AGENDA NHS Leeds CCG Governing Body Meeting

Date: Wednesday 30 January 2019 Time: 14:00 – 17:00 Venue: Pudsey Civic Hall, Dawson’s Corner, LS28 5TA

Please note: agenda timings are approximate Item Description Lead Paper Time GB Welcome and Apologies Gordon Sinclair N 14:00 18/108 Purpose: To record apologies for absence and confirm the meeting is quorate.

GB Declarations of Interest Gordon Sinclair N 18/109 Purpose: To record any Declarations of Interest relating to items on the agenda:

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

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

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

d) Indirect Interests Where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making. GB Questions from Members of the Public Gordon Sinclair N 14:05 18/110 Purpose: To receive questions from members of the public GB Minutes of the Governing Body meeting held on 28 Gordon Sinclair Y 14:15 18/111 November 2018

Purpose: To receive the minutes for approval GB Matters Arising Gordon Sinclair N 18/112  Amendment to Procurement Policy Item Description Lead Paper Time Purpose: To consider any matters arising that are not considered elsewhere on the agenda GB Action Log Gordon Sinclair Y 14:20 18/113 Purpose: To review the outstanding actions

RISK GB Corporate Risk Register Sabrina Y 14:25 18/114 Armstrong Purpose: To receive the corporate risks for review

GB Governing Body Assurance Framework Sabrina Y 14:35 18/115 Armstrong Purpose: To receive the Governing Body Assurance Framework for review

COMMITTEE CHAIRS SUMMARIES GB Primary Care Commissioning Committee – 29 November Sam Senior Y 14:45 18/116 2018

Purpose: To receive the summary for information and assurance GB Quality & Performance Committee – 16 January 2019 Stephen Ledger Y 18/117 Purpose: To receive the summary for information and assurance

STRATEGY GB Report of the Director of Strategy, Performance and Tim Ryley Y 14:55 18/118 Planning

Purpose: To receive an update on the strategic review, commissioning for value and commissioning intentions

BREAK FOR 5 MINUTES COMMISSIONING & FINANCE GB Integrated Quality & Performance Report (IQPR) Tim Ryley / Y 15:15 18/119 Jo Harding Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee

GB Finance Report Visseh Pejhan- Y 15:25 18/120 Sykes Purpose: To receive the finance report for information

GB CCG Financial Control, Planning and Governance Self- Visseh Pejhan- Y 15:35 18/121 Assessment Sykes

Purpose: To receive the assessment for information

GB Chief Executive’s Report Phil Corrigan Y 15:45 18/122 Purpose: To receive an update on key issues from the CCG’s Chief Executive

Item Description Lead Paper Time GOVERNANCE GB New Model Constitution Proposal Gordon Sinclair Y 15:55 18/123 Purpose: To receive and agree the proposed amends to the Constitution

GB Questions from Members of the Public Gordon Sinclair N 16:05 18/124 Purpose: To receive questions from members of the public

GB Forward Work Programme 2018/19 Gordon Sinclair Y 16:15 18/125 Purpose: To receive the programme and Committee Meeting dates for 2019/20

GB Any Other Business Gordon Sinclair N 16:20 18/126

Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest"

GB Confidential Minutes of the Governing Body held on 28 Gordon Sinclair Y 16:25 18/127 November 2018

Purpose: To receive the minutes for approval GB Procurement Update Visseh Pejhan- Y 16:30 18/128 Sykes a) Overall Procurement Plan

Purpose: To note the plan and approve the delegated authority

b) Update on Primary Care Mental Health Reprocurement

Purpose: To note the plan and approve the delegated authority

c) Tender Evaluation Report: Adult Specialist Weight Management Services (Tier 3)

Purpose: To confirm the approval of the award

GB Maternity and Neonatal Reconfiguration Sue Robins Y 16:50 18/129 Purpose: To receive and approve the proposal ITEMS FOR INFORMATION IFI1i. Minutes of the West Yorkshire & Harrogate Joint Y N/A Committee – Purpose: To receive the minutes for information Dates of Future Meetings: Wednesday 27 March 2019, 2pm

THIS PAGE IS INTENTIONALLY BLANK Governing Body Declarations (January 2019) Action Taken to Mitigate Risk Is the interest Practice B Declared Interest- (Name of the Name Title Role Type of Interest direct or Interest From Interest Until Code organisation and nature of business) indirect? Angela Collins Lay Member for Patient Governing Body N/A Nil Declaration and Public Participation Member Declare any potential conflict of interest at GP Member Governing Body Ben Browning B86020 GP Partner at Lofthouse Surgery Financial Interest Direct Governing Body/Board, sub committees and relevant Representative Member meetings Declare any potential conflict of interest at GP Member Governing Body Shareholder in Leodis Care Ltd (now a Ben Browning B86020 Financial Interest Direct Governing Body/Board, sub committees and relevant Representative Member dormant and non-trading company) meetings Declare any potential conflict of interest at GP Member Governing Body Ben Browning B86020 Member of Leodis LLP (Shell company) Financial Interest Direct Governing Body/Board, sub committees and relevant Representative Member meetings Declare any potential conflict of interest at GP Member Governing Body Ben Browning B86020 Spouse is a GP Partner in Lofthouse surgery Financial Interest Indirect Governing Body/Board, sub committees and relevant Representative Member meetings Declare any potential conflict of interest at GP Member Governing Body Spouse is city-wide lead for Learning Ben Browning B86020 Financial Interest Indirect Governing Body/Board, sub committees and relevant Representative Member Disability services meetings Gordon Sinclair GP Partner / Clinical Chair Governing Body B86030 GP Partner at Burton Croft Surgery Financial Interest Direct Ongoing Declare conflict or perceived conflict within context Member of any relevant meeting or project work Gordon Sinclair GP Partner / Clinical Chair Governing Body B86030 Director of Sinclair Healthcare (Sole) Financial Interest Direct Ongoing Declare conflict or perceived conflict within context Member of any relevant meeting or project work Gordon Sinclair GP Partner / Clinical Chair Governing Body B86030 Partner of Viva Healthcare LLP Financial Interest Direct Ongoing Declare conflict or perceived conflict within context Member of any relevant meeting or project work Gordon Sinclair GP Partner / Clinical Chair Governing Body B86030 Headingley Pharmacy LLP – Viva Healthcare Financial Interest Direct Ongoing Declare conflict or perceived conflict within context Member has a 25% interest of any relevant meeting or project work To declare any conflict or perceived conflict and in particular any decisions affecting joint working with Secondary Care Governing Body Leeds City Council including policy and resource Ian Cameron N/A Substantively employed by Leeds City Council Financial Interest Direct 01-Apr-16 Ongoing Consultant Member decisions

Jason Broch Assistant Clinical Chair Governing Body B86022 Partner Oakwood Lane Medical Practice Financial Interest Direct Ongoing Declare any potential conflict of interest at Member 10.05.2012 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Director Jemjo Healthcare Ltd Financial Interest Direct Ongoing Declare any potential conflict of interest at Member 10.05.2012 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Spouse business Airtight International Ltd Financial Interest Indirect Ongoing Declare any potential conflict of interest at Member 10.05.2012 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Spouse business Nails 17 Ltd Non-Financial Personal Interest Indirect Ongoing Declare any potential conflict of interest at Member 10.05.2012 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Director Leeds Jewish free school Non-Financial Personal Interest Direct Ongoing Declare any potential conflict of interest at Member 16.01.2014 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Director Brodetsky Primary School Non-Financial Professional Direct Ongoing Declare any potential conflict of interest at Member Foundation Interest 17.06.2014 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Chair of Governor's Brodetsky Primary School Financial Interest Direct Ongoing Declare any potential conflict of interest at Member 01.09.2012 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Founding Fellow of the Faculty of Clinical Financial Interest Direct Ongoing Declare any potential conflict of interest at Member Informatics 01.05.2018 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Gartner UK - Clinical Advisor Non-Financial Personal Interest Direct Ongoing Declare any potential conflict of interest at Member 01.05.2018 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Oakwood Lane Medical Practice is a Non-Financial Professional Direct Ongoing Declare any potential conflict of interest at Member shareholder of Calibre Care Partners Ltd (GP Interest 01.05.2018 Governing Body/Board, sub committees and relevant Federation) meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Shareholder / Director Chapeloak Non-Financial Professional Direct Ongoing Declare any potential conflict of interest at Member Investments Ltd Interest 15.02.2013 Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 Father’s business - Leeds Acupuncture Clinic Financial Interest Indirect Declare any potential conflict of interest at Member 10.05.2012 Ongoing Governing Body/Board, sub committees and relevant meetings Jason Broch Assistant Clinical Chair Governing Body B86022 General Practice work with IMH Group Financial Interest Direct Ongoing Declare any potential conflict of interest at Member 13.06.18 Governing Body/Board, sub committees and relevant meetings Joanne Harding Director of Nursing and Governing Body N/A Nil Declaration Quality Member Julianne Lyons GP Member Governing Body B86110 GP Partner at Leeds Student Medical Practice Financial Interest Direct Declare any potential conflict of interest at Representative Member Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Leeds Local Medical Committee Member Financial Interest Direct Declare any potential conflict of interest at Representative Member Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Spouse is a Director of Leeds Haematology Financial Interest Indirect Declare any potential conflict of interest at Representative Member plc Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Spouse is a trustee of the British Society for Non-Financial Professional Indirect Declare any potential conflict of interest at Representative Member Haematology Interest Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Spouse is a trustee of UK Myeloma Forum Non-Financial Professional Indirect Declare any potential conflict of interest at Representative Member Interest Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Spouse is an employee of the University of Financial Interest Indirect Declare any potential conflict of interest at Representative Member Leeds Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Spouse has an honorary contract with Leeds Financial Interest Indirect Declare any potential conflict of interest at Representative Member Teaching Hospitals NHS Trust Ongoing Governing Body/Board, sub committees and relevant meetings Julianne Lyons GP Member Governing Body B86110 Shareholder of Leeds West Primary Care Financial Interest Direct Declare any potential conflict of interest at Representative Member Limited Ongoing Governing Body/Board, sub committees and relevant meetings GP Member Governing Body Keith Miller N/A GP Partner, Kirstall Lane Medical Centre Financial Interest Indirect 01-Jan-12 Ongoing Representative Member GP Member Governing Body Spouse - Sarah Miller, Advanced Nurse Keith Miller N/A Financial Interest Indirect Ongoing Representative Member Practitioner, LTHT Peter Myers Lay Member for Audit and Governing Body N/A Director Finance Yorkshire Ltd Financial Interest Indirect 05/08/2015 Declare conflict or perceived conflict within context Conflict Matters Member of any relevant meeting or project work Peter Myers Lay Member for Audit and Governing Body N/A Chairman of the Equine and Livestock Financial Interest Indirect 03-Aug-17 Unlikely to cause conflict due to nature of interest. If Conflict Matters Member Insurance Group conflict arises to declare and withdraw if a decision is being taken. Phil Ayres Secondary Care Governing Body N/A I have established a coaching and facilitation 01-Oct-18 Ongoing Maintain awareness of potential influence over Consultant Member business for doctors and their teams. The decisions I may take as independent practitioner. purpose of my business is to improve Financial Interest Direct Abide by GMC code of conduct. Declare this interest effectiveness as leaders and professionals. at relevant meetings.

Phil Ayres Secondary Care Governing Body N/A I have commenced a contract with Leeds 01-Nov-18 31/03/2019 Maintain awareness of potential influence over Consultant Member Community Healthcare in my business as decisions I may take as independent practitioner. Financial Interest Direct facilitator and coach. Abide by GMC code of conduct. Declare this interest at relevant meetings. Philomena Corrigan Chief Executive Governing Body N/A Trustee for the Foundation of Nursing Non-Financial Professional Direct 01-Dec-15 Ongoing Declare any potential conflict of interest at Member Interest Governing Body/Board, sub committees and relevant meetings Declare any potential conflict of interest at Director of Corporate Governing Body Sabrina Armstrong N/A substantively employed by NHS England Financial Interest Direct 01-Oct-14 Ongoing Governing Body/Board, sub committees and relevant Services Member meetings Sam Senior Lay Member for Primary Governing Body N/A Lay Member for Primary Care Bassetlaw CCG Financial Interest Direct 01-Sep-17 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning Member of any relevant meeting or project work Sam Senior Lay Member for Primary Governing Body N/A Lay Representative National School of Financial Interest Direct 01-May-16 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning Member Healthcare Science of any relevant meeting or project work Sam Senior Lay Member for Primary Governing Body N/A Lay Advisor Health Education England (West Financial Interest Direct 01-May-16 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning Member Midlands) of any relevant meeting or project work Sam Senior Lay Member for Primary Governing Body N/A Patient and Public Panel Member - National Financial Interest Direct 01-Apr-17 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning Member Institute Health Research of any relevant meeting or project work Sam Senior Lay Member for Primary Governing Body N/A Chairperson - Brampton United Junior Non-Financial Personal Interest Direct 01-May-13 Ongoing Declare conflict or perceived conflict within context Care Co-Commissioning Member Football Club (S63 6BB) of any relevant meeting or project work Simon Stockill Medical Director Governing Body N/A Partner at Sleights and Sandsend Medical Financial Interest Direct 01-Apr-16 Ongoing Declare conflict or perceived conflict within context Member Practice, Whitby (Hambleton, Richmondshire of any relevant meeting or project work & Whitby CCG) Simon Stockill Medical Director Governing Body N/A GP Appraiser, NHS England (Yorkshire & Financial Interest Direct 01-Dec-13 Ongoing Declare conflict or perceived conflict within context Member Humber) of any relevant meeting or project work Simon Stockill Medical Director Governing Body N/A Clinical Lead for Quality Improvement Ready Financial Interest Direct 01-Sep-16 Ongoing Declare conflict or perceived conflict within context Member Programme, Royal College of GPs of any relevant meeting or project work Lay Member for Governing Body N/A Nil Declaration Stephen Ledger Assurance Member Sue Robins Director of Operational Governing Body N/A Nil Declaration Delivery Member Governing Body Director of Strategy, Tim Ryley Member N/A Nil Declaration Planning & Performance Visseh Pejhan-Sykes Chief Finance Officer Governing Body N/A Niece works for CCG as Digital Non-Financial Personal Interest Indirect 11-Dec-17 Ongoing Not to participate in any decisions which may affect Member Communications Officer this post, e.g. cut budget

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Minutes NHS Leeds CCG – Governing Body Meeting Wednesday 28 November 2018 1.30pm – 4.30pm The Old Fire Station, Gipton, Leeds, LS9 6LN

Members Initials Role Present Apologies Dr Gordon Sinclair (Chair) GS Clinical Chair  Dr Jason Broch JB Assistant Clinical Chair  Dr Ben Browning BB Member Representative  Angela Collins AC Lay Member – Patient & Public Involvement  Philomena Corrigan PC Chief Executive  Jo Harding JH Director of Quality & Safety  Dr Stephen Ledger SL Lay Member – Assurance  Dr Julianne Lyons JL Member Representative  Dr Keith Miller KM Member Representative  Peter Myers PM Lay Member – Governance  Visseh Pejhan-Sykes VPS Chief Finance Officer  Samantha Senior (Deputy SS Lay Member – Primary Care Co-  Chair) Commissioning TR Director of Strategy, Performance &  Tim Ryley Planning Dr Phil Ayres PA Secondary Care Specialist Doctor  Dr Simon Stockill SSt Medical Director  Additional Attendees Susan Robins SR Director of Operational Delivery  Dr Ian Cameron IC Consultant in Public Health Medicine  Sabrina Armstrong SA Director of Corporate Services  Suzanne Lofthouse SL Corporate Governance & Risk Administrator  Sam Ramsey (Minutes) SRa Corporate Governance Manager 

Members of the Public Observing the Meeting - 4

No. Agenda Item Action GB Welcome and Apologies 18/83 GS welcomed everyone to the Governing Body meeting. Apologies had been received on behalf of Simon Stockill. The Chair confirmed that the meeting

No. Agenda Item Action was quorate.

GB Declarations of interest 18/84 Members were asked to raise any declarations of interest in relation to agenda items.

Nothing further was raised.

GB Questions from Members of the Public The meeting was opened up to the public to take any questions they had at 18/85 this stage.

No questions were asked.

GB Minutes from Previous Meetings 18/86 GS presented the minutes from the NHS Leeds Governing Body and the Annual General Meeting held on 26 September 2018 for approval.

An amendment was requested to page 3 of the Governing Body minutes to ensure the sentence was clear and should read ‘individual organisation agendas’ and amend from ‘mitigating risk’ to ‘CCGs mitigation’. The Chair SR agreed to circulate the amended version for final approval.

The Governing Body: a) approved the minutes of the NHS Leeds Governing Body in light of the amendments above and Annual General Meeting held on 26 September 2018.

GB Matters Arising 18/87 There were no matters arising.

GB Action Log 18/88 The Governing Body reviewed the action log and noted the following updates:

18/73-1 – PC provided an update in relation to the Mental Health Strategy and the Governing Body noted that the JSNA which would be produced with the local authority would feed into the Mental Health Strategy. The Mental Health Strategy would be brought to a future Governing Body meeting as an agenda item.

GS confirmed that all other actions had been completed.

GB Corporate Risk Register 18/89 SA presented the corporate risk register highlighting the current red risks on the register. Members noted that there had been no change in the 3 red risks since the last Governing Body meeting.

No. Agenda Item Action The Governing Body was informed that work was underway with regards to consistency of application of risk reporting and risk scoring methodology and the Risk Manager was providing training to individual teams.

The Governing Body was asked to review the risks on the corporate risk register, including the controls and assurance from the committees.

A query was raised in relation to risk 339 and the increase in patients requiring treatment for prostate cancer and whether there was a context behind the surge that could be noted in the narrative. Members noted that campaigns do put additional pressure on LTHT and is difficult to control in terms of risk, but the CCG are aware of campaigns as they are being undertaken. In relation to prostate cancer, SL drew Governing Body members’ attention to the Quality & Performance Committee Chairs Summary (GB18/95) within which further assurance had been requested with respect to younger, high risk groups of patients with prostate cancer. SR informed the Governing Body members that in relation to younger referrals assurance had been given that patients were seen on clinical priority and younger patients with more aggressive cancer would be seen under that clinical priority.

It was queried whether it was possible to contextualise figures within the risk, noting that although we continue to see more people within 62 days, the overall figures are greater as there are more people waiting. This was noted by the Governing Body.

SR highlighted to members that in relation to risk 679, the total waiting size was at its lowest point in March 2018 following significant redesign work. Inpatient numbers continue to be steady and further focus will be done on outpatients.

The Governing Body:

a) reviewed the Corporate Risk Register b) reviewed the controls, assurances and mitigating actions in place to manage the risks

GB Governing Body Assurance Framework (GBAF) 18/90 SA presented GBAF for the Governing Body to review, highlighting that there had been no changes to the scoring but updates had been highlighted in bold within the document. Members also noted an amendment to the format, to separate out internal and independent assurances and to align to the internal audit plan for 2018/19. Members were reminded that risk appetite would be considered as part of the risk workshop in December.

A query was raised in relation to risk 6 and the absence of secondary care workforce. Members noted that as a CCG we do not have a statutory obligation to the secondary care workforce, but as commissioners would support Primary Care in terms of their workforce development.

No. Agenda Item Action

Population Health Management was raised in ensuring that provider organisations are being supported and getting the correct information. The Governing Body was assured that across West Yorkshire and Harrogate there is a commitment to population health management and has confidence that Leeds is working together and has now been identified as one of four national pilot schemes.

A further query was raised with regards to our role across the city in relation to workforce and members noted that the workforce programme is chaired by Sara Munroe and feeds into the Leeds Health & Care Academy. The CCG role is as a partner and working towards the same goal.

The recruitment of healthcare professionals from the EU and the implications of Brexit were raised as a concern. Members recognised that this was a more significant risk in Secondary Care. It was highlighted that the workforce tool that practices should complete would increase knowledge of any gaps for future recruitment and planning purposes.

The Chair highlighted that the risk does reference wider partners and the involvement of other providers but recognised the changing landscape.

The Locality Care Partnerships (LCPs) were raised and the consideration to be given to these as a control. It was recognised that further conversations need to take place between commissioners and providers to create a framework to assess against.

The Governing Body: a) received the Governing Body Assurance Framework.

GB Strategic Review 18/91 TR presented the report to update the Governing Body on the CCG Strategic Plan, and an update on the wider strategic context at both a national and regional level.

The Governing Body noted that the NHS is due to announce its refreshed Long Term Plan along with planning guidance in December 2018. Once published, Leeds will, in response, be expected to contribute a 5 year plan

linked to that of West Yorkshire. Members were assured that Leeds is committed to producing an aligned plan to the refreshed Leeds Plan and highlighted that consideration to this plan would need to be given by the Governing Body.

TR provided an update on the progress to date of the delivery framework focusing on ambition, alignment and action. It was recognised that work was underway in a number of areas to make substantial changes which were reflective of the approach being taken, particularly in relation to frailty and end of life care and population health management.

No. Agenda Item Action

A query was raised in relation to a communications plan for staff and partners on the strategic plan and delivery framework progress. Members noted that staff engagement events would be taking place throughout December and through the strategy team it would be communicated through partnership forums and agendas. An event would be taking place on 14th December with various key leaders from across the system to set the direction in relation to population health management.

In relation to the collective ambitions across the city to improve the health of the poorest the fastest, a query was raised as to whether the delivery framework and population health management would provide a better understanding of those groups. The Governing Body was informed that the locality care partnerships would support this process and drive an understanding of what interventions should be taken to support this cohort of people.

A further query was raised in relation to non-recurrent funding and the risks involved if investments from partners do not continue, for example within the cancer strategy. Members acknowledged that there is a risk and further work needs to be done to ensure funding is strategic and long term.

In relation to the work undertaken from a West Yorkshire and place based level, the importance of clear lines of communication was stressed to ensure the flow of the totality of the system.

From a primary care perspective, it was raised that there was a need to ensure the development of LCPs was considered and the ability for the strategy to adapt to that. The Governing Body acknowledged the importance of drivers of change, particularly GP practices and schools and the need to consider these in the development of the strategy and delivery framework.

A query was raised in relation to communication for patients and the public and possible impacts that it could have. Members recognised the importance of ensuring the plan/strategy is developed further and then consider utilising the LCP delivery framework across different areas of the city to communicate.

The Chair queried the timeframes and what would be done in relation to the other cohorts in the meantime in order to keep the flow of work. The Governing Body was assured that there was a managed timeframe in place with regards to the other cohorts, however the importance of the 5 year plan response was recognised. A guide would be produced to consider the direction of travel in developing the long term plan.

The Governing Body: a) noted and commented on the report

No. Agenda Item Action GB Committee Chair’s Summary - Primary Care Commissioning Committee 18/92 – 27 September 2018 SS presented the Committee Chair’s Summary for the Primary Care Commissioning Committee held on 27 September 2018 for information.

SS highlighted the positive news in relation to the agreement from the PCCC to award a 1% pay uplift to practice staff on the proviso that practices complete the workforce tool. In completing the tool, this would provide Primary Care with the opportunity to submit the information in order to gather more intelligence about the workforce and the different operating models in practices.

The Chair queried whether this was a 1% uplift of non-recurrent funding for this year and VPS raised that this would be discussed further at the national clinical commissioners forum and would look to national planning guidance to dictate.

The Governing Body: a) received the report.

GB Committee Chair’s Summary - Audit Committee – 24 October 2018 18/93 PM presented the Committee Chair’s Summary for the Audit Committee held on 24 October 2018 for information.

PM informed the Governing Body of the current likely forecast outcome and highlighted that the QIPP target of £34.3m was unlikely to be achieved. Members had been updated on the IFRS16: Accounting for Leases and its possible impact and were awaiting NHSE guidance.

The Governing Body was informed that in relation to the CCG Financial Control, Planning and Governance Self-Assessment, there had been an increased number of unplanned cash drawdowns, however the Audit Committee had received assurance from VPS that these reflected circumstances rather than problems.

Two internal audits had been completed and both had received positive outcomes, one receiving a rating of ‘significant’ and one receiving a rating of ‘full’.

In relation to the Business Continuity Plan, the Audit Committee had raised concerns of the current BCP and this had been escalated to PC and GS. The Governing Body noted that this had been addressed by the Quality & Performance Committee who had been assured of the plan in place. The Governing Body also noted that the BCP had been attached to papers for information.

The Governing Body: a) received the report.

No. Agenda Item Action GB Committee Chair’s Summary - Remuneration & Nomination Committee – 18/94 17 October 2018 SS presented the Committee Chair’s Summary for the Remuneration and Nomination Committee held on 17 October 2018 for information.

SS highlighted that the Committee had agreed that a performance related pay scheme should be developed and this would be drafted and presented at the next Committee meeting.

In relation to the gender pay gap, the Governing Body was informed that the gap is widened due to the low number of males in lower graded roles and this would be considered by the CCGs Workforce and Diversity Group.

The Remuneration and Nomination Committee had approved the timetable for the recruitment of the new Chief Executive and this would commence shortly. SS informed the Governing Body that following a recent change to the constitution from NHSE, the responsibility for making decisions on executive remuneration would now be approved by the Governing Body and the constitutional arrangements would be adopted.

The Governing Body: a) received the report.

GB Committee Chair’s Summary – Quality & Performance Committee – 14 18/95 November 2018 SL presented the Committee Chair’s Summary for the Quality & Performance Committee held on 14 November 2018 for information.

SL raised to the Governing Body items of limited assurance. Following concerns raised at the last Governing Body meeting in relation to breast 2 week wait referrals, the Quality and Performance Committee was satisfied with reasonable assurance regarding breast 2 week wait, however in relation to the 62 day referral treatment, it was agreed that this had only provided limited assurance and would continue to be monitored by the Quality & Performance Committee.

In relation to IAPT and the continuing concerns to reach target, the Quality & Performance Committee agreed limited assurance and recognised that it could take the reprocurement of services to fully address the gap. The Governing Body was informed that a further update would be provided to the next Quality & Performance Committee.

Following an internal audit of the Continuing Healthcare service, the Audit Committee had requested that the Quality & Performance Committee reviewed the current status and required actions in relation to outstanding reviews. The Committee had been reasonably assured regarding the financial status and the clinical care, however limited assurance had been agreed in relation to the action plans provided to return trajectories to a reasonable level

No. Agenda Item Action and the Committee agreed to receive an updated trajectory at the January Committee.

SL informed the Governing Body that the Quality & Performance Committee had been reasonably assured in relation to the content of the Emergency Planning Statement of Compliance and recommended that the Governing Body approve the statement of compliance for submission.

The Governing Body agreed the level of compliance with the core standards along with the action plan and deep dive responses.

IC confirmed to the Governing Body that as the CCG had rated partial assurance, the improvements against the plan would be looked at in 3 months’ time and SL assured members that this would be considered by the Quality & Performance Committee.

A query was raised in relation to partial compliance and whether this would have any implications and SR assured the Governing Body that this was not the case and had confidence in the CCGs ability to oversee and manage a CCG incident.

No concerns had been raised by the Committee in relation to the Business Continuity Plan and this had been approved.

SL highlighted to the Governing Body that the Committee had not approved the amendments to the infertility policy. This was a complex area and other CCGs had also raised concerns. Further details on the equality assessment were being assessed to ensure the CCG were satisfied.

The Governing Body: a) received the report and; b) agreed the level of partial compliance in relation to the Emergency Planning Statement of Compliance

GB Integrated Quality & Performance Report (IQPR) 18/96 TR presented the Integrated Quality & Performance Report (IQPR) and confirmed to members that this had been reviewed in detail by the Quality & Performance Committee. Attention was drawn to four key areas, referral to treatment, urgent care, cancer and IAPT. Another area of importance was raised as personal health budgets as the organisation were seen to be doing well in this area.

JH raised the e-coli target to members, highlighting that this is challenging across the whole health economy as is a relatively new national target. A system had been put in place and was meeting reporting and monitoring targets, however infection rates were rising and therefore it was increasingly difficult to meet the infections target. Work would continue to take place to continually improve infection rates, but members acknowledged that nationally

No. Agenda Item Action there was a concern regarding the ability to meet all areas.

A query was raised in relation to the trend bars on the cancer 2 week wait as TR the bars were green, however the target had not been met and was red within the current data. TR agreed to highlight with Mark Fox.

A further query was raised in relation to the access rates for Children’s mental health and SL confirmed that the Quality & Performance Committee had recently looked at this and a further update would be provided to a future Quality & Performance Committee. It was acknowledged that with regards to mental health, workforce capacity was below the required level and the new reprocurement would help to address the issues of workforce and sites in order to meet the demand. A short-medium term recovery plan was in place with the main provider which would focus on recruitment.

The Committee recognised the work that was being done in practice by mental health workers, however capacity was raised as an issue. TR highlighted the importance of ensuring that resources are shifted with the shift of activity and people.

The Governing Body:

a) received and reviewed the IQPR dashboards; discussed the information and noted the current areas of underperformance.

GB Finance Report 18/97 VPS presented the finance report for the seven months to 31st October 2018 and the expected outturn position for the 2018-19 financial year.

The Governing Body noted that in relation to the target of reducing running costs by 20%, the in year staff turnover and other earlier than expected reductions in non-pay costs had resulted in the CCG being able to achieve the full year trajectory earlier than expected and therefore running costs would be forecast to underspend against allocation. Members acknowledged that all Clinical Commissioning Groups across England had been informed that they would have to make a reduction to their administration costs by a further 20% by 2020/21. The CCG was in a good position due to the managed costs following the merger and therefore the focus would be on areas where money had been allocated elsewhere. Members were assured that suggestions had been made and work would be undertaken.

VPS informed members that the CCG had moved from red to amber on the QIPP delivery target and that although the CCG was still significantly some way from achieving its £34.3m QIPP target with a forecast of just over £20m, risks identified during the planning stage had now been mitigated or reduced enabling the CCG to achieve its overall in year financial target.

Members noted that the financial risk regarding the Transforming Care

No. Agenda Item Action Partnership trajectory had been delayed, therefore the money had now been utilised which resulted in a reduction of risk. The risks and processes surrounding the services were under continuous review.

The Governing Body was informed that in relation to LYFPT, the out of area treatment costs were significantly overspending. The Newton Europe work suggested that the beds available were not being utilised effectively, and on that basis the CCG would reinvest non-recurrent funding with LYPFT to support. Following the Newton Europe work, a new protocol had been introduced and the CCG was confident that it would make a difference.

VPS assured the Governing Body that the forecast position was that we were on track to meet our financial plan.

A query was raised in relation to underspend and VPS confirmed that there had been a request from NHSE for the CCG to increase the control total which would address any potential for underspend. In relation to the underspend within the Medicines Optimisation in Care Homes Project, members acknowledged that this was due to risks that had not crystallised.

The Governing Body queried whether there were any risks that had not been highlighted and the only concern raised was in relation to the Transforming Care Partnership and the planning trajectory. Members acknowledged that for various reasons, the patients were still within the current care system when it had been thought that the number would have reduced. The infrastructure had now been put in place to reduce the number of patients and the Governing Body was assured of this process.

The Governing Body:

a) noted the month 7 financial position; b) discussed, commented and highlighted actions required to progress and report to the next meeting of the Executive Management Team.

GB CCG Financial Control, Planning and Governance Self-Assessment 18/98 VPS presented the financial control, planning and governance self- assessment for information and assurance and highlighted that this document would be reviewed by the CCG and submitted to NHS England on a quarterly basis.

The Chair confirmed that the self-assessment had been presented to the Audit Committee and was supported. The self-assessment would be shared with the Governing Body on a quarterly basis.

The Governing Body:

a) Noted the CCG quarter 2 2018/19 CCG Financial Control and Governance Self-Assessment

No. Agenda Item Action GB Chief Executive’s Report 18/99 PC presented the Chief Executive’s Report highlighting the key areas within the report.

The CQC Review of the Leeds Health & Care System took place in September and October and as a result of this a summit would be held on 17th December to feed back the themes in detail. The CQC did identify that data demonstrated there had been double the rate of admissions from care homes for non-elective admissions and this would be something we would consider as an organisation. The Governing Body was assured that this would be included within the strategy approach and population health management would look at the frail population.

The Governing Body noted that there had been a relocation of Harrogate and Rural Districts Mental Health Services and inpatient services would move from Harrogate to York, which would allow for an upgrade in in-patient facilities with individual en-suite accommodation.

The Big Leeds Chat had taken place in October and asked Leeds citizens what they liked about living in the city of Leeds, how they stay healthy and anything they would want to change. An engagement report would be produced to summarise the key themes emerging from the first event.

Members acknowledged that a public facing campaign had taken place in relation to not prescribing over-the-counter medicines to outline what people can do and why people are being asked to buy their own medicines.

In relation to ‘Building the Leeds Way’, members noted that LTHT are currently preparing their planning application to Leeds City Council in preparation for their Outline Business Case (OBC) Submission to NHS England later this financial year. The scheme centres on major redevelopment on the Leeds General Infirmary site with some minor enabling and upgrade works at other sites. LTHT would be exploring a range of financing options.

A query was raised in relation to the differences between the hospital estates strategy and community estates strategy. The Governing Body noted that the CCG had agreed to obtain support to look at Primary Care estates and highlighted the need to consider significantly reducing the carbon footprint.

The Governing Body: a) received the Chief Executive’s report.

GB Policy Approval 18/100 i) Review of Operational Scheme of Delegation VPS presented the policy and highlighted the proposed amendments, in particular the different thresholds for health contracts and non-healthcare contracts which would put the procurement thresholds in line with the EU thresholds.

No. Agenda Item Action

A query was raised in relation to the minimum number of quotations and the Governing Body was informed that we would be required to evidence that we have sought the minimum number to ensure the process was transparent.

The Governing Body: a) approved the proposed amendments

ii) Procurement Policy Review VPS presented the revised version of the procurement policy and highlighted that this had been reviewed by the Audit Committee on 24 October 2018 and they had recommended that it be approved by the Governing Body.

The Governing Body: a) approved the revised version of the Procurement Policy

iii) Standards of Business Conduct SA presented the Standards of Business Conduct Policy and highlighted that this had been reviewed by the Audit Committee on 24 October 2018 and they had recommended that it be approved by the Governing Body.

The Governing Body: a) approved the policy

GB Questions from Members of the Public 18/101 The meeting was opened up to the public to take any questions they had at this stage.

Jon Prentis asked the Governing Body about the plans for the new children’s hospital at the Leeds General Infirmary and whether there was any further information on the number of beds at the new hospital.

VPS confirmed that the details of the modelling and assumptions in relation to this had not yet been shared and once this had been received it would provide further details on this query. It was noted that further information is required to find out what services will be included within the building which will impact on the question being asked. The member of the public was informed that the stakeholder engagement process will take place from January to March.

GB Forward Work Programme 2018/19 18/102 The Governing Body’s work programme was presented for information.

The Governing Body: a) received the forward work programme.

GB Any Other Business 18/103 None noted.

No. Agenda Item Action Date of next meeting: 30 January 2019, 2.00 – 5.00pm

IFI1. For information

i) Minutes of the West Yorkshire & Harrogate Joint Committee – 4th September 2018 The Governing Body received the minutes of the West Yorkshire & Harrogate Joint Committee held on 5th June 2018 for information

ii) EPRR Self-Assessment & Business Continuity Plan The Governing Body received the EPRR Self-Assessment & Business Continuity Plan for information

iii) Commissioning for Value Update The Governing Body received an update on the Commissioning for Value Framework and current schemes

Approved and signed by:

Dr Gordon Sinclair, Clinical Chair, NHS Leeds CCG

Date:

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MINUTES ACTION LOG – GOVERNING BODY

ITEM ACTION ACTION: ACTION BY: COMPLETED/UPDATE NO: NO: 26 September 2018 GB 1 Chief Executives Report In progress. 18/73 Governing Body recommendation to reconsider the Mental Health PC Mental Health Strategy to be brought Strategy including consideration of the mental health needs of the to future Governing Body meeting. student population.

28 November 2018 GB 1 Minutes from Previous Meeting Complete. 18/86 An amendment was requested to page 3 of the Governing Body SR Amendment made and final version minutes to ensure the sentence was clear. circulated to Governing Body members. GB 1 Integrated Quality & Performance Report Complete. 18/96 A query was raised in relation to the trend bars on the cancer 2 week TR/MF The CCG Informatics team will wait as the bars were green, however the target had not been met and review the full report to see if there was red within the current data. TR to highlight with Mark Fox. are any further corrections like this that need to be made.

GB 1 Update to Procurement Plan 2018/19 VPS Complete. 18/105 Further update on the IAPT reprocurement to be brought back to the To be discussed at the January January 2019 Governing Body meeting with timescales. Governing Body meeting.

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Agenda Item: GB 18/114 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 30 January 2019

Title: Corporate Risk Register January 2019

Lead Governing Body Member: Sabrina Tick as Category of Paper appropriate Armstrong, Director of Corporate Services () Report Author: Anne Ellis Playfair, Risk Manager Decision

Reviewed by EMT/SMT/Date: by email Discussion  Reviewed by Committee/Date: Quality & Information Performance Committee 16 January 2019 Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing  2. Reduce health inequalities across our city  We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health  4. Increase their confidence to manage their own health and wellbeing  5. Achieve better integrated care for the population of Leeds  6. Create the conditions for health and care needs to be addressed around local  neighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge  2. Failure to assure the delivery of high quality services, leading to commissioned services not  reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and  implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve  health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions  7. Failure to enable partners to work together to deliver the CCG commitments  8. Failure of system to be adaptable and resilient in the event of a significant event 

EXECUTIVE SUMMARY:

The CCG uses Datix as an internal risk management system which enables risks to be recorded and managed by all members of staff. Risks are aligned to the appropriate CCG committee for overview and scrutiny.

The risks are included on the CCG operational risk register and reviewed within individual directorates and by the executive management team. As per the CCG risk management strategy, all risks at a score of 12 and above are presented to the relevant CCG committee for review and assurance. Assurance on areas of concern is reported from the CCG committees to the Governing Body via the CCG committee chair report. The Governing Body receives the Corporate Risk Register (all red risks scored at 15 and above) for review at each meeting and is supported by the CCG committee chair updates. The CCG Governing Body Assurance Framework is presented as a separate agenda item.

Following a detailed review of the risk register, there are now 39 active risks on the CCG risk register (previously 60), the main reason for the reduction in risks follows the decision to remove the risks relating to achievement of performance targets from the risk register. A risk is something that might threaten the achievement of objectives. Once there is certainty of an event happening it is no longer a risk. Performance targets previously reported as risks had breached or were close to breaching and as such are issues which are managed and reported through the IQPR rather than the risk register.

The three corporate risks reported in November 2018 related to performance targets and as such are no longer included on the corporate risk register. These related to the following performance targets:  Cancer 62 day urgent GP referral to treatment standard  RTT – Incomplete Pathway (number of patients waiting)  RTT – 52 Week Waits

Currently there are no corporate risks to report to the Governing Body. Risks will continue to be reviewed and teams will be supported through the risk review and identification process. Any risks that are scored at 15 or above will be escalated to the Corporate Risk Register.

NEXT STEPS:

 All risks will be reviewed as per the bi-monthly cycle in accordance with the CCG risk management strategy and presented to the assigned committee for review.  The Corporate Risk Register will be presented to the CCG Governing Body at each meeting.

RECOMMENDATION:

The Governing Body is asked to: a) NOTE the outcome of the risk review process and the impact on the Corporate Risk Register

Agenda Item: GB 18/115 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 30 January 2019

Title: Governing Body Assurance Framework

Lead Governing Body Member: Sabrina Tick as Category of Paper appropriate Armstrong, Director of Corporate Services () Report Author: Anne Ellis Playfair, Risk Manager Decision

Reviewed by EMT/ Date: by email Discussion  Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

EXECUTIVE SUMMARY:

1. The Governing Body Assurance Framework (GBAF) provides a structure and process that enables the CCG to focus on the principal risks to achieving its strategic commitments and be assured that adequate controls are operating to reduce these risks to acceptable levels (the risk appetite).

2. The GBAF format enables the Governing Body to review each of the risks, analyse the controls and assurances, clearly identify any gaps and the actions needed to address them. The graph illustrates the movement of the risk score throughout the year in relation to the risk appetite. Risk appetite is the total impact of risk the CCG is prepared to accept in pursuit of its strategic objectives and has been agreed for each risk.

3. As part of the review cycle, each of the principal risks have been reviewed and updated by the director leads. Updates made since the previous version are highlighted in bold italics.

4. There are currently a number of risks in which the CCG is operating above the agreed risk appetite. For these risks a number of mitigating actions have been identified and once implemented, the risk level should reduce to the level of risk appetite the CCG has agreed to tolerate.

NEXT STEPS:

5. The Governing Body will continue to review the GBAF at each meeting and directors will continually monitor and update their risks accordingly.

RECOMMENDATION:

The Governing Body is asked to:

a) RECEIVE the Governing Body Assurance Framework.

2 Appendix 1

Governing Body Assurance Framework (GBAF) 2018-2019

Introduction

The Governing Body Assurance Framework (GBAF) sets out how the CCG will manage the principal risks to delivering the strategic objectives. The GBAF enables the Governing Body to corporately assure itself (gain confidence, based on evidence). The framework aligns risks, key controls and assurances alongside each objective.

Where gaps are identified, or key controls and assurances are insufficient to reduce the risk of non-delivery, action needs to be taken. Planned actions will enable the Governing Body to monitor progress in addressing gaps or weaknesses and to ensure that resources are allocated appropriately.

Governing Body responsibility for the GBAF

It is for the Governing Body to:  Establish strategic objectives.  Identify the principal risks that threaten the achievement of these aims.  Identify and evaluate the design of key controls intended to manage these principal risks.  Set out the arrangements for obtaining assurance on the effectiveness of key controls across all areas of principal risk.  Evaluate the assurance across all areas of principal risk.  Identify positive assurances and areas where there are gaps in controls and / or assurances  Put in place plans to take corrective action where gaps have been identified in relation to principal risks.  Maintain dynamic risk management arrangements including a well-founded risk register.

Assurance

The GBAF provides the basis for the preparation of a fair and representative Annual Governance Statement. It is the subject of annual review by both Internal and External Audit.

CCG Commitments:

We will focus our resources to -

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

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

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

Summary of strategic risks

Initial Current Risk appetite Key changes since last review Ref Risk to delivering the CCG commitments Score Score Inadequate patient and public engagement results in ineffective decisions and No change to current score. Mitigating actions 1 20 4 4 challenge updated. Failure to assure the delivery of high quality services, leading to commissioned No change to current score. Mitigating actions 2 20 8 8 services not reflecting best practice and improving care not yet due. Failure to achieve financial stability and sustainability Current score and risk appetite reduced. 3 20 12 8 8 4

Lack of provider and clinical support for change will impact on the development and 4 16 12 8 No change to current score. implementation of the CCG strategy Resources are not targeted effectively to areas of most need, leading to failure to No change to current score. Mitigating actions 5 20 16 12 improve health in the poorest areas updated. Insufficient workforce capacity, capability and adaptability to deliver the ambitions No change to current score. Additional controls 6 (Primary Care) 16 12 9 and assurances added. Mitigating actions updated. Failure to enable partners to work together to deliver the CCG commitments No change to current score. Mitigating actions 7 9 9 4 updated. Failure of system to be adaptable and resilient in the event of a significant event Current score reduced. Mitigating actions 8 20 16 12 8 updated.

Risk 1: Inadequate patient and public engagement results in ineffective decisions Lead Director/risk owner: Sabrina Armstrong, Director of Corporate Services Relevant commitments: All Date last review: January 2019 Risk Rating Rationale for current risk score: (likelihood x consequence) All appropriate controls are in place to plan and deliver effective patient and public involvement (PPI). Initial score: However the consequence of these controls failing has the potential to result in challenge and ultimate 5 x 4 = 20 20 referral by Scrutiny board to judicial review. This would impact on the CCG’s reputation as well as delaying Current score: Current any proposed changes. 10 Score 1 x 4 = 4 0 Risk appetite: Risk Rationale for risk appetite: 1 x 4 = 4 Appetite It would not be possible to reduce the risk to a score lower than 4. This is due to the potential consequence of a control failure supplemented by circumstances outside our control. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Remit to CCG volunteer panel (PAG) to provide assurance around engagement and/or consultation plans. Volunteer panel in place. Action Owner Due by  Significant and major engagement/consultation plans taken to Scrutiny Board for Ensure communications or engagement team reps co- Strategy and Ongoing discussion and approval to proceed. opted onto appropriate commissioning steering Commissioning groups to ensure the patient voice is heard. teams  CCG has recruited further expertise to the engagement team – a full complement of staff in place. Communications  The engagement plan template includes the Equality Impact Assessment to identify and Engagement impact on protected characteristics and discrete communities. Team  Contract with Voluntary Action Leeds (VAL) to undertake asset-based engagement in harder to reach/engage communities. VAL are continuing to recruit to their volunteer Further enhance our approach to engagement and Communications Strategy in involvement activity beyond our statutory duties. Our and Engagement place by June Health Champions. focus will be on proactive, ongoing conversations with Team 2019  Monthly VAL contract meetings and VAL KPIs reviewed quarterly. communities and individuals to build a foundation of  CCG has a lead role in continuing to develop the citywide engagement hub which evidence that supports commissioning plans for includes engagement colleagues from provider teams. health outcomes  CCG works closely with Healthwatch as part of the People’s Voice network.

 Communications and engagement incorporated into Commissioning for Value (CfV)

template.  CCG community network continues to grow.  Quarterly communications and engagement reports published and shared.  Annual PPI review published in July 2018. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance Ongoing awareness raising throughout the CCG about statutory duties in relation to patient and public  Evaluation reports written and provided to commissioning teams to incorporate in their engagement. plans and influence service change.  Reports published on the CCG website and shared with members of the public who expressed an interest for further detail: ‘You said, we did’.  Regular liaison with, and attendance as appropriate at, Scrutiny Board to support commissioning colleagues.

Independent Assurance  ‘Green’ assessment rating for PPI from NHS England in 2017 (latest rating).  Internal stakeholder engagement audit October / November 2018; this has been rated High Assurance (highest rating). Audit still classed as ‘draft’ as not yet been to Audit Committee  NHS Leeds CCG invited by NHS England to present examples of good practice to Amber rated CCGs at a North of England workshop on Improvement and Assessment Framework (IAF)for engagement and community involvement Additional Comments: Link to Risk Register:

Risk 2: Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care Lead Director/risk owner: Jo Harding, Director of Quality & Safety Relevant commitments: All Date last review: January 2019 Risk Rating Rationale for current risk score: Initial score: 20 The CCG has in place quality standards, and Current measures quality outcomes via a range of methods 4 x 5 = 20 10 Current score: Score and processes to assure the quality of care we 0 commission for our patients. 2 x 4 = 8 Risk

Appetite Risk appetite: Rationale for risk appetite: 2 x 4 = 8 A risk appetite of 8 has been applied to this risk as the CCG aims to minimise the likelihood of the risk occurring but the consequence of failure remains high due to the potential impact on patients. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be  Quality Surveillance tool is being utilised across the CCG (including primary care) to monitor quality and performance of our providers enabling the CCG to identify issues and offer doing?): additional support at an early stage to ensure service improvements  Provider quality visit schedule developed for 2019-2020; awaiting sign off at QPC in January 2019 Action Owner Due by  Commissioning for Quality and Innovation (CQUIN) framework in place to incentivise providers for quality improvement and includes contract penalties where performance fails Planned review Deputy July 2019  Clear national and local quality expectations and standards agreed and included in contracts of all small Director of  Contractual requirement for providers to provide regular quality performance reports on key quality, safety and experience measures providers to Nursing and  Bi-monthly CCG Patient Insight Group (PIG) to monitor and review patient experience. Themes and trends identified and actions taken ensuring intelligence supports service determine current Quality improvements and commissioning decisions QA processes  Process developed and supporting measures in place to seek assurance on and assess quality impact of provider Cost Improvement Plans and make  Joint clinical quality review groups held with providers to receive reports on and assess standards of quality, supported by robust system and method of review and challenge recommendations for change  Annual assurance required from providers that Cost Improvement Proposals have been assessed for impact on quality and signed off by provider medical and nursing directors

 Quality Impact Assessment tool incorporated into Commissioning for Value toolkit to ascertain risk of commissioning/decommissioning decisions.

 Establishment of joint city wide health and local authority care home group to support quality improvement and introduction of supporting and joint processes as outlined in the care home

protocol.

 Safeguarding Key Performance Indicators and Safeguarding Standards Framework developed to monitor performance of provider organisations in terms of both safeguarding children and adults at risk.  A GP Safeguarding Standards Framework has been developed to monitor annually the performance of primary care in terms of both safeguarding children and adults at risk.  Oversight of Serious Incidents via STEIS and DATIX. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances Internal Assurance should we seek):  Joint Clinical Quality Review Groups review key quality requirements, expectations and performance requesting remedial action plans where required using a systematic and robust methodology of review and challenge  Primary Care Quality Surveillance group monitors key quality performance information and standards of quality of primary care provision, monitoring remedial action plans where required  The revised draft QEIA tool has been developed for the WY&H HCP and which will be recommended for adoption within Leeds CCG. The tool and supporting guidance and policy are due to be presented to the Joint Committee in January for approval.  Director of Quality and Safety attends West Yorkshire Quality Surveillance Group (QSG) where oversight of quality across West Yorkshire is discussed  Contract Management Board receives quality update briefing from Providers identifying any key areas of concern/under performance and associated remedial actions.  Integrated Quality and Performance Report, including all pathways and primary care, is reported to the CCG Quality and Performance Committee with highlights and exceptions then reported to the Governing Body  Reporting of all providers under enhanced surveillance to the Quality and Performance Committee  Robust governance structure in place within the CCG provides assurance on the quality of services to Governing Body  Safeguarding Team review and monitor the GP Safeguarding Standards Framework on an annual basis, providing advice and support where practices are non-compliant.  Safeguarding Team attend Clinical Quality Review Groups to review and gain assurance in respect of Quarterly Key Performance Indicators and the Annual Safeguarding Standards Framework which includes Section 11 assurance regarding provider safeguarding children responsibilities.  Safeguarding Team is cited on all safeguarding DATIX reports and Serious Incidents.  Development of the safeguarding annual declaration for care homes Independent Assurance  CQC inspection programme – reports and action plans are monitored via provider quality meetings  Internal audit of Individual Funding Requests provided High assurance. Additional Comments: Link to Risk Register: Planned internal audits in 2018/19: Amber  Safeguarding 550 – QIPP (9)  Patient Experience 334 – Amber drug monitoring via Neptune (8)  Continuing Healthcare 27 – Management of HCAIs (9 )  Personal Health Budgets Red  Performance Management 28 – Learning from medication related incidents (12)

Risk 3: Failure to achieve financial stability and sustainability Lead Director/risk owner: Visseh Pejhan-Sykes, Chief Finance Officer

Relevant commitments: We will focus our resources to - Date last review: January 2019 . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city Risk Rating Rationale for current risk score: (likelihood x consequence) . Failure to achieve financial stability could lead to a breach in our statutory duties and have an adverse effect on our local Initial score: population. NHSE is increasingly concerned about rapidly deteriorating finances in CCGs where previously healthy year end 4 x 5 = 20 projections have spiralled into deficit positions in-year, often due to a lack of scrutiny and understanding of the CCG’s underlying 20 Current Current score: recurrent financial position under its Governance processes. 10 Score . Whilst the CCG has a number of key financial controls and financial contingencies in place to monitor and deliver financial 2 x 4 = 8 0 performance in 2018/19, it’s longer term financial stability is predicated either on the delivery of a significant QIPP programme, or Risk Previous 3x4=12 a significant increase in allocations to around 5%+ per annum. Risk appetite: Appetite . Projections of the CCGs financial plans into the next 5 years suggest that from late 2018/19 and thereafter, the CCG is facing 1 x 4 = 4 significant financial pressures with cost reduction schemes still to be identified, evaluated and negotiated across the system Previous 2x4=8 Rationale for risk appetite: . Commissioners are facing significant and increasing risks from changes to NHS policy such as Transforming Care Partnerships, as well as demographic challenges at a time where annual investment in the NHS is at its lowest. Our local acute provider has significantly ageing estates stock requiring at least £350m of investments to modernise and ensure that care can be provided in the most effective configuration conducive to patient care. There are simply not enough resources available in Leeds to meet all current needs and demands. . The rationale behind the reduced risk (post assessment of risk appetite) is that Leeds does have the option to consult on rationing the provision of healthcare – a measure that is already being implemented in other areas and Leeds is also making progress on risk alignment across the heath system to change clinical decisions that can improve system efficiency and reduce system costs. Controls (what are we currently doing about the risk) Mitigating actions (what more should we be doing?):  Balanced Financial Plan for 2018/19 reviewed and accepted by NHSE and the Governing Body noting Action Owner Due by contingencies and mitigation for 2018/19 financial balance 5 year planning horizon process for the CCG to Governing March 2019  More in depth and rigorous monthly financial reporting to budget holders, NHS England, the Governing Body include potential and detailed spend reduction Body and executives plans to be identified, evaluated, consulted on and  Monthly contract information now extended to include primary care users of data implemented  Budgetary and governance control systems for identifying and controlling financial risks  Detailed financial policies and budgetary control framework outlines responsibilities and ground rules  Commissioning for Value Delivery Board to oversee delivery of QIPP  Aligned Incentive Contract with main Acute Provider  Regular CFO meetings across Leeds, West Yorkshire and Y&H  Detailed scheme of delegation Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek) : Internal Assurance  Health and social care economy in Leeds is financially challenged and the magnitude of values involved in one of the largest  Monthly finance report to SMT, Audit Committee and Governing Body identifying any current financial “places” in the UK means that the challenge is of significant financial value (and potentially unmanageable) nationally and locally if risks the system spirals into deficit.  Prescribing finance position included in monthly finance updates  Within the context of the West Yorkshire and Harrogate Integrated Care System (ICS), Leeds is also one of only 2 places that  Escalation of exception reports from Commissioning for Value Delivery Board to Governing Body remains in financial balance and is therefore shouldering the added burden of “propping up” other places by not drawing down on  Procurement Programme monitoring and delivery reporting historical surpluses to ease in year financial pressures – albeit non-recurrently.  Monthly budget reports are issued and discussed at budget holder meetings  A shared control total for West Yorkshire and Harrogate does however offer potential (if delivered in its totality) to attract significant  Budgetary control framework in place transformational resources into the ICS footprint which will benefit all parties to the ICS. Much of this is outside of Leeds’ control to  Scheme of financial delegation and detailed financial policies deliver with the added potential burden of having to hold peers to account to ensure securing these funds in addition to “keeping  Lead commissioner monthly forecasts our own house in order”.  Financial impacts of primary care commissioning appear to be less significant at current stage of planning  The wider Leeds Health and Social Care system is also closely interlinked with the provider landscape potentially suboptimal in its Independent Assurance current configuration to deliver the most cost effective and seamless care for service users in Leeds.  Internal and external audit reports provide high assurance (2017/18)  NHSE assurance meetings  Planned internal audits of financial systems and QIPP in Q3 2018/19 in progress Additional Comments: Risk register: The CCG has to reduce commissioning spend – some relates to areas of limited clinical value, others around more effective commissioning. 609 – Primary Care Payments (4 – green) 649 - Suppliers/providers paid in advance (4 – Some decommissioning of services will need to be considered and this will be overseen by the Commissioning for Value delivery board. 550 – Achievement of QIPP (9 – amber) green) However, ownership of these decisions must clearly and visibly sit with the Governing Body. 643 – Continuing Healthcare Financial Pressure 193 – NHS England ability to manage LTHT The risks associated with financial stability have been reduced based on an improved forecast position for 2018/19 for the CCG for Leeds as a and risks (6 – amber) contract (6 – amber) Place which is forecasting achievement of its collective financial plans for 2018/19. However,longer term risks still remain across Leeds 311 – Learning Disabilities budget overtrade (6 681 – Impact of IFRS16 ( 9 – amber) and the NHS as we await information around future allocations and revenue requirements for the CCG over the next 10 years in support of – amber) 682 – Impact of National Pay Award in 2019-20 the newly published NHS Plan– including the cost impact of Agenda for Change settlements for the NHS. The risk forecast reflects 548 - Statutory Financial Duties (4 – green) and onwards ( 6 – amber) therefore the current financial year only and will be revised again at the start of the next financial year – hopefully with a longer term 551 - Fraud and Corruption(6 – amber) 640 – Transforming Care Partnership ( 8 – horizon to support a longer term financial outlook for the CCG. 647 - IR35 Non Compliance (6 – amber) amber) 648 - Risk of non-compliance with VAT rules (6 661 – Citywide Overspend against prescribing – amber) budget (9 – amber)

Risk 4: Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy Lead Director/risk owner: Tim Ryley, Director of Strategy, Planning & Performance Relevant commitments: Date last review: January 2019 We will focus resources to - . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city We will work with our partners and the people of Leeds to - . Achieve better integrated care for the population of Leeds Create the conditions for health and care needs to be addressed around local neighbourhoods. Risk Rating Rationale for current risk score: (likelihood x consequence) Likelihood - through the providers’ Committees in Common approach (Leeds Providers’ Integrated Care Collaborative - LPICC), Initial score: Provider Partnership Board and supporting clinical strategy groups, there are strong arrangements in place to ensure strategic support 4 x 4 = 16 20 and alignment between commissioning priorities and provider development. Whilst there is a positive reception among providers the Current score: Current greater engagement of clinicians and working through of the necessary detail still needs to take place. 10 3 x 4 = 12 Score 0 Risk appetite: Risk Consequence - the failure to gain support of all major providers will significantly limit a number of key objectives of the strategy in 2 x 4 = 8 Appetite particular greater integration.

Rationale for risk appetite: Provider support for the changes articulated in the CCG strategy is key to delivery. It is unlikely given the range of providers and number of clinicians involved that all opportunities for changes of direction or levels of engagement by one or more can be ruled out entirely and sustained vigilance and supportive action will be ongoing. Though as we work through detail and develop governance risk should further reduce.

However, the move in Leeds from an individual organisational focus to system focus means that the development and implementation of the CCG strategy is equally dependent on the alignment of the CCG’s commissioning approach with the Local Authority. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Leaders of main provider organisations are engaged in the development of the CCG Strategic Plan. Regular discussions within the Partnership Executive Group between leaders of commissioning and provider organisations to ensure Action Owner Due by transparency and system alignment regarding strategic direction of travel as a system. Need to develop further aligned incentive contracts Visseh Pejhan- April 2019  System Integration Team supporting LPICC and facilitating the Provider Partnership Board - a key objective of this across provider landscape Sykes group is to ensure provider alignment with commissioning priorities and act as a strategic partner to the Leeds CCG.  Intra-provider governance arrangements are being developed through the Committees in Common (LPICC) – this will Further strategic utilisation of resources to create Tim Ryley December expedite decision making to respond to the CCG strategy more responsively. environment in which providers are actively encouraged 2019  System Integration Team leading key areas of strategy implementation, support for the GP Confederation and to work together and innovate Commissioning of Outcomes for frailty – already supported by providers in the city and associated actions being implemented.  Co-production of Aligned Incentive Contract with LTHT reflects provider support to new approaches to contracting as part of wider commissioning strategy.  We have supported the establishment of a formal provider Committee-in-Common (LPICC) involving LTHT, LYPFT, LCH and the GP Confederation. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek) : Internal Assurance  Providers collectively choose to prioritise and focus on work that supports delivery of CCG Strategic Plan e.g. working  Internal measures and milestones to measure the assurances described. collectively to deliver system outcomes  Increasing levels of trust between leaders of commissioning and provider organisations in Leeds. Commissioning and Provider leaders proactively engage with each other to inform decision making that will have a system impact.  Clinical and financial risks are shared and managed differently between the CCG and providers and also between providers  The Provider CIC (LPICC) work-plan aligning with the CCG Strategic Plan and Delivery Framework priorities.

Independent Assurance  CQC system review feedback due in December 2019

Risk 5: Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas Lead Director/risk owner: Tim Ryley, Director of Strategy, Planning & Performance RelevantAdditional commitments: Comments: Risk register: Date last review: January 2019 WeVery will good focus progress resources on reducing to - the risk with considerable controls in place. Still require a period of time to ensure new 655 – Member Engagement (9 amber) arrangements. Deliver arebetter being outcomes fully embedded for people’s and health that system and well relationships-being strengthen further before risk within risk appetite. 331 – Providers not engaging with the CCG (6 – amber) . Reduce health inequalities across our city

Risk Rating Rationale for current risk score: (likelihood x consequence) Commissioned services and programmes may not be designed in a way which meets the needs of groups who have Initial score: poorer access to services, particularly preventive, proactive and primary care services. This could result in an increase 5 x 4 = 20 20 in health inequalities with some patients receiving sub-optimal care and potentially poor patient experience outcomes. Current score: Current 10 Score 4 x 4 = 16 0 Most recent Public Health Annual Report has identified increased inequalities across the city, with more people living Risk appetite: Risk in the 10% most deprived wards. 3 x 4 = 12 Appetite Rationale for risk appetite: This strategic aim is a significant challenge, particularly given reductions in funding across the public sector. As such, we need to work with partners to endeavour to make the difference, recognising that focusing CCG resources in the right areas, whilst challenging in itself, will only go so far.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):

 CCG Strategic plan is grounded in the Health and Wellbeing Strategy and reflects the city Joint Action Owner Due by Strategic Needs Assessment (JSNA) & local health needs with a clear focus on reducing health inequalities. Map all existing work to address health of the poorest the Nichola Stephens March 2019  CCG detailed policy position on reducing health inequalities under development by April fastest and understand the impact 2019. All commissioning plans will be expected to demonstrate how they align to this Build in monitoring impact of actions taken into the IQPR John Tatton December 2018 document. March 2019  Memorandum of Understanding in place between Leeds CCGs and Leeds City Council to Redesign approach to health inequalities impact assessment Becky Barwick March 2019 deliver Public Health Healthcare Advisory Service (PHHCAS) with action plan.  CCG is an active member of the Health and Wellbeing Board and other partnership Develop process for differential investments across the city to Tim Ryley December 2018 arrangements, e.g. Partnership Executive Group, Leeds Health and Care Plan. more effectively meet needs Becky Barwick March 2019  Commissioning for value programme now established to understand how commissioning investments impact on finance, quality and health outcomes.  Primary Care Quality Improvement Schemes – funded on a weighted capitation (but no requirement for all practices to participate).  Joint data analysis team in place across Local Authority and CCG.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek) : Internal Assurance  PHHCAS MOU and annual plan documents and delivery against action plan is monitored at  Mechanisms to monitor the impact of commissioning decisions on the health of the poorest need to be meetings developed. These then need to be included in the IQPR.  Regular public health reports to CCG reported every 6 months to CCC  2016 LWCCG PH Profile shows CCG priorities reflect population health needs

Independent Assurance: Internal audits of Business Case Procedures and Performance Management are planned in 2018/19; these will provide a level of independent assurance.

Additional Comments: Risk register: The CCG is at the early stages of actively implementing this strategic commitment and managing this 305 – Compliance with the Equality Act 2010 Public Sector Equality Duty (6 – amber) risk.

There is much work to do to build a full understanding of the impact of current work and how we will monitor and measure success.

Risk 6: Insufficient primary care workforce capacity, capability and adaptability to deliver the ambitions Lead Director/risk owner: Dr Simon Stockill, Medical Director Relevant commitments: Date last review: January 2019 We will work with our partners and the people of Leeds to - . Achieve better integrated care for the population of Leeds . Create the conditions for health and care needs to be addressed around local neighbourhoods. Risk Rating Rationale for current risk score: (likelihood x consequence) 20 Current Despite the actions taken, the availability of a current and future workforce supply within primary care remains a national issue. Initial score: 10 Score 4 x 4 = 16 0 Rationale for risk appetite: Current score: Risk Ensuring there is sufficient workforce capacity and capability across primary care and Local Care Partnerships is a complex issue 3 x 4 = 12 Appetite that will require continuous strategic and operational focus. Risk appetite: The opportunity to work with primary care ‘at scale’ should realise new benefits that are not currently available which should 3 x 3 = 9 mitigate the overall risk profile. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):

Primary Care Workforce:  A review of the workforce requirements to deliver The Leeds Health and Care Plan has been undertaken. The recommendations have been agreed Action Owner Due by by the Partnership Executive Group (PEG). This includes the establishment of the Leeds Health and Care Academy. Consider the challenge and Simon 2019/20  Investment linked to workforce planning and workforce development into general practice has been made through the Quality Improvement opportunity set out in the Stockill Scheme (QIS); national initiatives e.g. Time to Care; GP Access Fund; and transformation monies. NHS Long Term Plan and  The CCG actively participates in the West Yorkshire and Harrogate ICS Primary and Community Care Workforce Group 19/20 planning guidance,  Implementation and reporting against GP Forward View (GPFV) workforce trajectories. including aligning potential  CEO of GP Confederation now chairs Primary Care Workforce Group, recognising the lead role of the Confederation in responding to the additional investment workforce agenda.  The role of the Leeds GP Confederation in relation to workforce planning and workforce development is reflected in the CCG/Confederation Partnership Agreement  The CCG is leading a programme of international GP recruitment on behalf of the ICS.  New roles developing within general practice e.g. care navigation; Rotational Paramedic; role of occupational therapists in primary care pilot; shared roles across a number of practices.  Extended access delivery includes wider workforce and ways of delivering e.g. virtual appointments; pharmacists and physiotherapists  General Practice Nurse Strategy developed and launched by Stephanie Lawrence.  Additional data collection directly from practices to give a robust baseline due for completion 10 Jan 2019. Local Care Partnerships (LCPs):  Locality leadership teams are in place across 18 agreed LCP footprints, supported by the investment to release the leaders from clinical practice.  Investment has been made into general practice via the QIS focussed on collaborative working in localities.  The primary care development team has restructured and aligned to 18 LCP footprints and are actively supporting locality leaders.  The Leeds GP Confederation role in supporting the development of LCPs is described in the CCG/Confederation Partnership Agreement  RAIDR dashboards are being developed at a locality level as well as at individual practice level.  Locality health profiles have been produced for each of the 18 LCP footprints to enable a service response based on local need.  Public health is developing locality ‘asset’ profiles for each LCP.  Leaders from adult social care; Leeds Community Healthcare; third sector; and community pharmacy are being identified for the 18 LCPs alongside the general practice leaders.  Leeds has been awarded £844k discretionary transformational funding via the West Yorkshire and Harrogate Integrated Care System for the purpose of accelerating progress in establishing primary care networks (LCPs in Leeds). This allocation will enable an increase in capacity to deliver.  Thea Stein identified as system wide lead Chief Executive Officer and Senior Responsible Officer for the LCP programme.  Head of LCP development appointed and further recruitment of roles to support LCP development funded from £844k approved  Development of LCPs included on the work plan for the Leeds Provider Integrated Care Collaborative.  Tim Ryley to develop the commissioning framework for LCPs on behalf of the Integrated Commissioning Executive.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we Internal Assurance seek): Primary Care workforce: Local Care Partnerships:  Need to understand the new role for the Advanced Training  Monitoring of the completion of workforce tool  Evidence of wider partners coming together in LCP meetings across the city. Practice in Leeds as the Primary Care Workforce Training Hub.  Reporting against GPFV trajectories to NHS England  General Practice locality leaders describing their involvement with wider partners in  Need increased return rate for the workforce planning tool from  Primary Care Workforce Steering Group meets bi- LCPs at the Leeds GP Confederation Strategic Board. practices. monthly chaired by CEO of GP Confederation with  Strategic support for the LCP vision evident from PEG.  Need to understand the OD capacity required to deliver the membership from all stakeholders  System wide stakeholder group meets bi-monthly to track progress necessary leadership training and to facilitate integrated ways  LCP development programme reported via LPICC of working across organisations in each LCP.  Independent assurance – consider requesting a review by internal audit

Additional Comments Risk register: Ensuring we have the workforce to deliver a sustainable primary care today and a workforce to deliver a transformed primary care for tomorrow is hugely 651 – General Practice Workforce (15 - amber) complex. 672 – Delivery of online consultations (4 – green) The establishment of the Leeds GP Confederation brings new opportunity to engage with primary care ‘at scale’ and develop workforce initiatives for 675 – Development of at scale organisation (6 – amber) general practice across the city e.g. a local ‘bank’ for locum GPs; employment contracts that allow working across a locality; development and support 670 – Changes to general practice add rating programmes for newly qualified GPs. This is yet to be realised. 652 – Delivery of Extended GP Access Service add rating Developing Local Care Partnerships as the way of delivering integrated local services as described in the Leeds Health and Care Plan is a massive transformational programme for the whole system.

Risk 7: Failure to enable partners to work together to deliver the CCG commitments Lead Director/risk owner: Phil Corrigan, Chief Executive Relevant commitments: All Date last review: January 2019

Risk Rating Rationale for current risk score: (likelihood x consequence) Changing Governance arrangements across the health and social care economy both within Leeds and West 3 x 3 = 9 Yorkshire may lead to failure to coordinate actions around shared priorities which could lead to omission or Current score: 20 duplication of actions. There are risks around competing priorities between need for placed based services and 3 x 3 = 9 10 Current support to local providers, and the requirement to work at Integrated Care System (ICS)/ West Yorkshire Score Risk appetite: 0 Sustainability and Transformation Partnership (STP) level. 2 x 2 = 4 Risk Appetite Rationale for risk appetite: To minimise this risk we need clear partnership arrangements to ensure all our joint plans are delivered.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):

 Integrated Commissioning Executive (ICE) meetings and Partnership Executive Group meet Action Owner Due by on a monthly basis. Local: A review of health and social care integration is Phil Corrigan March 2019  A new provider Committee in Common meets quarterly with representation from the Local being undertaken by ICE and a Commissioning rd Authority and 3 sector. Memorandum of Understanding (MOU) for West Yorkshire signed Framework developed by November 2018. and in place. Aligned incentives contracting approach to be extended  Aligned incentives contract in place with Leeds Teaching Hospitals NHS Trust (LTHT) which across providers and so strengthen alignment. facilitates alignment of priorities.  Representatives from the GP Confederation attend the Leeds Health and Care Partnership Executive Board. Representation from the Local Authority invited to the planning meeting in the CCG.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek) : Internal Assurance  Provider Committee in Common will be reported to the Governing Body, via the CEO Report. West Yorkshire minutes and issues are included in the CEO report to the Governing Body, Integrated Commissioning Executive (ICE) and Leeds Health and Care Partnership Executive Board. Issues are reported via the CEO to the Governing Body. The Health and Well Being Board reviews our collective progress every quarter.

Independent Assurance An internal audit of Partnership Governance Arrangements is planned in 2018/19

Additional Comments: Risk register: N/A N/A

Risk 8: Failure of system to be adaptable and resilient in the event of a significant event Lead Director/risk owner: Sue Robins, Director of Operational Delivery Relevant commitments: All Date last review: January 2019

Risk Rating Rationale for current risk score: (likelihood x consequence) 20 The current capacity and system flow issues within Leeds are year round with particular slow down in patient flow 5 x 4 = 20 seen during winter. A significant event can be a ‘rising tide’ or a one off event / epidemic, so the resilience 10 Current Current score: Score mitigations and plans are wide ranging. Most resilience planning is done with other organisations especially 3 x 4 = 12 0 Leeds City Council. Previous 4x4=16 Risk Risk appetite: Appetite Rationale for risk appetite: 2 x 4 = 8 No system can plan for every eventuality, so residual risk will remain.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):

 System Resilience Assurance Board (SRAB) supported by Operational Resilience Group Action Owner Due by  Engagement at West Yorkshire level with local resilience forum and West Yorkshire urgent Review of Leeds CCG Business Continuity Plan Debra Taylor- Sept 2018 care meetings Testing of the plan can only be undertaken following its Tate Oct 2018  Leeds Plan has Urgent Care Rapid Response Programme approval. Nov 2018  Surge and escalation plans in place and tested through exercises, plus training Complete  Business continuity plans in place for providers as part of NHS contract, including General practices. Implement the Leeds resilience plan actions ( Newton SRAB March 2019  On call systems in all providers plus the CCG, linking to NHS England (NHSE) and region Europe recommendations) at times of pressure  Weekly situation report (sitrep) meetings across Leeds system planned from Nov 2018 Leeds Urgent Care strategy implementation - delivery of Debra Taylor- Review - March  Operational delivery meetings x3 week from Nov 2018 urgent treatment centres Tate 2019  Leeds resilience plan in place - to support system flow. Review of escalation and mutual aid arrangements Debra Taylor Nov 2018  Winter plans in place, includes primary care and public health / comms actions Tate Complete  Leeds urgent care strategy - in consultation and implementation during 2018/20 Self-assessment against national EPRR standards Debra Taylor Sept 2018 Undertaken alongside the Business Continuity Plan. Tate Nov 2018 Complete Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek) : Internal Assurance  SRAB receives reports from across Leeds system - SRAB dashboard.  Workforce review for urgent care system sustainability, not yet assuring re: workforce capacity - system  Leeds resilience plan has agreed x12 metrics to demonstrate impact from transformation wide - being looked at by Workforce group at local and West Yorkshire level activity.  Self-care/ management and access to out of hours (OOH) services for urgent presentation - being  Daily system and performance reports including A&E attendance - breaches, hospital addressed through Urgent care strategy. Delayed Transfers of Care (DTOCs) etc. - all measures of system pressures and system flow.  Urgent care dashboard shows activity and pressures in contracted services e.g. GP out of hours or Yorkshire Ambulance Service (YAS).  CCG IQPR details system performance against a range of measures - presented to Quality & Performance Committee and Governing Body.  Annual self-assessment against national emergency care standards - goes to Governing Body.  Outputs from real or tested scenarios and learning - reports and action plans produced, e.g. LTHT Pathology incident - winter reviews, measles outbreaks etc. Independent Assurance  NHSE complete an annual CCG assurance assessment through quarterly reviews.  Internal Audit Risk Deep Dive review 2017/18 provided Significant Assurance.  CQC System Review Additional Comments: Risk register: N/A 541 – System resilience – maintaining flow during demand and capacity pressures (12 – amber) 650 – CCG Business Continuity and EPRR Plan (6 – amber)

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Agenda Item: GB 18/116 FOI Exempt: N

NHS Leeds CCG Governing Body

Date of meeting: 30 January 2019

Title: Chair’s Summary – Primary Care Commissioning Committee Lead Governing Body Member: Sam Tick as Senior, Lay Member and Chair – Primary Category of paper appropriate Care Commissioning Committee () Report Author: Karen Lambe, Corporate Decision Governance Officer Discussion Information  Approved by Lead Governing Body Member (Y/N) Y

EXECUTIVE SUMMARY: This report provides the NHS Leeds CCG Governing Body with a summary of items discussed and outcomes and risks identified at the Primary Care Commissioning Committee meeting held on 29 November 2018.

RECOMMENDATION:

The Governing Body is asked to:

(a) RECEIVE the report.

Description of key items of business discussed and key outcomes 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Primary Care Commissioning Committee (PCCC) meeting held on 29 November 2018. Further information can be obtained by reference to the minutes of that meeting.

Chief Executive’s Update

2. The Committee was updated on the Care Quality Commission (CQC) Review of the Leeds Health and Care system which was due to be published on 17 December 2018. The report highlighted that care home admissions were double those of similar cities in England. A scoping exercise was being undertaken to identify what actions needed to be taken.

General Practice Forward View (GPFV) Delivery Plan Update

3. Members were informed that Leeds was achieving 100% extended access to evening and weekend appointments via the GP Confederation. During October 2018, over 8500 appointments had been available through the service with an average utilisation of 79%.

However, concern was expressed that over 500 DNAs had been recorded for the same period.

4. The issue of 111 direct booking capability had not yet been resolved. This would be discussed with the GP Confederation and reported back to the PCCC on 31 January 2019.

Chair’s Summaries from the Primary Care Operational Group (PCOG) meetings in October 2018 and November 2018

5. The Committee was informed of an increase in the number of requests for adhoc closures by practices to facilitate development time which was partly due to mergers and training opportunities. It was agreed that in order to avoid negative impact on service levels, the CCG would not support requests for closures between 1 December 2018 and 1 April 2019. Requests would only be considered if the designated ten TARGET afternoon sessions had been used and there were exceptional circumstances.

Practice Merger Proposals

6. The Committee received a request for a proposed merger between Yeadon Tarn Medical Practice and Rawdon Surgery. Members were informed that the proposal had been recommended by PCOG. It was noted that the practices had conducted a thorough engagement and produced an extensive report of their findings. Both practices had achieved ‘Good’ ratings by CQC and had received positive responses from their Patient Participation Groups (PPGs). Although one practice held a PMS contract while the other held a GMS contract, it was noted that the latter would be varied to incorporate the PMS contract. Members were assured that this would entail minimal disruption with no impact on patients. The Committee approved the recommendation to merge the two surgeries.

Procurement Update

7. Following an Urgent Action on 26 October 2018, members ratified the award of two practices to the preferred providers. The managed allocation of New Cross Surgery to Moorfield House Surgery was proposed, as was the managed allocation of Middleton Park Surgery to Bramley Village Health and Wellbeing Centre. Assurance was given that patients were satisfied with the outcome.

Update on the Quality Improvement Scheme

8. With regards to the Quality Improvement Scheme (QIS), members were informed that changes in national GP contracts were likely to result in a significant number of targets being retired from the model and changed to national programmes. The Committee discussed whether there was an opportunity for the scheme to develop from traditional health metrics to the social determinants of health and the benefits this could bring to the NHS as a whole. It was felt that QIS would have sufficient flexibility to enable GPs to set differentiated targets to assist localities in reducing health inequalities.

Primary Care Integrated Quality Performance Report

9. Members were informed that NHS England (NHSE) had recently commissioned a new tool which incorporated demand, capacity planning and differentiated appointment types to facilitate practices’ workforce planning. It was anticipated that the new tool would be phased in over the next 12 months to replace the existing one.

Primary Care Risk Report

10. Following a discussion concerning workforce shortages, the Committee agreed to revert risk rating 651 back to a major risk. It was agreed that more assurance was needed in order to consider reducing the rating.

Primary Care Finance Update

11. The Chief Finance Officer presented the month seven position. With regards to the recently approved 1% uplift to practices, members were informed that Leeds had been the only CCG in West Yorkshire to award this. In line with advice received from NHSE, the payment was made on a non-conditional basis.

12. The Committee was provided with an update of current Estates and Technology Transformation Fund (ETTF) schemes and approved practice rent increases, one of which was subject to the practice reducing its A&E and urgent care activity.

Strategies/Policies approved N/A Items of positive assurance or issues to be raised with the NHS Leeds Governing Body N/A Any additional comments N/A

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Agenda Item: GB 18/117 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 30 January 2019 Title: Chair’s Summary of Quality & Performance Committee Meeting held on 16 January 2019 Lead Board Member: Dr Steve Ledger, Lay Tick as Member, Assurance and Chair – Quality & Category of Paper appropriate Performance Committee () Report Author: Sam Ramsey, Corporate Decision Governance Manager Discussion  Information Approved by Lead Board member (Y/N): Y

EXECUTIVE SUMMARY: 1. This report provides the NHS Leeds CCG Governing Body with a summary of items discussed, outcomes and risks identified at the Quality & Performance Committee meeting held on 16 January 2019.

RECOMMENDATION: The Governing Body is asked to:

(a) RECEIVE the report.

Description of key items of business discussed 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Quality & Performance Committee on 16 January 2019. Further information can be obtained by reference to the minutes of that meeting.

Actions from Previous Meetings 2. The Committee received an update in relation to Continuing Healthcare Reviews and the current backlog. Members agreed that the report provided full detail on the actions that had been taken and provided clear analysis of the data. Although the Committee could not be fully assured that the backlog would be addressed, they were reasonably assured that there was an understanding of the problem and a clear way of dealing with it.

3. The Committee agreed that the outstanding number of reviews would be documented through the IQPR and a further discussion would take place to agree the metrics. This would then be reported back to the Committee through the IQPR.

Update on IAPT 4. The Committee received an update on the IAPT procurement and the waiting list for Step 3 Cognitive Behavioural Therapy.

5. There was concern raised in relation to the waiting time from referral to treatment (the wait can be up to 40 weeks); however the Committee was assured that improvements were being made with the existing provider to increase productivity. Long wait patients are offered on-line support options in the meantime. Recruitment of additional CBT therapists should reduce waiting list numbers. The work is ongoing until the newly procured service is in place.

6. The Committee agreed reasonable assurance in relation to the procurement and that this would be designed to address the current need. They also agreed reasonable assurance in relation to the current performance as an action plan was in place to rectify the issues.

7. There was an agreement that the Step 3 Waiting List would be reported on through the IQPR with narrative alongside the figures to highlight the actions being undertaken.

Integrated Quality & Performance Report (IQPR)

8. The Committee noted that following an action from the previous meeting, the overall level of assurance had been considered and exceptions had been highlighted where they required further information to demonstrate reasonable assurance.

9. The IQPR highlighted the number of people on GP Learning Disability Registers who have received an annual Health Check during the year as well below target. The Committee noted that following a Learning Disabilities Mortality (LeDer) review, the lack of Health Checks had been picked up as a contributing factor. Work was ongoing to support and promote this issue within General Practice, and it was anticipated that this would have an impact on the number of Health Checks completed.

10. The Committee ascribed reasonable assurance to this issue and noted that it would continue to be monitored through the IQPR.

11. The Committee noted that although positive work was ongoing with the Local Authority and Social Care, there were concerns around the use of community beds. Work was ongoing with LTHT to identify additional cohorts of patients who could be appropriate for admission to the Community Care Beds. The utilisation of community beds by GPs was discussed and in particular whether GPs were fully aware of how they can admit appropriate patients into these beds.

12. It was agreed that a further discussion would take place in the appropriate teams would address this, given that the beds are currently underutilised.

13. The Committee received a draft report outlining the health and wellbeing strategy key indicators and reporting progress against these. Members noted that there were two measures that had no national or local data available. Further work was required and this would be developed, including the mapping of CCG commissioning plans to high level indicators. The Committee was supportive of the developing report and a further iteration would return to the Committee in six months’ time.

Providers Under Enhanced Surveillance

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

CCG Risk Register

15. The risk register was presented. The Committee noted that the full risk register provides controls and assurances.

16. The Committee recognised that there had been a formal risk review and a Governing Body workshop focused on risk had been held in December 2018. This had resulted in a change to the risk register and performance related targets had now been removed.

17. The Committee was informed that there was 1 new red risk within its remit, resulting from a review and re-articulation of an existing risk. This risk was in relation to ‘Learning from Medication Related Incidents’. Members of the Committee agreed that this risk should be discussed further between the Clinical Governance team and the Medicines Optimisation team in relation to the scoring.

18. Post-meeting note: Risk 28: Learning from Medication Related Incidents had been reviewed since the Quality & Performance meeting took place and the score had been reduced:  The likelihood of Risk 28 has been reduced from ‘likely’ to ‘possible’ and is now scored at High Amber 12 and as a result has been removed from the Corporate Risk register, this risk will continue to be reported to the Committee until it is reduced below 12.

19. In relation to risk 541, System Resilience, the Committee was assured that the Leeds Resilience Plan continues to drive system flow and highlighted that communications for this year had been improved. Members were assured that staff within the hospitals were informed and prepared for a surge if required.

20. The Committee considered a risk in relation to Brexit and agreed that this would be discussed further with the Risk Manager.

21. The Committee noted that Risk 686, Transition of Commissioning Support Services had been aligned to the Governing Body, however due to the potential impact on quality and performance the risk had been presented to the Committee for information. Consideration was given as to how this might present itself to the Committee and it was acknowledged that there was a separate risk log aligned to the project.

22. It was agreed that the successful transition of services is of relevance to the Committee and a further update would be brought back to the March 2019 Committee meeting.

23. Post-meeting note: Risk 686: Transition of Commissioning Support Services  Following positive progress in the transition plan, Risk 686 had now been scored at

Amber 8. The risk would continue to be managed by the Transition Programme Board.

Quality Visit Proposed Schedule

24. The Quality Visit Schedule was proposed to the Committee as a means to support its quality assurance processes. The Committee noted that the schedule was illustrative rather than fixed and would be updated as required.

25. Members acknowledged that this was not a new process, but was a more structured approach, and Governing Body members would be invited to participate and provide their perspective on the visits. The Committee approved the proposed schedule.

Review of Clinical Quality Review Groups

26. The Committee approved the proposal to change the frequency of Clinical Quality Review Groups from bi-monthly to quarterly for each provider. Members were informed that this was a mutually agreed decision between the CCG and providers.

Workforce Race Equality Standard Action Plan

27. The Workforce Race Equality Standard (WRES) Action Plan was presented to the Committee for approval. Subject to minor amendments, the plan was approved and would be published on the NHS Leeds CCG website.

Information Governance Update

28. The Committee received an Information Governance update and agreed the recommended level of assurance as reasonable. Members noted that there was further work to be done on data flow mapping and to continue ongoing work to meet the 95% compliance level for Information Governance training.

Non-Medical Prescribing Policy

29. The amended Non-Medical Prescribing Policy was received for approval following comments raised at the previous Quality & Performance Committee meeting. The issues relating to GP mentoring and the funding aspects of non-medical prescribers had been addressed. The Committee approved the amended policy.

Strategies/Policies approved

 Non-Medical Prescribing Policy  NHSE: Items which should not be routinely prescribed in primary care

Items of positive assurance or issues to be raised with the NHS Leeds CCG Governing Body

Agenda Item: GB 18/118 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 30th January 2019

Title: Report of the Director of Strategy, Planning and Performance

Lead Governing Body Member: Tim Ryley, Tick as Category of Paper appropriate Director of Strategy, Planning and Performance () Report Author: Tim Ryley, Director of Strategy, Decision Planning and Performance Reviewed by EMT/Date: NA Discussion

Reviewed by Committee/Date: NA  Information

Checked by Finance (Y/N/N/A - Date): NA Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing  2. Reduce health inequalities across our city  We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health  4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds  6. Create the conditions for health and care needs to be addressed around local  neighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve  health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments  8. Failure of system to be adaptable and resilient in the event of a significant event

EXECUTIVE SUMMARY:

This paper provides an update to the CCG Governing Body on the following:

- The Annual Operational Planning Round - The NHS 10 year plan and CCG commissioning plans and intentions - Progress on the CCG Delivery Framework and Commissioning for Value

Members are asked to comment on the work underway and progress reported.

NEXT STEPS:

A further update will be provided to the March Governing Body meeting.

RECOMMENDATION:

The Governing Body is asked to:

(a) Note the report and comment on the work underway and progress reported

Report of the Director of Strategy, Performance and Planning

1. SUMMARY

This paper provides an update to the CCG Governing Body on the following:

- The Annual Operational Planning Round - The NHS 10 year plan and work on CCG commissioning plans and intentions - Progress on the CCG Delivery Framework and Commissioning for Value

Governing Body Members are asked to note the report and comment on the work underway and progress described.

2. Background

In July 2018 the CCG approved a Strategic Plan which would form the basis of its approach to commissioning within Leeds over the next five years. The Strategic Plan was designed to not be overly prescriptive and allow the CCG to adjust to situations within a set of strategic commitments and key principles. The NHS Long Term plan and the Operational Planning guidance for 2019-20 have recently been published and the CCG using these principles will look to deliver its part of these. The Delivery Framework sitting beneath the strategic plan is designed to align the CCG and its commissioning plans and capacity to the commitments and principles set out in the strategic plan. This report describes the approach we are taking to moving forward on delivery of our plans and describes the process and expectations of the NHS planning round.

3. NHS 2019-20 Operational Planning Round

The NHS published it requirements for operational planning for 2019-20 in December. The operational plans for next year are to be seen as the first year of the NHS Long Term Plan in terms of policy direction, but are to be developed in a similar way to previous annual operational plans. A summary of the expectations within the NHS operational planning guidance can be found in Annex A.

Many of the major items areas in the guidance, including for example the expansion of IAPT, Urgent Care Treatment Centres, Primary Care Networks (Locally link to LCPs), strengthening children and young people’s mental health services, greater use of personalised health budgets, and reform of outpatients, are already set out in our commissioning intentions.

The full Operational Planning Guidance can be found at:

https://www.england.nhs.uk/wp-content/uploads/2018/12/NHS-Operational-Planning-and- Contracting-Guidance-201920-FULL-VERSION.pdf

The CCG will be working with colleagues in Leeds and at the ICS to develop our response to these plans. In line with NHS England requirements Leeds has established a Place Based Planning Group which includes representatives from all statutory providers, representation from primary care, the Leeds Plan, the ICS and all Commissioners (CCG, NHS England a Leeds City Council). The CCG Director of Strategy, Planning and Performance chairs this group.

The group met on 9th January for the first time to agree the role and responsibility of the group. Its primary role is to provide a forum whereby Leeds planning leads can review submissions and through process assure both NHS England and its own leadership that our plans will deliver Activity, Performance, Finance and Workforce intentions that reflect system views and are owned across the Leeds System. The group will ensure that the submitted plans are consistent with the requirement of the planning guidance and where there is variance ensure that systems leaders can articulate the reasons for this.

The measure of success will be the extent to which plans submitted meet national expectations and the degree to which individual organisational plans triangulate with each other such that they provide a cohesive and consistent view.

A set of common assumptions for activity levels have been agreed and formed the basis of a first draft submission by the CCG and Leeds Teaching Hospitals Trust (LTHT) on the 14th January. These assumptions, their basis and application will be tested with colleagues from NHS England over the next two months.

CCG Commissioning leads are working with provider colleagues across Leeds through existing meetings such as the System Resilience Board (SRAB) to agree performance trajectories for constitutional and other performance standards and to draft the underpinning narrative for each area including that for the local application of policy requirements emerging from the NHS 10 year plan. This narrative will take into account information being provided by the ICS on work being done once across the whole of West Yorkshire & Harrogate.

The key submission dates are:

Submission Date First cut activity trajectories 14th Jan

Draft Performance and adjusted Activity plans. 12th Feb Draft Narratives Final Performance and Activity Trajectories 4th April Final Narrative

The Governing Body will be updated on progress at the March meeting.

4. NHS Long Term Plan and Commissioning Plans

In January the NHS Long Term Plan was published. The full document can be accessed here: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf

Further guidance is being issued and work is being done to assess the implications. However, leaders across the ICS and city are at work to ensure we are in a position to seize the opportunities the plan offers as much of it gives greater permission and support to pursue the course set out in the ICS, Leeds and CCG plans.

There is an expectation that each ICS will have developed a system level plan by autumn 2019 that describes how it will deliver the NHS priorities as set out in the long term plan over the next 5 years. The West Yorkshire & Harrogate ICS has indicated that, in line with its previous approach, that this will be derived from each place. Therefore Leeds will need to develop a response. It is likely the first draft of this will need to be ready in early June. More detail can be found in Annex B.

In developing the Leeds response we will need to bring together the CCG Strategic Plan and Commissioning Strategies (and where appropriate those of the Leeds City Council), the Leeds Plan refresh and the ICS requirements. The Partner Executive Group (PEG) have instigated a Leeds Plan refresh whose timescales align to this and are considering further detail on the approach and links to the NHS plan in January.

Internally, the CCG has tasked the commissioning leads to further develop medium term commissioning strategies and will work to these timescales. Work will also be undertaken through the auspices of the Integrated Commissioning Executive to strengthen further collaboration between ourselves and the city council as commissioners and ensure single commissioning plans in key areas such as children, care homes and mental health.

5. Delivery Framework To support delivery of the CCG Strategic Plan we have established a Delivery Framework and the final part of this update is intended to ensure Governing Body members are sighted on progress on key components of this framework.

If we start at the Meso level, as discussed previously, we are developing a set of medium term commissioning plans to align both to the CCG Strategic Plan and the NHS Long Term Plan. There is a common approach being adopted and overtime this is being moved to align to the Commissioning for Outcomes approach and looking at particular population segments. An iterative approach to this alignment will be taken.

The commissioning plans will in turn be shaped by macro policy approaches for each of the 6 CCG strategic commitments. Some of the work underway is described below:

Commissioning for Outcomes - The CCG has a draft policy developed which is being shared and discussed internally and more widely with partners. This will be the policy that shapes commissioning going forward and informs all aspects of our plans and approach.

- The Population Health Management (PHM) pilot was launched at PEG in December (see more details in the Accountable Officer’s report) working with 4 LCPs, the citywide Frailty Clinical Strategy group and a newly formed business intelligence and finance group.

- A frailty strategy is being developed through the auspices of LPICC (the Leeds Provider Integrated Committee in Common) and the CCG is in discussion with LPICC using this population segment as the best way to develop the new commissioning approach.

- A number of pieces of work in other areas are adopting an outcomes cased approach to service redesign and procurement – IAPT and Diabetes for example.

Health Inequalities and wider determinants - Again a draft policy has been created and further work is underway to consult on the best approach for the CCG to take leading to the development of a formal position on key issues and priorities, set of plans and appropriate metrics. An internal working group is now in place and meeting regularly to progress this at pace.

- This work will also be adapted to reflect the priorities set out in the NHS Long Term Plan without losing the specific Leeds priorities and the greater opportunities good partnership working with the Leeds City Council (LCC) provides locally.

Locality (LCP) Development - Utilising external NHS short-term funding for Primary Care Network development a programme director is now in place and a team working to her is being recruited. They will report to Thea Stein who is the city-wide SRO for LCP development.

- A small task group made-up of all partners including a voluntary sector representative is pulling together a Leeds LCP maturity framework describing the desirable features of an LCP and the steps towards these. It is anticipated that the framework will be in place within two months and will then form the basis of the city setting priorities and holding itself accountable for progress.

Integration - The local providers continue to meet as LPICC and there are a number of pieces of joint work being undertaken in areas such as frailty and respiratory. The CCG are looking at how we might facilitate deeper collaboration in a number of ways including: through expansion of the Aligned Incentive Contract (AIC) approach and a frailty transformation fund supporting the strategy led through LPICC.

- Conversations continue about new joint working arrangements between LCH and the GP Confederation through a committee-in-common and again shared pieces of working are emerging. The NHS Long Term Plan expectations of primary care networks is fully in line with our plans and it is anticipated will help accelerate deeper collaboration.

- The CCG and LCC through the Integrated Commissioning Executive are looking to agree an Integrated Commissioning Framework and set of plans shortly. This is based on a full partnership model in key areas such as Children’s and Care Homes.

Alongside this further work is being done on key CCG systems and processes. The Commissioning for Value process is morphing to work more at the meso-level and sign off commissioning strategies and monitor delivery of planned benefits in efficiency, quality and outcomes. This is supported by work being undertaken by the finance team to provide commissioners with budgets and move-us away from short-term funding approaches. Further work is also being done through the IQPR to monitor effectively the key metrics in the CCG Strategic Plan recognising many of these will only change slowly and so developing a set of leading indicators alongside.

6. Conclusion

There is significant change under way both nationally and locally in West Yorkshire and Leeds. In many ways this report is a snap shot of the work being undertaken to assure alignment between the national plans and the CCG/Leeds plans whilst progressing delivery of the CCG Strategy. The breadth of the work is considerable and Governing Body members are invited to receive and discuss the content of this report and if necessary seek further assurance on progress.

Annex A

The Operational Planning Guidance naturally includes considerable detail. But below is a summary of a number of salient points for members’ information. This is not exhaustive.

 There is a considerable focus on system (i.e.) Integrated Care System (ICS) plans. There will be system control totals and system level operational plans. These will be aggregated from local places this year.  The CCG allocation is designed to do four things: o Support stretching but realistic activity levels o Ensure pay awards can be met o Ensure mental health spending is at least at the same percentage as total allocation level plus an additional percentage o Meet the commitments in the 10 year plan to invest a greater proportion in primary and community care  There is no requirement for CCGs to contribute to national reserve or to spend any element of its recurrent resources non-recurrently as was previously the case  There will be a 20% real term cut in running costs by 2020/21 which must be achieved by the end of 2019/20.  Spending on Children’s and Young people’s mental health must former a larger percentage of all mental health spending  There will be a very hard push on 52plus week waiters with both commissioners and providers being fined £2500 for each case.  Looking for further efficiencies in areas such as medicines and treatments of low therapeutic value. There is also specific mention in terms of efficiency on: o Reduction and transformation of outpatients activity o Increased use of digital systems in physical and mental community health services o E rostering of clinical staff in providers to reduce use of agency o Reduction in transaction costs associated with contracting  The CQUIN is reduced from 2.5% of contract value to 1.25%.  All type 1 A&E Units must have 7 day same day emergency care  Continued focus on reducing long-stays in hospital  Urgent Treatment Centres in all areas  Must deliver improvements in mental health and LD including expansion of: o IAPT provision o Community Mental Health Teams o Crisis intervention for Children and Adults o Perinatal support, o Health checks for people with Learning Difficulties to 75%.

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West Yorkshire and Harrogate Health and Care Partnership

NHS Long Term Plan

Introduction

1. The purpose of this annex is to:

 Provide the Governing Body of NHS Leeds with more detail on the NHS Long Term Plan published on 7 January 2019 and to explain from an ICS perspective what it means for people living in Leeds.

Background

2. The NHS Long Term Plan will make sure the NHS is fit for the future, providing high quality care for everyone. Last summer the Prime Minister committed an extra £20.5 billion a year going into the NHS by 2023/4. The Plan shows how the NHS will use the extra money to deliver the best results for patients, taxpayers and staff.

3. Health and care leaders have come together to develop the Plan to get the most value for people out of every pound of taxpayers’ investment. The Plan, published on Monday 7 January has been drawn up by frontline health and care staff, patient groups and other experts.

4. The Plan sets out some of the ways that the NHS want to improve care for people over the next ten years; including making sure everyone gets the best start in life; reducing stillbirths and mother and child deaths during birth by 50%; taking further action on childhood obesity; increasing funding for children and young people’s mental health; bringing down waiting times for autism assessments. It also includes the importance of delivering world-class care for major health problems; preventing 100,000 heart attacks, strokes and dementia cases; investing in spotting and treating lung conditions early to prevent 80,000 stays in hospital and delivering community-based physical and mental care for 370,000 people with severe mental illness a year by 2023/24.

5. Supporting people to age well and increasing funding for primary and community care by at least £4.5bn; coordinating care better and helping more people to live independently at home for longer are also highlighted in the Plan alongside improving the recognition of carers and support they receive and making further progress on care for people with dementia.

6. The Plan also sets out how the NHS will overcome the challenges that the NHS faces, such as staff shortages and growing demand for services, by doing things differently and giving people more control over their own health and the care whilst preventing illness and tackling health inequalities.

7. The plan also recognises the importance of the NHS workforce, training and recruiting more professionals – including thousands more clinical placements for undergraduate nurses, hundreds more medical school places, and more routes into the NHS such as apprenticeships. It will also make the NHS a better place to work, so more staff stay in the NHS and feel able to make better use of their skills and experience for patients. Digital technology is also high on the agenda. We will keep you updated on what next in terms of workforce and public engagement over the coming weeks. This means that over the next few months, whether you are NHS staff, a patient or a member of the public, you will have the opportunity to help shape what the NHS Long Term Plan means for your area, and how the services you use or work in need to change and improve.

West Yorkshire and Harrogate Health and Care Partnership

8. Being part of the West Yorkshire and Harrogate Health and Care Partnership means that Leeds will be involved in the development of a five year strategy for the whole of the area. It is important to note that this plan does not replace the Leeds area plan. The aim is to build on both local and West Yorkshire and Harrogate work to date.

9. The Long Term Plan for the NHS gives formal backing to integrated care systems like West Yorkshire and Harrogate Health and Care Partnership. It gives a further boost to the priorities that the Partnership have been working and the help we need to deliver reductions in health inequalities and unwarranted care variation across the area. For example, the focus on mental health services, cancer, prevention, and primary care will build on our approach and the progress we have already made.

10. Our organisations are part of West Yorkshire and Harrogate Health and Care Partnership, as such Leeds health care leaders have begun the conversation about how we lead the development of our forthcoming five year strategy to ensure we continue to focus on the right things, for example primary and community care, preventing ill health, inequalities and improving quality and outcomes for adults and children – all of which align to the NHS Long Term Plan.

11. Over the coming months, alongside stakeholders, workforce and communities, The Partnership will work through what the NHS Long Term Plan means for West Yorkshire and Harrogate – explaining how the local plans, regional and national plans fit together – and most importantly what this means for people.

12. An editorial board for the West Yorkshire and Harrogate Health and Care Partnership five year strategy will be set up soon. The strategy will build on the significant work the Partnership has already done - as described in the ‘Next Steps to Better Health and Care for Everyone’ publication – to plan for ambitious improvements to health and care. This strategy will belong to us all. A draft of the strategy will be shared with you for your views ahead of publication in the autumn (2019). It’s important to note that the Partnership is not starting from scratch.

13. We are working together – councils, NHS organisations, voluntary and independent organisations and communities – in ways which recognise that in modern Britain it is multi-morbidity and the wider determinants of health that hold the key to our future. The quality of housing, education, environment, employment and lifestyle factors sit squarely alongside joined up health and care as priorities.

14. This approach recognises the importance of integrating services for people at a local level, for example in [Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield]. All decisions on services are made as locally and as close to people as possible. The development of the West Yorkshire and Harrogate five year strategy is predicated on this continuing to be the case.

15. West Yorkshire and Harrogate Health and Care Partnership is based on the principle of subsidiarity and the primacy of local place. Work only takes place at a West Yorkshire and Harrogate level when it makes sense to do so, and with the agreement of local partners, for example in the development of whole system approaches in cancer, mental health and maternity care. The aim is to put people, not organisations, at the heart of everything we do so that we meet the diverse needs of our communities.

16. The Partnership will take advantage of the investment that the NHS is providing nationally in local Healthwatch and the Health and Wellbeing Alliance to provide extra capacity for engagement with the public, and in particular seldom heard groups.

To make these ambitious visions a reality:

17. We will continue to work together at both a local and West Yorkshire and Harrogate level to join up the NHS so people don’t fall through the cracks, such as by breaking down the barriers between GP services and those in the community.

18. We will help individuals and families to help themselves, by taking a more active role in preventing ill-health, such as offering dedicated support to people to stop smoking, lose weight and cut down on alcohol.

19. The NHS will tackle health inequalities by working with specific groups who are vulnerable to poor health, with more funding for areas with high deprivation and targeted support to help homeless people, black and minority ethnic (BAME) groups, and those with mental illnesses or learning disabilities.

20. We will back our workforce by increasing the number of people working in the NHS, particularly in mental health, primary care and community services. We will also create a better working environment by offering better training, support and career progression and we’ll crack down on bullying and violence at all levels.

21. We will bring the NHS into the digital age, rolling out technology such as new digital GP services that will improve access and help patients make appointments, manage prescriptions and view health records on-line.

22. The NHS will spend this extra investment wisely, making sure money goes where it matters most. The NHS will build on the £6 billion we saved last year by reducing waste, tackling variations and improving the effectiveness of treatments – this will include bearing down on red tape, ensuring the NHS is used responsibly, and curbing fraud and other abuses.

What next?

23. Now the NHS Long Term Plan has been published, local NHS organisations – working together with each other, local councils and other partners – will develop their own strategies for the next five years, which set out how they will make the ambitions of the Long Term Plan a reality for the communities they serve.

24. This is possible because the key to delivering outstanding care in [add local place name] is our local partnership approach. Our aim is to put people, not organisations, at the heart of everything we do so that we meet the diverse needs of our communities. Health services, local authorities, charities and community groups are equal partners working together more practically to improve the quality and outcomes of our health and care services.

25. The focus for our local and West Yorkshire and Harrogate work is increasingly moving away from simply treating ill health to preventing it. We also need to tackle financial and workforce challenges by bringing together all of our precious resources locally and working with communities to help people to stay healthy and care for themselves – and helping the poorest fastest.

26. Further conversations with partners, stakeholders, public and staff will take place at both a local and West Yorkshire and Harrogate level. We will keep you updated as this work develops to ensure everyone has the opportunity to get involved and have their say.

27. This means at all levels:  We are working to improve people’s health with and for them  We are working to improve people’s experience of health and care  We want to make every penny in the pound count so we offer best value to the taxpayer  It is our role to help keep people well and make life better for those we serve.

28. Alongside the NHS long-term plan we will need additional resources and support for social care and for local government. Without these we cannot deliver our ambitions. We therefore look forward to seeing the Government’s Social Care Green Paper and the outcome of the spending review later this year.

Further reading

You may find the following information helpful:  You can view the NHS Long Term Plan here. A summary is also available here. Further information about the NHS Long Term Plan, including case studies can be found here.  West Yorkshire and Harrogate ‘Our Next Steps to Better Health and Care for Everyone’ here.  The positive difference West Yorkshire and Harrogate Health and Care Partnership is making here.

Contact details

For further information on the above contact Tim Ryley; Director of Strategy, Performance and Planning [email protected]

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Agenda Item: 119 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 30th January

Title: The Integrated Quality and Performance Report Lead Governing Body Member: Tick as Jo Harding, Director of Quality and Safety Category of Paper appropriate Sue Robins, Director of Operational Delivery () Report Author: Various Decision

Reviewed by EMT/Date: n/a Discussion  Reviewed by Committee/Date: Quality & Information Performance Committee, 16th January 2019 Checked by Finance (Y/N/N/A - Date): n/a Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing  2. Reduce health inequalities across our city  We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health 4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds 6. Create the conditions for health and care needs to be addressed around local neighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not  reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability 4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

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

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

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

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

1. SUMMARY

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

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

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

2. SUMMARY OF KEY PERFORMANCE ISSUES

2.1 Planned Care and Long Term Conditions  The CCG continues to marginally underperform against the 92% 18 week RTT waiting time standard. The specialties which continue to predominantly influence performance against this measure are those which are driving the high numbers of patients waiting over 52 weeks i.e. spinal surgery and colorectal surgery. The majority of spinal waiters over 52 weeks are those (mostly NHSE specialist commissioned) who can only be operated on in a regional centre. Some additional capacity has been identified with both NHS and Independent Sector providers.

 We remain above the March-18 RTT waiting list size (the requirement in 2018/19 is to be no greater than it) but the majority of the growth in the year has been in outpatient areas rather than inpatient/day cases where the total waiting list size has reduced. The specialties with the biggest growth in waiting list size since March are in: vascular surgery, rheumatology, dermatology and spines, together with some NHSE commissioned specialties (dental, clinical genetics).

 Following the recent, significant reduction in performance in breast cancer pathways, the breast symptomatic target is greatly improved but not yet achieved. There are likely to be ongoing challenges in January-19 due to patient availability over the holiday season. There is continued growth in demand in this pathway such that some patients are still being seen slightly later than the 2 week target.

 LTHT and the rest of the WY&H ICS continue to struggle to deliver the 62 day cancer targets. The main reason for the higher number of patients treated beyond 62 days remains the increase in the numbers of urology patients requiring treatment (linked to a prior increase in public awareness and presentation for screening), and the continued late transfers of patients from outside Leeds for treatment.

2.2 Unplanned Care  In October 2018, Leeds Teaching Hospitals NHS Trust did not achieve the required 95% performance standard for 4 hour waits in A&E. Reasons for this underperformance include sustained high emergency department attendances (exceeding 700 across both sites), increased acute demand on critical care and high acuity, high bed occupancy levels which is impacting on timely flow and continuing high levels of delayed transfers of care and medically optimised for discharge levels.

 In October-18, Yorkshire Ambulance Service (YAS) failed to meet the nationally set 7-minute average for responding to calls from people with life-threatening illnesses or injuries by an average of 10 seconds. However, responses to this category of call within 15 minutes for 90% of all calls of this type received was achieved. However, locally determined targets for this category of call have been achieved since June- 18.

2.3 Mental Health and Learning Disabilities  The national standard for IAPT access in 2018/19 is for 19% of the prevalent population to access the service in the reporting year. This equates to almost 1.6% of this population accessing IAPT support each month (approximately 1,600 - 1,700 people). Between April and October 2018, just over 8,400 people accessed IAPT support in Leeds - approximately 3,200 fewer than required levels. This is due to workforce capacity being below the level required to reach this target.

 Revised trajectories for people with a learning disability or autism reliant on inpatient care were agreed with NHSE England in November 2018 as part of a regional recovery trajectory review which significantly reduces this risk of underperformance in 18/19. A major contributing factor to our risk of underachievement is associated with the Ministry of Justice and the Responsible Clinician (for each patient) being reluctant to step down patients straight in to the community (from NHSE- commissioned care) due to the risk these patients pose and consequently this increases the number of patients under the responsibility of the CCG. Community treatment reviews continue to be undertaken to discuss opportunities of discharging people into the community and the CCG are scoping further opportunities to provide additional transitional and intensive support in communities.

 We are mandated to increase the number of health checks undertaken for people on the learning disability register by 64% in 2018/19 when compared to 2016/17. For Leeds this equates to a figure of 3,081 health checks being undertaken annually. By the end of Q2 667 such checks had taken place (against a YTD target of 1,203). Discussions continue to scope proposed action to be taken in 2019/20.

2.4 Children’s and Maternity  We are required to ensure 32% of children and young people with a diagnosable mental health condition can access NHS funded community services in 2018/19. This equates to just shy of 5,000 0-18 year olds being required to be able to access support in Leeds. Using activity data to date from the Mental Health Services Dataset, end of year performance is forecasted to be around 20% (3,000 children and young people).

 However, challenges remain with both our smaller providers and within our children and young people service clusters, including developing Mental Health Services Dataset (MHSDS) compliant databases and procuring connectivity to the Health and Social Care Network. These issues prevent the true number of children accessing support, which we believe is closer to the expected level of 5,000 per year, being reported upon within the national dataset.

 Two out of seven young people urgently referred to the CYP eating disorder service in the 12 months ending Q2 2018/19 were not seen by the service within one week of referral due to patient choice. Due to the small numbers involved, this led to an underperforming position against this reporting quarter and it is not felt there is a need for further action given the reasons provided by the provider.

2.5 Continuing Healthcare (CHC)  Reducing the number of full NHS CHC assessments taking place in an acute hospital setting remains to be challenging. The main performance issues are: o care homes requiring NHs funding assurance prior to offering a patient a place o patients and/or their families choosing not to move until the assessment is completed o the requirement to complete referrals within 28 days means that on occasion patients are assessed in hospital to ensure that an outcome is reached within 28 days; and o 20% increase in the number of referrals for Continuing Healthcare in October and November has resulted in more assessments being carried out in hospital to reduce the risk of a 28 day breach.

 The number of outstanding reviews has placed a further pressure on the service. Initial investigation shows that an unprecedented increase in referrals and roll out of the new National Framework for Continuing Care has impacted on the team’s ability to complete reviews. Clinical assessment time was taken out of the review team to provide training in the use of the new checklist which also impacted on the ability to maintain the reviews.

2.6 Neighbourhood Care  Since securing the additional funding and extending the focus and responsibilities of the Bed Bureau, significant reductions in delayed discharges have been noted. Similar reductions have been noted in the average length of stay of patients currently resident in the community care beds.

 Whilst patient flow through the community care beds (CCBs) has improved markedly, the number of referrals received and the ability to admit patients has remained challenging. However, no beds have been closed or unavailable so far this winter (e.g. due to maintenance or outbreaks etc). As a result, there has been spare admitting capacity every day since the expansion of the Bed Bureau role and the overall occupancy rate of the CCBs has fallen steadily during this period. On 24th

October there were 24 unoccupied beds in the system, and by 5th December this had risen to 52.

 Work is ongoing to identify additional cohorts of patients who could be appropriate for admission to the Community Care Beds, including step-up and step-down patients. The aim of this work will be to increase utilisation of the CCBs and to ensure that the beds continue to offer as much support to the wider system as possible.

2.7 Proactive Care and Population Commissioning  Leeds Wheelchair Service have routinely offer Personal Wheelchair Budgets (PWBs) from 1st April 2018. There has been a phased approach to implementation, starting with face-to-face clinics. Approximately half of all new referrals are now managed via the telephone with assessments being undertaken by clinical support staff. By incorporating telephone assessments, we have managed to deliver our target for 2018/19 within the first six months of the year; as of the end of Q2, we had 726 PHBs in place (vs a target of 540, equivalent to 48.5 PHBs per 100,000 population).

3. NEXT STEPS

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

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

3. RECOMMENDATION

The Governing Body is asked to:

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

6 The Integrated Quality and Performance Report

Report Period: October 2018

Contents

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

Report Key

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

92.5% 'Green' performance would be ≥ 92% 88.0% 'Amber' performance would be 87.4% ≤ x < 92% 85.0% 'Red' performance would be < 87.4%

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

Interpreting Trends Trend analysis is currently based upon comparing the latest performance with the performance in the previous period. A green arrow represents an improvement in performance An amber arrow represents no change in performance A red arrow represents a deterioration in performance

Sparklines Sparklines have been produced to demonstrate the distance away from the expected target level, with green representing a positive position and red representing underperformance.

The most recent period of data is shown furthest to the right in each sparkline. NHS Constitution and Operational Planning Measures Performance Measures (1 of 2)

Measure Target Data Period Current Trend (Difference from Target) NHS Constitution RTT ‐ Incomplete Pathway (18 week wait compliance) 92% Oct‐18 91.3% No more than 42,409 RTT ‐ Incomplete Pathway (number of patients waiting) Oct‐18 44,051 by Mar‐19 No more than 23 by RTT ‐ 52 Week Waits Oct‐18 74 Mar‐19 Diagnostic Waiting Times 99% Oct‐18 99.5%

Cancer ‐ 2 Week Wait 93% Oct‐18 94.6%

Cancer ‐ 2 Week Wait (Breast) 93% Oct‐18 90.9%

Cancer ‐ 31 Day First Treatment 96% Oct‐18 95.6%

Cancer ‐ 31 Day Surgery 94% Oct‐18 93.0%

Cancer ‐ 31 Day Drugs 98% Oct‐18 99.5%

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

Cancer ‐ 62 Day GP Referral 85% Oct‐18 74.5%

Cancer ‐ 62 Day Screening 90% Oct‐18 75.9%

Cancer ‐ 62 Day Upgrade 90% Oct‐18 55.6% A&E A&E Waiting Times: % 4 hours or less (LTHT ‐ All Types of A&E) 95% Oct‐18 82.9% Mental Health Dementia ‐ Estimated Diagnosis Rate 66.7% Oct‐18 74.7%

IAPT Access (YTD) 11.1% Oct‐18 8.0%

IAPT Recovery 50% Oct‐18 57.7%

IAPT Waiting Times ‐ 6 Weeks 75% Oct‐18 77.2%

IAPT Waiting Times ‐ 18 Weeks 95% Oct‐18 99.8%

EIP ‐ Psychosis treated within two weeks of referral 53% Oct‐18 78.3%

Improve access rate to CYPMH 32% Oct‐18 14.3% Waiting Times for Routine Referrals to CYP Eating Disorder Services ‐ Within 4 70% 2018/19 Q2 88.1% Weeks (Rolling 12 Months) Waiting Times for Urgent Referrals to CYP Eating Disorder Services ‐ Within 1 95% 2018/19 Q2 71.4% Week (Rolling 12 Months) Learning Disability Target Period Current Reliance on Inpatient Care for People with LD or Autism ‐ CCGs (All Length of 22 2018/19 Q2 21 Stays) Reliance on Inpatient Care for People with LD or Autism ‐ CCGs (Length of Stay 9 2018/19 Q2 13 of 5 Years and Over) Reliance on Inpatient Care for People with LD or Autism ‐ NHSE All Length of 17 2018/19 Q2 17 Stays) Reliance on Inpatient Care for People with LD or Autism ‐ NHSE (Length of Stay 11 2018/19 Q2 11 of 5 Years and Over) Number of people on GP LD Registers who have received an Annual Health 3,722 by Mar‐19 2018/19 Q2 667 Check during the year ‐ YTD Other Commitments e‐Referral Coverage 80% Sep‐18 84.2%

Personal Health Budgets (per 100,000) ‐ YTD 48.5 2018/19 Q2 83.6

Children Waiting no more than 18 Weeks for a Wheelchair 92% 2018/19 Q2 93.5%

Extended access at GP services (Full Provision) 100% by Oct 2018 Dec‐18 100.0% NHS Constitution and Operational Planning Measures Performance Measures (2 of 2)

Measure Target Period Current Trend

Quality Premium ‐ Emergency Demand Management Indicators No more than 241,592 Type 1 A&E attendances Oct‐18 20,952 in 2018/19 No more than 21,794 Non elective admissions with zero length of stay Oct‐18 1,723 in 2018/19 No more than 59,550 Non elective admissions with length of stay of 1 day or more Oct‐18 4,709 in 2018/19 Quality Premium ‐ Quality Indicators 12 months to Cancers diagnosed at early stage (detected at stage 1 and 2) At least 54.9% in 2017 53.4% 2017/18 Q2 2018 Overall experience of making a GP appointment 71.9% 68.9% (Jan‐Apr 18) NHS CHC eligibility decision made within 28 days 80% 2018/19 Q2 49.7% Less than 15% in Full NHS CHC assessments taking place in an acute hospital setting 2018/19 Q2 23.3% 2018/19 Recovery rate of people accessing IAPT services identified as BAME 49.8% Sep‐18 37.1%

Proportion of people accessing IAPT services aged 65+ 13.6% Sep‐18 3.6% No more than 481 in Whole health economy ‐ E. coli blood stream infections (12 months) Oct‐18 398 2018/19 Antibiotic prescribing for UTI in primary care ‐ Trimethoprim: Nitrofurantoin 12 months to 0.51 0.35 prescribing ratio* May 2018 Antibiotic prescribing for UTI in primary care ‐ number of trimethoprim items 12 months to 9,181 6,109 prescribed to patients aged ≥70 years* August 2018 12 months to Prescribing in primary care ‐ items per STAR‐PU* 0.965 or below 0.968 August 2018 Reported to estimated prevalence of hypertension (%) 57.6% 2018/19 Q2 57.9% Quality and Safety Performance Measures

Measure Target / Period LTHT LCH LYPFT Other* Nat Av in period YTD in period YTD in period YTD in period YTD Patient Safety Oct ‐ Nov Serious Incidents n/a 12 51 8 38 6 30 7 25 2018 Oct ‐ Nov Never Events n/a 13000000 2018 Jul17 to Jun Mortality Rate (Standardised Hospital Mortality Index) 1.00 1.071 18 MRSA Blood Stream Infection 0 Oct‐18 0 5 Clostridium difficile Infection (YTD) 138 Oct‐18 15 94 (* CCG) Classic Safety Thermometer (Harm Free Care) 94.3% Nov‐18 95.9% No Data 98.5%

Mental Health Safety Thermometer (% feeling safe) 88.2% Sep‐18 84.9%

Patient Experience

Friends and Family Test (% recommended) ‐ A&E 87.0% Oct‐18 88.0% 88.4%

Friends and Family Test (% recommended) ‐ Inpatient 95.8% Oct‐18 94.9% 94.2%

Friends and Family Test (% recommended) ‐ Outpatient 93.8% Oct‐18 94.9% 94.3%

Friends and Family Test (% recommended) ‐ Maternity Antenatal 95.3% Oct‐18 92.5% 98.3%

Friends and Family Test (% recommended) ‐ Maternity Birth 96.8% Oct‐18 98.3% 96.4%

Friends and Family Test (% recommended) ‐ Postnatal Ward 95.0% Oct‐18 93.0% 95.2%

Friends and Family Test (% recommended) ‐ Postnatal Ward (Community) 97.8% Oct‐18 100% 98.8%

Friends and Family Test (% recommended) ‐ Mental Health 89.3% Oct‐18 89.1% 92.8% 76.9% 71.8%

Friends and Family Test (% recommended) ‐ Community 95.5% Oct‐18 97.0% 96.5%

Friends and Family Test (% recommended) ‐ See and Treat/Non‐Conveyance (YAS) 91.7% Oct‐18 No Data No Data

Friends and Family Test (% recommended) ‐ Patient Transport Service (YAS) 91.6% Oct‐18 No Data No Data

Complaints ‐ Total Received n/a Mar‐18 846 14 204 14 212 15 858 YAS

Staffing 11.8% Staff Turnover variable Apr‐18 no data no data 12.50% (YAS) Sickness variable Jul‐18 4.14% 5.24% 4.24% 5.09% YAS

Agenda Item: GB 18/120 FOI Exempt:

NHS Leeds CCG Governing Body Meeting

Date of meeting: 30th January 2019

Title: Finance Report for 9 months ended 31st December 2018

Lead Governing Body Member: Visseh Pejhan- Tick as Category of Paper appropriate Sykes, Chief Finance Officer () Report Author: Judith Williams, Head of Corporate Reporting & Strategic Financial Decision Planning Reviewed by EMT/Date: N/A Discussion 

Reviewed by Committee/Date: N/A  Information

Checked by Finance (Y/N/N/A - Date): Approved by Lead Governing Body member (Y/N): Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing 2. Reduce health inequalities across our city We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health 4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds 6. Create the conditions for health and care needs to be addressed around local neighbourhoods Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

EXECUTIVE SUMMARY:

This report provides an update on the financial performance of NHS Leeds Clinical Commissioning Group for the nine months to 31st December 2018 and the expected outturn position for the 2018-19 financial year.

The CCG is on target to achieve its financial control total. The CCG is forecasting that £23m of the £34.3m QIPP target will have been achieved through a mixture of contract negotiations/budget discussions and commissioning for value programmes, and this together with risks identified during the planning stage which have now been mitigated or reduced, will enable the CCG to achieve its overall in year financial target. Resources are being directed into the Commissioning for Value programme to ensure that there is a robust process in place to review all commissioning expenditure and monitor QIPP plans. QIPP is reported and monitored through the Commissioning for Value Board.

The main changes in Month 9 are a decrease in the forecast for prescribing of £1m, based on the latest data, and a decrease in the forecast for other of £1m due to the receipt from NHS England of a non-recurrent allocation for the Quality Premium, where spend is already shown elsewhere in forecasts. CHC is also showing a reduction in the forecast of £0.9m (as a result of a review of active packages, and a milder winter than expected). Offset by an increase in the acute forecast of £0.5m in respect of overseas visitors and overtrades at Bradford where there has been issues with data flows.

NEXT STEPS:

Updates on the 2018-19 financial position will continue to be presented to the Governing Body and/or Executive Management Team (EMT) on alternate months to ensure that the CCGs’ financial position is formally reported and reviewed each month under the CCGs’ governance arrangements.

RECOMMENDATION:

The Governing Body is asked to:

(a) Note the Month 9 financial position (b) Discuss, comment and highlight actions required to progress and report to the next meeting of the Executive Management Team

2 NHS Leeds Clinical Commissioning Group Finance Report for the Nine Months ended 31st December 2018

Page 1 Financial Performance Report 31st December 2018

At 31st December NHS Leeds Clinical Commissioning Group 2018 At Year End 2018-19 RAG RAG

CCG Expenditure does not exceed planned level GREEN GREEN Programme spend less than allocation GREEN GREEN Running costs spend less than allocation GREEN GREEN Delegated Co-commissioning less than allocation GREEN GREEN Planned Surplus in year GREEN GREEN QIPP AMBER AMBER Clear identification of risks against financial delivery & mitigations GREEN GREEN Delivery of Mental Health Investment Standard GREEN GREEN

Better Payment Practice Code - to pay 95% of valid invoices by due date or within 30 days of receipt of a valid invoice, whichever is later GREEN GREEN Cash at bank balance within 1.25% of the monthly amount requested or £250k, whichever is greater GREEN GREEN Assessment of internal and external audit opinions on the timeliness and quality of returns N/A N/A

Overview 31st December 2018

The main changes in Month 9 are a decrease in the forecast for prescribing of £1m, based on the latest data, and a decrease in the forecast for other of £1m due to the receipt from NHS England of a non recurrent allocation for the Quality Premium, where spend is already shown elsewhere in forecasts. CHC is also showing a reduction in the forecast of £0.9m (as a result of a review of active packages, and a milder winter than expected). Offset by an increase in the acute forecast of £0.5m in respect of overseas visitors and overtrades at Bradford where there has been issues with data flows.

Page 2 Financial Position Summary 31st December 2018

Annual Variance NHS Leeds Clinical Commissioning Group Year To Date Annual movement from Revenue Expenditure 2018-19 Budget Actual Variance Budget Forecast Variance previous month £'000 £'000 £'000 £'000 £'000 £'000 £'000 Programme Services Acute Services 447,486 449,496 2,010 593,195 595,861 2,666 488 Mental Health Services 105,301 104,736 -565 140,401 140,103 -298 -298 Community Health Services including Childrens Services 103,900 103,543 -358 136,971 136,960 -11 6 Continuing Care Services 41,633 39,976 -1,657 55,511 53,450 -2,061 -862 Prescribing and Primary Care Services 117,179 114,932 -2,247 156,379 153,450 -2,929 -1,531 Other 5,302 3,798 -1,504 7,042 5,206 -1,836 -1,029 Primary Care Co-Commissioning 84,778 84,778 0 112,444 112,444 0 0

Total Programme Services 905,579 901,258 -4,321 1,201,943 1,197,475 -4,468 -3,227

RUNNING COSTS 11,073 10,078 -995 14,671 14,038 -633 0

RESERVES 1,636 6,951 5,316 8,967 14,068 5,101 3,227

CCG Net Expenditure 918,287 918,287 0 1,225,581 1,225,581 0 0

Allocations 31st December 2018

NHS Leeds Clinical Commissioning Group Co- IN YEAR Programme Running Costs Allocations 2018-19 commissioning ALLOCATION £'000 £'000 £'000 £'000 Opening Baseline Allocation 1,088,029 17,402 112,484 1,217,915 Subtotal Month 1 Adjustments 475 44 0 519 Subtotal Month 2 Adjustments 0 0 0 0 Subtotal Month 3 Adjustments 4,362 0 -895 3,467 Subtotal Month 4 Adjustments 957 0 0 957 Subtotal Month 5 Adjustments 89 116 0 205 Subtotal Month 6 Adjustments 1,264 0 0 1,264 Subtotal Month 7 Adjustments 117 0 0 117 Subtotal Month 8 Adjustments 2,129 0 4 2,133 Subtotal Month 9 Adjustments 3,153 0 851 4,004

Closing Allocation 1,100,575 17,562 112,444 1,230,581

M09 allocations: Non Recurrent allocations received of £1,070k in respect of achieving the Quality Premium, £837k for the development of Primary Care Networks, and £851k into Primary Care Co Commissioning in respect of previously unfunded GP uplift. Quarter 3 of the ongoing non recurrent allocations in respect of Diabetes (£169k) and Quarter 4 for medicines optimisation in care homes project (£146k) and second tranche of perinatal community services (£372k) and £304k for Transforming Care/LD transforming care received. Plus £188k for atrial fibrillation patient optimisation project.

Page 3 Risks and Mitigations 31st December 2018

NHS Leeds Clinical Commissioning Group Risks and Mitigations 2018-19 Risk Area Full Risk Value Description of Risk £'000 Winter pressures in acute sector, 52 week waits Acute Services 2,900

IAPT target delivery Mental Health 500

Winter pressures in community services Community Health 963 Care home fees Continuing Care 278

Prescribing Primary Care 0 Technical/contractual Running Costs 1,371 Total Risks 6,012 Full Mitigation Description of Mitigation £'000 Contingency held 6,012 Reserves held 0 Total Mitigation 6,012 Net Risk 0

Risks have dropped slightly this month, mainly related to reduction in the risk of overtrades in acute sector. Reserves are sufficient to cover all identified and quantified risks at this stage.

Page 4 Acute Services 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds Teaching Hospitals NHS Trust 316,433 316,655 223 418,443 418,443 0 Mid Yorkshire NHS Trust 20,435 20,207 -228 27,246 26,846 -400 Harrogate Foundations Trust 20,342 20,791 449 27,123 27,997 874 Bradford Foundation Trust 3,926 3,882 -44 5,234 5,270 36 York Foundation Trust 2,061 2,038 -23 2,748 2,689 -59 Other NHS Trusts 10,622 10,704 83 14,129 14,324 195 Non contract Activity 5,133 5,133 0 6,844 6,844 0 Non NHS Acute 33,337 34,805 1,468 44,498 46,407 1,909 Urgent Care 35,197 35,280 83 46,929 47,040 111 Total Acute Services 447,486 449,496 2,010 593,195 595,861 2,666

The CCG and LTHT continue negotiations around the 2019-20 contracts. The Acute forecast position has increased by £488k in Month 9. The main reason is the increase in overseas visitors costs of £302k, due to two high cost patients in recent months, one costing £199k in paediatrics, the other costing £106k in oncology. The other issue is an increase of £236k at Bradford Hospital. The Bradford Trust have had an issue with their trading activity data, and have not been sending out information to commissioners between Month 5 and Month 8. During this period the CCG activity at Bradford has increased, with non-elective showing an overspend of £198k, mainly due to admissions from A&E to the Clinical Decision Unit, as well as smaller overtrades in the colorectal surgery and paediatric specialties. A number of other points of delivery are underspending against plan, helping to offset a bigger overtrade. There are small increases in the forecast at Airedale and Calderdale Hospitals. Offset by a decrease in the forecast position for Mid Yorkshire Hospital of £150k, relating to day case, outpatient first and outpatient follow up activity. The day case activity is undertrading within the urology and clinical haematology specialties. Both first and follow up outpatients are undertrading across a range of specialties. The Independent Sector and any qualified provider (AQP) forecast position has remained relatively static as Month 9, increasing by only £33k across all contracts.

Page 5 Mental Health Services 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds and York Partnership Foundation Trust 74,427 74,457 30 99,236 99,238 2 Tees Esk and Wear Valley NHS Foundation Trust 825 786 -38 1,099 1,099 0 Bradford District Care NHS Foundation Trust 120 120 0 160 160 0 Independent/Voluntary Sector/LCC 3,927 3,937 10 5,236 5,236 0 Learning Disabilities 19,821 20,051 230 26,428 26,735 307 IAPT 1,230 1,230 0 1,640 1,640 0 Mental Health Specialist Services 3,904 3,131 -772 5,205 4,596 -609 Mental Health NCAs 383 380 -4 511 505 -6 Mental Health Other 663 643 -21 884 892 8 Total Mental Health Services 105,301 104,736 -565 140,401 140,103 -298

A budget of £375K has been transferred from CHC for the S117 MH FNC. Forecasts from December 2018 to the end of the financial year are now reflected in MH, the remainder of the year are within CHC. The Elective Funding Panel forecast has reduced by £278K for M9, this is due to a number of movements within the cohort including TCP delayed discharges and changes in funding responsibility. No other material changes to the forecast position in month 9. The CCG continues to exceed the growth in spend on mental health required by the Mental Health Investment Standard in 2018-19, due to non recurrent funding provided in year.

Page 6 Community Health Services 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds Community Healthcare NHS Trust 72,382 72,382 0 96,481 96,481 0 Voluntary Sector/Local Authority 14,103 14,221 118 18,804 18,962 158 Community Beds 8,712 8,626 -86 11,616 11,501 -114 Hospices 4,770 4,740 -30 4,903 4,870 -33 Reablement 2,105 2,105 0 2,807 2,807 0 Safeguarding 562 548 -14 749 733 -16 Sub Total Community Health Services 102,634 102,622 -11 135,361 135,355 -6 Children's Services excluding Continuing Care 1,266 920 -346 1,610 1,605 -5 Total Community Health Services including Childrens 103,900 103,543 -358 136,971 136,960 -11

No material change in community services forecast position, or childrens services forecast position.

Page 7 Continuing Care Services 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Continuing Healthcare (CHC) 26,263 23,817 -2,445 35,017 31,838 -3,179 Continuing Healthcare Personal Health Budgets (PHBs) 4,501 5,262 762 6,001 7,484 1,483 Funded Nursing Care (FNC) 6,328 6,551 223 8,438 8,431 -7 Children Continuing Care including PHBs 1,072 853 -219 1,429 1,169 -261 Continuing Healthcare - operational 1,829 1,663 -166 2,439 2,226 -213 Neuro-rehab 1,640 1,829 189 2,187 2,304 117 Total Continuing Care Services 41,633 39,976 -1,657 55,511 53,450 -2,061

Continuing Healthcare, including PHBs: decrease in forecast outturn of £1.586m for CHC this month, offset by increase in PHB forecast of £798k, reflecting the trend of an increase in number of PHB packages as this becomes the default delivery model for CHC. Overall decrease in CHC including PHBs of £788k, due to a review of active packages, and a milder winter than expected. Funded Nursing Care: £375k of budget has been moved out of FNC and into S117 FNC, which is included within the mental health section. CHC Operational: decrease in forecast of £67k this month attributable to a number of vacancies still outstanding, the expected start date for these roles has been moved back to February. There has also been a reduction in non pay because of a reduction in the amount of legal invoices this month. Childrens CHC: Q3 JDAR costs from LCC are still awaited, so the forecast is still based on Q2 and unchanged. With year end approaching the forecast for the ad-hoc childrens ventilation packages has been reduced by £10k as it becomes less likely the full budget will be spent. As these are ad-hoc costs reducing the forecast incrementally from December onwards will give us flexibility should more costs come in the last quarter. Neuro Rehab: no material change this month

Page 8 Prescribing and Primary Care Services 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Prescribing 94,377 92,877 -1,500 125,836 123,836 -2,000 Ex centrally funded drugs 2,561 2,561 0 3,414 3,414 0 Oxygen contract 876 876 0 1,168 1,168 0 Primary Care Schemes 14,537 14,498 -39 19,383 19,375 -8 Clinical Leads 461 441 -19 586 574 -12 Primary Care - GP IT 1,977 1,977 0 2,636 2,636 0 Medicines Optimisation in Care Homes Project 513 112 -401 772 233 -539 Sub Total Prescribing and Primary Care Services 115,302 113,342 -1,959 153,795 151,236 -2,560 Prescribing Staff 1,171 1,001 -170 1,561 1,385 -176 Primary Care Staff 586 537 -50 782 725 -57 Confederation Staff 120 52 -68 240 104 -136 Sub Total GP Confederation 1,878 1,590 -288 2,584 2,215 -369 Total Prescribing & Primary Care Services 117,179 114,932 -2,247 156,379 153,450 -2,929

Prescribing: October data has now been received; based on this information the forecast spend has been reduced by a further £1M to show a forecast underspend of £2M. The position is likely to reduce further in future months. The finance team are working with prescribing colleagues to monitor the position going forward and will amend the forecast as more data is received. Primary Care: In Month 9 CCGs across West Yorkshire have received an additional non recurrent allocation of £1/head (£837k for Leeds CCG) to support primary care development and address performance pressures relating to primary care. This is currently forecast to be fully spent and discussions are being held as to the best ways to utilise this funding. Staffing: In Month 9 additional non recurrent allocation was received for the Medicines Optimisation in Care Homes project and the Atrial Fibrillation project. Staff related to these projects have only been in post for part of the year and so there is an underspend on this area.

Page 9 Other Services 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Non acute commissioning - LIDS 578 565 -12 770 753 -17 Proactive Care and transformational projects 2,646 2,205 -440 3,531 3,120 -411 Cancer Projects 86 86 -1 115 114 -1 Programme Staff - Transforming care/out of area 113 106 -7 151 158 7 Programme Staff - Sustainability and transformation programmes 868 747 -121 1,124 952 -172 Programme Staff - Nursing and Quality 209 89 -120 282 109 -173 Quality Premium Programme 803 0 -803 1,070 0 -1,070 Total Other Services 5,302 3,798 -1,504 7,042 5,206 -1,836

Main change is receipt of £1,070k non recurrent allocation for Quality Premium. Spend is elsewhere within CCG and so shows as an underspend here

Page 10 Primary Care Co-Commissioning 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 GMS 18,674 18,697 23 24,899 24,914 14 PMS 36,128 36,202 74 48,171 48,196 25 APMS 3,227 3,237 9 4,303 4,301 -2 Premises cost reimbursements 11,876 11,798 -79 15,249 14,933 -316 Primary Care NHS Property Services Costs - GP 0 0 0 0 0 0 Other premises costs 167 172 5 222 222 0 Enhanced Services 2,154 2,035 -119 2,873 2,873 0 QOF 7,129 7,142 13 9,507 9,923 416 Other GP Services(inc PCO) 5,323 5,410 87 7,088 6,952 -137 Delegated Contingency 0 0 0 0 0 0 Reserves 99 85 -14 131 131 0 Total Primary Care Co-Commissioning 84,778 84,778 0 112,444 112,444 0

The nationally agreed GP pay increase was paid in October and was covered within the original budget. In Month 9 an additional non recurrent allocation of £851k was unexpectedly received to cover this payment. This is currently being forecast as fully spent, and options are being explored at the how to best utilise this funding.

Page 11 Running Costs 31st December 2018

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Pay 6,888 6,190 -698 9,184 8,379 -804 Non Pay/Income 4,185 3,888 -297 5,487 5,659 171 Total Running Costs 11,073 10,078 -995 14,671 14,038 -633

Running Costs are still expected to underspend by £633k at the end of the financial year. Underspend on pay has increased in month 9 reflecting current vacancies. Non pay expenditure is also showing a year to date underspend.

Page 12 Consolidated Statement of Financial Position 31st December 2018

31st December 2018 31st March 2018 £'000 £'000 Current Assets Trade & Other Receivables 7,039 3,556 Cash & Cash Equivalents 0 291 Total Current Assets 7,039 3,847 Total Assets 7,039 3,847

Current Liabilities Trade & Other Payables: (74,297) (63,132) Borrowings (862) 0 Provisions (1,518) (1,448) Total Current Liabilities (76,677) (64,579)

Total Assets less Current Liabilities (69,638) (60,732) Non-current Liabilities Provisions (1,268) (1,348) Total Non-current Liabilities (1,268) (1,348)

Total Assets Employed (70,906) (62,080) Financed by Taxpayers’ Equity General Fund (70,906) (62,080) Total Taxpayers’ Equity (70,906) (62,080)

Page 13

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Agenda Item: GB 18/121 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 30th January 2019

Title: CCG Financial Control, Planning and Governance Self-Assessment Q3

Reviewed by Committee/Date: Information  Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

EXECUTIVE SUMMARY:

The Financial Control, Planning and Governance Self- Assessment template has been designed by NHS England in conjunction with the Financial and Resilience Working Group (FRWG). The purpose of the template is to provide assurance that there are adequately designed and effective financial controls and governance processes in place to mitigate risk.

The self-assessment is designed to consider the overall control environment and covers financial control, planning and governance.

The assessment is required to be submitted to NHS England Area Team on a quarterly basis, reported to the next available CCG Governing Body meeting and will be used as an indicator of risk.

Q3 shows an improvement in the area of system wide performance, as all three main Providers are now forecasting achievement of control totals with all known risks mitigated across the place.

NEXT STEPS:

The self-assessment for quarter 3 2018/19 was submitted to NHS England Area Team on 10th January 2019 in line with the national timetable. It is to go to Audit Committee for endorsement on the 6th February 2019.

The self-assessment will be reviewed by the CCG and submitted to NHS England on a quarterly basis in line with NHS England reporting requirements and will be submitted to Audit Committee for subsequent endorsement and Governing Body for information.

RECOMMENDATION:

The CCG Governing Body is asked to:

(a) NOTE the CCG quarter 3 2018/19 CCG Financial Control and Governance Self– Assessment

2 Period Q3 <