretation or construction of this Agreement; and

9.6 Reference to a paragraph is a reference to the whole of that paragraph unless stated otherwise and in the event and to the extent only of any conflict between the paragraphs and the Schedules, the paragraphs shall prevail over the Schedules.

9.7 Reference to ‘stakeholders’ within this constitution shall include, but is not limited to:

. General Practices . Other CCGs . (Shadow) Health and Wellbeing Board . Local Authorities . LINks, (shadow) local HealthWatch and other patient groups . NHS Providers (including NHS Trusts, NHS Foundation Trusts, Mental Health Trusts and Community Trusts), and other Providers . Clinical Networks . Commissioning Support Services . The public in general . Voluntary sector organisations NHS Commissioning Board and other regulatory bodies.

10 Commencement and duration

10.1 This constitution is made between the members of Basildon & Brentwood CCG and shall commence on the Commencement Date and continue in force until such a time as it may be amended in line with the procedures for amending CCG constitutions published by NHS England in May 2013. The constitution is published on the CCG’s website.

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11 Name

11.1 The name of the Clinical Commissioning Group is “NHS Basildon and Brentwood Clinical Commissioning Group (BBCCG)” and will be referred to thereafter as “the CCG” or “BBCCG”.

12 Locality

12.1 The overall locality of the CCG shall be NHS Basildon and Brentwood and shall be made up of the member practices as set out in Schedule 1 of this Constitution, grouped into individual localities described in Schedule 4. Most practices shall reside within the geographical boundaries of Basildon and Brentwood. The geographical area covered by the CCG is therefore fully coterminous with Basildon and Brentwood Borough Councils.

13 Principal purpose

13.1 The principal purpose of the CCG is to act as the body that discharges devolved commissioning responsibility for its registered population ensuring local health services meet evidenced needs and offer best value for money for use of NHS financial resources

13.2 The duty of board members is to commission services for their population, functioning as a unitary board, taking collective responsibility for the governance of the organisation and decisions of the board. Board members are also responsible for facilitating communication between the localities and the Board.

14 Membership

Application for membership

14.1 Applications from other practices to enter Basildon and Brentwood CCG should initially be made to any of the Chair of the relevant locality.

14.2 A new practice may join only through one of the existing localities, and if they are willing to abide by the constitution, principles and governance arrangements of the CCG.

14.3 An unsuccessful applicant will have the right of appeal to the CCG Chair.

14.4 Schedule 1 of this constitution contains the list of practices, together with each locality lead signing a ‘Memorandum of Agreement’ confirming their agreement to this constitution along with the duties and responsibilities of the CCG and member practices.

Eligibility of Membership

14.5 Any General Practice situated within the geographical area covered by the CCG which holds a contract for the provision of primary medical services and whose practice population is in the majority resident in Basildon and Brentwood shall be eligible for

NHS Basildon and Brentwood CCG Constitution v54.0 Page 9 of 67 membership of the CCG.

14.6 No Practice shall become a Member of the CCG unless that Practice:

a) is a holder of a primary medical contract; b) is a primary care services provider in the relevant Locality; c) has completed an application for membership to the CCG; d) has submitted an application to the NHS Commissioning Board and had its application approved; and has been entered into the Register of Members (schedule 1).

Expulsion

14.7 A member practice shall only be expelled from the CCG through the provision of relevant statute.

15 Accountability of the CCG

15.1 The group will demonstrate its accountability to its members, local people, stakeholders and the NHS Commissioning Board in a number of ways, including by:

a) publishing its constitution; b) appointing independent lay members and non GP clinicians to its governing body; c) holding meetings of its governing body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting); d) publishing annually a commissioning plan; e) complying with local authority health overview and scrutiny requirements; f) meeting annually in public to publish and present its annual report (which must be published); g) producing annual accounts in respect of each financial year which must be externally audited; h) having a published and clear complaints process; i) complying with the Freedom of Information Act 2000; j) providing information to and working with the NHS Commissioning Board as required.

In taking these steps to demonstrate its accountability, the CCG will also therefore facilitate stakeholder understanding and awareness of CCG priorities.

15.2 In addition to these statutory requirements, the group will demonstrate its accountability by:

k) Publishing its principal commissioning and operational policies e.g. a policy about funding exceptional cases l) Holding engagement events up to four times per annum.

15.3 The governing body of the group will throughout each year have an ongoing role in reviewing the group’s governance arrangements to ensure that the group continues to

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16 Functions and general duties

16.1 The functions that the group is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health’s Functions of clinical commissioning groups, June 2012. They relate to:

a) commissioning certain health services (where the NHS Commissioning Governing Body is not under a duty to do so) that meet the reasonable needs of: I. all people registered with member GP practices, and II. people who are usually resident within the area and are not registered with a member of any clinical commissioning group; b) commissioning emergency care for anyone present in the group’s area; c) paying its employees’ remuneration, fees and allowances in accordance with the determinations made by its governing body and determining any other terms and conditions of service of the group’s employees; d) determining the remuneration and travelling or other allowances of members of its governing body.

16.2 In discharging its functions, the group will:

a) act, when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and the NHS Commissioning Board of their duty to promote a comprehensive health service and with the objectives and requirements placed on the NHS Commissioning Board through the mandate published by the Secretary of State before the start of each financial year; b) Meet the public sector equality duty; c) Work in partnership with its local authority[ies] and neighbouring CCGs to develop joint strategic needs assessments and joint health and wellbeing strategies. The CCG will achieve this by: I. Delegating responsibility to . The CCG’s governing body (Governing Body), . The audit and remuneration committees, and other committees as set out in Schedule 8 of this constitution II. Establishing key policy documentation that defines the integrated governance framework of the CCG such as its Standing Financial Instructions, Standing Orders, Scheme of Delegation, Commissioning Strategy and other key documentation available on the CCG internet. III. Establishing measurable objectives within its Commissioning Strategy that are monitored and published annually and revised at least every four years. IV. establishing commissioning and QIPP plans to support the delivery of the strategy that clearly set out inter alia the mechanisms for collaborating with neighbouring CCGs;

NHS Basildon and Brentwood CCG Constitution v54.0 Page 11 of 67 V. Monitoring progress of the delivery of its duties, to be monitored through the CCG reporting mechanisms defined within the terms of reference of the aforementioned sub-committees, as defined in schedule 8. VI. Publishing, at least annually, sufficient information to demonstrate compliance with this general duty across all CCG functions.

16.3 General Duties – in discharging its functions the group will:

a) Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements b) Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution c) Act effectively, efficiently and economically d) Act with a view to securing continuous improvement to the quality of services e) Assist and support the NHS Commissioning Board in relation to the Governing Body’s duty to improve the quality of primary medical services f) Have regard to the need to reduce inequalities g) Promote the involvement of patients, their carers and representatives in decisions about their healthcare h) Act with a view to enabling patients to make choices i) Obtain appropriate advice from persons who, taken together, have a broad range of professional expertise in healthcare and public health j) assess the information requirements of the CCG using the Commissioning Intelligence Self-Assessment Tool (CISAT) to ensure there is sufficient capacity / capability to deliver those requirements and assess its capability to meet information governance requirements managed in accordance with legislation and best practice as defined within the NHS Information Governance toolkit; k) Promote innovation l) Promote research and the use of research m) Have regard to the need to promote education and training for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty n) Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the group considers that this would improve the quality of services or reduce inequalities. The CCG will achieve this by: I. Delegating responsibility to . The CCG’s governing body (Governing Body), . The audit and remuneration committees, and other committees as set out in Schedule 8 of this constitution

NHS Basildon and Brentwood CCG Constitution v54.0 Page 12 of 67 II. Establishing key policy documentation that defines the integrated governance framework of the CCG such as its Standing Financial Instructions, Standing Orders, Scheme of Delegation, Commissioning Strategy and other key documentation available on the CCG internet. III. Establishing measurable objectives within its Commissioning Strategy that are monitored and published annually and revised at least every four years. This will have specific regard to equality and diversity. IV. Monitoring progress of the delivery of its duties, to be monitored through the CCG reporting mechanisms defined within the terms of reference of the aforementioned committees V. Publishing, at least annually, sufficient information to demonstrate compliance with this general duty across all CCG functions.

16.4 General Financial Duties – the group will perform its functions to as to:

a) Ensure its expenditure does not exceed the aggregate of its allotments for the financial year b) Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by the NHS Commissioning Board for the financial year c) Take account of any directions issued by the NHS Commissioning Board, in respect of specified types of resource use in a financial year, to ensure the group does not exceed an amount specified by the NHS Commissioning Board d) Publish an explanation of how the group spent any payment in respect of quality made to it by the NHS Commissioning Board. The CCG will achieve this by: I. Delegating responsibility to . The CCG’s governing body (Governing Body), . The audit and remuneration committees, and other committees as set out in Schedule 8 of this constitution II. Establishing key policy documentation that defines the integrated governance framework of the CCG such as its Standing Financial Instructions, Standing Orders, Scheme of Delegation, Commissioning Strategy and other key documentation available on the CCG internet. III. Establishing measurable objectives within its Commissioning Strategy that are monitored and published annually and revised at least every four years. This will have specific regard to equality, [insert more...]; IV. Monitoring progress of the delivery of its duties, to be monitored through the CCG reporting mechanisms defined within the terms of reference of the aforementioned sub-committees, as defined in schedule 8. V. Publishing, at least annually, sufficient information to demonstrate compliance with this general duty across all CCG functions.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 13 of 67 16.5 Other relevant regulations, directions and documents

a) The group will I. comply with all relevant regulations; II. comply with directions issued by the Secretary of State for Health or the NHS Commissioning Board; and III. take account, as appropriate, of documents issued by the NHS Commissioning Board. b) The group will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant group policies and procedures.

17 Decision making: the governing structure

Authority to Act

17.1 The clinical commissioning group is accountable for exercising the statutory functions of the group. It may grant authority to act on its behalf to:

a) any of its members; b) its governing body; c) employees; d) a committee or sub-committee of the group.

17.2 The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the group as expressed through:

a) the group’s scheme of reservation and delegation; and b) for committees, their terms of reference.

Scheme of Reservation and Delegation8 (refer to section 53: Schedule 7)

17.3 The group’s scheme of reservation and delegation sets out:

a) those decisions that are reserved for the membership as a whole; b) those decisions that are the responsibilities of its governing body (and its committees), the group’s committees and sub-committees, individual members and employees.

17.4 The clinical commissioning group remains accountable for all of its functions, including those that it has delegated.

8 Also referred to as ‘Scheme of Delegation’ or ‘SoD’.

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General

17.5 In discharging functions of the group that have been delegated to its governing body (and its committees), individuals must:

a) comply with the group’s principles of good governance, b) operate in accordance with the group’s scheme of reservation and delegation, c) comply with the group’s standing orders, d) comply with the group’s arrangements for discharging its statutory duties, e) where appropriate, ensure that member practices have had the opportunity to contribute to the group’s decision making process.

17.6 When discharging their delegated functions, committees, sub-committees and joint committees must also operate in accordance with their approved terms of reference (refer to section 54 schedule 8).

Committees of the Group

17.7 The committees established by the group are described in schedule 8. The following committees have been established by the group:

1. Clinical Executive Committee 2. Audit Committee 3. Remuneration Committee 4. Governance Committee 5. Finance and Performance Committee 6. Patient Safety and Quality Committee 7. STP Joint Committee 8. Procurement Committee 7.9. Primary Care Commissioning Committee

18 Members of the governing body of the CCG

18.1 The Governing Body shall have the right to decide the maximum number of members from time to time, notwithstanding that the majority shall be practising clinicians. This should take account of9:

. ChairmanChair, Deputy Vice Chairman . Accountable Officer . Chief Operating Officer (Alliance Director or other place based Executive lead) . Chief Finance Officer . A maximum of 12 GP members and no maximum on the number elected from each locality as formula is 1 to 25,000 registered patients . At least two Lay members . Secondary Care Specialist Doctor

9 The roles described in section 180.1 are clearly defined in the definitions table at the outset of the constitution. Confirmation of the appointed roles of officers within the CCG will be formally recorded within minutes of a Board meeting and will be appended as an addendum to this constitution.

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. Chief Nurse . Other Officers appointed to the Joint Executive Team (non-voting)

18.2 Each of the key roles listed above will be appointed and remunerated, following determination by the Remuneration Committee and such determination shall be in accordance with the NHS Commissioning Board guidance on ‘Role Outlines, Attributes and skills published July 2012 or any superseding guidance, Act or provision made from time to time.

18.3 The roles and responsibilities of Governing Body members will be documented within comprehensive job descriptions approved by the Remuneration Committee.

18.4 The Governing Body may also co-opt observers and attendees with speaking rights to attend meetings as required including, but not limited to:

Essex County Council Public Health Consultant (or equivalent)

Essex County Council Director of Social Services (or equivalent)

Eligibility for Governing Body Membership

18.5 No person shall be appointed a CCG Governing Body Member if he or she:

. Is not eligible to work in the UK . Becomes of unsound mind . Is adjudged bankrupt . Is convicted of a criminal offence . Is guilty of immoral behaviour . Is the subject of a national disqualification by the General Medical Council or has been removed from the Medical Performers’ List on the grounds of suitability of efficiency. . Has been dismissed (except by redundancy) by an NHS body . Is subject to a disqualification order set out under the Company Directors Disqualification Act 1986 . Has been removed from acting as a trustee of a charity.

Elections to the Governing Body

18.6 Where necessary, as part of the appointment of GP members, the Governing Body shall conduct elections at least every 3 years, in accordance with the principles as set out in Schedule 2. During the first 3 years’ elections will be staggered to ensure some Formatted: Font: (Default) Arial consistency of Governing Body members, and a rolling programme of elections will then be adopted in line with this phased approach.

18.7 In order to maintain fairness and equality during the electoral process the elections shall be conducted in line with the principles set out by North and South Essex Local Medical Committees Limited.

18.8 Any GP wishing to stand for appointment to the Governing Body shall do so in accordance with the criteria as set out in Schedule 2.

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Removal / Disqualification from the Governing Body

18.9 A Governing Body member shall be removed from office:

a) If a receiving order is made against him or he makes any arrangement with his creditors. b) If in the opinion of the Governing Body (having taken appropriate professional advice in cases where it is deemed necessary) he becomes or is deemed to be of unsound mind. c) If he ceases to be a provider of primary medical services, or engaged in or employed to deliver primary medical services, other than those lay Members of the Governing Body who have been duly appointed or elected by the Governing Body. d) If he is suspended from providing primary medical services in which case the removal or suspension from the Governing Body shall be at the discretion of the Governing Body. e) If he shall be convicted of a criminal offence whereby the sentence imposed shall be for a minimum of 6 months’ imprisonment (whether such sentence is held to be suspended or conditional). f) If he shall have behaved in a manner or exhibited conduct which has or is likely to be detrimental to the honour and interest of the Governing Body or the Clinical Commissioning Group and is likely to bring the Governing Body and/or Clinical Commissioning Group into disrepute. This includes but is not limited to dishonesty, misrepresentation (either knowingly or fraudulently), defamation of any Member of the Governing Body (being slander or libel), abuse of position, non-declaration of a known conflict of interest, seeking to lead or manipulate a decision of the Governing Body in a manner that would ultimately be in favour of that Member whether financially or otherwise. g) Where he has become ineligible to stand for a position as a result of the declaration of any Conflict of Interest under paragraph s 30 and 31. 23.

Tenure

18.10 The term of appointment for CCG Governing Body Members is 3 years. Governing Body members will be eligible to stand again if they wish to stand for another term (with the exception of the Chair see section 13)

18.11 The term of appointment of GP Governing Body members is not subject to recall by the localities.

Conduct of Governing Body Members

18.12 Employees, members, committee and sub-committee members of the group and members of the governing body (and its committees) will at all times comply with this constitution and be aware of their responsibilities as outlined in it. All Governing Body members and staff working on behalf of the CCG shall adhere to the seven Nolan

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Principles of Public Life (1995, definitions as revised in January 2013) as follows:

SELFLESSNESS

Holders of public office should act solely in terms of the public interest. INTEGRITY

Holders of public office must avoid placing themselves under any obligation to people or organisations that might try inappropriately to influence them in their work. They should not act or take decisions in order to gain financial or other material benefits for themselves, their family, or their friends. They must declare and resolve any interests and relationships. OBJECTIVITY

Holders of public office must act and take decisions impartially, fairly and on merit, using the best evidence and without discrimination or bias.

ACCOUNTABILITY

Holders of public office are accountable to the public for their decisions and actions and must submit themselves to the scrutiny necessary to ensure this

OPENNESS

Holders of public office should act and take decisions in an open and transparent manner. Information should not be withheld from the public unless there are clear and lawful reasons for so doing.

HONESTY

Holders of public office should be truthful

LEADERSHIP

Holders of public office should exhibit these principles in their own behaviour. They should actively promote and robustly support the principles and be willing to challenge poor behaviour wherever it occurs.

18.13 All members of the Governing Body and all CCG staff must comply with the group’s policy on business conduct, including the requirements set out in the policy (and S30 - 3122-24 of this constitution) for managing conflicts of interest. This policy will be available on the CCG’s website.

19 Governance of the Governing Body (Board)

19.1 General

. Every term of office shall commence on announcement of the outcome of any vote/ballot which shall take place at the outset of the meeting of the Governing Body. Any term of office shall also subsequently cease after the announcement of the new officers.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 18 of 67 . The Governing Body shall have the authority to engage, employ or appoint any consultant, employee or private contractor in order to facilitate the performance of its duties. Such individuals may be present at any Governing Body meetings at the discretion of the Governing Body but shall not be entitled to any voting rights. . The Governing Body shall have the right to establish an Executive Team or any such committee that it deems necessary to aid in the discharge of its responsibilities.

19.2 Proceedings of the Governing Body

. The Governing Body Members may fix for each year dates, times and places on and at which meetings are to be held. . The Notice of such meetings shall be served no less than 7 working days to all Governing Body members and if particulars have been given in writing no less than 1 month before the first of those meetings, no further notice need be given of them. . The Governing Body shall meet in public 6 times per year during the interim period (prior to authorisation) and transition period (a year from the date of authorisation) moving to all Board meetings being held in public thereafter. . Any business deemed prejudicial to the public interest (paragraph 8(3) of Schedule 2 of the 2012 Act) shall be held in a private session of the Board under ‘Part II’ business. . Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the chair or the Governing Body or relevant committee at least 10 working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at lead 7 working days before the meeting takes place. . The date, time and venue of all Governing Body meetings will be made public with at least 7 days’ notice on the CCG website. The notice shall include the agenda and papers related to the agenda. . No meeting of the Governing Body shall be held without either a Chairman or Vice Chairman being present. In the absence of the Chair, the Deputy Chair will Chair the meeting. If neither is present or able to Chair, then a temporary Chairman shall be nominated from the remaining Governing Body members.

19.3 Quorum

. The quorum at meetings shall be no less than 50% of the full Governing Body, with clinicians in the majority. Localities should ensure representation, by delegation or proxy if Governing Body Members are not themselves available. . Any quorum of the Governing Body or its sub-committees shall exclude any member affected by a Conflict of Interest under sections 30 and 31 22. If this paragraph has the effect of rendering the meeting in-quorate, then the Chairman shall decide whether to adjourn the item in question to another meeting. . For all other of the group’s committees and sub-committees, including the governing body’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 19 of 67 19.4 Voting

. Each locality shall have voting rights in accordance with the rules set out in Schedule 4. . All members of the Governing Body shall be permitted to carry a vote on any decision of the Governing Body. No Observer or co-opted member shall carry a vote. In the case of an equality of votes, the ChairmanChair shall carry the casting vote. . Any elected Member of the Governing Body shall be entitled to nominate a proxy to vote on his behalf in the event that he cannot attend a meeting of the Governing Body. In those circumstances the ChairmanChair (or acting ChairmanChair) should be informed one week prior to the meeting of the non-attendance and shall receive a duly completed and authorised proxy form, as per Schedule 3 of this Constitution. . Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting. . For all other of the group’s committees and sub-committees, including the governing body’s committees and sub-committee, the details of the process for holding a vote are set out in the appropriate terms of reference.

19.5 Decisions

. In so far as possible the CCG Governing Body shall endeavour to reach decisions by consensus. . Notwithstanding the above, the Decision of the Governing Body shall be by simple majority of those present at a meeting in by virtue of the votes they hold. . A decision that has a profound effect such as removing the commissioning rights of the locality or expropriating the right of a Governing Body Member (e.g. expulsion) shall only be made if supported by three quarters of the total members by virtue of the votes they hold. Such motion can only be moved on the floor if two thirds of the voting members are in support. . The CCG Governing Body will reach decisions through processes enshrined in its constitution and in accordance with law.

19.6 Observers

. The Governing Body may in its absolute discretion invite such persons as it thinks fit to attend the whole or any part of the Governing Body meeting (such persons shall not be permitted to vote).

19.7 In Camera/Closed Sessions

. The ChairmanChair of the Governing Body can determine items that need to be discussed in closed session. . The Governing Body may require all or any of the invited observers to withdraw from any meeting if it wishes to consider any business in camera.

19.8 Annual General Meeting

NHS Basildon and Brentwood CCG Constitution v54.0 Page 20 of 67 . The CCG shall hold an Annual General Meeting (AGM) once in each year provided that not more than 15 months shall elapse between the date of one Annual General Meeting and that of the next. . The AGM shall be held in publically accessible premises within the geographical area of the CCG.

19.9 Minutes

. The Governing Body shall keep records and proper minutes of all Governing Body meetings, resolutions and business conducted. . The names of all members of the meeting, present at the meeting shall be recorded in the minutes of the meeting. This shall apply to all meetings of the Governing Body and committee meetings. . The accuracy of minutes will be discussed approved and minuted at subsequent meetings of the Governing Body or relevant committee. . Minutes of all formal meetings will be a matter of public record.

19.10 Petitions

. Where a petition has been received by the group, the chair of the governing body shall include the petition as an item for the agenda of the next meeting of the governing body.

19.11 Chair of a meeting

. At any meeting of the group or its governing body or of a committee or sub- committee, the chair of the group, governing body, committee or sub-committee, if any and if present, shall preside. If the chair is absent from the meeting, the deputy chair, if any and if present, shall preside. . If the chair is absent temporarily on the grounds of a declared conflict of interest the deputy chair, if present, shall preside. If both the chair and deputy chair are absent, or are disqualified from participating, or there is neither a chair or deputy a member of the group, governing body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.

19.12 Chair’s ruling

. The decision of the chair of the governing body on questions of order, relevancy and regularity and their interpretation of the constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.

19.13 Emergency powers and urgent decisions

. The powers which the Governing Body has reserved to itself may in emergency or for an urgent decision be exercised by the Accountable Officer and the ChairmanChair after having consulted at least two non-officer members. The exercise of such powers by the Accountable Officer and ChairmanChair shall be

NHS Basildon and Brentwood CCG Constitution v54.0 Page 21 of 67 reported to the next formal meeting of the CCG PCT Governing Body in public session for formal ratification.

19.14 Sub-Committees

. The Governing Body shall have the authority to delegate any of its activities to a subcommittee. Such sub-committee shall be made up of either members of the Governing Body, any consultants and/or employees approved by the Governing Body. . The Governing Body has appointed a number of committees, which includes an Audit Committee and Remuneration Committee (described in sections 31 and 32 respectively). The full committee structure arrangements are described in Schedule 8. . All meetings of Governing Body appointed committees shall be governed by the arrangements set out within this section (11). . All committees shall have an approved Terms of Reference defining the role and responsibility of the committee, its membership and governance processes.

19.15 Standing Financial Instructions (SFIs), Standing Orders (SOs) and Scheme of Delegation (SoD).

. The Governing Body shall approve the CCG SFIs, SOs and SoD once satisfied that they adequate represent the needs of the CCG. . Schedule 7 of the constitution will be the form used for such authorisation. . If for any reason the standing orders are not complied with, full details of the non- compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the governing body for action or ratification. All members of the group and staff have a duty to disclose any non-compliance with these standing orders to the Accountable Officer as soon as possible.

20 Role of the Governing Body

20.1 The role of the Governing Body includes among others:

. To carry out delegated commissioning work devolved to it by the participating localities. . In fulfilling these obligations, the Governing Body shall ensure robust arrangements are in place for the CCG so that it demonstrates to its stakeholders that they are discharging their functions responsibly and in the best interests of patients and the public.

20.2 The duties of the CCG Governing Body can be described across six main areas which are:

. Setting of strategic direction

NHS Basildon and Brentwood CCG Constitution v54.0 Page 22 of 67 . Commissioning, Financial and Performance management (meaning performance management of providers of commissioned services, e.g., referral to treatment waiting times etc.) . Locality organisational development . Clinical leadership development . Securing continuous improvement in quality of local health services . Ensuring probity

20.3 These duties are without prejudice to any function or responsibility which has been retained by a participating locality as having exclusive jurisdiction.

In detail the Board shall as far as reasonably practicable:

20.4 Ensure that all providers of primary medical services in the locality are Members of the Clinical Commissioning Group.

20.5 Support a variety and diverse approach to commissioning, particularly for practices to work proactively to improve efficiency and value.

20.6 Encourage innovation by enabling and supporting practices and clinicians in creating changes.

20.7 Engage in a collaborative approach with the local NHS (both with neighbouring CCGs and other Provider organisations) in securing new services for patients fully responsive to local health needs.

20.8 Ensure that there are robust plans and responsibilities assigned to manage staff engagement, external relationships and communications.

20.9 Facilitate the delivery of the required management cost savings whilst ensuring sustainable functions.

20.10 Facilitate the delivery and implementation of any guidance or standards issued by any relevant regulatory body.

20.11 Work with any other appropriate bodies, which are involved at any relevant time, in commissioning or provision of primary and secondary care services.

20.12 Work collaboratively to deliver the patient pathway outcomes and milestones set out in any Local Delivery Plan. This will require on-going discussion between the CCG, partner CCGs and provider organisations about long-term strategy and plans.

20.13 Ensure effective liaison with and reporting to Members of the Clinical Commissioning Group and NHS Commissioning Board (as appropriate).

20.14 Develop and keep under review robust governance arrangements which shall be complied with by all Members within the Clinical Commissioning Group.

20.15 Develop and document systems and processes for dealing with, monitoring and learning from Serious Incidents.

20.16 Comply with all relevant procurement law and policy, amongst other mechanisms, and adhere to the obligations placed on the Board and Clinical Commissioning Group with

NHS Basildon and Brentwood CCG Constitution v54.0 Page 23 of 67 regard to all Providers applying the following principles of:

. transparency and openness, . equality of treatment,

20.17 Be engaged in the day to day management and application of commissioning and related activity in the Locality and shall operate in good faith using all due skill and diligence.

20.18 Fairly and equitably advertise any specific salaried posts.

21 The ChairmanChair and Vice ChairDeputy manChair

21.1 The ChairmanChair and Vice ChairDeputy manChair shall serve on the Governing Body for a period of no more than 3 years after which the positions shall be subject to reappointment. No ChairmanChair shall serve on the Governing Body for a period of more than 3 years without a break of at least 1 year.

21.2 The ChairmanChair and Vice ChairDeputy manChair will be selected by all voting members of the Governing Body. The elected chair will then need to seek the support of at least 66% of each of the member practices of the CCG through a ratification process overseen by the LMC.

21.3 Where the ChairmanChair is a GP, the Vice ChairDeputy manChair shall be a lay member.

21.4 The roles of ChairmanChair and Accountable Officer shall not be held by the same individual. At least one of these posts must be held by a clinical member of one of the member practices.

21.5 The Chair of the Audit and Remuneration Committees could be the Vice ChairDeputy Chair of the Governing Body but would be precluded from being its ChairmanChair.

21.6 Where the ChairmanChair is a lay member of the Governing Body, an alternative lay member will be required to Chair the Remuneration Committee. It is not possible for the Chair of the CCG to also be the Chair of the Remuneration Committee.

21.7 The Accountable Officer, Chief Finance Officer, Secondary Care Specialist Doctor, Registered Nurse (Chief Nurse) or the Lay member with the lead role in overseeing key elements of financial management and audit may NOT be the Chair of the governing body.

21.8 The Chair of the governing body may also be the Clinical Leader of the CCG, where the role is performed by the individual recognised as the leading clinician. Where the role of the Accountable Officer is also performed by a clinician, the CCG shall formally identify one of them to be known as the Clinical Leader. Confirmation of the appointed roles of officers within the CCG will be formally recorded within minutes of a public Board meeting and will be appended as an addendum to this constitution.

21.9 The Vice ChairDeputy manChair deputises for the Chair of the Governing Body where he / she has a conflict of interest or is otherwise unable to act.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 24 of 67 22 Accountable officer (Chief Officer / Chief Clinical Officer)

22.1 The Governing Body will select and appoint an Accountable Officer following ratification by the NHS Commissioning Board.

22.2 The individual who takes on the Accountable Officer role will be proposed by the CCG and appointed to this role by the NHS Commissioning Board referred to in 13.2 above). In circumstances where the Accountable Officer role is undertaken by the Lead Clinician they will be known as the Chief Clinical Officer. When a manager undertakes the role, the individual will be known as the Chief Officer. In circumstances where a CCG chooses to appoint a clinician to the Chair of the governing body and nominate a clinician for the role of the accountable officer (to be appointed by the NHS Commissioning Board), then the CCG should identify one of them to be known as the Clinical Leader. Confirmation of the appointed roles of officers within the CCG will be formally recorded within minutes of a public Board meeting and will be appended as an addendum to this constitution.

22.3 The Accountable Officer will have specific responsibilities for ensuring that the CCG complies with its financial duties, promotes quality improvements and demonstrates value for money.

22.4 The Accountable Officer has ultimate responsibility for the delivery of services in accordance with required standards, which includes ensuring that there is a process in place to reduce health inequalities in access to and the outcome from healthcare. This will be managed via the Patient Safety and Quality Committee. The Accountable Officer must be either,

. A GP who is a member of the CCG (who shall be known as the Chief Clinical Officer); . An employee of the CCG or any member of the CCG (who shall be known as the Chief Officer); or . In the case of a joint appointment, an employee of any member of any of the groups in question or any member of those groups.

22.5 Where the Accountable Officer iss a clinician, in addition to the Accountable Officer’s general duties (working in partnership with a senior manager) they will take the lead in interactions with stakeholders, including the NHS Commissioning Board.

Where the Accountable Officer is a not a clinician from the member practices, then the chair of the Governing Body must be elected from the clinical members.

2214.6. In the event of short-term absence (up to approximately one month), the Chief Nurse, Formatted: Indent: Hanging: 1.27 cm Chief Finance Officer or a member of the Joint Executive Team (which includes the Chief Nurse, Chief Finance Officer, Chief Operating Officer) will deputise for the Accountable Officer according to their areas of expertise. If the Accountable Officer is absent or the post is vacant for more than one continuous month, the Board will appoint an interim Accountable Officer with the agreement of NHS England.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 25 of 67 23 GP MEMBERS

23.1 The appointment process for the GP members of the Governing Body will be conducted in accordance with the process and principles set out in schedule 2 of this Constitution.

23.2 The duty of all Governing Body members is to commission services on behalf of the population of the CCG.

24 LAY MEMBERS

24.1 The Governing Body will nominate at least two lay members who should ideally be residents of the area covered by the CCG or be able to demonstrate how they are otherwise able to bring that perspective to the Governing Body.

24.2 Both lay members shall have a good understanding of the operation of the Governing Body and of good governance practices. One lay member will have a lead role in overseeing key elements of governance. This member will have recent financial and audit experience and will act as ChairmanChair of both the Audit and Remunerations Committees.

24.3 One lay member will have expertise and knowledge of the local community and will have a lead role in championing public and patient involvement.

24.4 One of the lay members will undertake the role of Vice ChairDeputy manChair of the Governing Body.

24.5 The term of office of lay members will be 3 years, after which the post will be subject to reappointment.

24.6 The lay members will be appointed in accordance with the procedures set out in schedule 2 to this Constitution.

25 SECONDARY CARE SPECIALIST AND BOARD NURSE

25.1 One member shall be a doctor who is a secondary care specialist who has a high level of professional expertise and knowledge. This member will bring an understanding of patient care in the hospital setting.

25.2 One member shall be a registered nurse who will bring a broader view from the nursing perspective, on health and care issues, and especially the contribution of nursing to patient care.

25.3 The Board Nurse appointed to the Governing Body shall be accountable for patient safety and will provide regular reports to the National Reporting and Learning system. The Board Nurse shall be responsible for Safeguarding (including both the Local Safeguarding Children Board and the Safeguarding Adult’s Board). This role therefore includes close co-operation and liaison with the Local Authority on these matters.

25.4 The secondary care specialist and Board Nurse shall be appointed in accordance with national guidance applicable at the time of the appointment and procedures set out in

NHS Basildon and Brentwood CCG Constitution v54.0 Page 26 of 67 schedule 2 to this Constitution.

26 Chief Operating Officer & Chief Finance Officer

26.1 The Chief Operating Officer is the CCGs most senior manager responsible for the day to day running of the CCG in circumstances when the CCG has a Chief Clinical Officer (i.e. its clinical leader undertakes the accountable officer role).

26.2 The Chief Finance Officer, whilst a member of the Executive team, is also a member of the Governing Body who has an appropriate recognised accounting qualification.

26.3 The role of the Chief Finance Officer is to provide financial advice to the CCG and to supervise the financial control and accounting systems.

26.4 Where the CCG has a Chief Clinical Officer (hence a clinician who undertakes the Accountable Officer role) and they decide to appoint a single individual to undertake the combined roles of the Chief Operating Officer and Chief Finance Officer, this officer shall be known as the Chief Finance and Operating Officer. Confirmation of the appointed roles of officers within the CCG will be formally recorded within minutes of a public Board meeting and will be appended as an addendum to this constitution.

27 Accountability and rules of engagement with Member Practices

27.1 General

. The CCG is a membership organisation and will act as an agent of its member practices listed in Schedule 1. . This change in status and culture will be underpinned by a number of bilateral accountability measures detailed in section 11.

27.2 Regular Meetings

. In addition to the AGM referred to in Paragraph 11.8, there will be at least two other CCG meetings for all member practices that do not have the public in attendance.

27.3 Survey of Practices

. The Governing Body will undertake an annual survey of its member practices to obtain feedback on levels of satisfaction and perceived engagement with the commissioning process. . The report will be discussed at one of the CCG’s public Governing Body meetings.

27.4 Power of Recall

. The GP members of the Governing Body will be appointed in accordance with the process set out in Schedule 2. . Safeguards must exist to guard against the possibility of the Governing Body becoming out of touch with the views and needs of its member practices.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 27 of 67 . A Power of Recall therefore forms part of the Constitution. This will allow the GP members to be recalled following an AGM called by at least 75% of the CCG’s constituent GPs, provided that the response rate is at least 50% of eligible GPs.

27.5 Responsibilities of Member Practices

The responsibilities of member practices to the CCG are set out in Schedule 4.

27.6 Memorandum of Agreement

. The effective participation of each member practice will be essential in developing and sustaining high quality commissioning arrangements.

. A Memorandum of Agreement between localities and the CCG will be put in place as a means of clarifying the expectations and obligations of both parties. This will be reviewed no less than every two years by the CCG Board and the localities to ensure it remains relevant and fit for purpose.

. Minutes of locality meetings will be received for information and monitoring by the Clinical Executive Group (CEG) on a monthly basis to facilitate communication between the CEG and localities

28 Devolved commissioning structures

28.1 The CCG is able to delegate any of its functions, decision making powers and associated budgets to devolved commissioning structures which may include locality sub-committees.

28.2 The details of any devolved locality commissioning arrangements are detailed in Schedule 4.

28.3 Responsibilities of localities have also been summarised in Schedule 4.

28.4 The terms and detail of any such delegation will form part of the CCG’s Schemes of Delegation and Standing Financial Instructions.

28.5 Each participating locality shall have access to a management budget in accordance with their voting share ratio.

28.6 The CCG Governing Body shall prepare and submit a budget at the beginning of each financial year to the Participating localities.

29 Joint working with other CCGs

29.1 Basildon and Brentwood CCG recognises the importance of working collaboratively with other CCGs to achieve whole health economy service improvements and addressing the wider health inequalities within a local population. The CCG will work

NHS Basildon and Brentwood CCG Constitution v54.0 Page 28 of 67 with neighbouring CCGs to maintain and develop a range of collaborative arrangements, to be agreed by the Governing Body as required.

29.2 For additional information on how the CCG will work with other CCGs, refer to section 20, role of the Governing Body.

29.3 Joint commissioning arrangements with other Clinical Commissioning Groups

29.3.1 The CCG may wish to work together with other CCGs in the exercise of its commissioning functions.

29.3.2 The CCG may make arrangements with one or more CCG in respect of: 29.3.2.1 delegating any of the CCG’s commissioning functions to another CCG; 29.3.2.2 exercising any of the commissioning functions of another CCG; or 29.3.2.3 exercising jointly the commissioning functions of the CCG and another CCG

29.3.3 For the purposes of the arrangements described at paragraph 29.3.2, the CCG may: 29.3.3.1 make payments to another CCG; 29.3.3.2 receive payments from another CCG; 29.3.3.3 make the services of its employees or any other resources available to another CCG; or 29.3.3.4 receive the services of the employees or the resources available to another CCG.

29.3.4 Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions.

29.3.5 For the purposes of the arrangements described at paragraph 29.3.2 above, the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 29.3.2.3 above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

29.3.6 Where the CCG makes arrangements with another CCG as described at paragraph 29.3.2 above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; • Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 29 of 67 29.3.7 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 29.3.2 above.

29.3.8 The CCG will act in accordance with any guidance issued by NHS England on co- commissioning.

29.3.9 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body.

29.3.10 The governing body of the CCG shall require, in all joint commissioning arrangements as detailed in this clause 29.3, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

29.3.11 Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year. In the case of the STP Joint Committee, 12 months’ written notice is required;

29.4 Joint commissioning arrangements with NHS England for the exercise of CCG functions

29.4.1 The CCG may wish to work together with NHS England in the exercise of its commissioning functions.

29.4.2 The CCG and NHS England may make arrangements to exercise any of the CCG’s commissioning functions jointly.

29.4.3 The arrangements referred to in paragraph 29.4.2 above may include other CCGs.

29.4.4 Where joint commissioning arrangements pursuant to 29.4.2 above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question.

29.4.5 Arrangements made pursuant to 29.4.2 above29.4.2 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG.

29.4.6 Where the CCG makes arrangements with NHS England (and another CCG if relevant) as described at paragraph 29.4.2 above, the CCG shall develop and agree with NHS England (and the other CCG as appropriate) a framework setting out the arrangements for joint working, including details of:

NHS Basildon and Brentwood CCG Constitution v54.0 Page 30 of 67 • How the parties will work together to carry out their commissioning functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; • Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements; and

29.4.7 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 29.4.2 above.

29.4.8 The CCG will act in accordance with any guidance issued by NHS England on co- commissioning.

29.4.9 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body.

29.4.10 The governing body of the CCG shall require, in all joint commissioning arrangements as detailed in this clause 29.4 that a quarterly written report is presented to the governing body and at least annual engagement events are held to review aims, objectives, strategy and progress and an annual report on progress made against objectives is published.

29.4.11 Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 31 of 67 29.5 Joint commissioning arrangements with NHS England for the exercise of NHS England’s functions

29.5.1 The CCG may wish to work with NHS England to exercise specified NHS England functions.

29.5.2 The CCG may enter into arrangements with NHS England to: • Jointly exercise such functions as specified with NHS England.

29.5.3 Where arrangements are made for the CCG to exercise NHS England functions jointly with NHS England a joint committee may be established to exercise the functions in question.

29.5.4 Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties.

29.5.5 For the purposes of the arrangements described at paragraph 29.5.2 above, NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

29.5.6 Where the CCG enters into arrangements with NHS England as described at paragraph 29.5.2 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of: • How the parties will work together to carry out their commissioning functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including payments towards a pooled fund and management of that fund; • Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

29.5.7 The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into arrangements pursuant to paragraph 29.5.2 above.

29.5.8 The CCG will act in accordance with any guidance issued by NHS England on co- commissioning.

29.5.9 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body.

29.5.10 The governing body of the CCG shall require, in all joint commissioning arrangements detailed in this clause 29.5 that a quarterly written report is presented to the governing body and at least annual engagement events are held to review aims, objectives,

NHS Basildon and Brentwood CCG Constitution v54.0 Page 32 of 67 strategy and progress and an annual report on progress made against objectives is published.

29.5.11 Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

30 Conflict of interest

30.1 The CCG will abide by the national Code of Conduct for managing conflicts of interest10. A definition of “conflict of interest” is:

“A conflict between the private interests and the official responsibilities of a person in a position of trust”. A conflict of private interest (or duty) and public duty arises where a member has any interest which might influence, or be perceived as being capable of influencing, his or her judgement even unconsciously.

If a member has a pecuniary, personal or family interest, whether that interest is actual or potential and whether that interest is direct or indirect, in any proposed contract or other matter which is under consideration or is to be considered by the CCG, the member shall disclose that interest to the Governing Body as soon as he becomes aware of it.

30.2 A Conflict of Interest may include but shall not be limited to:

. A Member of the Governing Body or any of its sub-committees holding partnership in, employment in, directorship or trusteeship of or majority or controlling shareholdings in or other significant associations with any Provider. . A Member of the Governing Body or its sub committees holding simultaneous office in both a Local Medical Committee and the Clinical Commissioning Group on completion of the transition stage of development/after April 2013. . Any interest the Member of or its sub-committees if registered with the General Medical Council (GMC) would be required to declare in accordance with paragraph 55 of the GMC’s publication “Management for Doctors or any successor code” including the referral of any patient by a member to a Provider or the Governing Body or its sub-committees in which the member has a Conflict of Interest. . Any interest that the Member of the Governing Body or its sub-committees if registered with the Nursing and Midwifery Council (NMC) would be required to declare in accordance with paragraph 7 of the NMC’s publication Code of Professional Conduct or any successor code including the referral of any patient by a member to a Provider in which the member has a Conflict of Interest.

10 Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG- commissioned services NHS Commissioning Governing Body publication July 2012.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 33 of 67 . Any other interest whatsoever that should be dutifully declared under The Health and Social Care Act 2012 and guidance issued by Department of Health from time to time. . a direct pecuniary interest: where an individual may financially benefit from the consequences of a commissioning decision (for example, as a provider of services); . an indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from the consequences of a commissioning decision; . a non-pecuniary interest: where an individual holds a non-remunerative or not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision (for example, where an individual is a trustee of a voluntary provider that is bidding for a contract); . a non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequence of a commissioning decision which cannot be given a monetary value (for example, a reconfiguration of hospital services which might result in the closure of a busy clinic next door to an individual’s house); . where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories

30.3 If in doubt, the individual concerned should assume that a potential conflict of interest exists.

31 Declaration of conflict of interest

31.1 Individuals contracted to work on behalf of the group or otherwise providing services or facilities to the group will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest in accordance with the guidance set out in this constitution. This requirement will be written into their contract for services.

31.2 As required by section 14O of the 2006 Act, as inserted by section 25 of the 2012 Act, the clinical commissioning group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the group will be taken and seen to be taken without any possibility of the influence of external or private interest.

31.3 Where an individual, i.e. an employee, group member, member of the governing body, or a member of a committee or a sub-committee of the group or its governing body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the group considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this constitution.

31.4 The CCG shall maintain a specific Conflict of Interest Policy to guide staff in identifying and subsequently acting appropriately to address any conflict of interest.

31.5 The Accountable Officer of the Clinical Commissioning Group shall maintain one or more registers of interest of all Members of the CCG, the Governing Body or its committees / sub-committees and its employees recording all declarations of Conflicts

NHS Basildon and Brentwood CCG Constitution v54.0 Page 34 of 67

of Interest in the forms set out in Schedule 5.

31.6 The Accountable Officer will write to all member practices annually seeking confirmation of any changes which have not otherwise been reported. The Accountable Officer will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the group’s decision making processes, in accordance with the full detail of the CCG Conflict of Interest Policy.

31.7 The register of interests shall be kept by the Governing Body and shall be made available on written request. The register of interest will be available for regular review by the CCG Internal Auditors.

31.8 Any Member of the Governing Body or its sub-committees subject to a Conflict of Interest or to any change in circumstances which may bring to light a potential future Conflict of Interest or any previous or current Conflict of Interest shall:

. declare the nature and extent of any Conflicts of Interest (including any benefit already or expected to be received) to the Accountable Officer for inclusion on the register, in the form set out in Schedule 5 prior to any relevant discussion regarding any specification for or award of the goods or services to which the Conflict of Interest relates; within 28 days of appointment or as soon as such Conflict of Interest becomes apparent whichever is the sooner; . declare the nature and extent of any Conflict of Interest at the beginning of any meeting in which relevant discussion regarding any specification for or award of the goods or services to which the Conflict of Interest relates; . if the Member of the Governing Body or its sub-committees seeks to refer a patient to a Provider he/she must declare the nature of any Conflict of Interest to the patient and note the nature of the Conflict of Interest related to any referral on the patient’s medical record as suggested by Paragraph 76 of GMC’s Good Medical Practice code; and . be refrained from discussing or voting on any matters related to such Conflict of Interest unless the Accountable Officer deems that the Conflict of Interest is not a prejudicial conflict of interest.

31.9 All invitations to tender or contract issued by the Clinical Commissioning Group shall require any tendered or potential contractor to declare any Conflicts of Interest within 28 days in the form set out in Schedule 5.

31.10 Interests which are relevant and material include:

- Partnership (e.g. in a general practice which will benefit from the proposal) or employment in a professional partnership e.g. Limited Liability Partnership; - Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies) - Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the NHS; - Majority or controlling share holdings in organisations likely or possibly seeking to do business with the NHS;

NHS Basildon and Brentwood CCG Constitution v54.0 Page 35 of 67 - Any connection with a voluntary or other organisation contracting to provide NHS services; - Research funding/grants that may be received by an individual or their department.

32 Failure to disclose conflict of interest

32.1 Failure to disclose any Conflict of Interest by any Member of the Governing Body may result in the disqualification of that Member by special resolution of the Governing Body under the disqualification provisions detailed in paragraph 10.9.

32.2 Failure to disclose any Conflict of Interest by any member of the Governing Body regarding a bid from a potential Provider, will not necessarily render any decision made by the Governing Body or its properly constituted sub committees as invalid. Although the Governing Body shall reserve the right to declare any such contract invalid or impose such requirements or conditions upon that Member or any contract to which the Conflict of Interest pertains, as it sees fit.

33 Transparency in procuring services

33.1 The group recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The group will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

33.2 The group will publish a Procurement Strategy approved by its governing body which will ensure that:

a) all relevant clinicians (not just members of the group) and potential providers, together with local members of the public, are engaged in the decision-making processes used to procure services; b) service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way

33.3 Copies of this Procurement Strategy will be available on the group’s website

33.4 Where the CCG may develop / procure shared services and support to enable the discharge of its statutory and operational functions, the CCG will ensure that these arrangements have been assured through BDU business review or equivalent process and that this will be documented within the SLA / Memorandum of Understanding (MoU) or MoA with the assured support provider.

34 Transparency, ways of working and standing orders

General

34.1 The group will publish annually a commissioning plan and an annual report, presenting the group’s annual report to a public meeting.

34.2 Key communications issued by the group, including the notices of procurements,

NHS Basildon and Brentwood CCG Constitution v54.0 Page 36 of 67 public consultations, governing body meeting dates, times, venues, and certain papers will be published on the group’s website.

34.3 The group may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public.

34.4 The BBCCG will clearly establish strategic organisational objectives which will form the basis of a Governing Body Assurance Framework programme to manage all CCG risks, including clinical, financial, corporate, information, and research governance risks that may impact on the delivery of strategic objectives including the CCG Commissioning strategy, plans and the QIPP. The process for managing risk is set out within the CCG Standing Financial Instructions.

Standing Orders

34.5 This constitution is also informed by a number of documents which provide further details on how the group will operate. They are the group’s:

. Standing orders – which sets out the arrangements for meetings and the appointment processes to elect the group’s representatives and appoint to the group’s committees, including the governing body; . Scheme of reservation and delegation – which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the group’s governing body, the governing body’s committees and sub-committees, the group’s committees and sub-committees, individual members and employees; . Standing Financial Instructions – which sets out the arrangements for managing the group’s financial affairs.

35 Termination of membership of the clinical commissioning group

35.1 A Member practice ceases to be a Member where that practice no longer satisfies the criteria of membership as set out in paragraphs 614.5 & 14.6 herein.

35.2 The Member practice shall give written notice to the NHS Commissioning Board and the Governing Body as soon as practicable in the event of any of the circumstances which may give rise to termination of membership, together with a formal request that his membership is terminated.

35.3 The NHS Commissioning Board shall be entitled to terminate a practice’s membership of the Clinical Commissioning Group, if it becomes aware of any of the circumstances as set out in this section 27 and as applicable to any current Member practice.

A practice’s membership of the CCG can only be terminated by the NHS Commissioning Board.

35.4 Any Member practice, if served with a notice of termination of membership by the NHS Commissioning Board shall have the right of appeal against that decision by application to the NHS Commissioning Board.

35.5 The decision of the NHS Commissioning Board on consultation with the Clinical

NHS Basildon and Brentwood CCG Constitution v54.0 Page 37 of 67 Commissioning Group, Local Medical Committee and any other relevant party shall be final.

36 Public and patient involvement in commissioning of health services

36.1 The CCG has an engagement plan setting out the various ways in which the organisation will engage with its patients, community, partner organisations and other stakeholders.

36.2 Each locality will deliver relevant elements of the strategy and in particular make arrangements to involve individuals to whom services are being or may be provided in the commissioning process. Each locality shall be committed to ensuring all of its commissioning proposals are overseen by relevant stakeholders, including patient engagement group or committee (where in place), prior to implementation.

36.3 The engagement plan establishes the systems and processes for monitoring and acting on patient feedback, including complaints, and identifying quality including safety issues. The Patient Safety & Quality Committee is the Governing Body delegated sub-committee responsible for ensuring quality and reviewing systems and process relating to quality and safety issues on a regular basis.

36.4 The CCG has established a complaints policy for handling complaints in accordance with the statutory framework for complaints handling.

36.5 Specifically, our patients will be involved;

. In the identification of local health needs via the development of the Joint Strategic Needs Assessment in conjunction with the Essex CC Health and Wellbeing Governing Body; . In the planning of commissioning arrangements by the consortium; . In the development and consideration of proposals by the CCG for changes to the commissioning arrangements where the proposals would have a significant impact on the manner in which the health services are delivered to the individuals or the range of health services available to them; and . In decisions of the CCG affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact. . In the monitoring of services commissioned by the CCG.

37 Responsibilities to external bodies and agencies

37.1 The CCG shall, in line with any relevant statutory obligations, ensure that its plans are shaped and informed by the Health and Wellbeing Governing Body’s strategy and priorities.

37.2 The CCG will play a full and active involvement in the Health and Wellbeing Governing Body, including attendance at meetings and contributing to the development of the local Health and Wellbeing Strategy.

37.3 The CCG shall develop relationships across South Essex to develop plans for the

NHS Basildon and Brentwood CCG Constitution v54.0 Page 38 of 67 wider transformation of services.

37.4 The CCG will explore the possibility of developing integrated care arrangements including the pooling of budgets with local partners where this is deemed in the best interests of the people of Basildon and Brentwood and is in line with regulation including section 75 agreements.

37.5 The CCG will comply with any relevant conditions set out by the National Commissioning Governing Body as a requirement of authorisation.

38 Employment, remuneration and expenses

38.1 In accordance with paragraph 11.1, the Governing Body shall be permitted to employ or engage the services of any individual if it reasonably believes that the employment or engagement of such an individual shall be of benefit to the CCG as a whole.

38.2 A Remuneration Committee shall be established to make recommendations about appropriate remuneration and terms of service for members of the Governing Body as per section 32.

38.3 The CCG will publish details of remuneration paid to members (in each locality) in its annual report.

38.4 The group recognises that its most valuable asset is its people. It will seek to enhance their skills and experience and is committed to their development in all ways relevant to the work of the group.

38.5 The group will seek to set an example of best practice as an employer and is committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.

38.6 The group will ensure that it employs suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected of staff employed by the group. All staff will be made aware of this constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

38.7 The group will maintain and publish policies and procedures (as appropriate) on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The group will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters

38.8 The group will ensure that its rules for recruitment and management of staff provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.

38.9 The group will ensure that employees' behaviour reflects the values, aims and principles set out above.

38.10 The group will ensure that it complies with all aspects of employment law.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 39 of 67 38.11 The group will ensure that its employees have access to such expert advice and training opportunities as they may require in order to exercise their responsibilities effectively.

38.12 The group will adopt a Code of Conduct for staff and will maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced.

38.13 Copies of this Code of Conduct, together with the other policies and procedures outlined in this chapter, will be available on the group’s website

39 Audit Committee

39.1 In line with the requirements of the NHS Audit Committee Handbook, NHS Codes of Conduct and Accountability, and the Higgs report, the governing body has appointed an Audit Committee established and constituted to provide the CCG Governing Body with an independent and objective review on its financial systems, financial information and compliance with laws, guidance, and regulations governing the NHS. The Terms of Reference will be approved by the CCG Governing Body and reviewed on a periodic basis.

39.2 The Audit Committee will be chaired by the Lay Member with lead responsibility for governance. referred to in Paragraph 16.2.

39.3 Other members of the Audit Committee shall be agreed by the chair of the audit committee.

39.4 Schedule 8 of the Constitution provides some background to and the Terms of Reference of the Audit Committee, its role, responsibilities and how such a committee will operate.

39.5 The CCG Scheme of Delegation defines the authority delegated from the CCG Governing Body to the Audit Committee.

40 Remuneration Committee

40.1 In line with the requirements of the NHS Codes of Conduct and Accountability, Remuneration and Terms of Service Committee has been appointed by the governing body.

40.2 The Committee shall be comprised exclusively of Lay Members, who are independent of the management of the CCG. The committee is accountable to the governing body.

40.3 Any remuneration as above may take any mutually acceptable form and may or may not also include any arrangements in connection with the payment of a pension, allowance or death, sickness, disability benefits to or in respect of that individual, as the Committee thinks fit.

40.4 The purpose of the Committee will be to advise the CCG Governing Body about appropriate remuneration and terms of service for the Governing Body including:

NHS Basildon and Brentwood CCG Constitution v54.0 Page 40 of 67 . All aspects of salary (including any performance-related elements/bonuses). . Provisions for other benefits, including pensions and cars. . Arrangements for termination of employment and other contractual terms.

40.5 All final matters for decision on remuneration will lie with the Governing Body.

40.6 Remuneration of lay members will be carried out in accordance with Department of Health guidance issued from time to time and will not be decided upon by the remuneration committee as established by this constitution due to potential conflict of interest. Any decisions made will be fully documented and approved by the Governing Body.

40.7 Schedule 8 of the Constitution provides some background to and the Terms of Reference of the Remuneration Committee, its role, responsibilities and how such a committee will operate including remuneration of lay members. The Terms of Reference of the Remuneration Committee is reviewed and approved by the Governing Body annually.

40.8 The CCG Scheme of Delegation defines the authority delegated from the CCG Governing Body to the Remuneration`Audit Committee.

41 Primary Care Commissioning Committee Formatted: Left, Indent: Left: 0 cm, Hanging: 1.27 cm

41.1 THIS Committee is required by the terms of the delegation from NHS England in Formatted: Heading 2 relation to primary care commissioning functions. The Primary Care Commissioning Committee reports to the Governing Body and to NHS England. Membership of the Committee is determined in accordance with the requirements of Managing Conflicts of Interest: Revised statutory Guidance for CCGs 2017. This includes the requirement for a lay member Chair and a lay Vice Chair.

Formatted: Heading 2, Indent: Left: 0 cm, Hanging: 1.25 cm Formatted: All caps

42 The terms of reference for each of the above committees are included in Formatted: Indent: Left: 0.51 cm Schedule 11 to this constitution and form part of the constitution.

Formatted: Indent: Left: 1.27 cm, No bullets or numbering

4143 STP Joint Committee

The governing body has conferred or delegated the following functions, connected with the governing body’s main function, to the STP Joint Committee, which will enable the CCG, together with the other participating CCGs, where appropriate, to actto act collectively in the planning, securing and monitoring of services to meet the needs of

NHS Basildon and Brentwood CCG Constitution v54.0 Page 41 of 67

the population of Mid and South Essex, as well as represent the STP footprint for services commissioned over a larger area.

Full terms and conditions of all committees including the STP Joint Committee are available to download from the CCG’s website at: http://basildonandbrentwoodccg.nhs.uk/about-us/constitution-and-terms-of-reference

4244 Dispute resolution

42.144.1 If a dispute arises between the CCG and a member practice or between member practices, then all parties are required to follow the Dispute Resolution Procedures detailed in Schedule 6.

4345 Confidentiality

43.145.1 The expression “Confidential Information” as used in this Constitution means any information which any Board Member may have or acquired in relation to the Clinical Commissioning Group or another Member and/or is marked confidential and is in addition to any statutory, professional or other duty of confidence to which the Member is subject including but not limited to the NHS Code of Confidentiality, the Data Protection Act 1988, Caldicott and Safe Havens, the Access to Health Records Act 1990, the Human Rights Act 1998 and the Computer Misuse Act 1990; General Medical Council (2000) Confidentiality: Protecting and Providing Information; and the BMA (1999) Confidentiality and Disclosure of Health Information guidance.

4446 Variation

44.146.1 This Constitution may be extended or varied by the agreement or consent of at least 75% of responding current member practices (as set out in Schedule 1). Changes will be subject to an application to NHS England (in either May orMay or November each year), as determined by national guidance at the time.

44.246.2 This Constitution may be varied without agreement or consent if the variation is deemed necessary as a result of any enactment, law or regulation, or Direction of the Secretary of State.

4547 Notices

45.147.1 Any notice or other communication required to be given to the Clinical Commissioning Group shall be in writing and shall be delivered by hand or sent by pre-paid first-class post or other next working day delivery service at its principal place of business, or sent by fax to the Clinical Commissioning Group’s main fax number.

45.247.2 Any notice or communication shall be deemed to have been received if delivered by hand, on signature of a delivery receipt, or if sent by fax, at 9.00 am on the next Business Day after transmission, or otherwise at 9.00 am on the second Business Day after posting or at the time recorded by the delivery service.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 42 of 67

4648 Distribution

46.148.1 For transparency, the CCG has made this constitution and other key documentation available to patients and the public in the following ways:

. Hard copies available for inspection or collection at our headquarters or the local health premises; . Hard copies available upon request by post (to the head office address) or by email to [email protected] . Electronic copies will be available for download on our internet site or upon request to the aforementioned email address.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 43 of 67

4749 Schedule 1 - list of member practices of the Clinical Commissioning Group

The membership of the CCG are from the Brentwood, South Essex Managed Care, Arterial and Partnership /BIC localities and the associated practices.. The member practices are:

Arterial

Dr Butler & Partners Western Road Surgery, Formatted Table 41 Western Road, Billericay, CM12 9D Dr Dabas The New Surgery, 27 Stock Road, Billericay, CM12 0AH Dr Cockcroft & Partners The Billericay Medical Practice, Stock Road, Billericay, CM12 0BJ Dr Rasheed 93 Chapel Street, Billericay, CM12 9LR Dr Mitchel & Partners Ballards Walk Surgery, 49 Ballards Walk, Basildon, SS15 5HL Dr AnMaskara Dipple Medical Centre, East Wing Wickford Avenue Pitsea SS13 3HQ Dr T Nasah Dipple Medical Centre, South Wing, Wickford Aveune, Pitsea, SS13 3HQ Dr Dabas Queens Park Surgery, 24 The Pantiles, Billericay, CM12 0UA Dr Din The Oakdin Surgery, 58 Laindon Road, Billericay, CM12 9LD Dr N. Sarfraz South Green Surgery, 14-18 Grange Road, Billericay, CM11 2RE

NHS Basildon and Brentwood CCG Constitution v54.0 Page 44 of 67

Dr M Sims Dipple Medical Centre, West Wing, Wickford Avenue, Pitsea, SS13 3HQ Dr J Arayomi Dipple Medical Centre, West Wing, Wickford Avenue, Pitsea, SS13 3HQ Dr S Basu Surgery, 32 Knights, Basildon, SS15 5LE Dr F Hlordzi (0.5 Practice with Dr Clayhill Medical Practice, Ogunbiyi) Southview Road, Vange, SS16 4HD

Brentwood

Dr Woolterton & Partners Beechwood Surgery, Formatted Table Pastoral Way, Brentwood, CM14 5WF Dr Hildebrand & Partners The Tile House, 33 Shenfield Road, Brentwood, CM15 8AQ Dr Ward & Partners The Surgery, Mount Avenue, Shenfield, CM13 2NL Dr Naeem & Partners The New Surgery, 8 Shenfield Road, Brentwood, CM15 8AB Dr Ainsworth & Partners Rockleigh Court Surgery, 136 Hutton Road, Shenfield, CM15 8NN Dr Emond & Partners The New Folly, Bell Mead, High Street, Ingatestone, CM4 OFA Dr M Hunt The Highwood Surgery, Highwood Hospital Site, Geary Drive, Brentwood,

NHS Basildon and Brentwood CCG Constitution v54.0 Page 45 of 67 CM15 9DY Dr N Butler & Partners Deal Tree Health Centre Blackmore Road Doddinghurst CM15 OHU Brambles Surgery PMS Brambles Practice, Highwood Hospital, Geary Drive, Brentwood CM14 4FZ

SEMC

Dr NewAnichebe Aegis Medical Centre, Formatted Table 568 Whitmore Way, Basildon SS14 2ER Shotgate Practice Shotgate Surgery, 340 Southend Road, Shotgate, Wickford, SS11 8QS Dr Rai Swanwood Partnership, 2 Market Avenue, Wickford, SS12 0AG Wickford Health Centre Wickford PMS Practice, Wickford Health Centre, 2 Market Road, Wickford SS12 0AG The Gore Surgery The Gore PMS Practice, 69 The Gore, Basildon SS14 2DD Dr Salako & Partner Langdon Hills Medical Practice, Nightingales, Langdon Hills, Basildon, SS16 6SA Southview Park Surgery Southview Park, London Road, Vange, SS16 4QX Dr Ogunbiyi & Partner - (0.5 Practice Clayhill Medical Practice, with Dr F Hlordzi) Southview Road, Vange, SS16 4HD Robert Frew Medical Centre The Robert Frew Medical Centre, Silva Island Way,

NHS Basildon and Brentwood CCG Constitution v54.0 Page 46 of 67 Salcott Crescent, Wickford, SS12 9NR London Road Surgery The London Road Surgery, 64 London Road, Wickford, SS12 0AN

Partnership and BIC

Dr Chajed & Partners Kingswood Medical Centre, Formatted Table Clayhill Road, Basildon, SS16 5AD Dr Marshall & Partners The Health Centre, Laindon, Basildon, SS15 5TR Dr M Aslam Murree Medical Centre 201 Rectory Road Pitsea SS13 1AJ Dr Kamdar Rose Villa Surgery 6 Rectory Park Drive Pitsea Basildon SS13 3DW Noak Bridge Medical Centre Bridge Street Noak Bridge Basildon SS15 4EZ Fryerns Medical Centre Peterborough Way Craylands Basildon SS14 3SS Dr H S Rao Dipple Medical Centre, West Wing Wickford Avenue Pitsea SS13 3HQ Dr W Degun & Partners 93 The Knares Lee Chapel South Basildon SS16 5SB Dr B B Jas & Partner The Surgery 48 Matching Green Basildon SS14 2PB Dr K K Abraham & Partner Felmores Centre Felmores

NHS Basildon and Brentwood CCG Constitution v54.0 Page 47 of 67 Basildon SS13 1PN Dr J J Mampilly The Surgery Felmores Centre Felmores Basildon SS13 1PN

NHS Basildon and Brentwood CCG Constitution v54.0 Page 48 of 67

Arterial

Western Road Surgery, 41 Western Road, Billericay, CM12 9D The New Surgery, 27 Stock Road, Billericay, CM12 0AH The Billericay Medical Practice, Stock Road, Billericay, CM12 0BJ Chapel Street 93 Chapel Street, Billericay, CM12 9LR Ballards Walk Surgery, 49 Ballards Walk, Basildon, SS15 5HL Dipple Medical Centre, South Wing, Wickford Aveune, Pitsea, SS13 3HQ Queens Park Surgery, 24 The Pantiles, Billericay, CM12 0UA

South Green Surgery, 14-18 Grange Road, Billericay, CM11 2RE Dipple Medical Centre, West Wing, Wickford Avenue, Pitsea, SS13 3HQ Dipple Medical Centre, East Wing, Wickford Avenue, Pitsea, SS13 3HQ Surgery, 32 Knights, Basildon, SS15 5LE

NHS Basildon and Brentwood CCG Constitution v54.0 Page 49 of 67 Clayhill Medical Practice, Southview Road, Vange, SS16 4HD

Brentwood

Beechwood Surgery, Pastoral Way, Brentwood, CM14 5WF The Tile House, 33 Shenfield Road, Brentwood, CM15 8AQ The Surgery, Mount Avenue, Shenfield, CM13 2NL The New Surgery, 8 Shenfield Road, Brentwood, CM15 8AB Rockleigh Court Surgery, 136 Hutton Road, Shenfield, CM15 8NN The New Folly, Bell Mead, High Street, Ingatestone, CM4 OFA The Highwood Surgery, Highwood Hospital Site, Geary Drive, Brentwood, CM15 9DY Deal Tree Health Centre Blackmore Road Doddinghurst CM15 OHU

SEMC

Aegis Medical Centre, 568 Whitmore Way, Basildon

NHS Basildon and Brentwood CCG Constitution v54.0 Page 50 of 67 SS14 2ER

Swanwood Partnership, 2 Market Avenue, Wickford, SS12 0AG

Langdon Hills Medical Practice, Nightingales, Langdon Hills, Basildon, SS16 6SA

Clayhill Medical Practice, Southview Road, Vange, SS16 4HD The Robert Frew Medical Centre, Silva Island Way, Salcott Crescent, Wickford, SS12 9NR The London Road Surgery, 64 London Road, Wickford, SS12 0AN

Partnership and BIC

Kingswood Medical Centre, Clayhill Road, Basildon, SS16 5AD The Health Centre, Laindon, Basildon, SS15 5TR Murree Medical Centre 201 Rectory Road Pitsea SS13 1AJ Rose Villa Surgery 6 Rectory Park Drive Pitsea Basildon SS13 3DW Bridge Street

NHS Basildon and Brentwood CCG Constitution v54.0 Page 51 of 67

Noak Bridge Basildon SS15 4EZ Peterborough Way Craylands Basildon SS14 3SS

93 The Knares Lee Chapel South Basildon SS16 5SB The Surgery 48 Matching Green Basildon SS14 2PB Felmores Centre Felmores Basildon SS13 1PN Aryan Medical Centre Felmores End Basildon SS13 1PN

NHS Basildon and Brentwood CCG Constitution v54.0 Page 52 of 67 4850 Schedule 2 – appointment of General Practitioners to serve as members of the Governing Body of Basildon and Brentwood Clinical Commissioning Group

Background

. The provisions of the Health and Social Care Act 2012 require the formation of GP led Clinical Commissioning Groups (CCGs). . GP leaders with the requisite skills and a mandate from their colleagues locally, will need to work closely with member practices, the NHS England and other agencies to oversee the successful transfer of commissioning responsibilities to CCGs.

The Appointment Process

. The appointment of GPs to serve as members of the Governing Body of a CCG must be conducted fairly through an election process . GP appointment to the Governing Body is from elections undertaken at locality level. The CCG will oversee these elections. . The appointment process of each of the BBCCG localities must operate within the principles set out below

The process below applies equally to each of the localities.

Key Principles

Who is eligible to apply?

. Any GP working in one of BBCCG’s member practices, irrespective of their contractual status, (partner, salaried or locum) will be eligible to apply. . Governing Body representatives are drawn from each of the localities within the BBCCG and applicants for Governing Body roles are be elected from within the locality in which they are based. . Each locality has one voting Governing Body member for every 25,000 registered patients so the number of available Governing Body roles for each locality will vary from time to time according to the size of the locality. . The application process will be publicised as widely as possible. . The CCG will ensure that all eligible GPs are contacted individually. . The application process will run for a period of between two and four weeks.

Defining the Electorate

. The CCG management team will contact member practices to ascertain the names of all GPs working with them, including any GPs on maternity/paternity/sick leave as at a date agreed with the CCG. . This list of GPs will constitute the list of eligible applicants within that locality.

Application Process

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The CCG management team, on behalf of the locality lead, will write to all eligible GPs seeking applications.

Returning Officer

The CCG will nominate a Returning Officer who locality members agree to be sufficiently impartial to the outcome of the voting process.

Election Process

If the number of applicants exceeds the number of vacant posts, an election will be necessary. Ballot papers will be issued by the CCG management team under the scrutiny of the Returning Officer to all GPs that form part of the agreed electorate, together with supporting statements from the applicants. In localities each GP has one vote to elect a locality member.

Any salaried partner or locum GP working in a member practice of that locality will be entitled to vote For the purposes of voting, a locum should have worked periodically for a member practice for a period of 12 months or more or be otherwise deemed by the Governing Body to have an enduring local presence within the CCG area.

The papers will list the names of each of the applicants and the electorate will be asked to vote for their preferred candidates, with one vote for each Board place available (1 seat per 25,000 registered patients). The successful candidates will be selected by simple majority.

Ballot papers must be returned to the Returning Officer by the date stated. A period of between two and four weeks will be allowed for the return of completed ballot papers.

Any ballot papers received after the deadline or not completed in accordance with the instructions on the reverse of the ballot paper will be invalid.

Counting the Result

. The total votes for each candidate will be counted by the Returning Officer. . Election of successful candidates will be by simple majority . The Returning Officer will communicate the results to the nominated locality lead. . The results will then be communicated to the eligible candidates and electorate by the Returning Officer via the management team of the CCG.

Tenure of Governing Body Posts

Once elected, Governing Body members can serve up to 3 years. Locality elections will be staggered throughout the 3-year period to ensure some consistency of Governing Body members, with each locality in turn conducting elections every 9 months. During the first 3 years of the CCG the tenure of Governing Body members may be less than 3 years in order

NHS Basildon and Brentwood CCG Constitution v54.0 Page 54 of 67

to ensure that each locality is given the opportunity to re-select Governing Body members as the organisation takes shape. The timetable for Governing Body elections from November 2015 is therefore as follows:

November 2015 - Arterial November 2016 - BIC August 2016 - Partnership May 2017 - SEMC January 2018 - Brentwood

NHS Basildon and Brentwood CCG Constitution v54.0 Page 55 of 67 4951 Schedule 3 – proxy form

[NAME AND ADDRESS OF GOVERNING BODY MEMBER]

Before completing this form, please read the explanatory notes overleaf.

I being a Governing Body member of the BBCCG appoint the ChairmanChair of the Governing Body meeting or (see note 3)

[INSERT NAME OF PROXY]

As my proxy to attend, speak and vote on my behalf at the Governing Body Meeting of the BBCCG to be held on [DATE] at [TIME] and at any adjournment of the meeting.

I direct my proxy to vote on the following resolutions as I have indicated by marking the appropriate box with an ‘X’. If no indication is give, my proxy will vote or abstain from voting at his or her discretion and I authorise my proxy to vote (or abstain from voting) as he or she thinks fit in relation to any other matter which is properly put before the meeting.

RESOLUTIONS FOR AGAINST

[ORDINARY BUSINESS]

1. [INSERT TEXT OF RESOLUTION]

2. [INSERT TEXT OF RESOLUTION]

3. [INSERT TEXT OF RESOLUTION]

[SPECIAL BUSINESS]

4. [INSERT TEXT OF RESOLUTION]

5. [INSERT TEXT OF RESOLUTION]

Signature Date

Notes to the proxy form

. As a Governing Body member of the CCG you are entitled to appoint a proxy to exercise all or any of your rights to attend, speak and vote at a general meeting of the CCG. You can only appoint a proxy using the procedures set out in these notes.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 56 of 67 . Appointment of a proxy does not preclude you from attending the Governing Body meeting and voting in person. If you have appointed a proxy and attend the Governing Body meeting in person, your proxy appointment will automatically be terminated.

. A proxy does not need to be a Governing Body member of the CCG but must attend the meeting to represent you. To appoint as your proxy a person other than the ChairmanChair of the meeting, insert their full name in the box. If you sign and return this proxy form with no name inserted in the box, the ChairmanChair of the meeting will be deemed to be your proxy. Where you appoint as your proxy someone other than the ChairmanChair, you are responsible for ensuring that they attend the Governing Body meeting and are aware of your voting intentions. If you wish your proxy to make any comments on your behalf, you will need to appoint someone other than the ChairmanChair and give them the relevant instructions directly.

. To direct your proxy how to vote on the resolutions mark the appropriate box with an "X". If no voting indication is given, your proxy will vote or abstain from voting at his or her discretion. Your proxy will vote (or abstain from voting) as he or she thinks fit in relation to any other matter which is put before the Governing Body meeting

. To appoint a proxy using this form, the form must be: − Completed and signed; − Sent or delivered to the Governing Body of the CCG at Phoenix House, Christopher Martin Road, Basildon and − Received by the Governing Body of the CCG prior to commencement of the meeting.

. Any power of attorney or any other authority under which this proxy form is signed (or a duly certified copy of such power or authority) must be included with the proxy form.

. As an alternative to completing this hard-copy proxy form, you can appoint a proxy electronically by email to the Chair before the meeting commences.

. If you submit more than one valid proxy appointment, the appointment received last before the latest time for the receipt of proxies will take precedence.

. For details of how to change your proxy instructions or revoke your proxy appointment see the notes to the notice of the Governing Body meeting.

. You may not use any electronic address provided in this proxy form to communicate with the CCG for any purposes other than those expressly stated.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 57 of 67 5052 Schedule 4 – devolved commissioning structures

NHS Basildon & Brentwood CCG

Schedule 4 - Devolved Commissioning Structures

Background

Whereas, the Basildon and Brentwood NHS CCG is a Federated CCG of four Consortia.

Whereas, the 4 Consortia had agreed to come together to commission services pursuant to the NHS Health and Social Act 2012.

Whereas, there are local variations as to the commissioning needs of the patients’ populations in these localities.

Whereas, practices engagements are crucial to the successful commissioning activities and can only be ensured through locality functions.

It is resolved and agreed:

The Governing Body of the CCG shall be the decision making body of the organisation, with delivery of agreed strategies mostly taking place within the localities.

The 4 localities shall be as stated below any amendment, addition, variation to the nature and composition of the locality shall only be valid by approval of the CCG Governing Body.

A ‘Locality’ is a defined group of GP Practices, within a specific geographic area that are members of the CCG and are recognised as a locality. Schedule 1 of this constitution sets out the current member practices of the CCG and defined the localities to which they belong. The process for GP Practices to join a locality is subject to the governance arrangements set out within this constitution. Localities are accountable to the CCG Governing Body

. Arterial . Brentwood . Partnership and BIC . South Essex Managed Care (SEMC)

In the performance of any obligation devolved to a locality, the overriding objective shall be in furtherance of assisting the CCG of its statutory functions and this obligation shall override any other local considerations.

To assist the locality to achieve its functions, localities shall have residual right to appoint following consultation with the CCG Governing Body any person or persons to carry out its delegated function. Staff would be formally employed or contracted by the CCG but be line managed by locality leads.

In the main this means that the CCG delegates responsibilities to the localities may include (but not limited to) the following:

NHS Basildon and Brentwood CCG Constitution v54.0 Page 58 of 67 . Agreeing with the Governing Body a local plan for delivering the targets and priorities of the CCG . Accountability for delivery of the local plan . Commissioning of services in agreement with the CCG Governing Body. . Engaging with member practices (for which each locality will have access to a budget to pay for clinical time, meeting venues, etc.) . Engaging with the local community and patients . Managing the Prescribing Budgets . Managing the level of practice referrals to hospital and the referral management processes

The Role of the CCG and the Governing Body

The CCG has ultimate responsibility and accountability for the delivery of its obligations and achievement of nationally set targets. Whilst the delivery of some of this may be devolved to localities, the accountability of the CCG cannot be devolved and therefore remains with the CCG. The CCG is accountable to the NHS Commissioning Board and the Department of Health. The CCG Governing Body is responsible for approving the Scheme of Delegation, SFI and SOs and ensuring compliance with them. However, in line with national policy, the CCG is a member led organisation and would endeavour to ensure the widest possible engagement of clinical members in making these decisions.

Among other key functions, the CCG Governing Body will:

. Have over-arching corporate responsibility for the management of the organisation and delivery of national requirements. . Establish and agree governance policies and processes for the organisation. . Deliver statutory duties, managing CCG wide financial risk. . Agree overarching priorities and targets for the QIPP plan . Agree the staffing structure and engage staff . Agree a management budget for each locality to support its engagement activities. • Provide ‘Umbrella’ engagement functions, managing relationships with NHSCB, HWB, other CCGs etc. • Enable and support locality groups - including the provision of information to monitor activity and targets. • Identify and spread good practice and encourage collaborative working.

The Role of the Localities

Localities will have the relationship with their practices and be in best position to influence clinical change to make any changes necessary to implement proposals agreed. In the case of practices that do not engage with the locality, the locality will have the option of passing this aspect onto the CCG to deal with.

Localities will agree a local delivery plan with the Governing Body which sets out plans for the year. Any additional proposals from the Localities for service developments, investments or other changes will be presented to the CCG Governing Body (or relevant sub-committee) for agreement.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 59 of 67 Any over spend of individual practices shall normally initially be identified and managed within localities and localities would agree with their practices timelines in terms of how this would be achieved, within the over-arching CCG plan for managing budgets. Once again a locality will be at liberty to escalate this to the CCG at any time if it wishes, and the CCG retains the right to intervene at any stage if required. This means that the CCG retains the right to intervene in circumstances where the locality actions to recover the overspend are not achieving or are not expected to achieve the desired result.

Localities will be responsible for undertaking the following functions on behalf of the CCG Governing Body (here categorised against the 6 domains of authorisation):

1. QIPP delivery

• Locality members’ delivery against agreed actions • Regular analysis of commissioning activity/spend, taking or recommending to the CCG Governing Body any remedial actions • Monitoring prescribing spend and ensuring delivery of the QIPP initiatives • Generating ideas for new schemes, clinical pathways, refinement of proposals, etc.

2. Peer Review

• locality lead to receive, interpret and disseminate activity and financial reports across the group • plans to address specific areas of relevant variation • Referral management systems are in place and being used by all practices

3. Patient engagement

• delivery of the relevant elements of the CCG’s engagement plan, including developing patient groups, PPGs, newsletters, attendance at patient group meetings, etc. • using patient feedback to influence service development, e.g. Patient Choices feedback, complaints,

4. Other Engagement

• Governing Body member participation – GPs, practice managers, nurses, etc. taking on regular or ad hoc roles (locality members can take part in Governing Body activities without being Governing Body members) • engaging with all member practices, locality meetings, practice visits, development support or addressing performance issues, etc. • engaging with local H&WBB developments – sub groups developing the JSNA and borough council activities

5. Financial management

NHS Basildon and Brentwood CCG Constitution v54.0 Page 60 of 67 • Developing a spending plan for the locality management budget • Compliance with Standing Orders / SFI’s • Participate in any relevant external/internal audit within the agreed timeframe

Locality Management Allowance The CCG is responsible for the overheads associated with managing the CCG in the delivery of its obligations, however, annually Localities will receive a devolved budget or ‘locality management allowance’ based on a cost per patient to be used for overheads associated with the delivery of Locality functions on behalf of the CCG. Funding will be made available to Localities through a dedicated cost centre budget, administered by the CCG, providing the expenditure falls within the allocated budget and is used to deliver the agreed objectives. One or two nominated leads of each locality will be designated budget holders to approve transactions. All transactions must be in line with the Standing Financial Instructions and procurement rules of the CCG.

The Role of GP Practices

The CCG is made up of its member GP Practices and these are an integral part of the CCG, sharing responsibility for delivering primary care services to their local community as well as participating in the delivery of locality functions.

Individual GP Practices will be involved in the following activities (this is not an exhaustive list):

• Sign up to the ‘ethos’ of their locality group and CCG • Active involvement with the CCG and locality group, promoting innovation and service developments • Share good practice and promote the highest quality services • Following the clinical pathways and referral protocols agreed by the CCG (except in individual cases where there are justified clinical reasons for not doing this). • Participating in and delivering, as far as possible, the clinical and cost effective strategies agreed by the CCG, through its QIPP plans agreed at CCG level. • Initiate/participate in audits • Management of their own referrals and prescribing • Internal and intra-practice peer review • Sharing appropriate referral, prescribing and emergency admissions data. • Establishing a practice reference group or equivalent means of obtaining the views and experiences of patients and carers. • Responding in a timely manner to reasonable information requests from the CCG.

Individual GP Practices will only be responsible for the management of their Practice within their contractual arrangements agreed with the NHS Commissioning Board and will not therefore act in a silo capacity in delivering CCG objectives as this will be managed only at locality level in which the GP Practices will participate.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 61 of 67 5153 Schedule 5 – member, governing body member, committee and sub- committee member and employee declaration form: financial and other interests

This form is required to be completed in accordance with Basildon & Brentwood CCG’s Constitution.

Notes:

Within 28 days of a relevant event, CCG members, the members of its governing body, members of its committees or sub-committees (including those of its governing body) and employees need to register their financial and other interests.

If any assistance is required in order to complete this form, then the member or employee should contact the Head of Corporate Governance.

The completed form should be sent by both email and signed hard copy to the Head of Corporate Governance.

Any changes to interests declared must also be registered within 28 days of the relevant event by completing and submitting a new declaration form.

The register will be published as set out in the CCG’s Conflict of Interest Policy or otherwise made accessible to members of the public on request.

Members, governing body members, committee and sub-committee members and employees completing this declaration form must provide sufficient detail of each interest so that a member of the public would be able to understand clearly the sort of financial or other interest that person has and the circumstances in which a conflict of interest with the business or running of the CCG might arise.

If in doubt as to whether a conflict or potential conflict of interests could arise, a declaration of the interests should be made.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 62 of 67 Interests that must be declared:

1. Roles and responsibilities held within member practices;

2. Directorships, including non-executive directorships, held in private companies or PLCs;

3. Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG;

4. Shareholdings (more than 5%) of companies in the field of health and social care;

5. Positions of authority in an organisation (e.g. charity or voluntary organisation) in the field of health and social care;

6. Any connection with a voluntary or other organisation contracting for NHS services;

7. Research funding/grants that may be received by the individual or any organisation they have an interest or role in;

8. Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role within the CCG whether such interests are those of the individual themselves or of a family member, close friend or other acquaintance of the individual.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 63 of 67 Declaration:

Name: Position within the CCG: Interests: Types of Interest Details Personal interest or that of a family member, close friend or other acquaintance? Roles and responsibilities held within member practices Directorships including non- executive directorships, held in private companies or PLCs Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG Shareholdings (more than 5%) of companies in the field of health and social care Positions of authority in an organisation (e.g. charity or voluntary organisation) in the field of health and social care Any connection with a voluntary or other organisation contracting for NHS services

Research funding/grants that may be received by the individual or any organisation they have an interest or role in [Other specific interests?]

Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role within the CCG

NHS Basildon and Brentwood CCG Constitution v54.0 Page 64 of 67 To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly and no longer than annually. I give my consent for the information to be used for the purposes described in Basildon & Brentwood CCG Constitution and published accordingly.

Name: ______

Signature: ______

Dated: ______

NHS Basildon and Brentwood CCG Constitution v54.0 Page 65 of 67 5254 Schedule 6 – dispute resolution procedures

Background

It is almost inevitable that on occasions practices will disagree with decisions made by their commissioning group or in some cases, actions taken by other practices that impact on them. It is important that all practices have the ability to appeal against any such decisions and have the right to request that any dispute is resolved by means of an agreed Dispute Resolution Procedure that forms part of the commissioning group’s constitution.

The arrangements to deal with disputes arising from the new commissioning responsibilities will follow closely existing procedures which involve a three staged process.

Stage 1: The Informal Process

Informal resolution helps develop and sustain a partnership approach between practices and between practices and commissioning groups.

Each party may involve the LMC at this stage in either an advisory or mediation role.

It is a requirement that the Informal Process must have been exhausted before either party is able to escalate the dispute to Stage 2: The Local Dispute Resolution Panel.

Stage 2: The Formal Local Process

In cases where either party remains dissatisfied with the outcome of Stage 1, then they have the right to request Formal Local Dispute Resolution in writing, including grounds for the request to the Accountable Office of the commissioning group.

Other than in cases, which in the opinion of the Accountable Officer and following consultation with the LMC, are considered to be frivolous or vexatious, a Local Dispute Resolution Panel (LDRP) will be convened to hear the dispute and make a determination.

Members of the LDRP

The Panel will consist of:

. A clinical member of the Governing Body of another commissioning group. . A GP conciliator (from a Panel to be established by the LMCs). . An LMC representative (from a different part of Essex), or . For Lay members, a representative from a professional body of their choosing . Panel Secretary (non-voting).

The Panel will agree its own ChairmanChair.

The Hearing

NHS Basildon and Brentwood CCG Constitution v54.0 Page 66 of 67 The hearing will be held within 20 working days of the request being lodged. At least 7 working days’ notice of the hearing date will be given to all participants.

Documentation

All relevant documentation will be provided to all parties and panel members at least 5 working days before the hearing.

Procedure at the LDRP Hearing

The discussion of the Panel will remain confidential. The Panel Secretary will keep a record of the hearing.

The Appellant will be asked to present their case. Members of the Panel will be given the opportunity to ask any questions relevant to the case.

The Respondent will be asked to present their response. Members of the Panel will be given the opportunity to ask any questions relevant to the case.

The Appellant and the Respondent will then withdraw.

Following the presentation of the facts the Panel will deliberate and reach a decision on the case based on a majority of the voting panel members.

The Panel Chair will notify both parties of the decision including any recommendations in writing within 7 days after the hearing.

If either party disputes the decision of the LDRP and the decision relates directly to provisions in its GMS/PMS contract, then it may refer the matter to the Family Health Services Appeal Unit (FHSAU) of the NHS Litigation Authority in line with relevant NHS Regulations, for dispute resolution under the “NHS Dispute Resolution Procedure”.

Stage 3: Appeal to The Secretary of State through the FHSAU – NHS Dispute Resolution Procedure

Written requests must be directed to the FHSAU, 1 Trevelyan Square, Boar Lane, Leeds, LS1 6AE within three years beginning on the date on which the matter giving rise to the dispute happened or should reasonably have come to the attention of the party wishing to refer the dispute.

Disputes should be addressed directly to the FHSAU and must include: . The names and addresses of the parties to the dispute. . A copy of the contract. . A brief statement describing the nature and circumstances of the dispute.

Inter Practice Disputes

It is envisaged that the Stage 2 Formal Process will be used in the main to deal with disputes between individual practices and commissioning groups.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 67 of 67 In cases where the dispute is between practices and it is an issue that warrants formal dispute resolution, then the same process and timescales will apply.

The only proposed change is that the LMC representative on the LDRP will be a representative from an LMC outside of South Essex. It is extremely unlikely that any disputes between practices will be appropriate for referral to the Secretary of State for determination as detailed in Stage 3.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 68 of 67 5355 Schedule 7 – approval of standing financial instructions, standing orders and scheme of delegation

Name Version Document Date Date of Governing Body Approval Corporate Governance V1.0 February 2014 6th February 2014 Manual (comprising Standing Orders, Standing Financial Instructions and Scheme of Delegation)

6th July 2015 2nd July 2015 Corporate Governance V2.0 Manual (comprising Standing Orders, Standing Financial Instructions and Scheme of Delegation)

7th September 2017 N/A – changes made in Corporate Governance V3.0 the SORD by NHS Manual (comprising England by using their Standing Orders, power to amend the Standing Financial CCG’s constitution Instructions and Scheme BB CCG Corporate of Delegation) Govenance Manual (J

The above three documents define the financial regulation of the CCG. All documents were reviewed and approved by the Basildon and Brentwood CCG Governing Body with the exception of the last update of the SORD made by NHS England in relation to the STP Joint Committee delegated functions.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 69 of 67 5456 Schedule 8 – Clinical Commissioning Group Committee Structure

Basildon and Brentwood NHS CCG Governing Body

NHS Basildon and Brentwood CCG Committee Structures

[NHS Basildon and Brentwood CCG structure

STP Joint Committee

The terms of reference for the Committees of the Governing Body are on the CCG website here:

http://basildonandbrentwoodccg.nhs.uk/about-us/constitution-and-terms-of-reference

NHS Basildon and Brentwood CCG Constitution v54.0 Page 70 of 67 5557 Schedule 9 – Basildon and Brentwood NHS CCG etiquette protocols

. Prepare well for the meeting as your contribution is integral to the proceedings. If you are contributing a report, please send it in good time to meet the secretary’s deadline to ensure that the papers are sent to all Members a week before the Committee meeting, and gives the Chair the opportunity to scrutinise what is to be included.

. You will also be expected to have read the papers so that the Meeting discussion can focus on key elements in order to make decisions. If you are presenting a paper, please assume that the Committee members have read it so your introduction should be concise and limited to the key points.

. Always remember to switch off your mobile phone and any other devices.

. Acknowledge any introductions or opening remarks with a brief recognition of the chair and other participants.

. Always address the chair when making your points and talk through the chair to the Committee members.

. Never interrupt anyone or talk over someone else – even if you disagree strongly. Note what has been said and return to it later with the chair’s permission.

. Do not hold side conversations when someone else is talking.

. When speaking, be brief and ensure what you say is relevant.

. It is a serious breach of business etiquette to divulge information to others about a meeting. What has been discussed should be considered as confidential.

. Decisions by the Governing Body are final and can only be revisited in exceptional circumstance.

. The Governing Body is the Final arbiter on all issues, once the decision is reached it is critical for good governance that all members assist in its implementation.

. It is the responsibility of the Chair to maintain order, keep to allotted times, allow everyone to have their say, provide to focus to deliver successful outcomes, and to ensure the agenda meets the needs of good governance.

. It is the membership’s responsibility to respect the role of Chair and to assist them in the delivery of the above. The underlying principles of the all the above business meeting etiquette pointers are good manners, courtesy and consideration. If these are adhered to, the changes of offence and misunderstanding are greatly reduced.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 71 of 67 5658 Schedule 10 – NHS constitution

The NHS Constitution sets out seven key principles that guide the NHS in all it does:

1 the NHS provides a comprehensive service, available to all - irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population 2 access to NHS services is based on clinical need, not an individual’s ability to pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament. 3 the NHS aspires to the highest standards of excellence and professionalism - in the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population. 4 NHS services must reflect the needs and preferences of patients, their families and their carers - patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. 5 the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population - the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being 6 the NHS is committed to providing best value for taxpayers’ money and the most cost- effective, fair and sustainable use of finite resources - public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves 7 the NHS is accountable to the public, communities and patients that it serves - the NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose.

Source: The NHS Constitution: The NHS belongs to us all (March 2012)11

11 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132 961

NHS Basildon and Brentwood CCG Constitution v54.0 Page 72 of 67 59 SCHEDULE 11 – TERMS OF REFERENCE

5759.1 Audit Committee Terms of Reference Formatted:2 Heading

Terms of Reference

Committee: Audit Committee

Frequency Of Meetings: Five times a year.

Committee Chair: Lay Member (Audit)

Membership: Lay Member (Audit) Lay Member (Governance) Secondary Care Consultant [The Chair of the CCG Board shall be able to attend meetings by invite].

Attendance: Chief Finance Officer Head of Corporate Governance Internal Auditors External Auditors Local Counter Fraud Service / Local Security Management Service (as required)

Further representatives to be invited by the Chair

Lead Officer: Head of Corporate Governance

Secretary: Team Administrator

Quorum: At least two committee members

Date Approved: Audit Committee 20 November 2019 & Board 28 November 2019

Version 3.3

Review Date: 30 November 2020

NHS Basildon and Brentwood CCG Constitution v54.0 Page 73 of 67 DELEGATED AUTHORITY

The Board has established a Committee of the Board to be known as the Audit Committee (the Committee), in accordance with the CCG Standing Orders and Standing Financial Instructions. The committee is a non-executive committee of the Board and has no executive powers, other than those specifically delegated in these terms of reference.

The Committee is established in accordance with the NHS Basildon and Brentwood CCG’s constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the constitution.

The Committee terms of reference are available upon request and shall be contained on the website of the CCG.

It is acknowledged that the Board is ultimately accountable for the actions of the Audit Committee and therefore the Committee will:

I. report on its work by presenting the minutes of its meetings to the Board. II. report to the Board on an annual basis, the work undertaken in the previous year and the intended programme of work for the forthcoming year. III. review the Terms of Reference annually and submit for Board approval.

PURPOSE OF COMMITTEE

In line with the requirements of the NHS Audit Committee Handbook, NHS Codes of Conduct and Accountability, and more recently the Higgs report, the Audit Committee must provide the CCG Board with an independent and objective review on its financial systems, financial information and compliance with laws, guidance, and regulations governing the NHS.

The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised by the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.

DEVOLVED FUNCTIONS

Section 9 of the CCG Constitution describes the CCG functions and duties delegated to the Board. The Board delegates to the audit committee those functions relating to areas outlined in the remit and responsibilities of the audit committee stated below.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 74 of 67 REMIT & RESPONSIBILITIES

Integrated Governance, Risk Management and Internal Control

The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the organisation's activities (both clinical and non-clinical), that supports the achievement of the organisation's objectives.

In particular, the Committee will review the adequacy of:

• all risk and control related disclosure statements (in particular the Annual Governance Statement and declarations of compliance with the Regulations of the Health and Social Care Act 2012), together with any accompanying Head of Internal Audit statement, external audit opinion or other appropriate independent assurances, prior to endorsement by the Board.

• the underlying assurance processes that indicate the degree of the achievement of corporate objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements. This will be achieved by means of reviewing and endorsing the Board Assurance Framework on a quarterly basis and the Risk Management Strategy annually and recommending these to the CCG Board for approval.

• the policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements.

• the policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the Counter Fraud and Security Management Service.

In carrying out this work the Committee will primarily utilise the work of Internal Audit, External audit and other assurance functions, but will not be limited to these audit functions. It will also seek reports and assurance from Board members and CCG officers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

This will be evidenced through the Committee’s use of an effective Board Assurance framework to guide its work and that of the audit and assurance functions that report to it.

Internal Audit

The Committee shall ensure that there is an effective internal audit function established by management that meets mandatory NHS Audit Standards and provides appropriate independent assurance to the Audit Committee, Accountable Officer and Board. This will be achieved by:

• consideration of the provision of the Internal Audit service, the costs of the audit and any questions of resignation and dismissal

NHS Basildon and Brentwood CCG Constitution v54.0 Page 75 of 67 • review and approval of the Internal Audit Strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the Assurance Framework

• consideration of the major findings of internal audit work (and management’s response), and ensure co-ordination between the Internal and External Auditors to optimise audit resources

• ensuring that the Internal Audit Function is adequately resourced and has appropriate standing within the organisation

• annual review of the effectiveness of the internal audit function

External Audit

The Committee shall review the work and findings of the External Auditor appointed by the Audit Commission and consider the implications and management’s responses to their work. This will be achieved by:

• consideration of the appointment and performance of the External Auditor, as far as the Audit Commission’s rules permit

• discussion and agreement with the External Auditor, before the audit commences, of the nature and scope of the audit as set out in the Annual Plan, and ensure co- ordination, as appropriate, with other External Auditors in the local health economy

• discussion with the External Auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee

• review all External Audit reports, including agreement of the annual audit letter before submission to the Board and any work carried outside the annual audit plan, together with the appropriateness of management responses

Other Assurance Functions

The Audit Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications to the governance of the organisation.

These will include, but will not be limited to, any reviews by Department of Health, NHS England or Regulators/Inspectors (e.g. Health & Safety Executive, NHS Litigation Authority etc.) professional bodies with responsibility for the performance of staff or functions (e.g. Royal Colleges, accreditation bodies etc.).

In addition, the Committee will review the work of other committees within the organisation, specifically the Governance Committee, the Patient Safety & Quality Committee and the Finance & Performance Committee, whose work can provide relevant assurance to the Audit Committee’s own scope of work. In reviewing the work of these committees, and issues around risk management, the Audit Committee will wish to satisfy themselves on the assurance that can be gained from the CCG’s systems for ensuring sound clinical governance across the providers from whom the CCG commissions care.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 76 of 67 Counter Fraud

The Committee shall satisfy itself that the organisation has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work.

Management of Conflicts of Interest within the CCG

The Committee has a specific responsibility for providing assurance to the Board that the CCG has effective processes in place for managing conflicts of interest with regard to Board members and officers/staff. This role includes review of the CCG’s Conflicts of Interest Policy (in conjunction with the Governance Committee) and quarterly review of the Register of Board Members’ Interests.

Management

The Committee shall request and review reports and positive assurances from directors and management and internal control.

They may also request specific reports from individual functions within the organisation (e.g. clinical audit) as they may be appropriate to the overall arrangements.

Financial Reporting

The Audit Committee shall review the Annual Report and Financial Statements before submission to the Board, focusing particularly on:

. the wording in the Annual Governance Statement and other disclosures relevant to the Terms of Reference of the Committee . changes in, and compliance with, accounting policies and practices . unadjusted mis-statements in the financial statements . major judgemental areas . significant adjustments resulting from the audit The Committee should also ensure that the systems for financial reporting to the Board, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Board.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 77 of 67 MANAGING THE COMMITTEE

The Committee will conduct its business in accordance with National Guidance, and relevant codes of conduct / good governance practices for example Nolan’s seven principles of public life.

Membership

The Committee shall be appointed by the CCG Board as set out in the constitution and may include individuals who are not on the governing body. The lay member on the CCG Board with a lead role in overseeing key elements of governance, will be the chair of the audit committee. The Committee shall consist of no less than three lay members (including one or more lay members who have been appointed solely to serve on the Audit and Remuneration Committees). The Audit Committee Chairman shall be the Lay Member responsible for governance, appointed by the CCG Board in accordance with the Constitution. The Chairman of the CCG Board shall not be a member of the Committee but will be invited to attend once a year and will be entitled to attend any meeting. The Chief Finance Officer or nominated representative, Internal Audit, External Audit and Local Counter Fraud representatives shall normally attend meetings. At least once a year the Committee should meet privately with the External and Internal Auditors. The Accountable Officer, Chief Operating Officer and other executive or senior officers of the CCG may be required to attend upon request of the Committee, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director. The Accountable Officer should be required to attend at least annually, to discuss with the Audit Committee the process for assurance that supports the Annual Governance Statement. The nominated Secretary shall be Secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the Chairman and committee members during and outside of audit committee meetings.

Committee Chair

In the event of the chair of the committee being unable to attend all or part of the meeting, he or she will nominate a replacement from within the membership to deputise for that meeting.

Secretary

The nominated officer who shall act as secretary is stated at the outset of this Terms of Reference. The secretary will be responsible for supporting the chair in management of committee business and for drawing the committee’s attention to best practice, national guidance and other relevant documents as appropriate

NHS Basildon and Brentwood CCG Constitution v54.0 Page 78 of 67 Qualification and Disqualification for membership and appointment of the chair

The CCG Constitution sets out the processes for qualification and disqualification of members. The appointment of members to this committee shall be via Board approval of the terms of reference of this committee, which sets out its membership.

Frequency and notice of meetings

Meetings shall be held not less than five times a year. The External Auditor or Head of Internal Audit may request a meeting if they consider that one is necessary.

Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the chair or committee secretary at least 10 working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted 5 working days before the meeting takes place.

The date, time and venue of all committee meetings will be notified to members at least 7 days’ notice. The agenda and papers for the meeting will be circulated to members 7 working days in advance of the meeting.

Minutes and Committee Papers

The minutes of Committee meetings shall be formally recorded by the designated secretary and submitted to the Board. The Chair of the Committee shall draw to the attention of the board any issues that require disclosure to the full Board, or require executive action.

Decision Making / Policy and Best Practice

In making decisions the Committee will apply best practice in the decision making processes.

RELATED COMMITTEES

All other committees of the Board shall present the minutes of their meetings (and where appropriate papers) relating to any matter of internal control or risks stated on the Board Assurance Framework so that the Audit Committee is fully informed of such matters to enable them to discharge their responsibilities.

Other working groups / committees that provide assurance to the committee are:

. Governance Committee; . Finance & Performance Committee; . Patient Safety & Quality Committee

NHS Basildon and Brentwood CCG Constitution v54.0 Page 79 of 67 REPORTING & REVIEW

Reporting to the CCG Board

The Committee will report to the Board annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embedding of risk management in the organisation, and integration of governance arrangements and the appropriateness of ongoing compliance against the terms of its authorisation with NHS England.

Annual Review of Effectiveness

The committee will conduct an annual self-assessment of its effectiveness and report the findings of the assessment to the Board.

CONFLICTS OF INTEREST

The CCG’s rules on conflicts of interest as set out in the CCG Constitution, Standing Orders and Standing Financial Instructions apply to the work of this Committee. Members or those in attendance must, at the outset of the meeting, declare any interest that they may have in a matter and withdraw from the discussion on that item.

Latest Review: CCG Board 28 November 2019

NHS Basildon and Brentwood CCG Constitution v54.0 Page 80 of 67 59.2 Remuneration Committee Terms of Reference

REMUNERATION COMMITTEE Formatted: Centered

TERMS OF REFERENCE

Committee: Remuneration Committee

Frequency Of Meetings: As and when deemed necessary by the Chair, but no less than two meetings per annum.

Committee Chair: Lay Member

Membership: Lay Member (Audit & Governance)

Lay Member (PPI)

Secondary Care Consultant In Attendance: Human Resources Business Adviser

Further representatives as required at particular meetings according to the items on the agenda, by invitation of the Chair

Lead Officer/Secretary: Head of Corporate Governance

Quorum: At least two Members

Date Approved: Remuneration Committee – 17 January 2019

Board – 28 March 2019 Version 1.7

Next Review Date: 31 March 2020

NHS Basildon and Brentwood CCG Constitution v54.0 Page 81 of 67 OVERVIEW

The main objective of the Remuneration and Terms of Service Committee (the Committee) is to make recommendations to the CCG Board on all aspects of the remuneration and terms of service of the CCG Executive and Board Members, re their terms and conditions and assessment of their performance. The role of the Remuneration Committee is to ensure that fairness, equity and consistency is applied in this process.

In addition the Committee will determine any annual inflationary pay awards for CCG Senior Managers, or other staff on local contracts of employment.

The Committee must operate to advice and guidance from NHS England. The Committee will conduct its business in accordance with the provisions of the CCG’s Standing Orders, Standing Financial Instructions and Scheme of Delegation.

AUTHORITY

The Committee is authorised by the Board to make decisions within its terms of reference, including matters specifically referred to by the Board. It is authorised to seek information it requires from any employee of the CCG. It is authorised to obtain legal or other independent professional advice and to secure the attendance of such outsiders with relevant experience and expertise that it considers necessary.

MAIN DUTIES

• To keep under review, and to make recommendations to the Board on, the remuneration and other benefits of the CCG Executive and Board and where detailed above, other senior managers;

• To ensure senior staff / Board members are fairly rewarded for their individual contribution to the CCG having proper regard to local circumstances and performance and to the provisions of any national arrangements for such staff where appropriate;

• To advise the Board on any arrangements for termination of employment and any other contractual matter in respect of the posts within the remit of the Committee;

• To review and endorse changes to staff positions that affect agenda for change band 8d and above;

• To review any arrangements outside national terms and conditions.

MEMBERSHIP: As set out on page 1.

ATTENDANCE:

NHS Basildon and Brentwood CCG Constitution v54.0 Page 82 of 67 The Chief Finance Officer and Chief Officer will be present at the Committee meetings when discussion takes place on matters requiring their input and attendance to provide information to the remuneration committee on matters presented.

A senior Human Resources specialist will attend the Committee meetings in an advisory capacity.

The Human Resource specialist will provide the Committee with information on any issues arising from the following:-

• Job evaluation information

• Trends in pay and conditions of service

• Levels of remuneration offered by similar organisations

• Information on the local labour market

• Retention of key skills

• Any other contractual issues including severance payment and legal advice as required

The HR specialist will support the Committee in the process of confirming individual and, if appropriate, objectives for the Senior Team.

In the event that the Remuneration Committee is required to discuss and make a decision with regard to the remuneration levels or terms and conditions of lay members, then the following will apply:

• A GP Board member will be nominated by the CCG Chair to take the chair for the portion of any Remuneration Committee where these items are discussed;

• Either the individual lay member whose remuneration is under discussion or all of the lay members (depending on the specifics of the agenda item) will be asked to leave the meeting for these items;

• The voting members of the Committee, for these items, will then be the Acting Chair of the Remuneration Committee (GP Board member), other non-conflicted members of the Committee and if required either the Accountable Officer or the Chief Finance Officer;

• Some matters may be more appropriate to be discussed via email / conference call. When a decision is required this will be recorded as if a normal meeting and all non- conflicted Committee Members should be asked to record their agreement to the decision. These minutes will then be approved at the next ordinary meeting of the Committee.

COMMITTEE CHAIR

NHS Basildon and Brentwood CCG Constitution v54.0 Page 83 of 67 In the event of the chair of the committee being unable to attend all or part of the meeting, he or she will nominate a replacement from within the membership to deputise for that meeting or part of the meeting.

LEAD OFFICER/SECRETARY

It may be appropriate not to store all discussions/ papers on the shared drive. Where discussions or documents need additional protection, they may be filed with the relevant Human Resources Business Adviser.

QUALIFICATION AND DISQUALIFICATION FOR MEMBERSHIP AND APPOINTMENT OF THE CHAIR

FREQUENCY AND NOTICE OF MEETINGS

The Committee will meet a minimum of two times a year to discuss the remuneration and performance of CCG Executive and Board. In light of advice from the Chair/CFO/AO, the Committee may also be convened at other times.

MINUTES AND COMMITTEE PAPERS

The minutes of Committee meetings shall be formally recorded by the designated secretary and submitted to all members of the remuneration Committee. If other members or individuals request to see papers, the Committee will discuss the request taking the advice of human resources and governance (particularly information governance).

DECISION MAKING / POLICY AND BEST PRACTICE

In making decisions the Committee will apply best practice in the decision making processes.

The Chair of the Committee (or the acting Chair) will have a casting vote.

NHS Basildon and Brentwood CCG Constitution v54.0 Page 84 of 67 The Committee will conduct its business in accordance with National Guidance, and relevant codes of conduct / good governance practices for example Nolan’s seven principles of public life.

ANNUAL REVIEW OF EFFECTIVENESS

The committee will conduct an annual self-assessment of its effectiveness and report the findings of the assessment to the Board.

CONFLICTS OF INTEREST

Formatted: Normal

NHS Basildon and Brentwood CCG Constitution v54.0 Page 85 of 67 59.3 Primary Care Commissioning Committee

[to be inserted once agreed] Formatted: Font: Italic

NHS Basildon and Brentwood CCG Constitution v54.0 Page 86 of 67 Agenda Item 14

Basildon & Brentwood CCG Governing Body meeting in Public - 26 November 2020 Quality Report

Purpose of Report: The purpose of the report is to provide an update on the activities of the CCG for the Board since its last meeting, and other key events of which members should be aware.

Recommendations and The Committee/Board is asked to note the following: decision/actions: Patient Safety (to include but not exclusive to) • Infection Prevention and Control • Serious Incidents and Never Events • Safeguarding • LeDeR • SEND • Care Homes • Continuing Healthcare

Patient Experience • Complaints • Assurance visits or service feedback • Quality Accounts • Clinical Effectiveness

Appendix 1 • Joint Committee Patient Safety Report provides a brief overview of key quality and patient safety issues for all services delegated to the CCG Joint Committee. • •

Executive Summary This paper reports progress of the delivery of the Patient Safety and Quality (including financial impact): programme within the Operational Plan. This paper was presented and discussed at the Patient Safety & Quality Committee and presented at the Board of Basildon and Brentwood CCG.

Written by/Presented by: Geraldine Rodgers, Deputy Chief Nurse [email protected]

Executive Director N/A Sponsor:

Non-Officer/Board Dr Sooraj Natarajan, Chair of PSQC Sponsor:

1 Fit with CCG Strategic Yes Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document).

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) N/A

Has the Equality/Quality/Privacy Impact Assessment N/A been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: N/A BAF Ref:

Conflicts of Interest: N/A

2 CHIEF NURSE REPORT 1. Introduction

This report provides the exceptions of key quality and patient safety issues for all services over which BB CCG has direct oversight and/or any services where the CCG is the lead on behalf of the Mid and South Essex CCGs.

2. Patient Safety Infection Prevention and Control – the narratives will be presented in Appendix A of this report.

2.1 Serious Incidents and Never Events

The Pressure Ulcer SI panel has now resumed, the October Panel meeting was attended by the CCG and the next panel meeting is due to take place in November.

There are currently 3 active serious incidents for NELFT Community Services being managed by BB CCG as detailed in the table below.

NELFT Data Category of Incident Number of Incidents Patient falls 2 Pressure Ulcers 1

EPUT Data (BB CCG Related - Managed by Thurrock CCG) Category of Incident Number of Incidents Unexpected/potentially avoidable death 8 Patient fall 2 Homicide 1

2.2 MSI Data – recorded in the PQSC papers in common – see appendix A

3 Safeguarding (Adults and Children)

3.1 Looked after Children

Update on IHA database:

Discussions continue on the creation of the SET-wide IHA database – updates include: • SET IHA database – On-going IT development/review of database. Awaiting details of next meeting from Lead. • SET-wide IHA Commissioning task and finish group – Plan for joint meeting with IHA providers and commissioners – being coordinated by Helen Farmer (Assistant Director for Integrated Commissioning for Children, Young People and Maternity Services) – Next meeting set for 5th November 2020. • CCG Commissioners and SET Providers are working towards Digital Solution – Outcome not finalised.

3 IHA Assessments: Current SET-wide difference in practice for IHA assessments; Some areas conducting face-to- face assessments others virtual. SET-wide meeting scheduled for 17 November 2020 by Designated Doctor LAC to agree to a common pathway considering the resurging COVID positive numbers. Monthly LAC catch-up meetings set up with between CCG and NELFT to obtain regular updates and raise any LAC challenges promptly, especially around IHA data and quality assurance.

3.2 Safeguarding Adults Quality and safety concerns at The Marillac Nursing Home, Brentwood. There is ongoing work with the Senior Management team at the Marillac and the CCG. There is also a piece of work being undertaken to support effective communication between the Marillac and Fresenius Kabi (FK) as an issue has been highlighted during the work carried out to support the provider. Support has been conveyed to the provider and they have welcomed delivery and training on Whzan to teams are equipped to monitor residents’ deterioration.

Ghyll Grove (HcOne) There continues to be ongoing organisational concerns with this provider in relation to care and support, risk assessments, clinical leadership, documentation, and escalation of issues. However, on the regular monitoring visits by Essex County Council they note a better atmosphere and nicer interactions. There is apparent failure of effective oversight at home and senior manager level which is still not improving. BB CCG are monitoring and supporting Essex County Council in promoting quality improvements within both provisions. There is also support from health partners at this time of flux within the provision of services. There is a further meeting planned with HcOne senior management to discuss the concerns within Ghyll Grove. Support has been offered by external partners as an interim measure to address any gaps in knowledge and competencies within the nursing unit. The Provider is currently on “High” on Essex County Council’s risk register. CQC have completed an unannounced visit in the past week, update awaited.

Oaklands (HcOne) There have been several safeguarding incidents raised in relation to medication and there have been several quality issues identified. The Care Home Pharmacy Support Team has provided oversight audit and support to address the medication issues with the home and offer further training, as requested by the CCG. There will be further external checks on the medication issues within the next reporting period.

4 The Provider is currently working towards completion of an action plan to address the ongoing issues, Essex County Council are monitoring progress. Issues will be picked up in the senior HcOne Management team meeting, as with Ghyll Grove. The provider is currently on “medium” on Essex County Council’s risk register.

Domestic Homicide review: There is currently one DHR which BB CCG is part of. There was an event in October to identify the learning, attended by BB CCG and all involved partners, the report authors are now finalising the report, and this will be submitted following further review of action plans. DHR - Review 1 – Ongoing involvement, final stages of report being written, and actions and recommendations agreed as a group, now waiting individual partner actions and recommendations to be agreed before report finalised and shared with family prior to being submitted. There have been two further DHR scoping requests since last reporting.

Serious Adult Review: There are currently three reviews being presented to the panel for consideration of review. BB CCG are awaiting the outcome of the decision and will be engaging with the reviews if they should be progressed. BB CCG have asked to present to the panel for one of the reviews due to previous involvement.

4 LeDeR Performance Allocation of reviews within 3 months – we are now consistently achieving this target and have sufficient funding and capacity to continue into next financial year.

Access to notes remains an ongoing challenge. Funding for a separate LD SystemOne Unit has been identified and is feasible but IG advice and guidance awaited.

5 Progress against Action Plan The Action Plan has now been agreed and approved by Southend and Thurrock Health and Wellbeing Board and is on the agenda for the November Essex County Council Health and Wellbeing Board. Essex Learning Disability Partnership (EDLP) have presented the work they are commissioned to deliver which forms the backbone of the plan, but is linked in with CCG forums around the priority areas Essex County Council’s Meaningful Lives Matter (MLM) project on Aging Well and Dying Well is committed to developing a joined-up approach to aging and end of life and has re-scoped its project plan across the next 18 months to reflect the LeDeR action plan. An additional bid is going forward to NHSE to fund a project on heart health, which we know from National 2019-2020 data is a direct cause or significant underlying factor in 30% of known causes of death.

5. SEND Update

5.1 COVID 19 and SEND Services reset :

• The NHS Children and Young people’s restoration plan 3rd June 2020 identified SEND therapy and nursing services as essential and services should reset as quickly as possible. • Through the CYP MSE steering group, SEND services were reviewed on a weekly basis and concerns over staffing were escalated to executive level and raised as a risk – NELFT children’s services received all redeployed staff back on the 1st September 2020 and services are resetting and reviewing both capacity and back log of care and referrals. • The letter from the Chief nurse for England dated October 2020 has requested that children services staff are not redeployed in any second wave of the virus and children’s services are protected – this letter has been shared with commissioners and providers.

Support for schools: • The CCG and DCO supported both special schools and mainstream schools in the offer of school provision to vulnerable pupils and those with an Education, health and care plan. Key areas of support • Safe return to school for pupils with complex health needs. • Health representation in the multi-agency risk assessments for pupils including those that had been advised to shield. • Development of system wide guidance and support resources for schools and colleagues to ensure safe and effective care in accordance with the National guidance. • Systemwide development of consistent guidance in relation to children with aerosol generating procedures and support for schools in undertaking a whole school risk assessment.

6 • Ensuring accurate and timely communications to health colleagues and partner agencies in relation to SEND. • Support and guidance for health colleagues as they return to their substantive roles and ensuring that any concerns are escalated and actioned and ensuring partner agencies are updated on the health reset. • Working alongside the Essex Family forum to ensure families are informed and have accurate contact numbers for health services. • It is important to note that services do not fully know the impact and increased level of need presented by children following lockdown and the level of need and demand will become more apparent over the autumn term.

5.2 Essex Written Statement of Action:

• Current workstreams include – Joint commissioning of therapy services and review of quality of the education, health, and care plan. • The MSE children’s workstream is fully sighted on the developments and requirements of the WSoA and are developing a work plan and areas of responsibility to ensure MSE is sighted and actively engaged within the work streams. • MSE has representation within all joint commissioning workstreams and the Executive lead for Children and Young people is a member of the joint commissioning steering group. • BBCCG DCO attended the recent DFE and NHSE/I monitoring call and both DEF and NHSE/I were pleased with the progress and recognised the concerns in commencing and progressing workstreams in relation to COVID 19. • Executive lead to explore the financial ask for the WSoA as this has not been formalised yet.

5.3 Personal Health Budget (PHB) Child & Adolescent Mental Health Service (CAMHS) Project – positive pathways

The pilot project was agreed for 6 months and supported young people aged 11-16yrs who are not attending school due to a mental health concern, through an individual coaching and mentoring programme. The 6-month pilot completed on the 30th June 2020 and BBCCG agreed to continue funding the project for a further 12 months on a full-time basis and to cover the whole of the BBCCG locality. The criteria for the service was reviewed : • The young person attends school in the Basildon, Brentwood, Billerciay and Wickford area. • The young person is aged 11-16 years. • The young person has not attended school due to a mental health • The young person has been referred to the local authority education access service. Thurrock Mind will continue to deliver the service and outcomes have been developed to demonstrate the impact on the young people engaged with the service. The youth coach has developed case studies and reports to support in the further development of the project. The project has been recognised at national level and the DCO and PHB lead will present to the East of England PHB forum.

5.4 Therapy Provision in special schools: The ongoing situation at Glenwood school was highlighted at the SEND inspection and the accountable officers for BBCCG, Mid Essex and Castle Point & Rochford (CPR) CCG produced a statement of commitment to supporting a timely resolution to the lack of therapy to out of area children. The current gap in provision is for: • Physiotherapy • Occupational therapy. NELFT are currently supporting 5 high level needs children and have written to express concern over their ability to continue to deliver this care due to capacity and the level of care they can offer. BBCCG, CPRCCG and ECC have agreed a joint funding plan to support the ongoing needs of children within the school. Additional Physiotherapy hours have been sourced and a band 6 occupational therapist has been recruited for two days a week for 12 months. Th objective is to transfer care from NELFT to the school’s community provider within the Autumn term 2020.

6. Care Homes 6.1 Care Sector Hub:

The local Care sector Hub meetings have been ongoing since the 4th May to support the care homes within our locality. These are held daily, and concerns escalated to the Care Sector Operational Tactical Group which currently now once a week. The terms of reference for the care homes are now completed which reflect the Enhanced Home Care Framework (March 2020). A new monthly Webinar has been set up for the first Tuesday of every month to support infection, prevention and control within Care Homes and Domiciliary care providers. This information has been shared with all BB CCG care homes and is being promoted via the Hubs, Essex County Council Care Provider communication and the CCG Care Provider bulletin. The top themes emerging from within the Care Sector hubs are: • Thirteen outbreaks (more than 1 case) of Covid (No recorded exposures) at the time of writing this report, this mark an increase from last month of three.

6.2 Technology Support Whzan a new piece of technology that we are providing to care homes across Mid and South Essex which will result in a better and more active level of clinical care for Nursing and Residential Home residents.

8 • 34 of the 50 care homes in BB area have the Whzan kit in place and all 34 have user accounts set up. • Pulse Oximeters have been delivered and therefore all care homes in the BB area have now received two oximeters each. • Three kits delivered to NELFT to assist with training. One kit delivered to St Luke’s nurse for training. • 31 homes have received portals from the CCG, in total 35 homes have received portals. The portals are provided to support residents to stay in touch with their loved ones. Whzan training and baseline observation training is supporting this work. Consequently, all residents in these locations will have baseline observations in place as part of their care and escalation care plan. We have also worked with Whzan to create a clinical dashboard for GPs to enable virtual monitoring. BB CCG are actively supporting homes to access the training from Essex County Council (PROSPER team) and Whzan. An update on Whzan and progress has been presented to Primary Care and has been very well received.

7.0 St Francis Hospice On 20 August 2020, the Basildon and Brentwood CCG was informed by St Luke’s hospice that they had become aware of a news article reported in the Romford Recorder regarding a staff consultation at St Francis’s hospice, Havering. This hospice provides care for end of life patients in Brentwood. As part of the government COVID response St Francis has received over 1 million additional funding via Hospice UK since April 2020, however COVID has had a significant impact on the finances and the future sustainability; therefore, they have invited employees to consider the options of voluntary redundancy and voluntary reduction in hours, the consultation closed on 21 August. The CCG have asked St Francis to consider their position in relation to requests for investment following their reset and recovery of services, which could be discussed with the CCG to ensure we minimise the negative impact on patient care for the residents of Brentwood. The CCG and St Luke’s hospice are still awaiting to hear the outcome of the consultation which closed on the 21 August 2020. Since last reporting this has been escalated internally within the CCG and a formal letter is to be sent to St Frances Hospice. Response and update awaited. St .Luke’s are also reviewing their situation, to ensure to minimise impact, the CCG are supporting these discussions.

8. Continuing Health Care Team (CHC)

NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the NHS where the individual has been assessed and found to have a ‘primary health need’. Such care is provided to an individual aged 18 or over, to meet health and associated social care needs that have arisen because of disability, accident, or illness.

Primary Health Need is a concept developed by the Secretary of State for Health to assist in deciding when an individual’s primary need is for healthcare (which it is appropriate for the NHS to provide under the 2006 Act) rather than social care (which the Local Authority may provide under the Care Act 2014). To determine whether an individual has a primary health need, there is an assessment process. Where an individual has a primary health need and is therefore eligible for NHS Continuing Healthcare, the NHS is responsible for providing for all of that individual’s assessed health and associated social care needs, including accommodation, if that is part of the overall need.

8.1 Deferred Assessments

Following the Governments response to the Covid-19 pandemic, NHS Continuing Healthcare (CHC) was suspended. Discharges from hospital and increases in care were funded centrally. A significant number of the CHC team were redeployed to Community Hospitals, and made up an important part of the Integrated Discharge Team, whilst a number of the team remained to case manage individuals already eligible and those being discharged from hospital. Importantly the team continued to commission the domiciliary care and care home placements through this most difficult time.

From the 1 September, CHC has restarted and the team are focusing efforts in reviewing these individuals to ensure that the care provision is adequate to meet needs and to determine their eligibility for NHS Continuing Healthcare and establishing the most appropriate funding authority.

NHS England has allocated a significant resource £235,000 to the CCG for additional staff in the CHC economy, including Social workers to assist in this matter. The CCG is actively recruiting to their existing establishment, whilst Essex County Council are actively recruiting.

The CCG is required to report directly to NHS England every 2 weeks on the progress against our projection of zero deferred assessments by 31 March 2021

13-Sep 27-Sep 11-Oct 25-Oct 08-Nov 22-Nov 06-Dec 20-Dec 03-Jan

Projection 308 226 208 190 172 154 136 118 108

Actual 308 226 183

10 17-Jan 31-Jan 14-Feb 28-Feb 14-Mar 28-Mar

Projection 90 72 54 26 18 0

Actual

8.2 Discharge to Assess

A Revised D2A process has been implemented since 1 September following national guidance, whereby all discharges are funded up to 6 weeks from a central fund. Those processed through the CHC are reviewed at week 3 and week 5, where a decision will be made as to the individual’s eligibility for NHS Continuing Healthcare

8.3 Fast Track Referrals

Fast track referrals for NHS Continuing Healthcare have been reinstated from1st September, this by passes the normal route into CHC for those individuals needs are rapidly deteriorating and may be entering the terminal phase of their illness.

8.4 Retrospective Cases

Retrospective reviews of care for individuals has also been resumed from 1 September and we have an individual dealing specifically with these cases. There always remains a risk to the economy from an increase in the request. Currently there are seven incomplete retrospective reviews.

8.5 Local Resolution Panel

In accordance with the National Framework the CCG has established a Local Resolution Panel. We now hear the individual appeals on behalf of Southend CCG and Castle Point & Rochford CCG.

14/15 15/16 16/17 17/18 18/19 19/20 20/21

Number of appeals 5 14 17 25 21 33 1

Number Upheld 0 1 1 1 2 1 1

8.6 Independent Review Panels (NHSE)

There remains a commitment to NHS England Independent Review panel from the CHC Team. The outcomes provide the CCG and partners acknowledgement that the multidisciplinary teams making the original decision and the subsequent local resolution panel’s decision are sound and evidence based.

11 There are eight cases awaiting review by NHS England.

14/15 15/16 16/17 17/18 18/19 19/20 20/21

Number of Reviews 3 7 4 1 5

Number Upheld 2 2 0 0 1

8.7 Quality Premiums (NHSE)

Quality Premiums for Continuing Healthcare are measured monthly on the number of decisions made in acute settings, as this is not generally the best environment to make those decisions. It is also measured on the length of time taken from referral to decision.

The Quality Premiums were suspended during the Covid-19 Pandemic and remain suspended, although every effort is being made to assess with 28 days.

9. Primary care

• All 35 practices remain open and operating a telephone triage service.

• Monthly PCN meetings continue to take place virtually with PCN development training which is happening across MSE.

• Locality meetings also continue monthly.

• Virtual Time to learn is taking place for both GPs and Nurses and is well attended as well as the previously planned IPC training.

10. Patient Experience

10.1 Complaints

The CCG receives complaints from patients, carers, family members and Members of Parliament. Where the complaint relates directly to a provider the permission of the individual is sought to refer to the relevant provider. The CCG will analyse any trends and themes arising from complaints and works with providers to address these. Complaints relating to primary care services are managed by NHS England. During 2019/20 192 complaints were opened and 181 complaints were closed meaning that there are currently 11 complaints that remain under investigation.

Locally from April to November there have been 62 new complaints and 58 of those have now been closed whilst 4 remain under investigation.

Trends and themes arising from complaints included wait time for blood tests, access to treatment or drugs, discharge procedures/poor aftercare and staff attitude. 12 11. Assurance Visits/Service Feedback

In September, a safeguarding meeting was held with NELFT. There had been several incidents and Datix reports which prompted NELFT to raise an internal organisational safeguarding alert. All system stakeholders were invited back to a follow up meeting, where a quality and safety review was undertaken which was analysed and themed and findings of recent night visits discussed

The inspection found that a lot of work had been undertaken to address the concerns and the patients spoken to were happy with the care they received.

This month the Deputy Chief nurse supported the estates team at Brentwood Community Hospital in the creation of a more dementia therapeutic friendly environment. On 10th November, the Chair and Deputy Chief Nurse conducted a supportive visit prior the ward moves. Brentwood Community hospital will now host two wards from Basildon Hospitals namely Baymen and Thorndon and NELFT will have two wards namely Gibson and Tower.

The Deputy Chief Nurse has also working with community nursing teams, in a supportive capacity to explore increased wrap around support to care homes.

12. Clinical Effectiveness

BB CCG are collating as many resources as possible to support care sector practice through this time. The system Care Sector Group, which BB CCG leads on, provides clinical system resources such as templates and guidance through the bi- weekly care sector bulletin. The team are also leading the Quality and Performance Quality Framework for the three community providers. This month the Deputy Chief Nurse undertook presentations, 1) ECC Provider Forum. 2) UCLP Webinar of “ Doing Things Differently” and trained the quality team at PROSPER to become trainer to educate staff to spot the softer signs of deterioration.

13 Quality Accounts

Please note the Essex Partnership University Trust (EPUT) mental health mid and south essex quality account 2019/20 CCG Mandated Summary Statement was reviewed and approved by the Board on 22 October 2020 to meet the deadline. The response summary is attached as Appendix b and the full report is available on the EPUT website https://eput.nhs.uk/about-us/reports-accounts/

14 Recommendation/s

The Board is asked to: Note the contents of the report; and seek any additional assurance required.

13 APPENDIX A - JOINT COMMITTEE QUALITY & PATIENT SAFETY REPORT PART ONE REPORT

1 Patient Safety

Infection Prevention and Control

National Standard Health and Social Care (Safety and Quality) Act 2015 – Reducing Harm in Care.

Key Issue 1 Rising Healthcare Associated Infections, Resistant Staphylococcus Aureus Bacteraemia and Clostridioides difficile infection, against Zero tolerance/set objective ceiling expectations respectively.

Key Issue 2 Rising cases of Covid-19 (SARS-CoV-2) and nosocomial outbreaks

Time scale for benefits National standard will not be achieved this financial year. to be realised

1. Purpose

This report provides an overview of the current Healthcare Associated Infection (HCAI) performance across the Mid & South Essex (MSE) health economy. Data provided details Meticillin Resistant Staphylococcus Aureus Bacteraemia (MRSAB) and Clostridioides difficile infection (CDI) cases. Reported nosocomial outbreaks of Covid-19 are also included.

2. Background

HCAI data is collated via reporting from the Mid and South Essex Foundation Trust (MSEFT) (Basildon, Broomfield and Southend Hospitals) and the Data Capture System. The zero-tolerance ambition for healthcare associated MRSAB was set in 2014, the post infection review (PIR) process changed in 2018 whereby only organisations above agreed thresholds were required to undertake a PIR. However, the PIR process as continued across the MSE via local agreement to ensure robust clinical reviews and subsequent learning are captured. No avoidable MRSABs have been identified to date.

MRSAB – All CCG Cases (Acute and Community) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD BB CCG 0 1 1 0 0 0 0 2 CPR CCG 0 0 0 1 0 1 0 2 MECCG 0 1 0 2 0 2 0 5 SCCG 0 0 0 0 0 0 0 0 TCCG 0 1 0 1 1 0 0 3

14 Pre 48 hours – Community cases There have been no new cases during the October, investigations are ongoing for the open cases.

Post 48 hours - Acute cases

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Broomfield 0 0 0 0 0 0 0 0 Southend 0 0 0 0 0 0 0 0 Basildon 0 0 1 1 0 0 0 2

The Broomfield case remains under investigation, final PIR to be reviewed. The Guys and St Thomas’ case (CPRCCG resident) is in progress, the PIR has been requested from the Trust.

Clostridioides difficile infection (CDI) – All CCG Cases (Acute and Community)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD BBCCG 3 3 4 5 8 6 2 31/63 CPRCCG 5 3 5 9 3 3 2 30/43 MECCG 3 5 7 7 10 12 7 51/136 SCCG 5 3 8 1 2 6 2 27/47 TCCG 0 1 3 3 5 1 2 15/23

Acute Cases

Broomfield Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD HOHA 1 2 2 2 3 1 3 14 COHA 1 1 0 0 0 3 1 6 Total 2 3 2 2 3 4 4 20/83

Southend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD HOHA 4 0 6 3 2 5 3 23 COHA 3 3 3 4 2 1 0 16 Total 7 3 9 7 4 6 3 39/51

Basildon Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD HOHA 1 0 1 3 4 3 3 15 COHA 0 2 2 4 5 2 0 15 Total 1 2 3 7 9 5 3 30/51 NB: It is important to note that data may vary due to late notification or identification of a case found on the DCS where notification from the hospital has not been received. HOHA – Hospital onset healthcare acquired COHA – Community onset healthcare acquired

15 Nosocomial Covid-19 outbreaks Basildon: At the time of writing the report there were five wards with nosocomial outbreaks involving both staff and patients. Daily outbreak control group meetings are being held, common themes identified are IPC practices i.e. social distancing, effective cleaning and decontamination and PPE compliance, patient movement and technique in relation to rapid testing resulting in confirmed false negative results.

Broomfield: There have been two outbreaks within this reporting period involving staff only. Outbreak meetings have been discontinued as control management has been effective, closure dates 15th November. Common themes identified are social distancing and car sharing.

NELFT (Brentwood and Thurrock Community hospitals): There have been three wards across the two community hospitals with nosocomial outbreaks involving both staff and patients. Regular outbreak control group meetings are being held, common themes are staff social distancing, effective cleaning/decontaminating, and PPE compliance. It is suggested that one of the ward outbreaks was due to a false negative test result.

3. Key points to note Concern regarding emerging issues/themes from nosocomial Covid-19 outbreaks in relation to non-adherence to basic standard IPC precautions and transmission-based precautions.

4. Next steps

• Discuss Clostridioides difficile infection recurrence rates with the MSE Foundation Trust Director of Infection Prevention & Control in relation to treatment management plans. • Agree tools for post infection review across MSE health economy.

Serious Incidents and Never Events

National Standard Serious Incident Framework (published 27/03/2015) which sets out that Provider focussed internal investigations should be completed within 60 days of the incident being reported.

Key Issue 1 Number of outstanding serious incident investigations across the Mid and South Essex Foundation Trust (MSEFT)

Key Issue 2 Timeliness of investigation

Time scale for benefits This is an ongoing process and this paper provides the current to be realised position.

1. Purpose To provide an oversight of serious incident investigation and learning across the providers.

2. Background There were a total of 16 new Serious Incidents (SIs) reported in September 2020, the StEIS categories for these incidents and the location are as follows:

16 September Serious Incidents by StEIS Category

StEIS Category Basildon EEAST Broomfield Southend Total Apparent/Actual/Suspected Self Inflicted Harm Meeting SI Criteria 0 0 0 1 1 Diagnosis Incident Including Delay Meeting SI Criteria 0 0 1 2 3 Maternity/Obstetrics Incident Meeting SI Criteria - Baby Only 1 0 0 1 2 Maternity/Obstetrics Incident Meeting SI Criteria - Mother & Baby 0 0 0 1 1 Maternity/Obstetrics Meeting SI Criteria - Mother Only 0 0 0 1 1 Pressure Ulcer Meeting SI Criteria 0 0 1 0 1 Slips/Trips/Falls Meeting SI Criteria 0 0 1 0 1 Sub-Optimal Care of Deteriorating Patient Meeting SI Criteria 0 0 1 0 1 Surgical/Invasive Procedure 2 0 0 1 3 Treatment Delay Meeting SI Criteria 0 1 0 0 1 VTE Meeting SI Criteria 0 0 0 1 1 Total 3 1 4 8 16

During September 2020, 63 cases were closed or de-escalated. At month end this left a balance of 143 open SIs across the organisations, 7 of these are currently subject to a Stop the Clock status, 5 of which are with the Health Service Investigation branch (HSIB). Of the remaining 136 cases, 45 are not currently due for submission and the remaining 91 are in progress. The MSE Foundation Trust (MSEFT) met their trajectory and submitted all their Covid Stop the clock serious incidents by 30.09.2020, however 17 remain under extension.

A review of the last 3 years of reported Serious incidents at the MSE Foundation Trust has been undertaken, and the highest reported categories are as follow:

% of % of % of Broomfield Top reported StEIS 2017/18 reported 2018/19 reported 2019/20 reported categories incidents incidents incidents

Pressure Ulcer Category 3/4 50 35.70% 25 16.20% 15 12.60%

Injurious Fall 15 10.70% 24 15.60% 16 13.44% Sub optimal care of 7 5% 21 13.60% 9 7.56% deteriorating patient 38 Treatment Delay 27 19.30% 20 13% (21 trolley 31.90% breech)

% of % of % of Basildon Top reported StEIS 2017/18 reported 2018/19 reported 2019/20 reported categories incidents incidents incidents Treatment delay 25 26.00% 26 25.74% 31 27.60% Diagnostic incident 18 18.75% 13 12.87% 10 8.92% Maternity incident (baby only) 8 8.30% 15 14.85% 12 10.71% Injurious fall 5 5.20% 10 9.90% 15 13.39% pressure ulcer 6 6.25% 4 3.96% 13 11.60%

% of % of % of Southend Top reported StEIS 2017/18 reported 2018/19 reported 2019/20 reported categories incidents incidents incidents Treatment delay 28 23.50% 22 26.50% 6 10.52% Surgical invasive procedure No data No data 12 14.45% 4 7.01% Slips/trips/falls 21 17.60% 8 9.60% 5 8.70% VTE 15 12.60% 7 8.43% 8 14.03% Diagnostic incident No data No data 3 3.61% 9 15.78% maternity baby only No data No data 3 3.61% 7 12.28% sub optimal care of det patient No data No data 2 2.40% 7 12.28%

3. Key points to note • There have been no reported Never Events within September • For all serious incidents reported the 72-hour report is scrutinised to ensure that immediate learning has taken place • Fortnightly meetings continue with the Acute Commissioning Team and the Associate Director for Patient Safety / Head of Patient Safety to discuss SIs across the MSEFT and plans to complete those under an extension. • Six weekly incident review meetings undertaken. • Focussed work is being undertaken to close the oldest SIs (2 cases from 18/19 remained open at the end of September). • Focus for all investigations remains the recommendations and learning; areas of concern are placed on the action plan tracker and monitored. • The review of Serious incidents for the last 3 years has not identified any overarching themes. Focused work is underway in a number of areas including pressure ulcers, VTEs and maternity.

4. Next steps • Continue with fortnightly meetings. • Restart of targeted Quality Assurance Visits. • Further review of reported Serious incidents to understand themes and trends, to include working with the MSEFT on a consistent list of categories and cause groups.

Harm Reviews – Referral to Treatment 52 Week Waits

National Standard NHS England established an operational standard to ensure that no-one waits more than 52 weeks from referral to treatment (RTT) and that 52-week breaches should trigger a review process.

Key Issue 1 There is not an established harmonised RTT harm review process across the three sites within the Mid and South Essex Foundation Trust (MSEFT)

Key Issue 2 Risk that current RTT harm reviews will not be completed in a timely manner resulting in lessons becoming outdated before actions can be implemented

Time scale for benefits RTT harm review task and finish group implemented in to be realised September 2020. Action plan to be agreed.

1. Purpose

To provide an update on the number of 52-week breaches and the related harm review position across the MSEFT.

2. Background

A risk stratified approach for completing harm reviews remains in place following discussions in June 2020. It was agreed that 100% of harm reviews for RTT would be completed in 3 key areas: dermatology; ophthalmology and colorectal. The MSEFT was asked to identify those harm reviews which are historic and the current picture of harm review completion going forward, focusing on the three key areas. The MSEFT has provided the current picture of historic harm reviews. Further work is required on the current picture as it has been identified by the Trust that there is some difficulty in extracting the colorectal data from the surgical data.

3. Key points to note

RTT Harm Review Task and Finish Group This group was established by the MSEFT in September 2020. The purpose of group is to ensure that there is a consistent and harmonised approach to RTT pathway breaches. Regular meetings planned from November 2020. A Standard Operating Procedure (SOP) has been completed. The RTT Harm Review Task and Finish Group will initially: • Establish a harmonised RTT harm review process across the three MSE sites with the ultimate objective of an RTT harm review panel for the MSE Trust • Support the Trust to understand the causes of long waits with the ultimate aim of returning to zero 52 week waits from Referral to Treatment.

4. Next steps

• RTT to be monitored and challenged via the monthly Clinical Quality Review Group. • A member Patient Safety and Quality Team will attend the Elective Care Board • A member of the Patient Safety and Quality Team attends the RTT panels • A member of the Patient Safety and Quality Team attends the weekly RTT Task & Finish Group. • Regular meetings have been instigated with the senior responsible officer to enable additional oversight, assurance, and momentum.

19 Harm Reviews – Cancer

National Standard NHS England (NHSE) agreed on ensuring that 100% of patients waiting longer than 104/63 days from urgent referral for suspected cancer to their first definitive treatment had received a root cause analysis (RCA) of the delay and a clinical harm review.

Key Issue 1 There is not a harmonised cancer harm review process across the three sites within the Mid and South Essex Foundation Trust (MSEFT).

Key Issue 2 Risk that current cancer harm reviews will not be completed in a timely manner resulting in lessons becoming outdated before actions can be implemented.

Time scale for Cancer harm review project workstream in place, with an overarching benefits to be action plan. Work is ongoing, all benefits to be realised by March realised 2021. The MSEFT has advised the Acute Commissioning Team (ACT) that the backlog with Cancer Harm Reviews will be completed by the end of December 2021.

1. Purpose To provide an update on cancer waiting times (104+ days) and the related harm review processes for cancer pathways across the MSEFT. To advise the committee of the progress and mitigations.

2. Background 104+ BREACHES The MSEFT submits data for each hospital site on a weekly basis. July 8th 2020, highlighted 320 breaches, the data received on the 21st October 2020 evidenced a continued downward line to 66 breaches. Graph 1 below provides detail of the trajectory for 104+ cancer breaches. Cancer Waiting Times 104+ Total Reported Breaches April 2019 - October 2020 350 300 250 200 150 100 50 0 06-Jul 13-Jul 20-Jul 27-Jul 01-Jun 08-Jun 15-Jun 22-Jun 29-Jun 05-Oct 12-Oct 19-Oct 06-Apr 13-Apr 20-Apr 27-Apr 07-Sep 14-Sep 21-Sep 28-Sep 03-Aug 10-Aug 17-Aug 24-Aug 31-Aug 04-May 11-May 18-May 25-May

Mid Southend Basildon Total

20 The areas with the greatest number of breaches are urology (22), upper GI (9) and skin (6). From the 66 patients the longest breach currently stands at 187 days. Sixteen of these delays are attributed to the Covid19 pandemic.

3. Key points to note • Panels are standardised at Southend and Basildon sites. Discussions continue to standardise the panel at Broomfield site. This is overseen by the Cancer Harm Review Project Workstream • A business case for a new cancer quality team has been approved. The implementation of this team is delayed due a staff consultation. • Three interim harm review co-ordinators are now in post on all three sites. • Tabletop exercise of Urology - The MSEFT has been asked to conduct a tabletop review for urology as part of the offline self-declaration work has been requested by NHSE/I. • Work in underway on developing a policy to support the SOP, based on a good practice document shared by the James Paget Hospital Foundation Trust

Southend Hospital Southend continues to make significant progress at completing the cancer harm reviews using StarLeaf. Since October 2020, panels take place twice a week, resulting in completion rate of 40-42 a week. No new themes have been identified within the last month to which was reported in Octobers paper (Joint Oncology Clinic and Robotic-assisted laparoscopic prostatectomy delays, which have now been addressed).

Table 1 - Number of harm reviews due/completed for patients on cancer pathways at Southend Hospital. w/c 19th October 2020 April 2019 to March 2020 April 2020 to March 2021 63 - 103 days 104+ days 63 - 103 days 104+ days Number Due 273 100 82 61 Number Undertaken 204 66 2 2 Performance 75% 66% 2% 3%

Broomfield Hospital Has a robust paper-based panel in place.

Table 2 - Number of harm reviews due/completed for patients on cancer pathways at Broomfield Hospital. w/c 19th October 2020 April 2019 to March 2020 April 2020 to March 2021 63 - 103 days 104+ days 63 - 103 days 104+ days Number Due 293 206 106 52 Number Undertaken 278 206 50 18 Performance 95% 100% 35% 47%

Basildon Hospital Has a robust virtual system in place using StarLeaf.

Table 3 - Number of harm reviews due/completed for patients on cancer pathways at Basildon Hospital. w/c 19th October 2020 April 2019 to March 2020 April 2020 to March 2021

21 63 - 103 days 104+ days 63 - 103 days 104+ days Number Due 323 143 68 43 Number Undertaken 277 143 31 17 Performance 86% 100% 46% 40%

4. Next steps • Cancer harm reviews will be monitored and challenged via the monthly Clinical Quality Review Group. • Provide a fortnightly update to members of the Mid and South Essex Cancer Delivery Group. • Meet monthly with the Associate Director of Nursing for Cancer to seek assurance with processes and provide professional peer review, support and challenge. • Ensure a member of the Patient Safety and Quality Team for the ACT attends site panels.

Acute – Quality Contract Oversight

National Standard The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 The National Clinical Audit and Patient Outcomes Programme NICE Guidelines

Key Issue 1 Delay in response to patient complaints

Key Issue 2 Alignment of processes across the 3 sites for the adoption of NICE guidance and Local/National clinical audit.

Time scale for benefits This is an ongoing process, and this paper provides the current to be realised position of the progress made.

1. Purpose To advise the committee of local updates surrounding Patient Experience/Complaints, local and national clinical audit and the adoption of NICE guidance.

2. Background As a direct consequence of the COVID-19 outbreak the following occurred: • Whilst complaints continued to be addressed it has been noted that response times have increased due to limited access to clinical staff • The Patient Advice and Liaison Services (PALS) continued, however face to face contact was suspended to reduce the potential of spreading infection. • Local clinical audits were suspended with the exception of those directly relating to COVID-19 • All National Audits were suspended • Only NICE guidance pertaining directly to the care of patients with COVID-19 was being published.

22 3. Key points to note

Complaints response performance at the three sites for the month of September 2020 was: Basildon 52%, Broomfield 65%, Southend 22%, giving an overall response rate for the Trust of 47% for September 2020.

The new site-based Patient Experience Coordinators have taken up post during September and they have undertaken an induction programme that has included meeting staff from across the hospital group and understanding the various forms, and how the Trust responds to patient feedback.

All active patient survey action plans, and other patient feedback is being monitored at divisional Governance meetings as standing agenda items.

With visiting restrictions being brought in across the hospitals ‘Letter to Loved Ones’ has been relaunched. This will be overseen by the Patient Experience Team.

4. Next steps continue to monitor the progress.

Maternity & Care Quality Commission

National Standard Providers of NHS services are required by law to be Care Quality Commission (CQC) registered. In order to ensure that registered providers meet a set of fundamental standards for quality and safety, the CQC as the regulator monitors and inspects, publishing what they find and summarise as a rating. Additionally, the CQC issues performance notices as appropriate and has the ability to place a provider in special measures.

Key Issue 1 Broomfield and Southend hospitals received ratings of “requires improvement” from visits undertaken in 2019, published in 2020

Key Issue 2 The Basildon Maternity inspection report was published by the CQC on 19 August 2020 (following the Inspection on the 12 June 2020); maternity services were rated as ‘Inadequate’.

Time scale for benefits As per actions for improvement to be realised

1. Purpose To summarise the latest position as presented by Mid and South Essex Foundation Trust (MSEFT) through its governance structure and the approach being taken in relation to their improvement plans following the latest CQC inspections of Southend, Basildon and Broomfield Hospitals.

23 2. Background The Basildon Maternity inspection report was published by the CQC on 19 August 2020 (following the Inspection on the 12 June 2020); maternity services were rated as ‘Inadequate’. Core services inspections were published in March 2020 for Broomfield and Southend (rated Requires Improvement) and Basildon (rated Good) in 2019.

3. Key points to note The CQC revisited Basildon’s maternity unit in September 2020, and publication of that report is still awaited. The original overarching action plan relating to inspections carried out earlier in the year for Broomfield and Southend alongside the 2019 outcome for Basildon, MSEFT reported as being on target to achieve delivery of the action plan. A number of actions were due for completion in September and October 2020.

4. Next steps MSEFT is being supported through a maternity improvement plan and have enrolled on the national Maternity Intensive Support Programme which has a 2 staged approach – diagnostic and implementation. This intensive support, alongside the triangulation of support already being offered from CCG and NHSE/I Regional Chief Midwife, Wendy Matthews – will form the basis of a supportive turnaround programme and Quality Improvement Plan for maternity in Mid and South Essex. MSEFT is running a series of culture workshops in November 2020 based on NHSI/E’s Compassionate Leadership Programme and linked to the CQC’s Well Led domain. Maternity will now feature in future reporting in the Joint Committee report covering transformation, acute performance, LMNS escalations and outcomes from the maternity intensive support programme.

East of England Ambulance Trust

Key Issue 1 East of England Ambulance Trust - well led inspection resulted in enforcement action from the CQC

Key Issue 2 The CQC recommendation that service is place into special

24 measures has been realised.

Time scale for benefits As per actions for improvement to be realised Section 29A warning – 28th November 2020

1. Purpose The purpose of this report is to summarise the position on the East of England ambulance Trust (EEAST) in relation to the outcome of its latest Care Quality Commission (CQC) inspection.

2. Background CQC undertook an inspection of EEAST 25/26th June 2020 in relation to the Well Led domain. Core services were not inspected, and ratings remained the same as the previously published report (July 2019) as Requires Improvement overall and Inadequate for Well Led. Suffolk CCGs are the lead commissioners for this service and Mid and South Essex have direct input for Essex. 3. Key points to note Enforcement notices relate in particular to the Well led Domain. The trust’s action plan is expected imminently and in the interim and will be shared with future Boards for oversight.

4. Next steps The EEAST Action Plan once received will be discussed in full at regional Contract Review meetings. Local implications will be discussed at the locality meeting in November.

The new MSE JET nurse has been invited to attend the EEAST oversight and assurance meetings moving forward, alongside other STP peers.

25 Appendix B

ESSEX PARTNERSHIP UNIVERSITY TRUST MENTAL HEALTH MID AND SOUTH ESSEX

EPUT QUALITY ACCOUNT 2019/20 CCG MANDATED SUMMARY STATEMENT

ESSEX PARTNERSHIP UNIVERSITY TRUST MENTAL HEALTH CONTRACT

Response statement from NHS Thurrock Clinical Commissioning Group on behalf of (Southend Clinical Commissioning Group, Castle Point and Rochford Clinical Commissioning Group, Basildon and Brentwood Clinical Commissioning Group and Mid Essex Clinical Commissioning Group) Mid and South Essex Health and Care Partnership.

The Clinical Commissioning Groups (CCGs) welcome the opportunity to review and comment on the Quality Account for Essex Partnership University Trust for 2019/20 and would like to offer the following commentary:

The CCGs are committed to commissioning high quality services from Essex Partnership University Trust and collaborate diligently to ensure that patients’ needs are met by the provision of safe, high quality services and that the views and expectations of patients and the public are listened to and central to the commissioning decision making and service development.

We have remained sighted on the Trust’s priorities for improving the quality of its services for its patients, and have continued to provide robust challenge and scrutiny through the Clinical Quality Review Group (CQRG) meetings with the contractual monitoring, review and discussion of quality issues.

The opening statement from the Chief Executive clearly sets out the EPUT vision and Quality Strategy. It outlines the development of the eight quality priorities for 2019/20 in line with NHS England/Improvement guidance. These priorities incorporated three areas of service user quality – safety, effectiveness and patient / carer experience at the core that aligned the quality priorities with EPUT corporate objectives. The CQRG receive a quarterly quality report that includes narrative and data indicating progress with the identified quality priorities.

Commissioners acknowledge the CQC ratings from the unannounced 3-day inspection programme of six core services in July 2019 and the well-led inspection in August 2019. The achievement of upholding the overall rating of ‘Good’ and receiving a rating of ‘Outstanding’ for the Caring domain and ‘Good’ in the Effective, Responsive and Well-Led domains are to be commended. Commissioner will maintain their commitment to work with EPUT in undertaking the continuous improvement journey regarding the safe domain which remains at requires improvement.

26 In March 2020 193 (87%) of internal actions to address the findings from the CQC inspection had been completed. Commissioner assurance has been provided that a reset and refresh meeting with the CQC has been held with the formulation of an action plan for the remaining outstanding actions signed off by the CQC.

The Suicide Prevention Strategy in 2019/20 laid the foundation stones for the work that is continuing in 2020/21. There is a comprehensive work plan linked to the National Confidential Inquiry into Suicide and Homicide (NCISH) quality standards identified for 2020/21. It is encouraging that the Trust have set stretch targets reflect the determination to provide safer services. Forty-eight (48) Serious Incident were reported for Mid and South Essex and of these forty (40) Serious Incident were unexpected deaths. EPUT has committed to reducing this number through its Suicide Prevention Strategy and this is set as a Quality Priority for 2020/21. EPUTs commitment to reducing unexpected deaths is further evidenced by the partnership work with the Samaritans, the implementation of the Grassroots Stay Alive app and the engagement with the work of the Zero Suicide Alliance.

Commissioners endorse the Quality Improvement (QI) methodology that EPUT are in the process of implementing as research evidence specifies that when effectively embedded QI drives continuous and sustainable patient safety improvements. Commissioners have confidence that this combined with the cohort of home-grown Quality Champions will influence and harness the determination, focus and energy on achieving the quality improvement programme in 2020/21.

Commissioners support the development of clinical innovation by the “EPUT Lab” where clinicians are empowered to identify technology that improves clinical decision making, supports individuals to manage their own health and frees up clinical time to allow smarter working across services. The pandemic has brought the use of technology to the forefront of the organisation supporting new ways of working and providing care. Commissioners are engaged in the forum and have witnessed the early benefits of the clinical engagement and technological advances operating symbiotically to enhance patient care and safety.

It is notable that EPUT have participated in 100% of the National Clinical Audits and 100% national confidential inquiries that are eligible and applicable to the services delivered by the organisation. The inclusion within the report of a comprehensive schedule of intended actions derived from the audits to improve the quality of healthcare delivery within the organisation highlights EPUTs dedication to learning from research and audit.

Essex Partnership University Trust have developed their Quality Priorities for 2020/21 in response to the challenges and opportunities of the COVID19 pandemic these are:

 Innovation  Improvement  Transformation 27

During Q4 of 2019/20 Essex Partnership University Trust adapted and adopted their mental health service delivery to implement technological solutions at pace and to deliver virtual options of care and treatment due to the presenting and prevailing risks to patients and staff from the COVID19 pandemic. During 2020/21 the transformation, reform and innovation required to respond to the needs of the population will undoubtedly continue to grow and test the Trust as we enter the new phases of the pandemic and the post pandemic recovery requirements for psychological treatment and aftercare. Mental Health will be at the core of the essential patient services and the flexibility and dedication of the workforce will be essential to sustaining safe, effective and efficient service delivery.

Overall the report is reflective of the commissioner knowledge of the Trust quality activities and ambitions. A collaborative transformational work programme has been developed in line with the Long-Term Plan (LTP mental Health) and by continuing our strong alliance through the Mental Health Partnership Board and integrating system and PLACE models of mental health service delivery we will to strengthen the quality of Mid and South Essex mental health commissioned services in 2020/21 and beyond.

Jane Foster-Taylor Chief Nurse

28 Agenda Item 15

2020/21 M7 Finance Report

BBCCG Board – 26 November 2020

Purpose of Report: To provide Board members with an update on the 2020/21 financial position

Recommendations and The Board is asked to note the content of the report and approve the decision/actions: virements set out in the accompanying schedule (last page of this item)

Executive Summary NHSE has committed to balance financial positions for the period M1-6. (including financial impact): The financial risks in the first half of the year were therefore minimal.

For M7-12 individual CCGs have received a resource allocation. Some additional System funding was allocated for the M&SE System and the System is required to deliver its financial targets in aggregate.

A £4m improvement on the M7-12 M&SE System plans submitted in October was required by NHSE. The System plan is now £34.7m higher than the System Control Total. Of this figure £27.2m relates to “funding errors” on which the System are in discussion with NHSE – leaving a net variance of £7.5m.

It is still proving difficult to forecast expenditure with usually available degrees of accuracy due to uncertainties over the level of some BAU services and the scale of additional services that will be required to address Covid and Winter pressures. However, the CCG is forecasting outturn in line with the planned £956k in-year surplus, assuming that Hospital Discharge Programme costs are fully reimbursed.

CCGs are expected to deliver the Mental Health Investment Standard (MHIS) in 2020/21. It is proving challenging to unravel the elements of MH transformation incorporated within the block payments NHSE calculated for the first half of the year for the purposes of reporting against the MHIS and work continues on this.

Written by/Presented by: Dee Davey, Interim Chief Finance Officer Natalie Brodie, Deputy Chief Finance Officer

Executive Director Dee Davey, Interim Chief Finance Officer Sponsor:

Non-Officer/Board Dr Ken Wrixon, Chair of Finance & Performance Committee Sponsor:

Fit with CCG Strategic 1.Ensure services are organised to respond to and meet COVID-19 Objectives? requirements.

4. Achieve key statutory financial duties including delivery of the system financial control total 9. Achieve System and organisational transformation to streamline decision making, improve VFM and better support new commissioning models

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this F&P Committee 19 November document).

Reports Submitted to Board only: Date signed-off by Executive Team. n/a (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) 

Has the Equality/Quality/Privacy Impact Assessment  been carried out and issues addressed?

Details of Stakeholder, Patient n/a & Public Engagement:

Risks / Link to BAF: Risk of achieving System and organisational BAF Ref: financial Control Total – System risks have increased under the M7-M12 financial regime

Conflicts of Interest: None

National Standard/ Local Objective 4. Achieve key statutory financial duties including delivery of the system financial control total. Key Issue 1 - Managing cost There are significant cost pressures to be managed for the pressures to remain within the System remainder of the financial year including winter pressures, Plan Covid costs, the reinstatement of CHC and prescribing cost pressures. Key Issue 2 – Delivering the MH Managing and reporting MH expenditure is particularly investment standard complex this year due to required block contract payment arrangements for NHS providers and the risks to availability of workforce to enable planned investments to be delivered. Key Issue 3 – Risk that the Region Nationally, regionally and at MSE System level, the will require further improvement of the aggregate System plans do not reflect compliance with the System financial plan financial target. We await further advice. National Standard/ Local Objective 1. Ensure services are organised to respond to and meet COVID-19 requirements. Key Issue 4 - The Covid vaccination System planning is at an early stage but the scale of the programme represents a significant programme is significant and will be required to be management and financial challenge. implemented at pace, Additional funding is expected to cover the cost of the programme.

Time scale for benefits to be Financial targets are required to be delivered for 31 realised March 2021 Risks – BAF Risk of achieving System and organisational financial Control Total – System risks have increased under the M7-M12 financial regime Finance Pack Month 7 2020/21

Natalie Brodie Deputy Chief Finance Officer November 2020 Contents

• Month 7 Headlines • Summary Financial Statement • 2020/21 Covid Costs • QIPP • Mental Health Investment Standard • Maximum Cash Drawdown (MCD) • Cashflow and Better Payment Practice Compliance (BPPC) • Statement of Financial Position (SOFP) • Aged Debtors and Creditors • Budget Virements Month 7 Headlines Month 7 Ending 31st October 2020

• On plan to deliver full year forecast of £956k surplus • Year to date position on plan – small overspend year to date reflects delay in national retrospective top-up • Month 7 year to date covid costs £6.5m • Retrospective net top-up allocations of £3.3M received to date – Month 1-5 £3.5M Covid, £(0.2M) Non Covid • Running costs on plan • QIPP forecast to deliver • On track to deliver the Mental Health Investment Standard (MHIS) • All 4 payment targets achieved Financial Statement Year to Date as at 31st October 2020 (M7)

CCG Expenditure Analysis 02PLAN01 02ACT01 02VAR01 02PLAN02 02ACT04 02VAR04

Net Expenditure Net Expenditure Net Expenditure Net Expenditure Net Expenditure Net Expenditure

Plan Actual Variance Plan Forecast Variance 31/03/2021 31/10/2020 31/10/2020 31/03/2021 31/03/2021 31/03/2021

YTD YTD YTD Year Ending Year Ending Year Ending

£'000 £'000 £'000 £'000 £'000 £'000 Revenue Resource Limit (in year) 223,056 382,703

Acute Services (ISFE) 124,659 124,659 (0) 211,628 211,628 (0) Acute services - NHS (Block) 123,047 123,047 (0) 209,637 209,637 (0) Acute services - Independent/commercial sector (outside of 1,612 1,612 0 1,992 1,992 (0) Nationally procured)

Mental Health Services (ISFE) 22,857 22,857 (0) 39,762 39,762 (0) MH Services - NHS (Block) 17,879 17,879 (0) 31,089 31,089 (0) MH Services - Independent / Commercial Sector (outside of 4,835 4,828 7 8,413 8,392 21 Nationally procured) MH Services - Other non-NHS 100 142 (42) 189 213 (24) MH Services - Other net expenditure 43 8 35 71 67 3

Community Health Services (ISFE) 23,486 23,298 189 40,271 39,949 323

Continuing Care Services (ISFE) 8,995 9,588 (593) 15,352 15,230 121

Primary Care Services (ISFE) 34,149 33,826 324 58,460 57,903 557 Prescribing 25,795 25,528 267 44,675 44,217 458 Community Base Services 2,445 2,484 (39) 4,754 4,847 (93) Out of Hours 2,657 2,602 55 4,563 4,317 246 £1.50 per head PCN Development Investment 257 256 0 440 440 0 GP IT Costs 452 440 12 770 751 18 PC - Other 2,544 2,515 29 3,258 3,330 (72)

Other Programme Services (ISFE) 5,886 5,816 69 11,181 12,193 (1,012)

Total Commissioning Services 220,033 220,044 (11) 376,654 376,666 (11)

Running Costs (ISFE) 2,864 2,864 0 5,093 5,093 0

Total CCG Net Expenditure 222,897 222,908 (11) 381,747 381,758 (11)

In Year Underspend/(Deficit) 159 148 11 956 945 11 Financial Statement cont’d Year to Date as at 31st October 2020 (M7)

• For Months 7-12 the CCG has been allocated a financial envelope of £191.576m.

• For Mth7-12 the CCG has received £5.1m System Covid funding towards incurred Covid costs. Organisations can continue to be fully reimbursed by NHSE for certain Covid programme areas, including the Hospital Discharge Programme (HDP). Any underspend against the System Covid funding will be returned to the System.

• The CCG is forecasting outturn in line with the planned £956k surplus assuming the HDP costs are fully reimbursed.

• The national arrangements whereby CCGs make payments to only a small number of NHS providers is continuing. For the time being, NHSE will also continue to hold and account for contracts for the main Independent Sector acute hospital providers.

• Prescribing is reporting a ytd underspend of £267k based on the latest PMD information.

• Running costs are on plan. 2020/21 Covid-19 Costs

At Month 7 the CCG has incurred £6.5m in relation to Covid-19 year to date. The CCG has received a retrospective top up of £3.3m for Months 1-5 - £3.5m Covid top up, £(0.2m) non Covid.

For Months 7-12 the CCG has an allocation from the System Covid funding of £5.1m. Costs for the Hospital Discharge Programme (HDP) from Month 7 onwards are outside of the envelope and are to be separately reimbursed. In Month 7 the CCG incurred £466k on HDP. Any underspend against the System Covid funding will need to be returned.

Covid Spend Months 1-6 Month 7 Month 7 YTD £'000 £'000 £'000

Clinical Supplies/Equipment/IT 109 21 130 Decontamination & PPE 201 23 224 Hospital Discharge Programme* 2,243 466 2,709 OOH Capacity Increase 228 5 233 Patient Transport (Essex Wide) 1,538 165 1,703 Prescribing (BOC) 11 - 11 Respiratory Hubs, AHVS Extension, and other Primary Care 814 197 1,011 Unsocial/Additional Hours 38 - 38 Other (incl. works on BCH) 50 405 455 5,232 1,282 6,514

*Month 7-12 costs outside of the CCG envelope and will be reimbursed 2020/21 QIPP

QIPP has proved difficult to progress due to the System Covid response. It is also proving difficult to assess the impact of any Medicines Optimisation schemes that have been able to continue. The current QIPP assumptions are in the table below. At Month 7 the CCG is reporting that it is on plan to deliver QIPP.

Month 1-6 Months 7-12 Total £'000 £'000 £'000

Medicines Optimisation 0 700 700 CHC 0 270 270 Other Contract Efficiences 120 120 240 HSCN 175 174 349 Finance Opportunities 978 978 1,956 Underspends 1,116 0 1,116 Total 2,389 2,242 4,631 2020/21 MHIS

At Month 7 the CCG was required to report on the MHIS. The CCG is required to demonstrate a 5.9% increase in Mental Health expenditure compared to 2019/20. Monitoring and reporting is challenging due to the constraints around payments to NHS providers.

The CCG is currently on plan to achieve the target however planned investments remain at risk largely due to the difficulties in recruiting staff for both existing services and new developments.

2019/20 2020/21 Outturn Forecast MH Parity Spend Details £'000s £'000s Growth % Children & Young People's Mental Health 3,405 3,682 8.1% Adult Mental Health & Improved Access to Psychological Therapies 25,705 26,769 4.1% CHC, Prescribing, Acute and other non-MH providers 11,191 12,226 9.2% Sub total excluding LD and separately reported dementia 40,301 42,677 5.9% LD and separately reported dementia 11,496 12,010 4.5% Total 51,797 54,687 5.6%

Programme Growth + 1.7% 5.9% Growth in MH spend 5.9% MHIS Achieved YES MCD 2020/21 Month Ending 31st October 2020 £'000 MCD October 2020 382,077 Maximum Cash Drawdown (MCD) Month Cash drawdowns Home Oxygen Payments made Advance pay Therapy by NHS BSA adjustment Drugs recharge for drugs • The CCG’s MCD at Month 7 is currently actual charges £382M. £'000 £'000 £'000 £'000

• The CCG has utilised 63.3% of it’s total April 53,130 31 3,111 (44) MCD at Month 7 due to paying the NHS May 28,000 32 3,730 (188) block payments one month in advance June 26,000 34 3,511 166 as mandated by NHSE. July 28,000 28 3,265 66 August 26,500 42 3,366 (30) • Cash will continue to be monitored very September 28,000 29 3,502 2 closely over the remainder of the October 28,300 28 3,173 62 financial year.

Total 217,930 225 23,658 33

£'000 Maximum Cash Drawdown 382,077 Less Year to date drawdown 217,930 Year to date BSA payments 23,916 241,846

Balance of MCD left 140,232

Percentage of MCD utilised 63.3% Percentage of months completed in financial year 58.3% Cashflow & BPPC 2020/21 Month Ending 31st October 2020

ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL Description Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Cash-flow Movements to October 2020

£'000 £'000 £'000 £'000 £'000 £'000 £'001 Opening Balance 129 4,674 2,843 825 260 1,670 12

Receipts • The closing October cash book position Drawdown 28,000 28,000 26,000 28,000 26,500 27,000 28,300 Supplementary Drawdown 25,130 0 0 0 0 1,000 0 is £(2.6)m. The closing bank balance is Other Income 670 926 354 719 513 216 243 £0.1m. Total Receipts 53,800 28,926 26,354 28,719 27,013 28,216 28,543

Payments: • NHS (43,876) (21,866) (23,640) (21,396) (21,677) (23,465) (21,680) Regular cash-flow discussions are Trade (4,558) (3,552) (4,343) (4,396) (3,543) (4,474) (4,782) undertaken with Arden & Gem CSU. Salary, Tax, Ni & Pension (519) (502) (388) (382) (383) (380) (389) BCF 0 (4,663) 0 (3,109) 0 (1,554) (1,554) Other (303) (174) (0) (2) (0) (1) (0) • The CCG aims to keep month end SAVINGS PLAN Total Payments (49,255) (30,757) (28,372) (29,284) (25,603) (29,874) (28,406) holding balances no greater than £1.0M.

Closing Bank Balance 4,674 2,843 825 260 1,670 12 149

Closing Bank Balance 4,674 2,843 825 260 1,670 12 149 Bacs run at end of month not cleared - 286 - 261 - 2,590 - 598 - 1,949 - 590 - 2,059 Bacs run at end of month not cleared - - 113 - - 111 - 275 - - 607 - 286 - 374 - 2,590 - 709 - 2,225 - 590 - 2,666

Outstanding Cheques - 0 - 0 - 0 - 1 - 1 - 1 - 2

Cashbook 4,388 2,468 - 1,765 - 450.35 - 556 - 578 - 2,518 Bank Charges 0 0 0 0 0 0 0 Unallocated cash at end of the month - 71 - - 7 - - - - 47 Out of Date Payable Order (OOH PO) ------Cash in Hand-Float Reimb Net Off 0 0 0 0 0 0 0 SBS SOFP 4,317 2,469 - 1,771 - 450 - 556 - 578 - 2,565 SOFP BI REPORT CASH FIGURE 4,317 2,469 - 1,771 - 450 - 556 - 578 - 2,565 DIFFERENCE ------

Better Payment Practice Compliance (BPPC) BPPC Type Target (%) % Achieved M1 M2 M3 M4 M5 M6 M7 YTD • 95% of eligible invoices must be paid within 30 days or within otherwise agreed Non NHS Number of invoices 95.0 97.0 98.8 98.7 98.6 96.9 98.9 99.0 98.4 timescales. Value of invoices 95.0 98.3 99.4 97.0 99.6 97.9 97.9 99.7 98.7 • The CCG achieved all of the 4 targets at NHS Number of invoices 95.0 98.4 98.6 91.0 100.0 96.1 97.3 97.5 97.0 Month 7. Value of invoices 95.0 100.1 100.0 100.2 100.0 100.0 100.0 100.0 100.0 SOFP 2020/21 Month Ending 31st October 2020

Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20

PPE 0 0 0 0 0 0 0 Accumulated Depreciation 0 0 0 0 0 0 0 Net PPE 0 0 0 0 0 0 0 Investment Property 0 0 0 0 0 0 0 Non-Current Assets Held for Sale 0 0 0 0 0 0 0 Non-Current Financial Assets 0 0 0 0 0 0 0 Other Receivables Non-Current 0 0 0 0 0 0 0 Total Other Non-Current Assets 0 0 0 0 0 0 0 Non-Current Assets 0 0 0 0 0 0 0 Cash (Cashbook balance) * 4,316,607 2,468,729 (1,771,061) (450,082) (555,772) (578,196) (2,565,311) Accounts Receivable 5,059,259 4,041,235 22,945,800 27,538,309 28,235,302 25,087,979 25,820,209 Inventory 0 0 0 0 0 0 0 Investments 0 0 0 0 0 0 0 Other Current Assets 0 0 0 0 0 0 0 Current Assets 9,375,865 6,509,964 21,174,739 27,088,227 27,679,530 24,509,782 23,254,898 TOTAL ASSETS 9,375,865 6,509,964 21,174,739 27,088,227 27,679,530 24,509,782 23,254,898 Accounts Payable 8,987,055 18,919,725 31,675,009 38,334,766 40,956,473 36,500,366 35,918,741 Accrued Liabilities 0 0 0 0 0 0 0 Short Term Borrowing 0 0 0 0 0 0 0 Current Liabilities 8,987,055 18,919,725 31,675,009 38,334,766 40,956,473 36,500,366 35,918,741 Non-Current Payables 0 0 0 0 0 0 0 Non-Current Borrowing 0 0 0 0 0 0 0 Other Liabilities 0 0 0 0 0 0 0 Long Term Liabilities 0 0 0 0 0 0 0 General Fund 0 0 0 0 0 0 0 Share Capital 0 0 0 0 0 0 0 Revaluation Reserve 0 0 0 0 0 0 0 Donated Assets Reserve 0 0 0 0 0 0 0 Government Grants Reserve 0 0 0 0 0 0 0 Other Reserves 0 0 0 0 0 0 0 Retained Earnings incl. In Year 388,811 (12,409,761) (10,500,270) (11,246,540) (13,276,943) (11,990,584) (12,663,844) Total Taxpayers Equity 388,811 (12,409,761) (10,500,270) (11,246,540) (13,276,943) (11,990,584) (12,663,844) TOTAL EQUITY + LIABILITIES 9,375,865 6,509,964 21,174,739 27,088,227 27,679,530 24,509,782 23,254,898

* Physical Cash 4,674,296 2,842,561 825,211 259,944 1,669,697 11,965 149,020

SOFP

• No long-term liabilities.

• Zero balance on fixed (non-current) assets as a result of some legacy property and equipment now fully depreciated. Aged Debtors Month Ending 31st October 2020

AGED DEBT As at 31 Oct 2020

ORG. TYPE Total Amount Current 1-30 Days 31-60 Days 61-90 Days 90+ £ £ £ £ £ £ NHS Trusts & FTs 0 0 0 0 0 0 NHS CCGs 225,988 220,218 5,770 0 0 0 NHS England 465,165 317,600 147,569 1 (5) 0 0 Non-NHS 65,971 65,971 0 0 0 0 Other (9,500) 0 (9,500) 2 0 0 0

TOTAL DEBTORS 747,624 603,790 143,839 (5) 0 0

225,000 NHS ENGLAND Pursuing with NHSE 1 (77,431) NHS ENGLAND Paid 02/11/20

Skills for Care income received 28/10/20. To be allocated to a 2 (9,500) SKILLS FOR CARE code Aged Creditors & Invoice Accruals Month Ending 31st October 2020

ACCOUNTS PAYABLE AGED CREDITORS & INVOICE ACCRUALS as at 31 Oct 2020

ORG. TYPE Total Amount Current 1-30 Days 31-60 Days 61-90 Days 90+ Days NHS Trusts & FTs (16,370) 0 0 (69) 24,201 (40,502) 3 NHS CSU 2,761 0 2,761 0 0 0 NHS CCGs 127,608 9,359 121,766 0 0 (3,518) NHS England 0 0 0 0 0 0 Non NHS (23,129) 250,094 50,046 17,849 1 (53,811) 2 (287,306) 4 Other 11,685 8,558 0 173 173 2,780 TOTAL CREDITORS 102,554 268,011 174,573 17,953 (29,437) (328,546)

NHS Trusts & FTs 779,933 NHS CSUs (10,491) NHS CCGs 242,939 Non NHS 3,128,794 5 Other 62,765 TOTAL INVOICE ACCRUALS 4,203,939

TOTAL CREDITORS & INVOICE 4,306,493 ACCRUALS

1 18,600 ST ANDREWS HEALTHCARE Paid 4th Oct

2 (14,818) CYGNET (OE) LTD Reconciled account 4/11/20 Invoices to be approved (14,340) CYGNET (OE) LTD Reconciled account 4/11/20 Invoices to be approved (15,218) CYGNET (OE) LTD Reconciled account 4/11/20 Invoices to be approved (14,727) CYGNET (OE) LTD Reconciled account 4/11/20 Invoices to be approved 8,337 SPRINGFIELD HOSPITAL Emailed RR at Springfield Hosp 30/10 to confirm balance. chased 04/11

3 (5,255) CHELSEA AND WESTMINSTER HOSPITAL NHS FT Credit reduces payment amount below zero 14,319 ST GEORGES UNIVERSITY HOSPITALS NHS FT Credit reduces payment amount below zero 14,319 ST GEORGES UNIVERSITY HOSPITALS NHS FT Credit reduces payment amount below zero 14,319 ST GEORGES UNIVERSITY HOSPITALS NHS FT Credit reduces payment amount below zero (74,931) ST GEORGES UNIVERSITY HOSPITALS NHS FT Credit reduces payment amount below zero

4 (44,020) NUFFIELD HEALTH Credit reduces payment amount below zero (48,242) NUFFIELD HEALTH (16,142) SPIRE HEALTHCARE LTD (32,065) SPIRE HEALTHCARE LTD Now refunded 8,951 SPIRE HEALTHCARE LTD (1,385) SPIRE HEALTHCARE LTD Invoice on system to be approved (11,415) SPRINGFIELD HOSPITAL (6,514) SPRINGFIELD HOSPITAL (74,787) SPRINGFIELD HOSPITAL Credit reduces payment amount below zero, Emailed RR at Springfield Hospital 30/10/20 (15,344) SPRINGFIELD HOSPITAL to confirm balance. Chased 04/11/20, once agreed will request they pay us the balance (5,942) SPRINGFIELD HOSPITAL (33,591) SPRINGFIELD HOSPITAL

5 1,668,620 NHS PROPERTY SERVICES LTD The majority of the prior year NHS Property Services invoices have now been cleared and expected credits should clear most of the remaining prior year balance. The balance now primarily represents 20/21 invoices. Budget Virements

Clinical Commissioning Virements Notes £'000 Acute 104,363 M7-M12 Acute Budget Mental Health 20,286 M7-M12 Mental Health Budget Primary Care 29,172 M7-M12 Prescribing £22,655k and Other Primary Care £6,517k Community and Continuing Care 27,770 M7-M12 Community £20,142k and CHC £7,628k Other Programme Services 6,355 M7-M12 Other Programme Services Budget 187,946

General Reserves £'000 General Reserves 0 0

Running Costs £'000 Running Costs 2,674 M7-M12 Running Costs Budget 2,674

In year surplus 956

Net Effect on Resource Limit 191,576

Rescource Limit Change £'000 Type Month

193,078 Transfer 6 months Programme Allocation from Central Reserve Recurrent Mth 7

2,547 Transfer 6 months Running Costs allocation from central reserve Recurrent Mth 7

5,144 STP Plan Transfer - System Covid distribution to other CCGs Non-Recurrent Mth 7

(9,193) CCG NR Adjustments to Model Breakeven Non-Recurrent Mth 7

Total Resource Limit Change 191,576 Agenda Item 16

Basildon & Brentwood CCG Governing Body meeting in Public Performance Report - 26 November 2020

Purpose of Report: To brief the Board on performance against key standards including constitutional standards.

Recommendations and For noting decision/actions:

Executive Summary The attached report outlines the performance of mid and south essex (including financial impact): (mse) CCGs against key standards including constitutional standards.

The slides highlight the impact of the Covid-19 pandemic on the delivery of services, the restart of services from July to October 2020 that has seen a recovery and improvement in performance. Referral to Treatment (RTT) performance is still seen as a significant challenge.

It is noted that a second wave of Covid-19 cases seen across the mse health system since October 2020 presents a risk to the recovery of health services.

Slide 14 in the attached presentation highlights a summary of key areas of performance.

Written by/Presented by: Emma Timpson, Director of Planning & Performance Executive Director Emma Timpson, Director of Planning & Performance Sponsor:

Non-Officer/Board N/A Sponsor:

Fit with CCG Strategic Yes Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document).

Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  )

Has the Equality/Quality/Privacy Impact Assessment been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: BAF Ref:

Conflicts of Interest: Performance report 2020/21

November 2020 Summary

• Covid -19 pandemic has impacted on the delivery of services, during the first phase some services were temporarily suspended whilst others were impacted by social distancing and change in patient behaviours. During the period July to October, the system has worked collaboratively to restart services particularly based around clinical need. • To support Phase 3 recovery and restoration, the Mid and South Essex health and care partnership have established governance arrangements to support the delivery of the asks and targets set out in the plan submitted to NHSE on 21 September 2020. • Services have begun to recover and improvements in performance have been seen in the priority area of cancer both for 2 week wait referrals and 62 day cancer backlog. The greatest challenge remains around RTT performance. • A second wave of Covid-19 cases has been seen across the system since October which presents a risk to the ongoing recovery of services. Impact of Covid-19

• The number of lab confirmed cases (pillar1 testing) for Mid and South Essex is 3898 (as at 15 November 2020) with a further 9,175 confirmed cases from Pillar 2 testing • The number of confirmed Covid-19 patients occupying beds at Mid & South Essex Hospitals Foundation Trust was 134 as at 16 November 2020 compared to a peak of 269 on 15 April 2020 • Up to the 30 October 2020, there were 992 patients who have sadly died in our hospitals (Basildon, Broomfield and Southend) • There have been a further 150 deaths in care homes and 14 in Hospices, across the Local Authorities in Mid and South Essex, where Covid-19 is mentioned on the death certificate

Source: NHSE/I Covid SitRep, ONS Registered deaths Covid-19 positive cases continue to rise across Mid and South Essex

Source: PHE * Please note: four day lag in reporting Primary Care Presentations with known Covid-19 symptoms Patient counts for COVID-19 like symptoms captured at GP and 111 services, as well as test results

CCG Registered Patient Counts per 100,000 Registered Population Population as at 1 Oct 2020 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 NHS Basildon and Brentwood CCG 284,257 0 1 195 603 261 108 85 97 293 520 NHS Castle Point and Rochford CCG 185,916 1 5 193 544 288 158 96 109 322 435 NHS Mid Essex CCG 398,511 1 3 190 493 270 100 93 95 264 317 NHS Southend CCG 190,057 0 1 247 625 317 180 96 115 341 423 NHS Thurrock CCG 182,189 0 5 229 628 259 108 83 91 277 441

There has been increasing primary care presentations with Covid-19 symptoms and confirmed test results across all CCGs within Mid and South Essex.

The highest rates per 1000,000 registered population have been seen in Brentwood, Billericay and Canvey.

Source: TPP Covid-19 query, run from Mid Essex, South East Essex and South West Essex Reporting Units The number of Covid-19 patients in our hospitals has continued to rise since October 2020

The majority of patients are being treated at Basildon Hospital, for 13 November 74 of 127 patients, but demand has been increased at the other two sites particularly at Southend hospital over the last week Source: NHSE/I Covid SitRep The number of Covid-19 patients requiring critical care ventilated support has also increased since October 2020, however not at the same growth rate seen in the first wave

The majority of patients are being treated at Basildon Hospital

Source: NHSE/I Covid SitRep Non-Elective demand at MSEFT

• Daily average A&E attendances peaked in September 2020, reaching near Pre-Covid levels, but have since reduced slightly. • However, bed occupancy has been increasing which reflects the trend in patients with a LoS over 21 days. • Community bed occupancy has remained at above 80% over the last two months • Tactical Operational Centre are working in partnership with MSEFT and community providers to optimise 14/21 length of stay plans. Mental Health demand

Mid and South Essex STP Weekly IAPT Referrals 800 • Mental Health Referrals have 700 647 600 602 recovered back to the pre COVID 626 500 average 400 • IAPT referrals are projected to recover 300

200 by December 2020 100 • The Liaison teams referrals have 0 dropped in October in line with reduction in A&E Attendances 09/03/20 16/03/20 23/03/20 30/03/20 06/04/20 13/04/20 20/04/20 27/04/20 04/05/20 11/05/20 18/05/20 25/05/20 01/06/20 08/06/20 15/06/20 22/06/20 29/06/20 06/07/20 13/07/20 20/07/20 27/07/20 03/08/20 10/08/20 17/08/20 24/08/20 31/08/20 07/09/20 14/09/20 21/09/20 28/09/20 05/10/20 12/10/20 19/10/20 26/10/20 02/11/20 09/11/20 16/11/20 23/11/20 30/11/20 07/12/20 14/12/20 Total Referrals Weekly Average Pre-COVID-19 Linear Forecast Performance Summary

• Cancer services are recovering in line with the Phase 3 recovery plan with improvements in 2 week wait referrals, 62 day backlog and 104+ day long waits. • Number of patients waiting more than 18 weeks at MSEFT decreased to 37,679 of which 5,432 waited more than 52 weeks as at end of September 2020. • RTT recovery is not on track to deliver the projected improvement in patients waiting over 52 weeks by the end of March 2021. • Access to Mental Health services (adult and children & young people) is increasing but is not yet meeting the standards • Dementia diagnosis rate has been impacted by the pandemic and remains on a downward trend • Health checks for people with Serious Mental Illness or Learning Disabilities is increasing but recovery remains challenging Cancer – 2 ww referrals • The number of 2ww referrals have recovered to pre-covid levels for September 2020 • Performance remains below the target of 93% • Significant amount of work has been undertaken with PCNs and Macmillan GPs to increase patient confidence to re-present to primary care Cancer – 62 day wait • The phase 3 plan is to reduce the backlog size to pre covid level of 181 by March 2021.

• MSEFT are on track to meet the this target and are currently ahead of trajectory.

• Performance for 62 day standard continues to not be met. September 20 was at 70.5% vs. standard of 85%. Cancer long waiters – over 104 days • The Phase 3 plan is to reduce number of patients with waits of 104+ days to zero by March 2021.

• The number of cancer patients waiting more than 104 days for treatment peaked week ending 5 July 2020.

• The number has decreased to 43 as at week ending 8 November 2020. The rate of decrease has slowed but based on current trend MSEFT are on track to achieve. Diagnostics waiting times

• Performance deteriorated significantly year to date during the Covid-19 pandemic with July performance at 49.8% (nationally 47.8%) • The number of patients waiting 13+ weeks has decreased to 5,930 from a peak of 10,9517 in June 2020 • System capacity to support recovery has been through collaborative working with the Tier 2 providers. • For September 2020, activity was below plan for CT and MRI. Non-obstetric ultrasound activity achieved submitted plan, however the plan submitted for phase 3 is less than pre-covid levels. • The system has been successful through COVID-19 monies to secure funding for replacement MRI and CT scanners and an additional MRI scanner which is yet to be installed. This will have an impact on recovery and sustaining performance in the future. Referral to Treatment (RTT) waiting times

• As at September 2020, the MSE Group performance has increased to 56.7% with their following backlogs being: • Patients waiting 18+ weeks decreasing to 37,679 • Patients waiting 40+ weeks decreasing to 14,155 • Patients waiting 52+ weeks increasing to 5,432.

• The phase 3 plan was to reduce the number of patients on an RTT pathway of 52+ weeks to 951 by March 2021. The number of 52+ week waiters has remained static over the last 5 weeks, with the latest position being 5,634 as at week ending 8th November.

• MSEFT are unlikely to achieve the phase 3 plan. The CCG is working with the Trust to develop a trajectory with underpinning assumptions over the next two weeks. Referral to Treatment (RTT) waiting times • The NHSE expectation is that the number of patients on an RTT pathway of 104+ weeks will be zero by March 2021. There are currently 46 patients who have been 104+ weeks. • The CCGs are working with MSEFT and NHSE/I to ensure all individuals have a plan clearly defined. • In addition patients waiting 78-103 weeks are being actively tracked and reported on including weekly to NHSE/I. • Operational oversight of the RTT recovery is led and coordinated via the Delivery Cluster • The system has identified five key priority specialties that will make an impact on the recovery of the RTT performance these are: • Orthopaedics • Ophthalmology • Dermatology • Urology • Paediatrics • The CCGs have identified clinical leads for each specialty to support this work. • The nationally commissioned Independent Sector capacity has been well utilised. There is a high likelihood the capacity available for NHS patients within the Independent Providers will significantly reduce from quarter 4 with the change from the national contract back to local contract. Advice and Guidance

• The number of Advice and Guidance requests to MSEFT has increased significantly in October 2020 • System capacity to support recovery has been through collaborative working with MSEFT to ensure turnaround times improve to meet the standard, improve primary care confidence in using service as know will get a response. • MSEFT introduced PANDO app during early phase of COVID; this was minimal Response times performance continues to improve as utilised by primary care and has now shown with the 95th percentile response reducing to 10, been ceased. 17 and 18 days for Basildon, Broomfield and Southend sites respectively. Activity recovery - MSEFT

Area / Key Performance Indicator Standard Latest Month Performance Trend

Actual 7,822 Day Case spells Sep-20 Plan 7,699 Actual 1,163 Ordinary spells Sep-20 Plan 1,254 Actual 25,017 Consultant-led first outpatient attendances Sep-20 Plan 23,796 Actual 43,621 Consultant-led follow-up outpatient attendances Sep-20 Plan 45,692 Actual 3,514 0 day length of stay Sep-20 Plan 1,951 Actual 6,558 1+ length of stay Sep-20 Plan 7,432

• The table above shows the September reported activity against the submitted Phase 3 recovery plan. • Daycase and elective activity are increasing and combined are above the plan. • Braintree Community hospital opened as a ‘cold’ site for orthopaedic surgery from October 2020 but is yet to be fully utilised. • Outpatient first attendances met the plan with 68% being delivered via face to face consultations. • Operational oversight of the activity recovery is led and coordinated via the Delivery Cluster • The is a risk that the increasing Covid-19 demand will reduce capacity to support elective recovery. Emergency Department (ED)

• MSEFT ED 4hour performance is 83.6% at the latest reported position (October 2020) • Tactical Operational Centre is in place to oversee Emergency demand and flow throughout the system • NHS111 Direct to Same Day Emergency Care Pathway Pilot commenced October 2020 at Basildon Hospital to allow direct bookable appointments • Conditions that generate high volumes of admissions have been targeted for pathway development work to define interventions that support management of patients as they are admitted. • The potential to divert patients into alternative pathways in place of admission is being developed via the patient flow workstream, these include, as already referred to SDEC, GP Hubs and Community alternatives. NHS 111 – calls answered in 60 seconds

• Performance for calls answered in 60 seconds was achieved for October 2020 • Implementation of Think NHS111 is on track to meet the December 2020 go live requirement. • Mid & South Essex Think 111 Programme Board established with two subgroups: Think 111: Acute Subgroup and Think 111: Integrated Urgent Care sub group, both have been established to ensure implementation of the initiatives to reduce the demand, congestion and overcrowding of Emergency Departments. Mental Health – IAPT performance

• IAPT referrals are increasing to pre-Covid levels. • Access rate of 1.2% achieved in September with a target of achieving 2.08% from January 2021. • Online booking system is now available for patients which should support reduction of DNAs • Expansion of workforce underway with additional trainees starting between now and January 2021 • 6 and 18 week waiting time targets now consistently achieved • Recovery rate for September was 51%, above the 50% standard. • The number of patients waiting over 90 days is reducing month on month but continuation is dependant on additional workforce and reduction in staff sickness rate. Mental Health performance

• Dementia diagnosis rate has continued to fall due to deaths in dementia patients and the impact of Covid-19 on referrals to memory assessment clinics and access to CT scans to confirm diagnosis. • Early intervention in psychosis (EIP) target has been consistently achieved. • Psychiatric patients follow up 7 days – requirement to report has been paused since Covid. However, the target has been consistently achieved. • Proportion of people with serious mental illness having a physical health check (based on rolling 12 months) reduced in Q2 from 24.4% to 23.4%. This falls significantly below the March 2021 Phase 3 target of 40% which reduced from the national target of 60% to reflect the challenges of recovery. Recovery and action plan is being developed and monitored by the Physical Health Implementation Group. CYP & LD performance

Area / Key Performance Indicator Standard Latest month Performance Comments

CYP - Mid and South Essex CCGs 2020/21 CYP Eating Disorder Service: Urgent cases starting treatment <=1wk 95% September 100.0% Based on actual local data for Q2 for all MSE CCGs CYP Eating Disorder Service: Routine cases starting treatment <=4wks 95% September 100.0% Based on actual local data for Q2 for all MSE CCGs Improving access to community MH services for CYP (cumulative) 35% August 26.2% Based on a rolling 12 months

• Waiting times for Children and young people to Eating disorder service have been met • Children and Young People’s access to Mental Health Services is currently below target. The CCGs have provided additional investment and a recovery action plan has been agreed with NELFT that focuses on workforce expansion, communications campaign and development of online platform

Cumulative number of Checks Completed Monthly Percentage Patients of LD Source: Local SystmOne on LD Register reporting CCG Register Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 with checks NHS Basildon and Brentwood CCG 1,125 21 27 69 105 124 171 202 18% • Proportion of people with learning disability having a physical health check in the first 6 months of the year was significantly lower than the previous year as a result of Covid-19. • Current performance at 18% is significantly below the 67% target. A system wide group has been established to identify ways of improving uptake. Agenda Item 17a

Summary of Audit Committee meeting held on 19 November 2020

BCCG Board Meeting 26 November 2020

Purpose of Report: To note the summary of the Audit Committee meeting held on 19 November 2020.

Recommendations and The Committee is asked to note the report. decision/actions:

Executive Summary The summary of the Committee meeting held on 19 November 2020 is (including financial impact): outlined below.

Written by/Presented by: David Triggs, Head of Corporate Governance/

Executive Director Dee Davey, Interim Chief Finance Officer Sponsor:

Non-Officer/Board Nick Spenceley, Lay Member Chair of Audit Sponsor:

Fit with CCG Strategic To deliver good governance in accordance with the CCG Constitution. Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document)

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) 

Has the Equality/Quality/Privacy Impact Assessment  been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: None BAF Ref: N/A

Conflicts of Interest: None

Escalation: None To the Board/ another Committee

Cover paper for use during COVID-19 pandemic across Mid and South Essex Summary of Audit Committee – Meeting held on 19 November 2020

1. Internal Audit Reports

1a. Internal Audit Progress Report Plan for 2020/21. The Committee noted the updates to the 20/21 Plan which continued to be impacted by the Covid 19 pandemic. It was noted that a number of the outstanding actions for joint CCG audits may be out of date or overtaken by changes to the Joint Executive Team structure. It was agreed that the Head of Corporate Governance be asked to take the actions forward with fellow governance leads;

1b Local Counter Fraud Service Progress Report. The Committee noted the plans for LCFS in 20/21 again impacted by Covid. It was noted that there continued to be an increased risk from fraud.

2. Board Assurance Framework (BAF). The Committee received a verbal update on the changes to the BAF which remained under development. The next steps to the BAF would be to continue with training for Executive Leads and Risk Owners and to align the BAF to delivery plans across the system.

3. Aged Debts update. The Committee noted a paper on the CCGs aged debts.

4. Conflicts of Interest Registers. The Committee noted the latest COI register.

5. Procurement Register. It was noted that this was being updated following a pause due to the impact of Covid. The updated register would be circulate d to the Committee as soon as this was available.

6. Effectiveness Review and Terms of Reference. The Committee undertook a self- effectiveness review which followed the format suggested by the HFMA. It was agreed to develop a short action plan to take forward the key outcomes from the review. Key actions included: • To insert into the diary an opportunity for the auditors to meet with the Committee members (without the presence of executives) 15 minutes before each Audit Committee; • To include a standard item allowing for reflection of the meeting at the close of the meeting; • To make a number of corrections to the self-effectiveness checklists; • To note that there were some minor changes to the terms of reference but in view of the impending changes to collaborative decision making it was felt that these should be deferred to January or March 2021.

Cover paper for use during COVID-19 pandemic across Mid and South Essex Agenda Item 17c

Clinical Executive Group (CEG) Update

Basildon & Brentwood CCG Board Meeting in Public 26 November 2020

Purpose of Report: The following is a summary of the key issues discussed at the October and November Clinical Executive Group meetings.

Recommendations and The Board is asked to note the update. decision/actions:

Executive Summary October update (including financial impact): • CEG members were given a presentation on the Respiratory Hubs and were taken through the options appraisal which had been undertaken by CCG Chairs for the provision of face to face consultations for patients, including those with Covid-19 symptoms. It was agreed that further discussion was required at Clinical Senate/ CEG. • The Interim Chief Finance Officer and Deputy Accountable Officer gave an update on primary care transformation investment and outlined the position around the spending commitments which have already been made and the reservices. • Dr Salako gave an update on the Diabetes programme and encouraged GP colleagues to promote the MyDiabetes App to their patients. It was also noted that there is concern around the pathway for Diabetic Foot referrals and the Deputy Accountable Officer agreed to speak to the Acute commissioning Team to see if capacity can be increased.

November update • CEG members received an update on a meeting held with Clinical Directors of the Primary Care Networks (PCNs) and agreed that those Clinical Directors not already Board members should be invited to Clinical Senate meetings. • CEG members received an update following a Trouble Shooting meeting with NELFT and noted that Drs Pereira & Dabas will be attending these meetings. • The role of localities and PCNs was discussed and it was noted that to disband localities would require a change to the Constitution. It was agreed not to proceed with this change at the current time. • A comprehensive and informative update on Children and Young Peoples’ services was given by Dr Natarajan, Alfie Bandakpara- Taylor, Sue Holland and Helen Farmer and the team were congratulated for their hard work over recent months. • An update on the Covid Vaccination Programme was given and it was noted that an enhanced service will be introduced for primary care for delivery of vaccine to their population. • An update was given on the Referral to Treatment recovery position. It was noted that an outside Agency has been employed to assist in clinically triaging referrals.

Written by/Presented by: Dr Babafemi Salako

Executive Director William Guy, Alliance Director Sponsor:

Non-Officer/Board Sponsor:

Fit with CCG Strategic N/A Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). N/A

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) N/A

Has the Equality/Quality/Privacy Impact Assessment N/A been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF:

Conflicts of Interest: None

Escalation: To the Board N/A To another Committee N/A To the BAF/CRR N/A Agenda Item 17d

Basildon & Brentwood CCG

Board Meeting in Public 26 November 2020

Purpose of Report: To receive a summary of the key issues discussed at the Patient Safety & Quality Committee (PSQC) Meetings held on 8 October and 5 November 2020.

Recommendations and To note the report and approve the proposed changes to the Committee decision/actions: terms of reference as highlighted (Appendix 1).

Executive Summary The Committee has met in October and November. The issues below are (including financial impact): a summary of the latest meeting and most are referred to in the Chief Nurse report.

1. Chief Nurse Report

The Committee noted the Chief Nurse Report and the key quality and patient safety issues.

2. St Francis Hospice

The Committee noted that it had been reported in the press that there were potential job losses due to the financial situation of the hospice. A staff consultation had been conducted in the summer and the outcome of this process was awaited.

3. St Luke’s Hospice

The Committee endorsed the Quality account.

4. Medicines Management Report

The Committee noted the contents of the Medicines Management Report. This included confirmation that the key warnings were being shared with GP practices and partners. It was also noted that there were increased risks of fraud.

5. Updated Terms of Reference

The Committee recommended that the Board approve minor amendments to the terms of reference (Appendix 1).

Written by/Presented by: Geraldine Rodgers, Deputy Chief Nurse/ Dr Sooraj Natarajan, Chair of PSQC

Executive Director Geraldine Rodgers, Deputy Chief Nurse Sponsor: Non-Officer/Board Dr Sooraj Natarajan, Chair of PSQC Sponsor:

Fit with CCG Strategic Yes Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this PSQC 5/11/20 document).

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) 

Has the Equality/Quality/Privacy Impact Assessment  been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: N/A BAF Ref:

Conflicts of Interest: N/A

Escalation: N/A To the Board To another Committee To the BAF/CRR Appendix 1

Patient Safety and Quality Committee

Terms of Reference

1. Introduction The remit of the Patient Safety and Quality Committee (the Committee) is to provide oversight and give assurance to the Clinical Commissioning Group’s (CCG) Board of the quality of services commissioned directly by the CCG and/or those that serve the population of the CCG. To promote continuous improvement, learning and innovation with respect to safety of services, clinical effectiveness and patient experience.

The Committee is established in accordance with CCG Constitution, Standing Orders and Scheme of Delegation. These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and which is affected in the CCG’s constitution and standing orders.

2. Membership Membership of the Patient Safety and Quality Committee will be as follows:

CCG representation: • Lay Representative • GP representation for the 4 localities • Chief Nurse • Deputy Chief Nurse • Nick Allinson, the Head of Continuing Healthcare • Patient and Quality Safety Managers • Senior Commissioning Lead • Public and Patient Engagement Board Lay Lead • Primary Care Manager • Safeguarding Leads for Adult/Children • Medicines Management Lead

Additional officers and representatives from other bodies may be invited to attend as appropriate.

3. Chair and Vice-Chair The Chair and Vice Chair will be appointed from the GP and Lay Members of the Committee.

4. Secretary The Patient Safety and Quality Committee will be supported by administrative support from the CCG, in terms of arranging meeting times and venues, ensuring meetings are quorate, circulating agendas and papers in advance and at meetings. The minutes of the Committee will be formally recorded and submitted to the CCG Board.

5. Lead CCG Officer The Lead Officer for this Committee is the Chief Nurse, who is also the Executive Officer with responsibility for patient safety and quality.

6. Quorum The Committee will be considered quorate when there is representation from: • Either chair or vice chair of the Committee • Minimum of 1 GP Clinical Lead representative • Minimum of 2 members of the Quality Support Team (which would normally include the Chief Nurse, Deputy Chief Nurse, Quality & Patient Safety Manager, Head of CHC and/or Safeguarding Leads) • Minimum of 2 other representatives The meeting will be considered quorate if the minimum requirements for attendance in the first 4 bullet points are met. If meeting ‘in common’ with other CCGs in Mid and South Essex then a reduced quorum of three will exist as follows: the Chair (or vice chair), the Chief Nurse (or nominee) and Deputy Chief Nurse or (nominee).

7. Frequency and Notice of Meetings The meetings of the Committee will be bi-monthly. Extraordinary meetings will be convened as necessary.

8. Remit and Responsibilities of the Committee The remit of the Committee is to provide oversight and alert the CCG Board where there are concerns about the quality of services commissioned directly by the CCG and/or those that serve the population of the CCG. To promote continuous improvement, learning and innovation with respect to safety of services, clinical effectiveness and patient experience.

To develop a work plan based on the work of the Committee, which includes the monitoring of systems and processes in place for quality, clinical effectiveness, patient safety, patient engagement and patient experience across all relevant health care providers. This work plan details the reports required and the frequency of reporting.

The key responsibilities of the Committee are:

• To seek assurance that the commissioning strategy for the CCG fully reflects all elements of quality (patient experience, effectiveness and patient safety) keeping in mind that the strategy and response may need to adapt and change.

• To develop and implement the Quality Strategy for the CCG. To have oversight of the early warning systems in place to enable swift response to assure the safety of the population that we serve.

• To provide assurance that commissioned services are being delivered in a high quality and safe manner, ensuring that quality is central to everything the CCG does. This will include jointly commissioned services.

• To have oversight of the Quality Impact of proposed QIPP plans, making recommendations to the CCG Board as to the safety of their adoption and implementation.

• To have oversight of the Quality Impact of provider cost improvement programmes (CIPs).

• To have oversight of the quality aspects of the contracts for driving improvements within the providers from which we commission services.

• To have oversight of the process and compliance issues concerning serious incidents requiring investigation; being informed of all Never Events and informing the CCG Board of any escalation or sensitive issues in good time. Ensuring all opportunities are taken to embed any learning.

• To seek assurance on the performance of commissioned organisations in compliance with the Care Quality Commission Essential Standards, Monitor terms of authorisation and any other relevant regulatory bodies.

• To receive and scrutinise independent investigation reports relating to patient safety issues and agree publication plans to promote opportunities for shared learning.

• To ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies on areas of concern. • To provide assurance to the CCG Board that the CCG is meeting its statutory obligations (including those for safeguarding children and vulnerable adults).

• This Committee has responsibility for monitoring quality across services commissioned by the CCG. The Committee will be mindful of the importance of gaining and tracking “soft” intelligence about services in addition to the more formal quantitative indicators of quality. This soft intelligence may include patient feedback through formal complaints and informal concerns, comment cards, media coverage and trends of low-level incidents. The CCG Chief Nurse will act as a conduit for both hard and soft quality information between the Committee and the Essex-wide Quality Surveillance Group.

• To have oversight of the CCG’s role in respect of research and development working with Academic Health Science Networks.

9. Relationship with the Governing Body

Delegated Powers from the Board The Committee reports directly to the CCG Board, providing assurance on the quality of secondary, community and tertiary health services provided to the CCG’s population to ensure quality, safety and a positive patient experience and delivery of the CCG’s statutory responsibilities.

Delegated Responsibility The Committee will apply best practice in the decision-making process and in all areas of operation. Where possible, it will take the agreed practices of the CCG, as set out in the Constitution, as the model for functioning.

10. Conduct of the Committee Members of the Committee are expected to comply with the same standards of conduct expected of all CCG and governing body members, as set out in the CCG Constitution and national NHS Constitution.

This includes: • Abiding by the CCG Conflict of Interest policy, thereby declaring all interests honestly and fully and declaring any conflict of interests. • Abiding by the Standards of Business Conduct articulated in the CCG Standing orders. • Abiding by the Nolan Principles of public life when discharging duties. The seven principles are selflessness, integrity, objectivity, accountability, openness, honesty and leadership. • The TOR will be agreed by the CCG Board and reviewed annually. • The Committee will undertake an annual self-assessment effectiveness sub-committee.

The Committee will produce an annual report detailing the achievements against its objectives and performance against the workplan. This report will be shared with the CCG Board for assurance and feedback.

Last Reviewed (PS&Q 5 November 2020) Board November 2020

Next Review November 2021