Virtual Governing Body

To be held on Thursday 4 March 2021

From 1pm until 3.30pm

VIRTUAL GOVERNING BODY To be held on Thursday, 4 March 2021 at 1pm A G E N D A

Ref Item Enclosure Led By Action Required 1. Apologies for Absence Verbal Dr Crichton For noting

2. Declarations of Interest Verbal All For noting

3. Minutes of the meeting held on 4 February Enc A Dr Crichton For approval 2021

4. Matters Arising not on the Agenda Verbal Dr Crichton For discussion

5. Notification of Any Other Business Verbal Dr Crichton For discussion

6. Questions from Members of the Public Verbal Dr Crichton For discussion (See our website for how to submit questions – required in advance)

7. Patient Story Verbal Dr Crichton For discussion

Strategy

8. Learning Disabilities Strategy Enc B P Tarantiuk For approval

9. Equality & Diversity Annual Report Enc C L Devanney For approval

Assurance

10. Quality & Performance Report Enc D A Fitzgerald For noting and • Spotlight Report on Living Well A Russell

11. Finance Report Enc E H Tingle For noting

12. Chair & Chief Officer Report Enc F D Crichton For noting

Items to Note

13. Integrated Care System CEO Report Enc G D Crichton For noting

Receipt of Minutes

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Ref Item Enclosure Led By Action Required 14. Receipt of Minutes Enc H D Crichton For noting

• Executive Committee – Minutes of the meeting held on 20 January 2021. • Engagement & Experience Committee – Minutes of the meetings held on 3 December 2021. • Primary Care Commissioning Committee – Minutes of the meeting held on 10 December 2020.

15. Any Other Business Verbal Dr Crichton For discussion

16. Date and Time of Next Meeting For noting Thursday 1 April 2021 at 1pm

Governing Body Quorum is 6 Members: Chair or Vice Chair, at least 3 Clinical Members and Chief Officer or Chief Finance Officer

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Minutes of the Virtual Governing Body Thursday 4 February 2021 at 1pm

Members Dr D Crichton NHS Doncaster Clinical Commissioning Present: Group (CCG) Chairman (Chair) J Pederson Chief Officer H Tingle Chief Finance Officer A Russell Chief Nurse Dr E Jones Secondary Care Doctor P Wilkin Lay Member S Whittle Lay Member Dr M Khan Locality Lead, Central Locality Dr M Pieri Locality Lead, North Locality Dr R Kolusu Locality Lead, East Locality Dr M Pande Locality Lead, South Locality

Formal A Fitzgerald Director of Strategy and Delivery Attendees L Devanney, Associate Director of Corporate Service & Present: HR A Goodall Healthwatch Doncaster Representative

In J Satterthwaite PA to Chair and Chief Officer (Minute attendance: Taker) J Telford Healthwatch Doncaster (Item 7 Patient Story) E Price Head of Strategy & Delivery – Children’s (Item 11 Performance Report) K Featherstone-Bennett Doncaster Council (Item 11 Performance Report) D Woodcock Performance & Intelligence Manager (Item 11 Performance Report)

Action 1. Apologies for Absence

Apologies were noted from:

• L Tully, Lay Member • Dr R Suckling, Director of Public Health • P Holmes, Doncaster Council Representative

2. Declarations of Interest

The Chair reminded Governing Body members of their obligation to declare any interest they may have on any issues arising at Governing Body meetings

which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).

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

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups:

None declared.

Declarations of interest from today’s meeting:

None declared.

3. Minutes from the Previous Meeting held on 3 December 2020

The minutes of the meetings held on 3 December 2020 were approved as a correct record.

4. Matters Arising not on the Agenda

There were no Matters Arising.

5. Notification of Any other Business

There was no notification of further business to discuss.

6. Questions from Members of the Public

There were no questions received from the Public.

7. Patient Story

Dr Crichton informed the Governing Body that the Patient Story will be discussed in Item 11 as part of the Starting Well Spotlight Report.

8. Climate Commission Report

In September 2019, Doncaster Council declared a Climate and Biodiversity Emergency and the Team Doncaster partnership of organisations set up a local Commission to advise on targets and actions for the borough as a whole in response to the threat of climate change.

Doncaster Climate and Biodiversity Commission has concluded that Doncaster is already experiencing the impact of climate change, and that the impact is likely to escalate dangerously over the coming years and decades unless

radical action is taken. Doncaster will need to act fast to reduce the likelihood of harm (mitigation) and to prepare to be resilient for changes in the climate that are already making an impact (adaptation).

The main area where action is needed is to reduce greenhouse gas emissions in Doncaster or related to Doncaster. The Commission considers that Doncaster must be very ambitious and aim to be ‘net-zero’ in greenhouse gas emissions by 2040 – this is also the target for Sheffield City Region and is 10 years ahead of the Government’s own 2050 target. In looking at the net-zero target for Doncaster, the Commission considered the local changes necessary across seven themes:

• Housing and Buildings • Energy • Transport and Travel • Land use, biodiversity and carbon storage • Food • Business and Enterprise • Resources and Waste

There were also four cross-cutting themes that emerged through the discussions:

• Fairness – no one should be unfairly disadvantaged • Responsibility – must be shared between national government, local institutions and businesses and individuals • Inclusion – we need to involve everyone • Changing behaviours – we need to make better decisions and choices

Some of the changes that need to be made will be very large scale and very costly, beyond Doncaster’s current resources. Government will need to make significant investments and enable money from other sources to be available to Doncaster. There will be some difficult choices and decisions to make. However, the Commission found lots of evidence to suggest that changes we need to make for the climate can also benefit the quality of our lives, providing us with better physical and mental health, stronger communities, and a greener cleaner environment. There is already good progress in some areas, and there is much more that we all can do now.

Recommendations for Team Doncaster

Vision: Doncaster will deliver its contribution to the regional, national and international effort to tackle the climate change emergency, creating a stronger economy, a sustainable natural and built environment, and a better quality of life for residents and for future generations. Doncaster should aim for net-zero greenhouse gas emissions by 2040.

All of Doncaster’s institutions, businesses and communities should aim to:

• Play its full role in local, regional, national and global responses to climate heating • Limit emissions within a carbon budget based on science and national or international protocols, updated as necessary • Reach a point where net-zero emissions can be achieved and maintained, by 2040 • Aim for 85% reduction in net greenhouse gas emissions from 2005 levels by 2030 or an approximate 13% - 14% annual reduction • Have systems in place that allow us to monitor and report on progress across the borough towards net-zero • Use ever-developing evidence (including from the community) to update climate plans on a regular basis • Develop the structures to govern our climate plans, hold those delivering the plans to account, and promote the engagement and participation of all parts of the Doncaster’s communities. • Promote carbon- and cost-effective, socially acceptable interventions and behaviour changes that are fair and inclusive, across the eight themes • Build stronger neighbourhoods and communities that are more sustainable and resilient to climate change • Make strong links between the recovery of our natural environment with our public health, and with our economic wellbeing

L Devanney requested that the Governing Body:

• Note the full report. • Agree that NHS Doncaster CCG fully supports the vision and aims as a Team Doncaster partner.

S Whittle acknowledged that she had learned so much from the report however queried the timescales as there was of work to be undertaken if the targets are to be met. J Pederson explained that there is an expectation upon the CCG to participate as it is for Doncaster as a whole. It may be necessary to utilise external expertise as our knowledge is limited. Dr Jones added that the CCG is a significant organisation both as an employer and commissioner and we have the ability to influence organisations we commission services from. Dr Crichton highlighted some dilemmas and that unfortunately the PPE used by the NHS is not biodegradable but is necessary during the COVID-19 pandemic.

The Governing Body:

• Noted the full report. • Agreed that NHS Doncaster CCG fully supports the vision and aims as a Team Doncaster partner.

9. Audit Committee Terms of Reference

L Devanney presented the Audit Committee Terms of Reference for approval by the Governing Body. They were reviewed in detail by the Audit Committee at its meeting on 10 December 2020 and there are no removals or inclusions to draw to the attention of the Governing Body.

The Governing Body approved the Audit Committee Terms of Reference.

10. Emergency Preparedness, Resilience and Response Policy

L Devanney presented the reviewed and updated Emergency Preparedness, Resilience and Response Policy to the Governing Body for approval.

The framework had been reviewed to address a recommendation from the Internal Audit Head of Internal Audit Stage 1 Report. The key change is summarised as follows:

• Section B – Emergency Planning Procedure. A new paragraph (3.4) has been included on page 14 to document that depending on the nature of the emergency, a coordinated planning and response approach at Doncaster Place level may be required to co-ordinate activities and facilitate co- operation between local organisations.

S Whittle asked how the policy is able to stand up against the pandemic and floods and was informed that the document has been tested many times and a Partnership approach had worked very well.

The Governing Body approved the Emergency Preparedness, Resilience and Response Policy.

11. Quality and Performance Report

A Fitzgerald presented the Quality & Performance Report for noting by the Governing Body.

A Fitzgerald informed the Governing Body that the vaccination programme is working well. There 5 vaccination sites in Doncaster and 2 hospital hubs delivering COVID-19 vaccines. Over 43,000 people, including the majority of our care home residents and those over 80 years of age have received their vaccinations and we remain confident that we are on track to achieve our target by 15 February 2021. Credit should be attributed to all organisations and our army of volunteers. Dr Crichton highlighted that the programme would continue for several months and will form part of the Performance Report going forward.

Dr Pieri gave the following update in respect of cancer 2 week waits:

• There has been a deterioration in the cancer 2 week waits performance particularly breast. October and November noted the highest peak in COVID-19 and this resulted in the system being under immense pressure which impacted on both staff and patients. Patients are in clinic for long periods of time for scans and tests etc and the logistics of maintaining COVID-19 safety, social distancing and cleaning in the clinics are challenging. Breast care in Doncaster is something we should be proud of and we are working with the Cancer Alliance to ensure patients with the highest risk are seen as soon as possible by mutual aid.

• A Rapid Diagnostic Centre is being developed in Doncaster which will be instrumental in undertaking CT scans of the thorax as part of the Lung Health Check programme. • The Cancer Alliance is facilitating a mutual aid arrangement across South Yorkshire and Bassetlaw.

Dr Crichton re-iterated the importance of a South Yorkshire & Bassetlaw approach to cancer treatment.

P Wilkin queried if there was a specific reason why the Referral to Treatment in specialties is below the England average. A Fitzgerald explained that there is no explanation however specialties are keen to explore what can be done. Guidance has just been received regarding the prioritisation of all patients who have had their appointments cancelled or delayed and they will be contacted by the Acute Trust in due course.

Patient Story

J Telford explained that the focus of the Patient Story was Social, Emotional and Mental Health (SEMH) for schools and detailed the experience of a 13 year old female as follows:

• The patient experienced emotional difficulties which impacted on her behaviours. • She attended mainstream school up to January 2021 and is now attending a special school. • The patient was referred by her GP in 2019 to Doncaster Child and Adolescent Mental Health Services (CAMHS). • Services accessed Core CAMHS, family therapy and SEMH. • Pending referral for the Social Communication pathway. • Face to face sessions were held at the East Laithe Gate Centre(ELG) • Family therapy sessions were completed. • SEMH input/discussions were held last year and now discharged. • Telephone contact was held during COVID-19. • The ID (Intellectual Disability) nurse for CAMHS now involved- will be visiting every three weeks in school. • The patient felt that the East Laithe Gate Centre was ‘alright’ and was ‘Happy to be seen in school’. • When asked if it was it helpful felt it was ‘half and half, it helped my problem’. ‘I think it helped my family’. ‘I am happier than I was 2 years ago’. • A quick response was received from the GP referral. • The patient was apprehensive but accepted there was a need. • CAMHS- ‘Brilliant from Day 1, they have been a great help and still are’. • ‘Family therapy sessions helped as I could offload, they put me at ease and allowed me to share what I might not share with family’. • ‘I was struggling, did not know what to do, they helped me understand the issues and gave me strategies’. • ‘They have been a great help for me, definitely’ • The patient was apprehensive about the referral.

• The first 2 sessions were difficult ‘talking about my problems’. • ‘There was no contact during lockdown, there was an option to ring them but would have liked some contact’. • ‘I would have liked to have talked to someone’. • The family member felt that the family therapy sessions in ‘lockdown not good’. Sessions were less often and by phone. • More regular sessions would have been helpful, cancellations due to COVID-19 and personal issues left long gaps.

The patient’s current situation

• In answer to what was the best thing the service has done - ‘Moved me to a new school’. • The school transfer was facilitated by school and CAMHS. • ‘I am happy I am in a new school, I have got friends’. • Introduction to new counselling service completed at home (before Christmas in PPE, happy with the visit). • The young person will be having regular visits from ‘a new nurse at school, I like her’.

J Pederson stated that the Governing Body has received previous patient stories relating to the CAMHS service and the strategies they provide and queried if they are something that could be taught in schools to help young people manage if needed. E Price advised that we are currently working with schools on this.

Dr Crichton thanked J Telford for attending the Governing Body meeting.

Spotlight Report – Starting Well

E Price and K Featherstone-Bennett gave a presentation on the Starting Well Delivery Plan with a focus on the following areas:

• Neuro Pathway updates o Since April there are longer waits regarding Attention Deficit Hyperactivity Disorder (ADHD) o Children are waiting longer for assessment of ADHD o 43% waiting in April (less than 18 weeks incomplete) o 16% waiting in October (less than 18 weeks incomplete)

• SEMH o There has been an increase in cases attending A&E during first lockdown. A number of presentations attending A&E between May and November 2020. o A SEMH group was established May 2020 o No data recorded in this detail before o Multi Agency meeting o Cases began to rise as first lockdown was coming to an end

• The SEMH Themes Group and Wider discussions o Increase in pressure within Schools o Staff sickness o Lack of pastoral support o Issues re-entering schools o Children sent straight to A&E • Recommendations • Strategic Intent • Next Steps • Higher level priorities

S Whittle reported that the Engagement & Experience Committee has noted that more information is required for GPs regarding CAMHS and asked if a date had been arranged for a discussion to be held in one of the TARGET sessions. E Price advised that a video can be shared with GPs and School Nurses and how different services may link in and refer.

P Wilkin queried how patients are signposted to services when they attend A&E. E Price reported the CAMHS clinicians are based in A&E. This demonstrates the multi-disciplinary rather than a medical approach. There is a link between CAMHS and Acute Paediatrics with a meeting being held on a 2 weekly basis attended by colleagues from Doncaster Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) and Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH). It is very much a community model.

J Pederson commented that there has been some challenge regarding the funding of the Young Advisors service and we need to use this a evidence the service is so successful.

Dr Crichton stated that there are real concerns regarding the impact of COVID- 19 on Children & Young People’s Mental Health as it is difficult for them to cope with no face to face interaction at school and with friends.

A Fitzgerald emphasised that a lot of work has continued during COVID-19 and focus will be maintained during planning for the forthcoming year. Team Doncaster was presented with education and skills strategies and one action is to improve mental health in schools and consider how this may become part of the curriculum.

Dr Crichton thanks E Price and K Featherston-Bennett for attending the Governing Body meeting.

The Governing Body noted the Quality and Performance Report.

12. Finance Report

H Tingle presented the Finance Report for noting by the Governing Body. It set out the financial position as at the end of December 2020 and the forecast for the year end.

The CCG has been working with an interim financial regime for April – September (Month 1-6) due to the Covid-19 pandemic and is now under a new regime for the remainder of the year.

The CCG is showing a positive variance of £3m against its deficit target of £1.3m and the same forecast. This is after the assumption that the funding for the Hospital Discharge Scheme for Months 7-9 is awarded which equates to £1.2m.

Finance colleagues have been reviewing the forecast position in detail following the agreement to fund the Month 6 top up variance in full. After further review there are two main areas where the CCG has a positive variance, these are Prescribing £2m and Service Development Funding (SDF) £0.9m. The CCG was prudent in its assessment of the prescribing costs at Month 6 due to the fluctuating and volatile spend incurred up to the end of July. Now the actual data has been received up to the end of October the actual costs are lower than expected and it is felt that this will continue to the end of the year.

For both these items NHS England had indicated that there could be clawback of unspent funds and that this would be kept under close review, the CCG therefore felt it was appropriate to notify NHS England of these underspends should they wish to claw this funding back as the CCG does not require it. If NHS England claw back this funding, then the CCG will be on target to deliver the £1.3m deficit target as per planning.

Included in the plan for Month 7- 12 is an expectation of delivering Quality Innovation Productivity and Prevention (QIPP) of £3.2m across numerous budget lines including Continuing Health Care (CHC), Prescribing and running costs. Detailed schemes have not necessarily been developed in all areas but monitoring of actual spend against plan is demonstrating that the expenditure is being contained within the budget set, and therefore the QIPP is being delivered. Work is underway to assess baselines as we move into 2021/2022 and start to think about planning.

When completing the plans for Month 7-12 several risks were identified regarding the following:

• Risk of top up funding not being agreed for the Month 6 position – this has now been approved so is no longer a risk. • Risk of the additional funding assumed in planning not being forthcoming – the CCG has received some of the Primary care funding and the Additional Roles Reimbursement Scheme (ARRS) spend is being reviewed on a monthly basis.

• Risks around delivery of a balanced position for Month 7-12 including risk of overspends in areas such as Individual Placements, CHC and Prescribing – the forecasts have been reviewed in detail and the spend is being managed within overall budgets. • Risk around delivery of QIPP savings – there are no pressures in the areas identified for QIPP and therefore it is assumed that this is being delivered • Risk of further COVID-19 spikes impacting on the ability to break even or incur additional unfunded costs – although the pandemic is still ongoing this is not impacting on the CCG’s financial position at this time.

The CCG therefore considers that the above risks are significantly reduced, and that the year end target will be delivered. The only risk is around the clawback of the surplus but this does not adversely affect the CCG’s achievement of the target.

Dr Jones acknowledged that the current position was unexpected. He asked how much of the Prescribing surplus is fortuitous and due to good management and prescribing practice; the CCG deserves to retain it if this is the case. Dr Jones also queried if the SDF is constrained for use in SDF or if it could be used for Referral to Treatment.

H Tingle reported that the SDF is given for specific purposes therefore there is less flexibility. We were informed to forecast our expenditure we could revisit the prescribing incentive schemes to ascertain how they are working.

P Wilkin enquired if there has been any implications that if a surplus is made, we will be asked to contribute to towards the national position or if we may carry it forward to the next year. We have been informed to roll over existing financial arrangements to Quarter 1. We are in the process of developing the Finance Plan for 2021/2022 and this will inclusive of all elements and risks.

Dr Crichton stated that we are currently in a more positive position however this could change between now and the end of the year.

The Governing Body noted the Finance Report.

13. Governing Body Assurance Framework 2020/2021 Quarter 2 Update

L Devanney presented the Governing Body Assurance Framework 2020/2021 Quarter 2 Update to the Governing Body for approval. The following key changes were presented to the Audit Committee on 10 December 2020:

• CO2 (2.2) – The consequence has been increased from 3 to 4 to effect the changes of moving into Wave 2 of the pandemic and winter pressures combined with system capacity to manage demand and maintain quality. This risk remains high. • CO3 (3.1) – both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and transformational expenditure. Following the notification of the allocations and the financial

framework, a revised financial plan has been developed. This risk has increased from high to very high. • CO3 (3.2) - both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and efficiencies. There is significant risk built into the revised financial plan which looks at efficiency savings across both CHC and prescribing. This risk has increased from high to very high. • CO3 (3.3) - both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and the system control total/affordability. The ICS are developing risk share arrangements across the system in the event of any Organisation not achieving its control total. This risk has increased from high to very high. • CO3 (3.4) - both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and the CCG control total. The CCG have agreed with the ICS that the CCG have an underlying £1.8m of unmitigated risk in our plan. This risk has increased from high to very high.

The Governing body noted the Governing Body Assurance Framework 2020/2021 Quarter 2 Update.

14. Quarter 2 2020/2021 Corporate Assurance Report

L Devanney presented the Quarter 2 2020/2021 Corporate Assurance Report for noting by the Governing Body. It was previously presented to the Audit and Executive Committees.

The Governing Body received and noted the Quarter 2 2020/2021 Corporate Assurance Report.

15. Chair & Chief Officer Report

Dr Crichton presented the Chair & Chief Officer Report and commented that a lot had occurred in the last two months. The following points were highlighted:

• CCG Response to Proposals: Integrating Care - Next steps to building strong and effective integrated care systems across England On the 26 November 2020, the NHS Improvement / NHS England Management Board considered options around the proposals for legislative reform, including giving ICSs a firmer footing in legislation which will likely take affect from April 2022. There was a 6-week engagement period and as part of this process the CCG Governing Body considered the proposals and provided a collective view. A report is expected by 10 February 2021. • Vaccination Programme Over 30,000 Covid-19 first dose vaccinations have been successfully administered in Doncaster. Doncaster is on track to deliver first dose Covid- 19 vaccinations to the majority of Priority Groups 1-4.These cohorts are:

o Care Homes Residents and Staff

o Population over age of 70 o Frontline Health and Care Workers o Clinically extremely vulnerable people

Dr Crichton extended his thanks to all those who had been involved in the programme including vaccination site staff, CCG staff, Local Authority colleagues and our army of volunteers. J Pederson added that Voluntary Action Doncaster has provided fantastic support and it has been real team effort across Doncaster.

The Governing Body noted the Chair & Chief Officer Report.

16. Integrated Care System CEO Report

Dr Crichton presented that Integrated Care System CEO Report and highlighted that there has been an improvement noted in the finances across South Yorkshire & Bassetlaw.

P Wilkin queried the capital slippage and asked if their plans had been shared. H Tingle advised that there were no concerns and that it related more to provider expenditure.

The Governing Body noted the Integrated Care System CEO Report.

17. Receipt of Minutes

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

• Audit Committee – Minutes of the meeting held on 10 September 2020. • Executive Committee – Minutes of the meetings held on 21 October, 18 November and 16 December 2020. • Engagement & Experience Committee – Minutes of the meeting held on 5 November 2020. • Public Primary Care Commissioning Committee – Minutes of the meeting held on 12 November 2020. • Joint Commissioning Management Board – Minutes of the meeting held on 17 September 2020.

18. Any other Business

Dr Crichton informed that Governing Body that W Feirn, retires at the end of February 2021 and has been in the NHS since 1979. He wished her well in her retirement. Dr Jones concurred and thanked her for her hard work with the Quality & Patient Safety Committee.

19. Date and Time of Next Meeting

Thursday 4 March 2021 from 1pm.

Meeting name Governing Body Meeting date 4 March 2021

All Age Strategy for People with Learning Disabilities and /or Autism Title of paper (2021 - 2024)

Executive / Anthony Fitzgerald, Strategy and Delivery Director Clinical Lead(s) Paul Tarantiuk, NHS Doncaster Clinical Commissioning Group, Strategy and Delivery and Manager

Author(s) Julia King, Doncaster Metropolitan Borough Council, Commissioning Manager, Public Health, Leisure and Strategic Commissioning

Status of the Report

To approve X To consider / discuss

To note

Purpose of Paper - Executive Summary

The purpose of this report is to seek agreement of the refresh and note the progress made to date of the All Age Strategy for People with Learning Disability and / or Autism.

The strategy was developed and refreshed in partnership with Doncaster Council, NHS Doncaster CCG, representatives of the Voluntary, Community and Faith sector including Autism Plus and Choice for All Doncaster (ChAD), people with lived experience, their families and carers and staff who work in the respective areas relating to the Strategic priorities.

The strategy addresses the key priorities as identified by the people with lived experience of Learning Disability and / or Autism, national guidance, policy, and emerging evidence.

The impact of COVID-19 has been significant for society. For many people with a Learning Disability and/or Autism and their families and carers, COVID-19 presents an even greater challenge, from social restrictions, greater caring responsibilities with less support, and the emerging evidence of increased risks from COVID-19 faced by those with either Learning Disability or Autism.

Through the engagement processes, people with lived experience, their families and carers identified areas of work that will make a positive improvement to their lived experience and expressed outcomes and identified areas of greatest importance. Stakeholders from all partner organisations were engaged and agreed the priorities set, with plans informed by underpinning evidence, national policy, and guidance.

The 5 key priority areas identified by stakeholders for development are • Diagnosis of Autism • Education and Inclusion

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• Employment. • Carers and Short Breaks • Housing and support

Three cross cutting themes are also being addressed across plans: • Health Inequalities • Young People in Transitions • Transforming Care

Key national policy and guidance, and the emerging evidence that informs the strategy and plans are referenced below.

Both the Learning Disability Partnership Board and the Autism Partnership Board have provided oversight of the emerging plans and their implementation, providing challenge and support where needed.

The strategy refresh addresses the emergence of COVID-19 during 2020 and recognises the inequitable impact the pandemic is having on people with Learning Disability & Autism, and from Black and Minority Ethnic (BAME) groups. Building on existing approaches, the Strategy outlines plans with key stakeholders and partners to reduce the disproportionate impact for these groups of people.

This strategy refresh provides Doncaster Council and NHS Doncaster CCG with assurance that positive progress has been made on the delivery of the Strategic Plans. The “all age” approach ensures improvement in the experience of people in a life transition and embeds aspiration for equal citizenship from an early age.

The plans align with the Doncaster Place Plan, are supported by the Joint Commissioning Strategy, and revised in light of emerging evidence (for example the Strategic Housing Needs Assessment) and regular challenge and update from people with lived experience through the Learning Disability and Partnership Boards.

Launching the strategy will provide the opportunity for partners to note the progress made so far, celebrate success and continue to deliver the plans to meet the needs of local people.

Recommendation(s) Governing Body is asked to:

1. AGREE the strategy and the identified priorities 2. NOTE the progress made to date

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

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Impact analysis To note -To be considered as part of business case development linked Quality impact to service reconfigurations.

Doncaster Council have completed A Due Regard Statement in accordance with development of the strategy and key principles. Decision makers must consider duties under the Public Sector Equality Duty at s149 of the Equality Act 2010. The duty requires Public Sector organisations when exercising their functions, to have ‘due regard’ to the need to eliminate discrimination, harassment and victimisation and other conduct prohibited under the Act, and to advance equality of opportunity and foster good relations between those who share a ‘protected characteristic’ and those who do not share that protected characteristic. Tick relevant box Equality An Equality Impact Analysis/Assessment is not required for impact this report. An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate X Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Equality impact assessments will need to be completed as part of any business case developments linked to service reconfigurations.

To note - To be considered as part of business case development linked to service reconfigurations.

Development of the strategy identified potential demand and pressure areas for services until 2024:

• An ageing population with increasing numbers of older people living with learning disability and / or autism • Increasing number of younger people with complex health and care Sustainability needs impact • Carers providing greater levels of care, who need increased availability and choice of Short Breaks options • Young people with autism reaching adulthood and eligibility for a social care assessment • Significant numbers of people currently living at home with ageing carers. • Increasing need for support and greater access to health and wellbeing services

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To note - To be considered as part of business case development linked to service reconfigurations.

It is estimated that the Council and CCG currently spend around £62m on services/support specifically provided for people with learning disabilities, autism or both, the Council around £31m and the CCG over £31m. A more detailed breakdown of this spend is provided in Table 3 in the Strategy Document (page 13).

Currently 43% of the total budget spent on residential care, and a further 33% on supported accommodation.

Financial Relatively small amounts of funding are spent on short breaks to support implications people living within their family home or Day Opportunities and 6% of the total spend is allocated via direct payments. Through delivery of the strategy there is a need to improve understanding of the kinds of support being provided via direct payments.

There are no financial implications which can currently be quantified arising from implementation of the strategy.

There may be financial implications during delivery of the strategy if service reconfiguration or development is proposed; any such financial implications will need to be considered at the time in accordance with seeking relevant approvals

The Autism Act 2009 created a statutory duty for the development by central government of a national strategy for meeting the needs of adults with autism, and statutory guidance to local authorities on the implementation of the strategy. The 2009 Act states that the guidance should be treated as guidance issued under section 7 of the Local Authority Social Services Act 1970, which requires local authorities in exercising their social services functions, to follow the guidance issued by Secretary of State. The strategy is compliant with the statutory guidance issued by the Secretary of State.

The Care Act (2014) describes roles and responsibilities of statutory organisations in the care and support of the people that it serves. Engagement and involvement of stakeholders is needed to ensure the Legal needs and outcomes of local population is understood, and ensure the implications challenges facing organisations to promote quality and sustainability are also understood.

Health inequalities experienced by people with learning disabilities and autism (LD&A) has been brought into sharp focus through the emergence of COVID-19. There is a range of factors that impact on people with of LD&A that mean they are up to 3.6 times greater risk of dying from the disease than the general population. (Public Health England 2020). Housing, access to information, timely medical care, and pre-existing health conditions are some of the issues the strategy and plans need to address to reduce this significant inequality for this group of people.

Similarly, people from Black, Asian and Minority Ethnic (BAME) groups are

Page 4 of 9 at significantly higher risk of mortality from COVID-19 than the wider population in general, and white British population in particular. Rates differ between ethnic groups, with men from black ethnic groups at greatest risk, which differs from previous years where black and Asian group’s all-cause mortality was lowest.

The strategy provides focus on the needs and experiences of people from BAME backgrounds. A plan will be developed to understand the specific groups impacted, and the actions needed to address the risks, working with, and driven by the affected communities, in partnership with the Minorities Partnership Group and colleagues in Public Health.

Understanding and addressing the risks faced by people by COVID-19 is crucial for all work plans across all priority areas and groups. Work is ongoing to ensure all plans are reviewed in light of emerging evidence, national guidelines, and best practice, with impact being monitored through regular and frequent Public Health, and multiagency forums including the Doncaster LD Quality Cell.

The National Transforming Care Programme has focussed on people living in secure hospitals/rehabilitation units, or at risk of hospital admission and has set very clear targets for people to be resettled into community settings. Progress has been made to support people into their own homes with appropriate support to meet their needs; with plans in place to move more people into specialist housing and support in 2021/22.

Building the right support and associated national service model (2015) (LGA, ADASS, NHSE) heralds that people with LD&A should expect, as people without a learning disability or autism expect, to live in their own homes, to develop and maintain positive relationships and to get the support they need to be healthy, safe and an active part of society.

Personalisation is a key concept to be realised within the LD&A Strategy delivery. Making It Real (TLAP 2018) describes a framework and a set of statements describing what good, citizen-focussed, personalised care looks like from the point of view of people themselves. Through the ongoing partnership working, delivery of the strategy will continue to embed personalisation in the support offers available for people, to enable them to live their best life.

Carers (UK) Caring behind closed doors: six months on - The continued impact of the coronavirus (COVID-19) pandemic on unpaid carers, identifies the challenge that they face, as more carers are now providing more care than a year ago, as services closed and the needs of the person they care for have changed as a consequence of the pandemic. 79% of carers reported they have either not had a break or have had insufficient breaks from their caring responsibilities.

The Shared Lives provider is working to expand its offers across short breaks. The Provider has secured additional funding to support the expansion plan to recruit additional carers and make successful placements. A strategic review of the Shared Lives model is also underway to ensure that the Doncaster offer provides the best opportunities for local

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people.

NHS Plan (2019) makes a commitment to provide more resources to support people in their communities, improve diagnosis waiting times and the NHS employing more people with learning disabilities or autism.

The Autism Act (2009) placed a duty on Government to produce a National Strategy for adults with autism, which was first produced in 2010 along with statutory guidance. Statutory duties arising from this Act, access to a diagnosis, raising awareness of autism, access to an assessment and services, and support into employment.

The National Autism Strategy (2015) is due to be revised and will include children in the next edition. Plans arising from this strategy will be reviewed once the new national Autism Strategy is published.

Management of None identified Conflicts of

Interest NHS Doncaster CCG alongside DMBC, agreed to undertake a revised LD and Autism strategy in late 2018. It was agreed that a significant component of this work would be the production of an Engagement Strategy for people with a learning disability, autism or both. This work was undertaken in three stages:

Stage 1: Co-production of the materials for the engagement strategy. NHS Doncaster CCG, Speakup and Inclusion North worked with key partners and Experts by Experience from Choice for All Doncaster (ChAD), Doncaster Parent Voice, Family Carers and the Strategy and Performance Unit within Doncaster Council.

Stage 2: Consultation / Engagement with people with learning disabilities, autism or both, family Engagement carers and staff. (internal Engagement Sessions: 12 Engagement Sessions were held with a total departments, of 123 people attending. The sessions were attended by people with clinical, learning disabilities, autism or both, family carers. stakeholder and members of staff public/patient) Online Questionnaire: Three questionnaires were created (one for people with learning disabilities, autism or both; one for family carers; one for members of staff). 145 people completed the online questionnaires (78 people with learning disabilities, autism or both; 45 family carers;18 members of staff) Engagement via focus groups, events involving the communities, LD and Autism Partnership Board, via online and paper questionnaires and through peer support stories. Choice for All Doncaster (CHAD) has 700 peer members and SpeakUp has over 100 members of people who live in Doncaster who have lived experience of a Learning Disability and/or autism.

Stage 3: Analysis of results.

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Following engagement and consultation with people with lived experience, five priority work streams were established, reflecting the key priorities agreed with all stakeholders:

• Diagnosis of Autism • Education and Inclusion • Employment. • Carers and Short Breaks • Housing and support

Over past 18 months, significant work has been progressed, and these areas remain priorities within the refreshed strategy. The Strategy document provides a brief ‘You Said, We Did, Next Steps’ overview for each of the five areas, with plans being regularly updated and revised as the work progresses.

In addition, three cross cutting themes which reflect key concerns of people with Lived Experience were also prioritised, and to be considered within all work-streams:

• Health Inequalities • Young People in Transitions • Transforming Care

Significant progress has also been made to deliver against each of the 3 cross cutting themes, as each of these areas are considered in the 5 work plans, with brief updates also available within the Strategy Refresh Document and next steps identified.

Throughout 2020 the objectives of the strategy were progressed through the five work streams and three cross cutting themes with progress updates reported through the Living Well Delivery Plan reporting process.

In September 2020, the Adult Social Care Commissioning and Contracts Team was reorganised into separate Operational and Strategic commissioning functions. Strategy Development and leadership moved to the emerging Strategic Commissioning Team under the Directorship of the Director of Public Health.

The reorganisation and change of leadership provided a timely opportunity to review and refresh the strategy, plans, and governance for the next 3 years.

The refresh takes account of revised and updated national policy and guidance relating to people with learning disability and autism, progress made so far in the implementation of the strategy’s work plans, and the emerging evidence relating to COVID-19 pandemic on people with learning disability, autism and people from black and minority ethnic groups.

Regular updates against progress are provided to and discussed at both the Learning Disability Partnership Board and the Autism Partnership Board.

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Draft Strategy presented at: • Health and Wellbeing Board • Autism and Learning Disability Partnership Boards Report • Joint Commissioning Operational Group previously • Doncaster Integrated Care Delivery Group presented at • Strategy Organisational Development Group • Overview and Scrutiny Committee

To note – To be considered as part of business case development linked to service reconfigurations.

If the strategy refresh was not progressed, the plans would risk being delivered against old data, and not take account of revised national and local strategy, guidance and best practice, including COVID-19 and its impact on identified groups. In addition, the Strategy would not have a formal launch.

There is a risk that the strategy is too ambitious in terms of the number of priority areas and there is insufficient capacity across health and social care to manage the work-streams and make real change. Mitigation actions taken so far include people with lived experience prioritising the areas that matter most to them, and 3 cross cutting themes being delivered through the 5 priority plans.

Identifying where work is already happening, utilising established networks and fully engaging other partners in delivery. It will also be important to find opportunities in all areas that are easy to achieve and not resource intensive. Risk analysis There is a risk that the strategy and engagement process have raised expectations which the Council, CCG and partners will struggle to meet due to resource issues. Launching the strategy with increased opportunities for people to get involved, and regular updates to the wider community on progress being made will help manage expectations while also sharing good news of progress.

National and local challenges in respect of social care and health funding will restrict the extent to which services and support can be developed with new funding. Ensuring that services are developed based on the principles of improved access to community and universal services, reasonable adjustments, and evidence based needs led developments will ensure that services offer best value for local people and the Doncaster Pound.

Supporting more people to live in their own home may for some mean more costly support packages. Housing and support must be needs led, with more people supported to access general housing, with adaptations made where needed, in line with the Doncaster Housing Strategy 5-year plan.

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Work is underway to develop a process for matching people to the appropriate housing and support based on their individual assessed needs and choices in a timelier way.

There is a risk that quality of data will continue to be problematic and hinder effective joint planning. This has been identified as a priority area within the strategy, to identify the gaps, reasons why the data is essential for planning and actions to improve the overall quality and reliability of information.

The strategy provides the impetus for the Council to ensure it is meeting its statutory duties in respect of the Autism Act 2009 and can demonstrate continuous improvement through the biennial Autism Self-Assessment Framework. There is a risk if the strategy is not robustly implemented that there will be gaps in meeting statutory duties and complying with national strategy.

The LD delivery plan which is contained within the joint commissioning Corporative proposals of the CCG and Local Authority will form part of the strategy. Objective / Assurance CO4 – Work collaboratively with partners to improve health, care and Framework reduce inequalities in well governed and accountable partnerships.

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Doncaster’s All Age Learning Disability and Autism Strategy 2021- 2024 Foreword

Raymond Humphryes - Choice for All Doncaster (CHAD)

I have been happy to be involved from the start of the Learning Disability and Autism Strategy, where we visited lots of services including day services and college, asking the views and opinions of people about what was important to them. I personally feel it is very important for people to have a voice about what is good, not so good and have the opportunity to suggest any changes they feel will help them in the future. This information needed to come from the people, as they are the experts by experience. The strategy will be there for everyone to view and make sure people’s voices have been heard.

Councillor Rachael Blake, Chair of the Health and Wellbeing Board, Doncaster Council

I couldn’t agree more with Raymond’s comments in his foreword. This strategy is for people living in Doncaster who have a learning disability, for people who are autistic and for family and friends involved in their lives who provide support where it is needed. The strategy and the actions within it are meaningless if they are not fully informed by the views of the people we are here to serve. The people we are here to serve aren’t defined by any diagnosis they have or by any services they receive. They are equal citizens with rights in every aspect of Doncaster life and who already make a powerful contribution to our Borough. Our strategy in a nutshell is to emphasise these rights and to provide more of the opportunities that are available to others who live, study and work in Doncaster. The last year has been a difficult one and Covid has affected a great many things. However I am pleased to see progress already reported against the priorities set by the Doncaster people who worked with Council and NHS leads on the strategy. There is so much more to do though. The strategy sets out our agreed priorities for the next three years and we will work with Doncaster people with a learning disability, autistic people and family carers every step of the way to ensure the words in this strategy continue to be accompanied by actions.

Final Edit

Dr David Crichton – GP, Vice- Chair of the Health and Wellbeing Board, Clinical Chair of NHS Doncaster CCG

The Coronavirus pandemic has highlighted more than ever the requirement for a more focused approach to look at the needs of people with Learning Disability and Autism. This development of a joint health and care strategy for Doncaster is vitally important. It confirms a commitment to diagnose individuals in a timely fashion, holistically assessed for care, with an ultimate goal of allowing people to lead to a fulfilling and healthy life.

Contents Foreword

1. Introduction 4

2. Outcome from Engagement Activities 4

3. What We Have Done So Far (Including ‘You Said, We 7 Did) 4. Cross Cutting Work Plans 17

5. Context 19

6. Understanding Needs 22

7. COVID-19 27

8. Doncaster Learning Disability and Autism Finances 28

9. Information and data sharing 32

10. Development of clear outcomes and Key Performance 32 Indicators (KPIs) 11. Communication and Engagement 32

12. Monitoring and Governance 33

Annex 1 - Understanding the Care and Health Needs of 34 People with Learning Disability and / or Autism in Doncaster 2021- 2024

1. Introduction Doncaster’s All Age Learning Disability and Autism Strategy 2021-2024 was jointly developed by Doncaster Council and NHS Doncaster CCG, in partnership with statutory and non-statutory partners from across Doncaster, and people with lived experience of Learning Disability and / or Autism during 2018/2019. Since the Strategy was developed and the priorities defined, five key work-streams have been set up to develop plans and progress key activities to address the five priorities, and three key cross cutting themes. The Doncaster Learning Disability and Autism Partnership Boards respectively have provided regular monitoring and challenge of the delivery, to ensure the plans deliver what people with lived experience need, want and expect from them. The partnership is making progress in delivery of the plans, and this document aims to provide an update of the context in which the Strategy is being delivered, a review of the progress being made, and outline the next steps for each of the work-stream areas.

2. Outcome from Engagement Activities In development of the Strategy, Doncaster Council and NHS Doncaster CCG commissioned SpeakUp and Inclusion North, to plan and facilitate engagement exercises to gain the views, experience and preferences people with lived experience to inform the development of the strategic plans. As part of the process, people with lived experience agreed a Vision Statement to describe the aim of the strategy and its delivery plans, with 16 underlying principles, which formed the foundation of the Strategy development. 2.1. Vision During the development of the Strategy, people with lived experience agreed to adopt the vision statement from the Transforming Care Programme, as the overarching vision for this programme: “We believe that children, young people and adults with a learning disability and/or autism have the right to the same opportunity as anyone else to live satisfying and valued lives, and to be treated with dignity and respect. They should have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives.”1 (Transforming Care 2015) 2.2. Key Principles In Doncaster, we will strive to ensure that people with learning disabilities and/or autism should: 1 Have access to a timely diagnosis in line with national guidance 2 Have a safe, happy and healthy childhood, accepted for who they are, supported to have self- worth and to develop skills and talents 3 Be encouraged to hope for the same things in life as other citizens-work, family life, relationships, own home

1 NHSE (2015) https://www.england.nhs.uk/wp-content/uploads/2015/10/service-model-291015.pdf

4 Be safe in their community and free from the risk of discrimination, hate crime and abuse 5 Should live in a family home or their own home with people they chose to live with unless there are exceptional circumstances why this can’t happen 6 Have access to a good education and learning throughout life 7 Aspire/hope to have a paid job and be supported to achieve this 8 Be supported by family carers/relatives whose own needs, rights and views have been fully considered and are supported in their caring role 9 Have equal access to good health care and be supported to live healthy lives 10 Have highly personalised support, which is built up around people’s strengths, their own networks of support and in their local community 11 Be supported to access universal and early support services, where their needs are understood, they are accepted for who they are and reasonable adjustments are made 12 Have the information they need to access social care and health services and universal services 13 Have a planned and smooth transition from child to adult life 14 Have a fulfilling and healthy later life with the same opportunities as other older people 15 Expect health and social care to work together with others to make the best of resources, working hard to achieve fully personalised support 16 Have their views and wishes in the centre of planning and shaping support

The Vision and Principles are central to the plans developed to deliver the priorities identified within the strategy. 2.3. Priorities for Doncaster Taking all the information from engagement, national and local policies and initiatives as outlined above, 16 areas of work to improve services, support and life opportunities, were identified. To ensure that progress is made on the key priorities, people with lived experience were asked to prioritise the areas that will have the biggest impact. Five areas were identified: a. Diagnosis of Autism b. Education and Inclusion c. Employment d. Needs of Carers and Short Breaks e. Housing and Support A further three areas of high importance were identified which need to be addressed by each of the work areas identified above: a. Health Inequalities b. Young people in Transitions c. Transforming Care Programme (supporting people to live their best life in the community) COVID-19 and its impact on people with LD&A and from Black Asian and minority ethnic groups will be added to the Health Inequalities plan, with an aim to reduce the impact and promote health and wellness for these groups of people.

During 2020, significant progress was made against each priority, as plans were developed and actions taken. Section 3 below, provides a summary of the key messages people shared with us, the key actions taken so far, and the immediate next steps being taken to move plans on.

The summaries are taken from the existing plans that are in place to drive forward some big changes. The plans are regularly reviewed and updated, as information and guidance change, but the focus remains on the priorities people told us were important to them.

2.4. Remaining Priorities – How They are Being Addressed.

The Strategy and subsequent delivery plans recognise the five areas as key priorities along with the three cross-cutting themes. Of the remaining eight work areas, three relate to client groups whose needs are addressed within the existing plans (older people, people with autism and people with complex needs).

Short Breaks is incorporated into the Family Carers priority due to the natural linkages and overlaps, as is the Carer Strategy refresh. Day Opportunities in part is addressed via the Family Carers and Short Breaks work and within Education and Employment.

Formal work on Early Help, Prevention and Health & Wellbeing is yet to start, significant work to address Early Help Prevention and Health and Wellbeing are being addressed elsewhere across the Council, for example through Communities and Localities.

Links across the Council and other partners exist and continue to develop to ensure that all opportunities to progress access and representation for People with learning Disability and / or Autism are made.

Following agreement of the strategy refresh, it is planned to undertake a stocktake of all plans, further identification of opportunities across the system, and alignment with existing system wide developments. This will enable a refreshed, prioritised and timetabled programme of work to be defined.

3. What we have done so far

3.1. Diagnosis of Autism The Autism Self-Assessment Framework undertaken in 2018 identified that waiting times for assessment was longer than reported in 2016 and appear to be increasing beyond the 18 weeks target. The engagement exercises identified the same issues that people are waiting longer times for assessment. People with lived experience, families and carers confirmed that for most people, a confirmed diagnosis is very important to them as it can help access the support in all areas of life, but that waiting times can be too long. Further work needs to be undertaken to ensure that diagnostic pathways are robust and work well for all, and an individualised post diagnosis support is offered.

You Said We Did Our Next Steps “Getting a diagnosis is really important, Currently 91% of children are diagnosed For Children because this can support people in all areas within 18 weeks. Ensuring that children and young people on of their life”. the autism, attention deficit disorder and We aim to further improve the waiting times other neurodevelopmental pathways have for diagnosis of Autism so that more children their needs identified and met in a are diagnosed within 18 weeks. consistently timely manner and post diagnosis support is a focus for the future Over the past year, NHS Doncaster CCG “It is important to get the right information with Rotherham, Doncaster and South For Adults: and support in a way that works best for you, Humber NHS Foundation Trust (RDaSH) Once RDASH plans are approved by NHS during and after diagnosis” have been working together look at ways to Doncaster CCG, RDASH and the CCG will “It is important to get a diagnosis close to improve diagnosis of Autism for Adults. start to put their plans in place, to move home, and not to have to wait a long time for towards reducing waiting times: a diagnosis” This involved partners working together to develop and agree an action plan2 which 1. NHS Doncaster CCG to consider the included the development of clear and proposed plans in February 2021. consistent Diagnosis pathways, with post diagnosis support.

2Doncaster Council and Doncaster CCG (2020) Doncaster Autism Delivery Plan.

2. Work through how to deliver the plans The emergence of the COVID-19 pandemic by June 2021 means it has been difficult to implement the 3. Should additional workforce be changes and see more people in a required, the recruitment will be reasonable timeframe. RDaSH was able to completed by September 2021 provide a limited Autism Diagnosis Service 4. Diagnosis training will be completed until June 2020. by November 2021 5. The waiting list for Adult Autism Since July 2020 the Autism Diagnosis diagnosis to be within NICE guidance Service has reopened fully and seeing as - date to be confirmed. many people as before. Work is ongoing to reduce the waiting list.

RDaSH has now developed a plan, which describes what they need to make the improvements to pathways to diagnosis, which has been sent to NHS Doncaster CCG, and will be considered by the CCG in February 2021.

3.2. Education and Inclusion Education and Inclusion were identified as a key priority by many families during the engagement exercises. People were concerned that there is not enough provision for children with a learning disability and/or autism in Doncaster, and that more is needed to support teachers, parents and children with lived experience of learning disability and autism with stronger links to employment.

Young people in the Borough want universal access to services and opportunities across the Borough, better information sharing between partners, and improvements in how we communicate with them; this includes information on services and events available to them.

You Said We Did Our Next Steps Teachers in schools don’t always understand Children and Young People’s services In early 2021, to ensure that the graduated the needs of children with learning launched the local ‘Graduated Approach’ to response to meeting special educational and disabilities, autism or both meeting need. The Graduated Approach disability needs is delivered coherently and makes sure that teachers identify and consistently and where possible locally. remove barriers to learning that children experience, and put in place effective special Ensuring that Doncaster’s secondary schools Further work needs to happen within educational provision in order to meet their provide curricula and teaching that effectively mainstream schools to ensure all staff have needs. meet the needs of students who have SEND the knowledge and skills to support people so that they make good progress and are with learning disabilities, autism or both Pathways in place to support employability well prepared for their next stage in within education. There needs to be an and life skills for young people with severe education and future employment emphasis on making reasonable adjustments and moderate LD; and Post 19 progression, that can support children and young people integrates support with CALDT to support Whist still in the consultation phase, the 2030 to achieve. transition out of Education. Education and Skills Strategy will be a crucial strategic driver in ensuring we have an There needs to be more careers advice and In order to support children and young inclusive education system. A key cross help into work people throughout the pandemic, there has cutting principle of this work is equitable and been a focus on providing positive activities inclusive learning, as well as a focus on best over the school holidays. This has focused start, skills and pathways and a model for on face to face and virtual activities and has post 16 education. People needed to support to develop skills supported emotional health and wellbeing, and independence Work has been undertaken to ensure all these activities are inclusive, with some focused exclusively for children and young More after school activities people with SEND.

In September 2020, The Bader Academy, a new special school for children and young people with Communication and Interaction Difficulties, opened in Doncaster. The school Better transport to help children stay local aims to meet the needs of children and young people aged 5-19 years with an Education, Health & Care Plan and a primary diagnosis of Communication & Interaction Difficulties, primarily High Functioning Autism Residential school is not good for some and Asperger’s, with related Social Emotional children and Mental Health Needs.

The curriculum delivered will ensure that all children and young people attending have a flexible, personalised education that helps There needs to be better links between them achieve their potential, not just focusing education and employment, with bespoke on education but employment and employment advice and greater work independence. experience opportunities for young people to access across Doncaster. A strategy group has been set up specifically to plan for the needs of young people who There needs to be a greater focus on are moving from children’s to adult services functional skills and supporting children and and employment. The group is making sure young people to gain these skills that there are strong links between the education and employment strands of the SEND programme

3.3. Employment

Being able to secure, maintain and develop in employment is an important aspiration for people. To be able to contribute and feel valued is central to health and wellbeing. People who participated in the engagement exercises ranked this area very highly.

While there are local schemes in place, many people feel they are sometimes difficult to understand, or are not joined up. In addition, some employers may have limited understanding or awareness of learning disability and autism.

The Adult Social Care Outcomes Framework (ASCOF) requires Local Authorities to report on the proportion of adults with a learning disability in paid employment. From an identified cohort of 793 working age people with learning disabilities during the year 2019/20, 12.5% were in some kind of paid employment. Doncaster’s performance at that time was 11th highest in England and highest within the Yorkshire and Humber region.

We have no clear information on the number of people with autism (who do not have a learning disability) in paid employment. We know however, from national information that numbers do not compare favourably to the general population; the National Autistic Society reports that:

 Only 16% of autistic adults in the UK are in full-time paid employment, and only 32% are in some kind of paid work  Only 10% of autistic adults receive employment support, 53% say they want it.

You Said We Did Our Next Steps Employers need to understand learning There are significant links between the Make sure that the Children and Young disability and autism and how they can make Education and Inclusion plan (which People’s Employment Plan, Education, and reasonable adjustments to help people addresses the needs of young people Inclusion Plans are all working together. sustain their employment reaching their full potential in both education and employment) and the Employment Plan, Once the mapping exercise is complete, we Doncaster Council and Doncaster CCG need which has a greater focus on Adults, and will develop a list of all the opportunities that to take the lead on employing individuals with increasing the available opportunities for can be shared with people. learning disabilities, autism or both. Adults and Young people transitioning into adulthood and employment market. We will be working with people with lived There need to be greater opportunities experience to list where there are gaps in available to people to move into work should We have started to identify and map out all of support services so plans can be made to people wish to do this so that individuals are the schemes, opportunities and projects meet unmet support needs. not volunteering for life. provided by companies across Doncaster

There needs to be bespoke employment that will help people with learning disability or We will make links to the Your Life Doncaster support for people with learning disabilities, Autism to enter the workforce. Website to make the information available to autism or both to support people into work all, and make sure it meets the needs of We are mapping out the employment support people with Learning Disability and Autism. The culture needs to change to ensure that services available to people with learning there is aspiration to work from a young age disability and Autism. Doncaster Council and NHS Doncaster CCG and this is embedded in transition and support to work with partners to look at opportunities planning. Several Proposals are being developed to to develop internships/ vacancies and progress access to employment options, volunteering opportunities All people should be supported to make an including development of internships at economic contribution to Doncaster as this Doncaster Council and Doncaster CCG brings benefits in terms of social, cultural and health rewards. The Autism Plus Employment Support service is now offered on-line to help more More supported employment opportunities. people access the service during the pandemic, and those who struggle to get to the office. There needs to be better links between education and employment, with bespoke employment advice and greater work experience opportunities for young people to access across Doncaster.

Aspirations of children and young people should be raised with there being an expectation that children and young people with learning disabilities, autism or both will move from education into work or continue further education at university

3.4. Carers and Short Breaks

Unpaid or Family Carers play a vital role in maintaining the health and wellbeing of those they care for. Carers have the statutory right to an assessment that addresses carers' well-being, mental and physical health. If the carer has eligible needs, a support plan will be developed to meet their needs. Adult carers can access support through the Doncaster Carer Reach-Out Service commissioned by Doncaster Metropolitan Borough Council. Young or sibling carers can receive help from Doncaster Young Carers Service.

Short Breaks (sometimes called respite care) support Carers to take a break from their demanding role and responsibilities whilst the person/people they care for is looked after in an environment that is safe and comfortable for them. Respite can be provided in a residential care service, an overnight stay within a Shared Lives family household, or a break arranged with another carer or family member. For many Carers, Short Breaks involve overnight stays; however, for some Carers a break during the day might be appropriate for them.

Our aim for Carers and Short Breaks is to ensure Carers are provided with a range of equitable and flexible short breaks opportunities that meet their needs and the needs of the person they care for.

We are committed to:  Ensuring family carers are equal partners in care  Valuing family carers expertise, insight and experience and we actively promote this  Work with family carers whenever we are planning or making changes  Supporting families and carers well to enable them to maintain and uphold their vital role in caring for their family members who have a learning disability  Ensuring our short breaks offer is clear and accessible  Working together with family carers to help us understand gaps in support and to plan  Making sure that carers have the opportunity to access personal budgets giving much more choice around how they can support their loved one.

You Said We Did Our Next Steps Carers deserve a voice Carers are embedded within Learning Once the results from the Carers Disability Partnership Board and the Autism questionnaire have been received, they will Carers would like to be involved Partnership Board, which drives the carer be reviewed by the Carers Operating Group, agenda and seeking service development to make recommendations to the Short We want choice, flexibility and availability of and improvement. Breaks Work-stream to ensure the plan Short Breaks that works for my family and includes the expressed views and needs of me. carers.

Carers Action Group is now in place, and co- chaired by carers. It is a forum specifically for Completion of the strategic review of Shared carers, and reports into the Carers Strategic Lives and take forward specific actions for Oversight Group (co-chaired by Carers) to the future development of the service. share ideas, and feedback on what needs to improve for carers in Doncaster. Undertake an Equality Audit within services and identify how services could be more Carers supporting family members with LD& responsive to the specific needs of individual A were actively involved in the development communities. of a survey for carers to get their views and feedback about short break respite services on offer in Doncaster

Working with partners including the Minorities Partnership Board to take forward positive actions to increase representation of BAME communities within the Carers and Short Breaks work stream.

Ensured that Carers are actively involved with commissioning of carer services, including review of the Short Breaks work stream, actively engaged with CETR processes in Doncaster.

Review has been completed of the Short Breaks services, and development of the service is now underway.

Strategic Review of Shared Lives is underway, that will inform the best way to develop the service to meet the growing demand for community based day opportunities, short breaks and long-term placements in Doncaster.

3.5. Housing and Support

The overarching aim of the Housing plan is to make sure that there is a suitable range of accommodation and support for people with Learning Disabilities and/or Autism. Following the engagement exercises an action plan was developed, which included the following objectives: a. People with learning disabilities, autism or both should be supported to live in a home that meets their needs and choices. b. People should be supported to have relationships and friendships so people live the life they choose with the right support. c. There needs to be more focus on transition planning

You Said We Did Our Next Steps Having a home of your own and being able to We looked at the housing and support needs Put in place the arrangements needed to choose who you live with is important of people with learning disability and Autism match landlords and housing to individuals for the next 10 years, including adults who that meets their specific needs and choices. It is important to have staff with the right skills are currently living with family carers, and young people who will transition into Adult Put in place plans that will overcome the and training to support you services; and prioritised these groups in this barriers that people are experiencing in year’s planning. accessing general housing and support. It is important to have different options about where you can live - Shared Lives should be Identified all the different types of housing Match people who choose to live at Askern a real option and support options that should be available with the people they want to live with and the for people with learning disability and / or available properties and support them to It is important that plans are developed with Autism. prepare for the move with the right support. young people about where they might want We checked with local services to make sure to live in the future the information that was collected about the When you have an assessment you are needs of people for the next 3 years is right. asked if you are happy about where you live and who you live with We have planned a new development of flats in Askern for supported living for people with You get good support to have a relationship learning disability and autism that will be and have friendships available in Spring 2022.

We have started to identify those in transitions to talk to them about their choices

and preferences about what they need, and where they would like to live.

Work is underway to make it easier for people to access the type of accommodation they need and choose, and in the place, they would like to live.

We have started to look at the barriers that people experience when accessing general housing and support.

We have been working with Supported Living Providers over the past year to increase the use of technology (e.g. use of video calling) to help people maintain contact with friends and family during the pandemic, and encourage visits and activities to help people maintain safe contact when restrictions have allowed.

4. Cross Cutting work plans. Three further priorities for Doncaster identified by people with lived experience, and driven by national policy are identified below, and may need to be addressed by each of the workstreams described above. These are called ‘cross cutting themes’. An example of this, developing short breaks offers, needs to take into account how COVID- 19 secure new placements are when placements are being considered. Another area is the Housing and Support plans need to consider the needs of Young People in Transitions as part of the planning, and those in the Transforming Care may need close health monitoring. 4.1. Health inequalities People with a learning disability have poorer physical and mental health the wider community. The pandemic has made this situation even harder for communities to maintain their health and wellness and for people with LD&A and those from BAME backgrounds, this inequality is even more apparent.

There needs to be a greater understanding of learning disability and autism amongst all health and social care professionals with consistency of approach and reasonable adjustments; and family carers need to be identified and supported in delivery of health interventions.

Training should meet national standards and include findings from LeDeR* and other reviews. Individuals with lived experience should be involved in the development of this training and where possible in its delivery. Health and social care services need to be joined up and information shared appropriately. This should link to priorities in the NHS Long Term Plan and Doncaster Joint Commissioning Strategy

The Health Inequalities work aim and objectives

“We will improve health outcomes and reduce health inequalities”

Key objectives:

 Annual health checks  Task and Finish group set up to focus on increasing uptake and quality of Learning Disability Enhanced Health in Care Homes Framework Implementation ongoing

 LeDeR (Learning Disability Mortality Review) sub group  Implementing learning from national reviews

 Flagging system introduced at DBHFT  Ensuring people with learning disabilities who are admitted to hospital have access to support from the Secondary Care Liaison Nurse.

 Improved discharge pathways  LD&A Quality Cell - partnership working across Health and Social Care.

 Cancer Awareness  networking professional relationships with Health Action Teams and the South Yorkshire Cancer Alliance

4.1.1. COVID-19

The Identification of COVID-19 as a significant risk to those with Learning Disability, Autism, and those from BAME backgrounds has alerted health and care organisations that action is needed to understand the risks and, with the affected groups, develop targeted plans to reduce or manage risks.

Data released3 in November 2020 shows the devastating impact of the pandemic, with the rate of people with a learning disability dying from COVID-19 estimated to be 3 to 4 times the rate in the general population.

During 2020, Doncaster Council, NHS Doncaster CCG, RDaSH, and Doncaster Royal Infirmary, set up a daily meeting to develop guidance, implement practices and protocols for local NHS, Council and commissioned services. The meeting aimed to make sure people receiving services were kept safe, that hospital discharges were safe and monitor for any outbreaks to make sure the right support was in place as quickly as possible.

4.2. Regional Transforming Care Programme (2016-19)

Doncaster is part of the South Yorkshire and North Lincolnshire Transforming Care Partnership (TCP). The TCP has developed our area plan to reduce our reliance on inpatient specialist beds for people with learning disability. The plan is written in response to Building The Right Support and the National Service Model, which sets out the national vision to transform models of care and support for people with learning disability and autism. The plan includes: a. A robust programme of Care and Treatment Reviews for adults and Care, Education and Treatment Reviews for children b. Developing and investing in intensive community support and forensic outreach c. Dynamic risk support register which include multidisciplinary members from health, social care and police d. Addressing Health inequalities e. Transitions f. Housing and skilled support through the Enhanced Supported Living Framework

“We will do everything possible to prevent people being admitted to secure hospital and to resettle those still in hospital”

a. Meet NHS E/I inpatient trajectories b. Implementation of Forensic Outreach Liaison Service c. Implementation and review of Enhanced Community Framework d. Review C&YP pathways and transitions e. Evaluation of crisis and intensive support team Over the past 4 years, the number of people from Doncaster in locked rehabilitation, assessment and treatment units or secure hospital has reduced by 75%. More work is being

3 PHE (2020): PH England Nov 2020 COVID 19 deaths of people identified as having learning disabilities: summary. Gov.uk PH England Nov 2020 Press Release People with learning disabilities had higher death rate from COVID-19. Gov.uk PH England 2020: Beyond the data: Understanding the impact of COVID-19 on BAME groups www.gov.uk

done to increase this number further to enable them to live in the community in their own homes. The Children and Young People’s (CYP) Proactive Monitoring & Support (PM&S) group has reviewed and monitored children and young people who are at risk of concerns that may escalate into the CETR process.

The PM&S group has enabled multiagency partnership to work effectively together as a means of ensuring that CYP receive proactive care, early intervention and support that prevents their situation from deteriorating. The fundamental aim is to improve childhood experiences.

For those CYP that are in hospital, the group reviews any discharge planning as a means of reducing any potential risk within the community and to prevent further hospital admission. The PM&S group provides clear accountability and focus that will support case managers in risk assessment and care planning.

 There were no TCP CYP admissions into Tier 4 Mental Health Services during the period 2018 / 2019  A proactive approach has resulted in a reduction of responsive CETRs

4.3. Transitions The aim of transitions is “To improve the experience of young people preparing for adulthood with a timely and seamless transition into adulthood”.

Key outcomes:  Ensure Transitions are addressed in the key work-streams  Education and Inclusion – links between Education and Employment explicit within the plans. A Transition Strategy is in place.  Employment – supported to overcome barriers to education and work towards entering employment  Short Breaks – Transitions identified as a key group in need of appropriate short breaks  Housing and Support – identified as one of 3 priority groups  Transforming Care – a key priority within the housing work stream to divert from hospital or progress into supported living.

Carers have told us that the aspiration to work with the family and young person from a young age needs to be embedded in transition and support planning.

Within education, a transition strategy is now in place with direction provided by the multi- disciplinary steering group. Similar work has also been undertaken in health services. Transitions planning starts in year 9 and covers Employment, Independent Living, Being Healthy and Friends, Relationships and Community.

5. Context Doncaster’s All Age Learning Disability and Autism Strategy has been developed in the context of other key national and local policies, which inform the way in which the plans are developed and put in place. National and local plans are focussed on ensuring people are supported in the best way and to reach their health and wellness potential.

The strategy has been developed and led by people with lived experience, and reflects the national and local priorities, including (but not limited to) the key plans outlined below:

5.1. Doncaster Borough Strategy The Doncaster Borough Strategy is due to be launched in 2021, and will build on the successes of the Doncaster Growing Together Plan in delivering transformation in the wellbeing of Doncaster people and places over the next 10 years. The Doncaster Borough Strategy will focus on the local quality of life issues residents have identified through ‘Doncaster Talks’ and also the global shared challenges like the climate change and biodiversity crisis. Delivery of these plans will enable the creation of quality jobs, improving education and skills, tackling inequalities and supporting culture and creativity, and will enhance the lives of all Doncaster, including those with Learning Disability and / or Autism. Through the development of the Learning Disability and Autism Strategy, people with lived experience, families and carers also told us that those issues raised in the Doncaster Talks, including quality employment and education and skills are some of the issues that matter most to them too.

The Learning Disability and Autism Strategy has been developed in Partnership with NHS Doncaster CCG, in the context of the Place Plan, which was refreshed in 2019, and underpinned by the development of the Doncaster Joint Commissioning Plan.

5.2. Health and Wellbeing Strategy (2016-21)

A key principle within the Health and Wellbeing (H&WB) strategy is that all Doncaster residents will be able to achieve their full potential in employment, education, care and life chances. This aligns well to the vision within this document for people with learning disabilities and/or autism. The overarching aims of the strategy are to prevent disease, disability and harm, and sustain health and wellbeing through a first class health and care system.

5.3. Doncaster Place Plan The vision of the Place Plan is that “…care and support will be tailored to community strengths to help Doncaster residents maximise their independence, health and wellbeing. Doncaster residents will have access to excellent community and hospital based services when needed…”4

The Place Plan 2019 refresh provides clarity about Doncaster’s plan to prioritise, develop and deliver health and social care as an Integrated Care Partnership. The plan clearly describes moving towards a focus on people as opposed to services. This means that instead of looking at where care is delivered, the partners are thinking about local communities and their needs.

The approach and vision described in the Place Plan links well with the vision agreed by people with Lived Experience in the development of the LD&A strategy, which was adopted from the Transforming Care National Service Model:

4 Doncaster Partnership (2019) Doncaster Place Plan Refresh 2019 – 2022: www.Doncaster.gov.uk

“We believe that children, young people and adults with a learning disability and/or autism have the right to the same opportunity as anyone else to live satisfying and valued lives, and to be treated with dignity and respect. They should have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives5.” The Place Plan is being delivered through three life stages of Starting Well, Living Well and Ageing Well. Meeting the needs of people of all ages with Learning Disability and Autism is a key focus of the Place Plan and is driven through Living Well Delivery plans, and spans the three life stages as identified.

5.4. Joint Commissioning Plan

To support the delivery of the Place Plan, the Strategic Partners developed and agreed the Joint Commissioning Strategy6. The Joint Commissioning Strategy sits across both health and social care, including Public Health, for adults and children. It captures the services commissioned by both Doncaster Council and NHS Doncaster CCG, with a particular focus on the areas where we will jointly commission. Commissioners and providers agreed to plan and deliver services in a more joined up way for a number of areas, including Learning Disability and Autism. The joint approach enables Commissioners to coordinate commissioning of services, reducing risk of duplication, and ensuring that gaps in services are more easily identified and addressed. Most importantly, joint commissioning aims to ensure that people who use services, experience a more joined up and holistic approach to their care and support.

5.5. The Children and Young People’s Plan (CYPP) (2017-20) and Impact Report 2018 and 2019.

The Doncaster Children and Young People’s Plan (2017- 2020) sets out our ambition to be the most child friendly borough in the country. We have made a commitment to review its impact on an annual basis and the views of children and young people have been the foundation to these assessments. The CYPP ensures the voices of children and young people is included in all we do; ensuring all children and young people have the opportunity to influence the services they access and the support they receive was central to plan, including children and young people with SEND. 5.6. SEND Strategy

The SEND Strategy sets out a vision for children who have special educational needs and disabilities (SEND) and details a number of imperatives, which drive the ambition for children to achieve fulfilling lives. The timeliness, identification and assessment of special educational need, and the effectiveness and efficiency of collaborative planning, involves the right people at the right time in the delivery and review of the impact of this support.

5.7. Regional Transforming Care Programme (2016-19)

5 NHSE (2015) https://www.england.nhs.uk/wp-content/uploads/2015/10/service-model-291015.pdf 6 Doncaster Council &NHS Doncaster (2019) Doncaster Joint Commissioning Strategy www.doncaster.gov.uk

the Right Support7 and the National Service Model8, which sets out the national vision to transform models of care and support for people with learning disability and autism. The plan includes:  A robust programme of Care and Treatment Reviews for adults and Care, Education and Treatment Reviews for children  Developing and investing in intensive community support and forensic outreach  Dynamic risk support register which include multidisciplinary members from health, social care and police  Addressing Health inequalities  Transitions  Housing and skilled support through the Enhanced Supported Living Framework

5.8. Housing and REACH Standards, (2019)

The REACH9 standards describe nine voluntary standards to help explore what a good life would be for people with learning disability and / or autism and how to make this happen. The principles of ‘supported living’ have always been about supporting people with a learning disability and/or autism (and others) to live a life of their choice with the right support.

5.9. Making It Real (TLAP 2018)

Personalisation is a key concept to be realised within the LD&A Strategy delivery. Making It Real10 describes a framework and a set of statements describing what good, citizen- focussed, personalised care looks like from the point of view of people themselves.

Through the ongoing review of delivery plans, the strategy aims to embed personalisation including choice, care and support planning, support to access, and use personal budgets, across all priority deliverables.

6. Understanding the Needs of People with Learning Disability and / or Autism in Doncaster (See Also Annex 1)

6.1. Age Profile The population of Doncaster continues to grow at a slightly lower rate than Yorkshire and the Humber and is predicted to grow by a further 1.2% by 2030. There is predicted to be an increase in all age groups from 55 years and above, which needs to be considered in the development of all health and care services, and recognising there is a reduction in the rate of growth for some of the younger groups. Services will increasingly need to address the ageing profile of people they support, for example, housing offers will need to address the future needs of tenants which will change over time, and recognise the increase in number of older people who will require appropriate housing.

7 NHSE (2015) https://www.england.nhs.uk/wp-content/uploads/2015/10/ld-nat-imp-plan-oct15.pdf 8 NHSE (2015) https://www.england.nhs.uk/wp-content/uploads/2015/10/service-model-291015.pdf 9 Paradigm (2017) https://paradigm-uk.org/what-we-do/reach-support-for-living/ 10 TLAP (2018) https://www.thinklocalactpersonal.org.uk/makingitreal/

6.2. Ethnic Diversity The ethnic profile of Doncaster demonstrates an increase in the number of people from Black, Asian and minority ethnic backgrounds. Emerging information describes the health inequalities faced by people from BAME backgrounds in the context of COVID-19, (described in more detail below) and that health inequality varies within different ethnic groups. Currently, nearly 9% of Doncaster residents identify as non-White British, and this proportion is expected to increase. Greater focus is needed to understand which groups are most affected by health inequalities and COVID-19 in particular. We will work with communities to understand the cultural needs, and inequalities they face, and how they can be addressed. 6.3. Data Issues National and local data describing people with Learning Disability, Autism or both is incomplete and compiled from various sources. (People’s needs are recorded as a ‘Primary Support Need, and does not consistently record where people have more than one need). The estimated number of people with moderate or severe learning disability in Doncaster is in line with the growth in the general population. Services to meet the needs of this group of people will need to continue to grow in order to meet their needs. The National Autistic Society says 'estimates of the number of people with autism spectrum disorders (ASD) who also have a learning disability vary considerably, and it is not possible to give an accurate figure. The Foundation for People with Learning Disabilities11 however, suggest that between 60% - 70% of people with Autism also have a learning disability. Most of the people diagnosed with Autism are men (1.8% of the population, women 0.2%).

6.4. Needs of people with Autism

The National Autistic Society says about the definition of Autism:

“The definition of autism has changed over the decades and may continue to change. Some people feel the spectrum is too broad, as people with autism can experience a wide variety of support needs, from 24/7 support needs to those who find supermarket lights too bright. Autistic people and their families with different support needs share many of the same challenges, whether that’s getting enough support from mental health, education and social care services or being misunderstood by people close to them”12.

Doncaster residents are experiencing long waiting times for autism diagnosis and access to post diagnosis support. Plans are in place to improve access to both over the coming months and described below.

The LD&A strategy was developed jointly for people with Autism and learning disability, in recognition of the distinct needs of both groups, and recognition that many people with Autism also have a learning disability. It is recognised that issues affecting people with Autism in particular, may require additional or focussed actions. For this reason, a separate action plan, that mirrors the key actions from the wider Strategy plan has been developed

11 Foundation for People with Learning Disabilities 2020: Learning disability statistics: autism https://www.learningdisabilities.org.uk/learning-disabilities/help-information/statistics/learning-disability- statistics-/187690 12 National Autism Society 2020: What is Autism? https://www.autism.org.uk/advice-and-guidance/what-is- autism

and includes actions specifically for people with Autism, for example, development of peer support networks. The Autism Partnership Board oversees the Autism plan.

6.4.1. Autism Self-Assessment Framework (SAF)

The Autism SAF is a national requirement for local health and care economies to complete, and is usually conducted on a biennial basis. The last SAF was completed in 2018. At the time, the plans relating to Autism were reviewed in the context of the 2018 SAF outcomes.

The planned SAF for 2020 has been postponed and will be reviewed when the report is published.

6.5. Needs of Children and Young People

During engagement exercises, families and carers identified a range of issues children and young people faced. The engagement exercises confirmed that people “…want to make sure that people with learning disabilities, autism or both have access to a good education in mainstream and special schools and those who are home schooled. We want to make sure young people get the support they need in school or at home to do this and that teachers understand the needs of pupils with learning disabilities, autism or both...”13

In 2019 a SEND Inspection identified a range of strengths and areas for development which were set out by the joint OFSTED/CQC inspection team. The areas for development included focus on Transitions. Some children and young people do not receive high-quality support at key transition points, and families report a wide variation in how much support they receive and how effective it is. Sometimes, preparation for transition between schools does not begin early enough or in a fully joined-up way.

A transition strategy is in place and aims to address the issues identified at review.

There continues to be a steady increase in the requests for statutory assessment and currently the Local Authority maintains 2247 EHCPs a 20% increase since 2019.

6.6. People and Employment

People with a learning disability and / or Autism are less likely to have a job than the general population14. Currently 6% of adults with a learning disability known to their local authority in England are in paid work.

Doncaster people with Learning Disability and/ or Autism describe that they need support to access and maintain employment, and want opportunities for real employment. There need to be greater opportunities available to people to move into work should people wish to do this so that individuals are not volunteering for life15.

Thirteen principles were agreed by the partners in the development of the Employment plans, which describe the outcomes that are needed to make the plans a reality for people with lived experience and include (but not limited to)

13 SpeakUp Advocacy (2019) Engagement Report 14 Mencap (2021) Employment Research and Statistics. https://www.mencap.org.uk/learning-disability- explained/research-and-statistics/employment-research-and-statistics 15 Speakup Advocacy (2019) Engagement Report.

a. Local employment services should be Joined up and there should be a clear picture of what is available, both specialist and generic b. There will be an understanding of the barriers people face accessing and keeping employment and the gaps in services and support c. People should have information about services and how to access them d. People should have support to understand the benefits system and how this impacts on employment e. Doncaster Council and NHS Doncaster CCG will lead by example in employing people with learning disabilities, autism or both and this will include ensuring that recruitment polices are appropriate f. There will be a clear pathway through school and from school into vocational training and work opportunities

Plans are in place and being progressed by partners to scope the opportunities available to people The information gathered will be shared on the YourLife Doncaster website, and used to identify where gaps exist to inform future planning.

6.7. Carers Needs Doncaster’s first All Age Joint Strategy for people with learning disabilities and people with autism considers the current national and local picture together with what is important to people and their family carers. 6.7.1. Family Carers Unpaid or Family Carers play a vital role in maintaining the health and wellbeing of those they care for. Carers have the statutory right to an assessment; this assessment looks at carers’ well-being, mental and physical health. If the carer has eligible needs, a support plan will be developed with them. Adult carers can access support through the Doncaster Carer Reach-Out Service commissioned by Doncaster Council. Young or sibling carers can receive help from Doncaster Young Carers Service. Carers in Doncaster said they wanted to have their voice heard, and help shape the development of services available to them – particularly Short Breaks (Respite Services). 6.7.2. Carer Groups and Representation The Carers Oversight Group and the Carers Working Group are working to increase their membership and representation, and understand the issues that matter to Carers. The Carers Working Group developed a survey for carers seeking views about Short Breaks. The survey closed January 2021, and the responses are analysed to inform next steps. Findings of the survey and report will be considered the Carers groups and the Short Breaks Work-stream to develop improvement plans. Early reports issues that matter to Carers include: a. Availability of different types of provision, including being able to book in advance to be able to take a holiday b. More information about options, what is available for people

6.7.3. Short Breaks Short Breaks (sometimes called respite care) supports parents and carers to take a break from their demanding role and responsibilities whilst the person/people they care for is looked after in an environment that is safe and comfortable for them. Short breaks can be offered in a residential care service, an overnight stay with in a Shared Lives family household, or a break arranged with another carer or family member. Our aim for Carers and Short Breaks is to ensure parents and carers are provided with a range of equitable and flexible short breaks opportunities that meets their needs and the needs of the person they care for. 6.7.3.1. Children and Young People Short Breaks For children, young people and their families, Doncaster provides a universal and targeted offer delivered through Doncaster Council’s voluntary register of children and young people with a disability, the Together Information Exchange (TIE). The targeted offer is for children and young people with complex needs, who meet set criteria. Throughout the pandemic, the SEND service has worked closely with schools and settings where children and young people with EHCP’s attended to ensure a risk assessment had been undertaken to deem if a child should be attending school. In addition, the team worked with parents to broker a school place or additional time in school. Welfare calls were undertaken for those children and young people with an EHCP who were not on a school role. This ensured regular contact with families, to discuss any issues, which arose due to Covid, and be signposted to the relevant agency if required. 6.8. Housing and Support A long term Housing Needs Assessment was undertaken in 2020, to help understand the sort of housing and support needs people with LD&A in Doncaster have. A comprehensive report has been published that confirms the needs of groups of people for the next 10 years. To address the needs, the Council’s guiding principle is that the general housing stock should be as accessible and flexible as possible, to allow the vast majority of people to continue to live in their existing homes and communities. To support this the Council needs to: a. plan and invest in aids, adaptations and new technologies which support independent living b. be clear about how wrap around support is provided to individuals and families including floating support, domiciliary care, more innovative models like Shared Lives, and also access to education, skills, employment opportunities c. make the best use of the existing specialist housing in the borough

Some people will need purpose built accommodation, especially those with severe learning disability and / or Autism, with additional needs. The assessment confirmed that young people transitioning into Adult care and those living with older carers are two priority groups with housing and support needs over the next 5 years. Work is ongoing with individuals to identify their needs and choices; and with landlords and developers to make sure the appropriate housing offers are available within the context of the Councils Housing Strategy refresh and Place Plan.

7. COVID-19 The emergence of COVID-19 during 2020 has been devastating for many people, businesses, schools and families as society adjusts to manage and live with the impact of the pandemic. For many people living with Learning Disability and Autism, the impact has been profound. Over the past few months, it has become clear that people with LD&A are at much greater risk of death from COVID-19 than the general population. Based on information collated by the Learning Disability Mortality Review (LeDeR), deaths of people with learning disability or Autism are more than 3.6 times higher than the general population16. Some researchers believe the rate in spring 2020 it was as high as 6 times higher17. Underlying health concerns and environment are some of the contributing factors to the difference in rates. 7.1. Adults with Lived experience

People with a Learning Disability and / or Autism face greater challenges than most in experiencing and dealing with the impact of COVID-19. From social distancing, mask wearing and communication, and the impact of lockdown restrictions on seeing and maintaining relationships with family and friends, the challenges have been significant for many people. Sensory issues have made mask wearing very difficult for some, and for those living in shared accommodation, maintaining social distancing is very hard, especially while managing infection prevention and control. Providers of residential and supported living services for LD&A have continued to work hard to keep the virus out of homes and care settings however, where outbreaks in residential settings have happened nationally, the consequences for many have been devastating. Doncaster health and care providers have worked closely together to make sure that people living in Supported Living Services and residential care have been kept as safe as possible during the pandemic. 7.2. Children and Young People The implication of COVID-19 on school closures has the potential to have a longer term impact on the educational outcomes for children and young people with SEND. During the first lockdown very few children attended school, however during the latest lockdown, children and young people with Education, Health and Care Plans have been encouraged to attend school to minimise the disruption to their learning and ensure greater gaps in attainment and outcomes do not emerge. 7.3. People from Black, Asian and Minority Ethnic Groups (BAME)

The inequality faced by people from BAME Groups in relation to COVID-1918 is becoming more apparent and is widely reported by Public Health England. A PHE review “Beyond the data: Understanding the impact of COVID-19 on BAME groups” found that the highest age standardised diagnosis rates of COVID-19 per 100,000 population were in people of Black ethnic groups (486 in females and 649 in males) and the lowest were in people of White ethnic groups (220 in females and 224 in males).

16 PH England Nov 2020 COVID 19 deaths of people identified as having learning disabilities: summary. Gov.uk 17 PH England Nov 2020 Press Release People with learning disabilities had higher death rate from COVID-19. Gov.uk 18 PH England 2020: Beyond the data: Understanding the impact of COVID-19 on BAME groups www.gov.uk

People from BAME backgrounds and those with Learning Disability and / or Autism are at greater risk from COVID-19 disease than the wider population19. It is a key aim of the Doncaster Partners to identify those at greatest risk, and working with communities, develop and implement plans to address those issues and reduce risks for the groups or individuals where possible. 7.4. Vaccination Programme The Vaccine roll out programme will offer a significant protection for people with Learning Disability and / or Autism. For many people, taking the vaccine will also be a challenge. Fear of needles, the potential need for some to have a Mental Capacity Assessment or being able to make an informed decision in the context of the impact on their own health and those around them will need to be addressed. Further work is needed to understand the issues affecting people with LD&A, to ensure we can plan support and care to reduce risks where possible, balanced with living a good life. Development and implementation of the plans continue to be refreshed and updated to take account of emerging risks and Government guidance. The Doncaster health and care system has put in place robust systems and processes, to proactively manage the risks, and respond to rapidly changing circumstances and guidance in managing the Doncaster COVID-19 response. 7.5. Carers During the pandemic, it has become clear that carers are providing more care than they were 6 months ago20. There are several reasons for the increase, and include the needs of the cared for person increasing and/or due to local services reducing or closing during lockdowns. Locally, some carers have expressed their exhaustion as they continued to care for their family member during lockdown and while services were closed, for example, day services. During COVID-19 pandemic, Carers Doncaster partners have worked hard to ensure that services provided are COVID-19 secure, and services have reopened where possible, providing a level of respite that was not available during the initial lockdown phase.

8. Doncaster Learning Disability and Autism Finances The Doncaster Health and Care Partnership and partners are committed to making the best use of the resources available to support Doncaster citizens. The Joint Commissioning Strategy outlines the commitment of both partners to a) Make best use of the Doncaster pound b) Avoid duplication c) Improve individual experience d) Improve individual and community outcomes e) Develop our workforce f) Maintain health and wellbeing

19 PH England 2020: Beyond the data: Understanding the impact of COVID-19 on BAME groups www.gov.uk 20 Carers UK (Oct 2020) Caring behind closed doors: six months on - The continued impact of the coronavirus (COVID-19) pandemic on unpaid carers www.CarersUK

The tables 1 and 2 below summarise the number of people who receive care from the Council, the CCG or both and the services that people use.

Table 1. Adults Receiving Social Care/CCG funded support Group of people People with Learning People with Autism Disabilities Known to social care and 1,053 (as at 19.01.21) 200 social care (some will health- adults and older 260 receive health funding* be counted in LD figure people People fully CHC funded 117 Not known People in receipt of a direct 302 (As at 26.01.21) 76 (As at 26.01.21) payment (social care) (62 reporting as having LD and personal health budget=24 ASD, and are included in the LD figures) Personal Health Budget 12 fully funded, 12 joint health Not known and care funded. *based on people using social care services with a housing need 2018 and CCG fully funded- people living at home with families (latter needs verification)

Table 2. The Services that people use

Service People with LD People with Autism The Council’s In House Service closed during A number of people with autism Day Services (SMILE) Covid Lockdown periods as a secondary need attend

348 as at Dec. 2019 (340 with a primary support need of LD 2 with autism only 6 older people with LD from Smile Service info December 2019) Diamond Centre RDaSH Closed Mar – Sept 2020. A number of people with autism (previously known as Dec 2020 - 22 attendees. as a secondary need attend Solar Centre) The services offers specialist services for people with complex health and care needs. Short Breaks (respite 107 in 2019/20 Includes 7% of people with LD care) residential Council 148 in 2018/19 who also have autism provided Plus a small number of people using private residential services Services purchased 199 < 65 years 60 through direct payments 17older people Personal Health Personal health budgets 24 Not known Health and No information is currently No information available wellbeing/community available currently – need to work with services. communities to understand

demand more, and impact of the LD&A plans to increase contact in communities. Shared Lives-short Too small numbers – risk Too small numbers – risk breaks/day opportunities GDPR breach. GDPR breach Home Care 108 Some people with Autism will (Long Term Primary be included in the LD figure Support reason LD, from 17.01.21 Dashboard)

CCC-9 – don’t know what this is Advocacy (2018/19) 355 (Voiceability) 45

8.1. Finance Summary Table 3. Expenditure by Care Type 2020/21 Forecast Outturn

Service DMBC CCG Total Residential Care £5.97 £20.7m £26.67m Hospital Care/Specialist Placement £0.0m £3.1m £3.1m Supported Accommodation £17.68 £2.9m £20.58m Day Services £2.0m £0.1m £2.1m Short Breaks £0.78m £0.5m £1.28m Direct Payments £2.88m £0.8m £3.68m Home Care £0.76m £0.4m £1.16m Extra Care Housing Support £0.05m £0.0m £0.05m Community Nursing - £2.5m 2.5m Community Social Work (CALDT and Area Teams £0.99m £0.0m £0.99m Primary Care Local Enhanced Service £0.0m £0.2m £0.2m TOTAL £31.11m £31.1m £62.21m *Excludes costs associated with transport and autism diagnostic service and ‘other’. a) 43% of the total CCG budget health and care budget is spent on residential care b) The minimum weekly cost of residential care is £535. c) Current spend on short breaks to support people living within their family home remains relatively low (excluding costs of short breaks and day opportunities arranged through direct payments) d) £2.1million is spent on day services.

‘The joint commissioning strategy through its governance structure continues to review funding and reflect the future direction of travel, aligned to key principles within this document. This will involve consultation with people who use services and their families whether some services should be reconfigured.

Table 4. Revenue Monitoring 2020/21 Quarter 3 (Updated) High Needs Block

Service DSG Quarter 3 Projected Budget Projection DSG for Year Variance

£'000 £'000 £'000 HIGH NEEDS BLOCK DSG

Mainstream EHCP Top Up funding 5,500 5,651 151

Special Schools - ISB 6,111 6,111 0 PRUs Incl. Mulberry Unit 2,879 2,884 5 North Bridge Enterprise College 947 947 0

Primary Outreach 388 425 37

Additional Resource Centre's 18 18 0

Big Picture Learning 803 726 (77) Secondary Outreach 106 106 0 Children's Specialist Equipment 25 25 0 Specialist Post 16 Institutions 1,483 2,335 852 Post 16 FE Colleges 388 562 174

Pupils Educated Out Of Area - LA 4,415 5,496 1,081 SEN Pupils Educated Out Of Area - LA 744 1,262 518 CWD Pupils Educated Out Of Area - 3,184 3,675 491 DCST Specialist AP provision 499 673 174 Other LA recoupment 200 501 301 ASD Schools Support 664 664 0 HI Schools Support 826 741 (85) VI Schools Support 318 314 (4)

Pre-School Inclusion - 933 892 (41) Portage/SEN Learning & Behaviour Support 353 353 0 Service Pupils Educated At Home 91 91 0 Independent Behaviour Provision 133 133 0 (Tops Team) Contributions to Centrally Retained 98 98 0 & De-delegated Budgets High Needs (269) (657) (388) Contingency/Unallocated HIGH NEEDS BLOCK Sub-total 30,837 34,026 3,189

9. Information and data sharing Access to information and data to underpin planning continues to be a challenge, especially in relation the supporting people with Autism. The development of the joint Doncaster Council and NHS Doncaster CCG Commissioning Strategy describes the ambition of working together, including sharing of information. Significant progress is made on developing shared data sets, and further work is ongoing to address the gaps where this is possible.

10. Development of clear outcomes and Key Performance Indicators (KPIs) Each of the five priority work-streams and the cross cutting themes have developed plans and started to make progress in delivering against the defined actions. Some of the actions already include KPIs, for example, delivery of Annual Health Checks, uptake of Cancer Screening and the existing ASCOF (Adult Social Care Outcomes Framework) standards for employment and housing. Further work is needed to define the outcomes for each of the work-streams aims and objectives, and the measures needed to make sure progress is being made against them. Further development of KPIs, robust use of existing measures to monitor progress is being planned, with the development of a dashboard to present and monitor progress. Health and Social Care colleagues are committed to joint working and sharing information through the delivery of the Living Well Plans (where the Learning Disability and Autism plans report to) and development of the systems needed to do this is ongoing.

10.1. Coronavirus (COVID-19) 2020

“It may seem premature to consider the impacts of COVID-19 but the sooner the impacts are assessed and the lessons are learnt the sooner and more effectively Doncaster people, families, communities, businesses, schools and institutions can plan for a more prosperous future. There will be government reports and inquiries in due course but this report starts to provide a Doncaster perspective on the pandemic. There are other perspectives and they too need to be heard”21.

The impact of COVID-19 on people with Learning Disability and Autism, and those from BAME backgrounds is significant. Further understanding of the impact and which groups and settings are at greatest risk is needed of what this means for the people of Doncaster. Plans are being developed with Public Health, local communities and services.

11. Communication and Engagement

Engagement with people with lived experience has been a central principle in the development, planning and delivery of the Strategy and this Refresh.

21 Doncaster DPH (2021) Appendix to Director of Public Health Annual Report 2020.

As work is moving more into delivery, and the identification of risks for people with LD&A and those from BAME backgrounds, further engagement work and regular communications about the strategy, programme of work and opportunities to get involved is needed. A key element of the CYPP is to ensure the voices of children and young people are included in all we do, ensuring all children and young people have the opportunity to influence the services they access and the support they receive. A Communications and Engagement plan is in development that spans the breadth of work and the communities the plans involve. The plan is building on the communication and engagement work that is currently underway, and will make a commitment to; a. Delivering regular updates to the wider community by Newsletter b. Sharing information about ways for more people to get involved at all levels of the strategy development and implementation. c. Targeting particular groups who are currently under-represented to seek views, and keep informed of the work and progress or challenges. d. Working with people with lived experience of all ages to make sure that engagement and communications are accessible and meaningful for them.

12. Monitoring and Governance Development and implementation of the Strategy and plans is overseen and challenged by the Learning Disability and Autism Partnership Boards respectively. Quarterly reports against each of the delivery plans are submitted through the Living Well Delivery Plan for monitoring by both Doncaster Council and NHS Doncaster CCG. It is anticipated that this will continue.

Doncaster’s All Age Learning Disability and Autism Strategy (2021-2024)

Annex 1 - Understanding the Care and Health Needs of People with Learning Disability and / or Autism in Doncaster 2021- 2024

1. Doncaster Population By Age The Doncaster Council State of the Borough in 201922, described the number of people living in the borough as 310,542, an increase of 3.2% since 2010. This rate of increase is lower than elsewhere in Yorkshire and the Humber, and expected to expand by a further 1.2% by 2030. Compared to the England average, it is estimated that Doncaster has a smaller proportion of adults aged 20 to 44 but has a higher proportion of people aged 45-69 and above (ONS, 2016). The largest growth is seen in people aged 65-74, and a reduction in growth of those aged 25-34. Growth rates of children and teenagers, and the number of people aged 70 and above, are similar to national trends Table 1 Proportion of the population by Age group compared to England.

Age Range Doncaster pop % England pop % 0-19 23.6 24 20-44 31.1 33.5 45-69 32.6 30.1 Above 70 12.8 12.3

Table 2 Estimated Percentage change between 2017 and 2030 (ONS, 2016).

Age band 2017 pop 2030 pop % change 0-14 55,069 52,064 -5.45% 15-24 33,203 34,478 +3.84% 25-34 40,705 34,977 -14.07% 35-44 36,462 40,360 +10.69% 45-54 43,214 36,471 -15.60% 55-64 38,845 39,013 +0.43% 65-74 31,995 37,210 +16.29% 75+ 25,857 36,506 +41.18%

An increase in all age groups from 55 years and above is expected to continue. This increase in the age profile will have implications for health and social care services, as the oldest group in the population expands, and the younger group see a lower rate of increase. Services will increasingly need to address the ageing profile of people they support, for example, future housing offers will need to address the future needs of tenants, which will change over time.

22 Doncaster Council (2019): Doncaster Council – State of the Borough. www.doncaster.gov.uk

2. Doncaster Population by Ethnicity Areas across Doncaster with significant Black and Minority Ethnic populations include Balby (16%), Belle Vue (26%), Bennethorpe (18%), Hexthorpe (24%), Hyde Park (46%), Intake (16%), Lower Wheatley (37%), Town Moor (20%), and Wheatley Park (20%). There is a wide range of cultural and ethnic groups within the Doncaster BAME community. In 2001 the population in Doncaster was 96.5% White British, which reduced to 91.8% in the 2011 Census, indicating that the diversity in the borough is increasing, and is expected to continue to increase. Greater focus is needed on working with communities to understand the cultural needs, choices, and inequalities, and build these into the emerging service developments and especially to address the health inequalities that people from Black and Minority groups, with Learning disability and / or Autism experience.

3. Doncaster Population with a Learning Disability or Autism National and local data describing people with Learning Disability, Autism or both is incomplete and compiled from various sources. (People’s needs are recorded as a ‘Primary Support Need, and does not consistently record where people have more than one need). Table 1 describes estimates of the number of people living with Learning Disability or Autism in the UK and Doncaster. The data for Children is incomplete, and estimates based on Children and Young People for whom Doncaster LA maintains their Education, Health & Care Plan Table 1 Estimated numbers of people living with Learning Disability or Autism 2019 Indicator People with Learning People with Autism Disabilities National Prevalence (all 1.5m – 1.6m based on 66m 700,000-726,000 based on age) UK population 1 and 1.1% of the 350,000 with SLD population National Population in 1.05m (2020 prediction) 438,334 (2020 prediction) England (over 18 years predicted to rise to 1.16m by 2040` Predicted to increase to 488,184 by 2040 Doncaster Population (all 7,722 3,089 based on 1% age) Doncaster Population (Over 5,784(2020 prediction) 2,446 (2020 estimated) 18 years) (1,198 with MSLD)

Predicted to increase to Predicted to increase to 6,362 by 2040 2,709 by 2040

5-17 years (with ECHP) 169 Moderate LD 602 School census 2020 97 Severe LD People (18-64) whose Predicted 84 LD in 2020 No local information behaviour presents a severe No local information challenge

Those on proactive support 32 adults (12 on heightened No breakdown available register monitoring) 56 children* (18 with heightened monitoring) Expected changes in Adults (18-64) very little Adults (18-64) 2.7% population-nationally change predicted to 2040. increase predicted by 2040. predicted However, 65+ predicted to 65+ predicted to increase by increase by 36% by 2040. 37% by 2040. *Proactive Support Register-children -is much broader than the Transforming Care definition as includes all children in 52 week residential placements.

3.1. People with Moderate or Severe Learning Disability People with moderate or severe learning disability may also be living with other complex health and care needs, and often require a range of services specifically developed to meet their particular needs. Table 2 describes the number of people estimated to be in those groups. The estimated number of people with moderate or severe learning disability in Doncaster is in line with the growth in the general population. Services to meet the needs of this group of people will need to continue to grow in order to meet their needs. Table 2 People predicted to have a moderate or severe learning disability, and likely to be in receipt of services, by age in Doncaster23 Age 2020 2025 2030 18-64 1,026 1,037 1,049

65+ 172 187 204 Total population 1,198 1,223 1,254

Around 1,269 people with moderate or severe learning disabilities locally are over 65 years, and 568 people with autism24. In line with the general population, it is anticipated there will be a continued increase in the number of older people with Autism, which services and commissioners will need to address in future planning. 3.2. People with Autistic Spectrum Disorder Table 3 below describes the number of men and women with a diagnosis of Autistic Spectrum Disorder in Doncaster. As is seen in the national figures, there are 6 times more men diagnosed with autism than women. Table 3. People predicted to have autistic spectrum disorders, by age and gender, projected to 2040 in Doncaster

2020 2025 2030 Males predicted to have autistic spectrum disorders in Doncaster 18-64 1,694 1,701 1,712

23 POPPI (2021): Estimate https://www.poppi.org.uk/index.php 24 POPPI (2021) https://www.poppi.org.uk/index.php

65+ 502 556 619 Females predicted to have autistic spectrum disorders in Doncaster 18-64 184 184 184 65+ 66 71 78 Total Population 2,446 2,512 2,593

It is understood that about 1.0 - 1.1% of adults in England live with Autism, (Based on using the Autism Diagnostic Observation Schedule). Most of those people are men (1.8%) with only 0.2% women meeting the criteria.

The National Autistic Society say that 'estimates of the number of people with autism spectrum disorders (ASD) who also have a learning disability, vary considerably, and it is not possible to give an accurate figure.

Some people with ASD may never come to the attention of services as having special needs, because they have learned strategies to overcome any difficulties with communication and social interaction and found fulfilling employment that suits their particular talents. Other people with ASD may not have a learning disability but need support from services, because the challenges their Autism presents can make social interaction, education and working more difficult than for other people in the community.

3.2.1. Referrals to Autism Service

The number of referrals into the Autism Service provided by RDASH has fallen this year, largely due to the impact of COVID-19 and the service closure during the lockdown period. (2020/21 figures are to Feb 2021).

Table 4 Number of people referred to the Autism Service year on year. Unique Referral Patient Team Year Count Count

DONCASTER AUTISM SPECTRUM 226 201 2018/2019 DISORDER TEAM

DONCASTER AUTISM SPECTRUM 262 214 2019/2020 DISORDER TEAM

DONCASTER AUTISM SPECTRUM 164 136 2020/2021 DISORDER TEAM

In line with expected growth, referral rates into the service are continuing to increase. A range of diagnoses has been recorded following assessment and includes: a. Autistic disorder b. Rett's syndrome c. Asperger's syndrome, d. Pervasive developmental disorder, e. Atypical autism f. Others.

The drop in number of referrals to the Doncaster ASD team for 2020/21 is reflective of the service closure due to the pandemic during the first half of the year, and more people are waiting for an assessment for diagnosis. 4. Headlines Summary

4.1. Adults - Learning Disability a) 1.05 million adults in England are estimated to have a learning disability (2020 England population projections) b) In total, approximately 5,800 adults in Doncaster have a learning disability and 1,269 of them are over 65 years old c) 1,200 adults have moderate or severe learning disabilities and 172 are over 65 years old d) 108 people with learning disability (primary support reason) receive home care (as at 17.01.21) e) 910 individuals have an open service with Primary Support Reason LD, 85 of which also have a recorded health condition of Autism f) Of these 910 individuals, 91.6% are of White British ethnicity g) 41 people with Learning Disabilities and Autism meet social care eligibility criteria

4.2. Adults - Autism

a) 440,000 adults in England are estimated to have autistic spectrum disorders b) It is estimated that up to 70% people with Autism, also have a learning disability. c) Approximately 2,500 adults in Doncaster have autism and 568 of them are over 65 years old d) 160 people with Autism meet social care eligibility criteria

4.3. Children and young people

By 2024, 72 young people with and EHCP and supported by children’s social care (has an Open Referral) will reach 18 years with a range of needs. (Some numbers of cases has been removed from each category as they are low and risk identifying individuals):

a. 23 children with EHCP due to Social, emotional and mental health issues b. 17 children with EHCP due to Autism Spectrum Disorder c. 10 children with EHCP due to Severe Learning difficulties d. v children with EHCP due to Mild Learning difficulties e. w children with EHCP due to Profound and multiple learning Disability f. x children with EHCP due to Physical Disability g. y children with EHCP due to Hearing Impairment h. z children with EHCP due to Attention Deficit Hyperactivity Disorder

There are 45 children open to Children’s Social Care with learning Disabilities or Autism Spectrum Disorder recorded who will turn 18 years old by 31/03/2024 in receipt of services from a. Children’s’ Disability Service b. Occupational Therapy Team c. Looked After Children d. Approximately 11.4% of all looked after children have a learning disability and/or autistic spectrum disorder (59 children in total)

Waiting times for a diagnosis of autism for children have vastly improved:

a. 100% within 18 weeks of first face to face contact for under 5’s

b. More than 90% for over 5’s. (This is from the point of referral to Autism Team).

4.3.1. Looked After Children

a) There are 27 looked after children who will reach 18 years by 2024 b) Approximately 6% of all looked after children have a learning disability and/or autistic spectrum disorder c) There are 346 children with an Education, Health and Care Plan due to a moderate or severe learning disability or autistic spectrum disorder who will reach the age of 18 by 2024 (based on those aged 14 & above at the 2020 School Census)

4.3.2. Children in Transitions Table 5. Young People with Learning Disabilities Transitioning to Adult Services up to 2030

Age (as at 8 9 10 11 12 13 14 15 16 17 2020) Doncaster 60 39 62 74 61 62 80 68 57 62

Table 6. Young People with Autism as at 2020 Year Year Year Year 10 11 12 13 Doncaster 71 82 40 37

Children in transitions include those living at home, and those in Looked After services.

This group of people require support as they move from Children and Young People’s Services, education and home environments, and into adulthood, employment, and their own home environment. For young people this can be a very unsettling time, and for those with Learning Disability and / or Autism has additional stressors, as every part of their lives can change.

Young People in Transitions is identified as a cross cutting theme within the Strategy, to ensure that developments in services specifically address the needs of this group of people, from housing to employment support.

5. Health, Learning Disability and Autism

People with a learning disability and / or Autism have worse health outcomes the wider population, and are more likely to experience a number of health conditions25.

“Women with a learning disability in England have an average life expectancy of 65, GP data from NHS Digital have shown—18 years lower than those without, which is worse than for

25 Mencap (2020) Health Inequalities https://www.mencap.org.uk/learning-disability-explained/research-and- statistics/health/health-inequalities

men. Men with a learning disability had an average life expectancy of 66 in 2017-18, compared with 80 in men without a recorded disability”26.

Patients with learning disabilities also had lower rates of cancer screening, most notably in cervical screening for women: only 31% had smear tests, compared with 73.2% of those without a learning disability.

5.1. Annual Health Checks with the GP

An annual health check helps you stay well by talking about your health and finding any problems early, so you get the right care27.

GP Practices are required to keep registers of people with learning disabilities and to offer annual health checks to people aged 14 years and above. GP practices and primary care networks are working towards improving the accuracy of people on their learning disability registers. Information currently available shows:

a. The number of people registered with a GP as of December 2020 is 1964. The peer group average for comparison is 172028 b. There has been an increase in the number of annual health checks completed. Since 2014/15 there has been an increase of 310 annual health completed on an annual basis. The percentage has decreased by form 53.8% to 44.4% showing work is required to improve the coverage of annual health checks29. c. Health checks are not currently offered routinely to people with autism.

Improving access to health checks for people with Learning Disability and / or Autism is a key aim of the Health inequality action plan.

5.2. Health Screening

As of December 2020 over the rolling year, people with learning disabilities living in Doncaster accessed the national Cancer Screening Programmes30 as detailed below. a. Bowel screening attendance at around 73.3%. (Doncaster c 65%) b. Breast screening 41.6% (Doncaster c63%) c. Cervical screening 48.8%. (Doncaster c74% d. Data not available for the number of people with autism who access screening.

While there is some good news in the uptake of screening, there is more to be done to ensure that all people who are eligible for the cancer-screening programme are encouraged and able to attend. Health colleagues are working with the regional health action teams to address the issues and barriers that exist for people with Learning Disability and / or Autism, and is included in the health inequalities action plan.

26 BMJ (2019) People with learning disabilities have lower life expectancy and cancer screening rateshttps://www.bmj.com/content/364/bmj.l404#:~:text=People%20with%20learning%20disabilities%20hav e%20lower%20life%20expectancy%20and%20cancer%20screening%20rates,- BMJ%202019%3B%20364&text=The%20inequality%20is%20greater%20in,men%20without%20a%20recorded %20disability. 27NHS 2020: Annual Health Checks – Learning Disability. https://www.nhs.uk/conditions/learningdisabilities/annual-health-checks/ 28 source GP practice registers December 2020 29 https://www.poppi.org.uk/index.php, NHS Outcomes Framework, Doncaster GP registers (2020) 30 NHS Doncaster CCG 2021: LD Health checks Dashboard

5.3. Learning Disability Mortality Review Programme (LeDeR)

The LeDeR Programme is the first national programme of its kind aimed at making improvements to the lives of people with learning disabilities and addressing the factors that lead to health inequalities and premature death.

Health and care services are reviewing deaths of people with Learning Disability and Autism to learn from them and improve the standard and quality of health promotion and care and support. People with learning disabilities, their families and carers have been central to developing and delivering the programme. Several priority care areas have been identified so far:  Constipation,  Epilepsy and Seizure management,  Sepsis,  Dysphagia (Difficulty swallowing)  Positioning Learning from the LeDeR programme is built into the Health Inequalities Plan.

The Integrated Care System is developing training and awareness sessions to improve outcomes identified in local LeDeR reports and will focus on the priority areas identified for Doncaster through the current reviews.

5.4. COVID-19

Public Health England estimates that people with Learning Disability and / or Autism are at more than 3.6 times more risk of dying from COVID-19 than the wider population31. In response to this finding, LeDeR through NHS Improvement has published their guidelines32 for reducing the risks to this group of people.

People from Black Asian and Minority Ethnic (BAME) groups are also identified as being at greater risk from COVID-19. Recent evidence is that some BAME groups are not taking up the vaccine when offered. Plans are in development to work with Public Health and BAME representatives to address the health inequalities and improve the outcomes for the at risk groups within the Learning Disability and Autism community.

5.5. Carers Nationally, 64% of carers have reported they have not been able to take any breaks from their caring role during the pandemic. 19% advised they have not been able to take as many breaks as they felt they needed. Overall, 79% of Carers advised they had either not taken any or been able to take sufficient breaks.

31 https://www.gov.uk/government/publications/covid-19-deaths-of-people-with-learning-disabilities

32 NHSI (2020): (LeDeR) programme Action from learning: deaths of people with a learning disability from COVID-19. https://www.england.nhs.uk/publication/action-from-learning/

Development of short breaks for carers was identified as a priority during the engagement exercises, and work is already underway to expand the offer for carers. The emergence of COVID-19 has made this more challenging, but also, more important than ever. As the population ages, increasing numbers of older people will have caring responsibilities for family members.

5.6. People’s Accommodation and Support Needs

In 2020, a Strategic Needs Assessment for the next 10 years housing and support needs for people across all ages with Learning Disability and / or Autism was commissioned across the South Yorkshire and Bassetlaw Integrated Care System.

In January 2021, the Councils Care Management system identified that 1,053 have a recorded accommodation status breakdown as shown in Table 7 below.

Table 7. Accommodation Status of people on the Care Management System

Acute / Long Stay Health Care Residential or Hospital 6 Adult Placement Scheme 20 Appvd Resid for Offenders Released or on Probation 1 Extra Care/Other/Sheltered Housing 5 Other Temporary Accommodation 6 Owner Occupier / Shared Ownership Scheme 19 Placed in temporary Accommodation by LA 5 Prison / Young Offenders / Detention Centre 1 Registered Care Home 115 Registered Nursing Home 5 Rough Sleeper / Squatting 1 Settled Mainstream Housing with Family/Friends 393 Staying with Family/Friends as a Short Term Guest 9 Supported Accom / Lodgings / Group Home 345 Tenant 91 Tenant - Private Landlord 31

Review of the Strategic Needs Assessment identified that young people in transitions and those living at home with their carers are two of the priority groups whose housing and support needs are significant and increasingly urgent. The Council currently has 38 new units being developed that will be available in spring 2022. The Strategic Housing Needs Assessment identified opportunities and gaps in the existing housing and support provision. In line with the Council’s Housing Strategy Refresh33 (2020) the Housing and Support plan aims to ensure that people will be supported to live in homes that meet their assessed

33 Doncaster Council (2021): Doncaster Housing Strategy 2021 – 2025. https://www.doncaster.gov.uk/services/housing/our-housing-strategy-2015-2025

needs, in their local communities. Housing and support options will be based on individual assessed needs, and will include d. General housing with adaptations and new technologies which support independent living e. Include the support needed by individuals f. May include purpose built specialist housing where this is needed and based on assessed need g. Include a wide range of accommodation and support from general housing with floating support, extra care, supported living, shared lives, and where needed, residential care services. Through the engagement exercises, people with lived experience said where they live is important, as is whom they live with. Maintaining relationships with families, friends and partners are essential. Housing and support options are being developed that ensure that people are able to live in their communities, and provide choice about who they live with.

Equality Impact Assessment

Doncaster’s All Age Learning Disability and Autism Strategy Subject of equality Refresh (2021-2024) analysis

Tick Policy Strategy X

Type Business case Commissioning service

redesign Contract / Procurement Event / consultation Name: Paul Tarantiuk and Julia King Paul Tarantiuk, NHS Doncaster Clinical Commissioning Group, Strategy and Delivery and Manager Owner Job Julia King, Doncaster Metropolitan Borough Council, Title: Commissioning Manager, Public Health, Leisure and Strategic Commissioning

Date 4th March 2021 The strategy aims to support people with a learning disability and/or autism to live their best life and have the same opportunities as everyone else living in Doncaster.

The vision statement of the strategy, which was agreed through the engagement process is that,

This strategy will identify priorities in terms of addressing the areas for action outlined in the national strategies whilst being mindful of the key principles that have been identified in the strategic plans of partners in Doncaster. The principles that will be addressed include:

1. Have access to a timely diagnosis in line with national guidance 2. Have a safe, happy and healthy childhood, accepted for who they are, supported to have self- worth and to develop skills and talents 3. Be encouraged to hope for the same things in life as other citizens-work, family life, relationships, own home 4. Be safe in their community and free from the risk of discrimination, hate crime and abuse 5. Should live in a family home or their own home with people they chose to live with unless there are exceptional circumstances why this can’t happen 6. Have access to a good education and learning throughout life 7. Aspire/hope to have a paid job and be supported to achieve this 8. Be supported by family carers/relatives whose own needs, rights and views have been fully considered and are supported in their caring role 9. Have equal access to good health care and be supported to live healthy lives 10. Have highly personalised support, which is built up around people’s strengths, their own networks of support and in their local community 11. Be supported to access universal and early support services, where their needs are understood, they are accepted for who they are, and reasonable adjustments are made 12. Have the information they need to access social care and health services and universal services 13. Have a planned and smooth transition from child to adult life 14. Have a fulfilling and healthy later life with the same opportunities as other older people 15. Expect health and social care to work together with others to make the best of resources, working hard to achieve fully personalised support 16. Have their views and wishes in the centre of planning and shaping support

Tick Staff X General public X Stakeholders Service users X Partners X Providers X Other Data and information from a wide range of sources has been used to understand the needs of people with a Learning Disability and/or Data collection and Autism and their family/carers in Doncaster. consultation Population demographics, including age profiles, ethnicity, and incidence of learning disability and/or Autism have been considered, with expected growth rates to 2030 included and the implications considered. Detail of this information is provided in:

Annex 1 – Doncaster All Age Learning Disability & Autism Strategy (2021)

Annex 1 Needs Assessment.docx

References are included in the strategy refresh document. Formulation of the strategy considered national strategy and policy where this is relevant, local policy and strategies, and emerging evidence for each of the workstreams and plans. With regard to health plans, ongoing learning is reflected within the plans, which are regularly updated in light of new evidence. With respect of COVID-19, evidence is regularly updated, and further local work is needed to build on existing good practice developed since the start of the pandemic, and a focussed approach to explore the risks and mitigations for specific groups, e.g. people from BAME, and those living in shared accommodation. Initial engagement with people with lived experience was framed around known areas of concern. The outcomes are detailed in the engagement section below. References are included in the main strategy document and include those listed below: a) Engagement Report for the Doncaster All Age Learning Disability & Autism Strategy, Speak Up Advocacy (2019) b) Doncaster Place Plan Refresh (2019-2022), Doncaster Partnership (2019) c) Doncaster Joint Commissioning Strategy, Doncaster Council & Doncaster CCG (2019) d) Appendix to Director of Public Health Annual Report 2020, Doncaster Council (2020) e) Housing Needs Assessment: Future need for accommodation with support 2020-2030, South Yorkshire and Bassetlaw Integrated Care System (2020) f) Projecting Adult Needs and Service Information (PANSI) 2021 https://www.pansi.org.uk/ g) Service Model for Commissioners, NHSE, ADASS, LGA (2015) https://www.england.nhs.uk/wp- content/uploads/2015/10/service-model-291015.pdf h) Building the Right Support, NHSE, ADASS, LGA (2015) https://www.england.nhs.uk/wp-content/uploads/2015/10/ld- nat-imp-plan-oct15.pdf i) REACH Standards, Paradigm (2017) ) https://paradigm- uk.org/what-we-do/reach-support-for-living/ j) Making it Real, TLAP (2018) https://www.thinklocalactpersonal.org.uk/makingitreal/ k) Foundation for People with Learning Disabilities: Learning Disability Statistics: Autism (2021) https://www.learningdisabilities.org.uk/learningdisabilities/help-information/statistics/learning-disability- statistics-/187690 l) What is Autism?, National Autism Society (2020) https://www.autism.org.uk/advice-and-guidance/what-is- autism m) Employment Research and Statistic, Mencap (2021). https://www.mencap.org.uk/learning-disability- explained/research-and-statistics/employment-research-and- statistics n) Caring Behind Closed Doors, Carers UK (2020) https://www.carersuk.org/images/News_and_campaigns/Car ing_Behind_Closed_Doors_Oct20.pdf o) PH England Nov 2020 COVID 19 deaths of people identified as having learning disabilities: summary. www.Gov.uk p) PH England Nov 2020 Press Release People with learning disabilities had higher death rate from COVID-19. www.Gov.uk q) PH England 2020: Beyond the data: Understanding the impact of COVID-19 on BAME groups www.gov.uk

Data collected by the Council’s Policy, Insight and Change team regarding Doncaster’s health and social care services for people with a learning disability and/or autism.

In August 2018 The Adult, Health and Wellbeing Directorate agreed a business case for the Co-production and Engagement plan for people with a learning disability, autism or both. Speak Up and Inclusion North were commissioned to deliver this, which involved engagement with users of services who have a learning disability and/or autism, their carers and professionals.

This work was undertaken in the following stages: • Stage 1 September 2018 – November 2018: Co-production of the materials for the engagement strategy, working with key partners and Experts by Experience from Choice for All Doncaster (ChAD), Doncaster Parent Voice, Family Carers, Doncaster Clinical Commissioning Group and the Strategy and Performance Unit within Doncaster Council. • Stage 2 November 2018 - January 2019: Engagement with people with learning disabilities, autism or both, family carers and staff, who shared their views on what's working well, what's not working and what needs to change in the future to ensure better services and better life opportunities. • Engagement Sessions: 12 Engagement Sessions were held with a total of 123 people attending. The sessions were attended by people with learning disabilities, autism or both, family carers and members of staff. • Online Questionnaire: Three questionnaires were created (one for people with learning disabilities, autism, or both; one for family carers; one for members of staff). 145 people completed the online questionnaires (78 people with learning disabilities, autism or both; 45 family carers;18 members of staff).

The engagement was shaped around the four Doncaster Growing Together themes; Learning, Working, Living and Caring which translated into Education, Employment, Housing and Health; with people also given the opportunity to tell us about any other issues of importance to them.

The materials used for this engagement were of Easy Read design and the sessions were spread across the Borough in a variety of settings, including Community locations, SMILE day services, Doncaster College etc. in order to include a cross section of the population, with reasonable adjustments being made to ensure accessibility and comfort for attendees during the sessions. Paper copies of the survey were also made available and a number were distributed to some of the venues where engagement sessions were held.

During May 2019 two further face to face engagement sessions were held, providing people with the opportunity to tell us what they thought of the draft plan, particularly around whether the key principles and priorities are right. The initial engagement had identified 16 priority areas of work, with this further engagement asking people to vote for their top priorities.

In addition to the engagement events we created an online questionnaire. In total we heard from 114 people; 53 People came to the events and 61 people had their say via the online questionnaire.

The top 5 priority areas identified were • Diagnosis of Autism • Education and Inclusion • Employment • Family Carers • Housing and Support

3 further areas of high importance were identified as cross-cutting themes that will be embedded and addressed by the 5 priority areas above: • Health Inequalities • Young People in Transitions (into Adult services) • Transforming Care Programme

The Strategy and subsequent delivery plans recognise the 5 areas as the main key priorities along with the 3 cross-cutting themes. Of the remaining 8 work areas, 3 relate to client groups whose needs are addressed within the existing plans (older people, people with autism and people with complex needs). Short Breaks has already been incorporated into the Family Carers priority due to the natural linkages and overlaps, as is the Carer Strategy refresh. Day Opportunities in part is addressed via the Family Carers and Short Breaks work and within Education and Employment.

Formal work on Early Help, Prevention and Health & Wellbeing is yet to start however we will be reviewing where these areas are being addressed within other Council service areas e.g. Communities and Localities. This, along with regular engagement with local people and their representatives, will enable us to identify gaps in services and provision for people with a learning disability and/or autism.

Following Cabinet and Governing Body agreement of the strategy, we plan to undertake a stocktake of progress so far, the existing plans, opportunities across the system to drive forward the learning disability and autism agenda, and develop a refreshed, timetabled programme of work, including data and information requirements (which incidentally is one the remaining areas of work). As part of this programme of work we will also consider workforce development.

People with learning disabilities and/or autism and their family/carers will continue to be engaged, checking in regularly to ensure all priorities are being considered and progressed appropriately.

Both the Learning Disability Partnership Board and the Autism Partnership Board have continued to be updated about the progress being made on the priorities within the Strategy. The Boards have approved of the action plans proposed, have been able to pose questions of Officers and have been able to inform and influence work streams. The Partnership Boards have a membership made of local people with lived experience, family carers, Voluntary and Charity groups, professionals, and other key stakeholders.

Strategic Commissioners attend the Carers Action Group and Carers Strategic Oversight Group. For the Carers Action Group in particular, Carers (including those who were involved in the original engagement for the strategy) will be kept informed about progress and updates regarding the priority areas. Carers will also be asked how they might want to be involved in the ongoing development and review of the strategy.

In January 2021, Strategic Commissioning attended the Minorities Partnership Group and presented the strategy and priority areas. The Group has advised the need to work more closely with communities to shape the work format moving forward. Agreed next actions will be to identify the communities most affected by COVID- 19, understand the barriers these communities face when using or accessing services, and how this has been impacted by the COVID-19 pandemic.

As part of the strategy refresh, we will be developing and implementing a communication and engagement plan, ensuring people in Doncaster are kept informed and updated, and are able to get involved in the strategy.

Negative: What are the Protected risks? Positive Neutral Negative characteristic Positive: What are the benefits / opportunities? The Strategy covers all age need with a specific priority area to develop transition including children to adult services or the development of all age pathways.

CYP plans relating to Age √ Education and Employment are largely driven through the SEND plans. Further alignment of the LD&A plans and the CYP plans is needed to ensure they align and that CYP experience a more joined up approach as they transition into Adulthood.

The needs of people with LD and/or Autism are both Disability √ addressed within the strategy, with recognition there are similarities and disparities between the broad groups, and that people’s needs are often described in more than one group. Services and provision will be developed that need the broad needs of each group, e.g. employment support, housing needs; in addition to the individual needs each person has that takes account of age, level and complexity of need. The Needs Assessment provides additional information e.g. about how many people have complex needs, the proportion of people with Autism with or without learning disability. Individual, personalised assessment and care are therefore central principles applied to the development and delivery of provision.

Gender No Impact

Based on the figures above, it is estimated that there are approximately 900 people in Doncaster from a BAME background and have a learning disability, autism, or both, and that this number is also increasing. Further work with communities and public health is needed to Positive understand the barriers and Race impact challenges that BAME communities may face when accessing services in Doncaster, and the changes that are needed to ensure their needs are met. Communications and engagement plan also need to reflect that people from BAME background have a representative voice and are involved within the development of the strategy plans and implementation, ensuring plans and responses are effective and appropriate to meet wide ranging needs and requirements.

Religion & Belief √

Sexual Orientation √

Gender √ reassignment

Pregnancy & √ Maternity

Marriage & Civil √ Partnership

Learning disability and autism partnership boards ensure Social Inclusion / inclusion and cohesion is Community √ included in each area of work Cohesion with 2-way communication and coproduction.

Conclusion & Recommendations Recommend the sign off to the strategy refresh and note of work including any already undertaken. resulting action plan

Review date February 2022

EQUALITY, DIVERSITY AND INCLUSION

DONCASTER METROPLITAN BOROUGH COUNCIL

Due Regard Statement Doncaster’s All Age Learning Disability and Autism Strategy (2021-2024)

How to show due regard to the equality duty in how we develop our work and in our decision making.

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Due Regard Statement

A Due Regard Statement (DRS) is the tool for capturing the evidence to demonstrate that due regard has been shown when the council plans and delivers its functions. A Due Reagrd Statement must be completed for all programmes, projects and changes to service delivery.

 A DRS should be initiated at the beginning of the programme, project or change to inform project planning

 The DRS runs adjacent to the programme, project or change and is reviewed and completed at the revelent points

 Any repoprts produced needs to reference “Due Regard” in the main body of the report and the DRS should be attached as an appendix

 The DRS cannot be fully completed until the programme, project or change is delivered.

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1 Name of the ‘policy’ Doncaster’s All Age Learning Disability and Autism Strategy (2021-2024) and briefly describe the activity being The strategy aims to support people of all ages with a learning disability and/or autism to live their best life, and have the same opportunities as everyone else living in Doncaster. considered including

aims and expected The vision statement of the strategy, which was agreed through the engagement process is that, outcomes. This will help to determine how “We believe that children, young people and adults with a learning disability and/or autism have relevant the ‘policy’ is the right to the same opportunity as anyone else to live satisfying and valued lives, and to be to equality. treated with dignity and respect. They should have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives”.

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10. Have highly personalised support, which is built up around people’s strengths, their own networks of support and in their local community 11. Be supported to access universal and early support services, where their needs are understood, they are accepted for who they are and reasonable adjustments are made 12. Have the information they need to access social care and health services and universal services 13. Have a planned and smooth transition from child to adult life 14. Have a fulfilling and healthy later life with the same opportunities as other older people 15. Expect health and social care to work together with others to make the best of resources, working hard to achieve fully personalised support 16. Have their views and wishes in the centre of planning and shaping support

2 Service area Strategic Commissioning responsible for completing this Public Health, Leisure and Strategic Commissioning

statement.

3 Summary of the Data and information from a wide range of sources has been used to understand the needs of information considered people with a Learning Disability and/or Autism and their family/carers in Doncaster. across the protected groups. Population demographics, including age profiles, ethnicity, and incidence of learning disability and/or Autism have been considered, with expected growth rates to 2030 included and the implications considered. Service users/residents Detail of this information is provided in:

Doncaster Workforce Annex 1 – Doncaster All Age Learning Disability & Autism Strategy (2021)

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LD&A Annex 1.docx

References are included in the strategy refresh document.

Formulation of the strategy considered national strategy and policy where this is relevant, local policy and strategies, and emerging evidence for each of the workstreams and plans.

With regard to health plans, ongoing learning is reflected within the plans, which are regularly updated in light of new evidence.

Education and inclusion plans are reviewed and updated in line with SEND inspections, and national review / updates of SEND Strategy and priorities. Data to support the 6 priorities (detailed below) is currently being explored to enable decision-making and next steps, with detail referenced in the SEND Programme Due Regard Statement.

As the COVID-19 pandemic progresses, emerging evidence of the impact on people with LD&A, and those from BAME communities is regularly reviewed to inform and support development of local plans, building on existing good practice developed since the start of the pandemic. A focussed approach is planned to explore the risks and mitigations for specific groups, e.g people from BAME, and those living in shared accommodation.

Initial engagement with people with lived experience was framed around known areas of concern. The outcomes are detailed in the engagement section below.

References in the main LD&A strategy document include those listed below:

a) Engagement Report for the Doncaster All Age Learning Diability & Autism Strategy, Speak Up Advocacy (2019) b) Doncaster Place Plan Refesh (2019-2022), Doncaster Partnershi (2019)

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c) Doncaster Joint Commissioning Strategy, Doncaster Council & Doncaster CCG (2019) d) Appendix to Director of Public Health Annual Report 2020, Doncaster Council (2020) e) Housing Needs Assessment: Future need for accommodation with support 2020-2030, South Yorkshire and Bassetlaw Integrated Care System (2020) f) Doncaster Council Due Regard Statement for Implementation of the SEND Strategy. g) Projecting Adult Needs and Service Information (PANSI) 2021 https://www.pansi.org.uk/ h) Service Model for Commissioners, NHSE, ADASS, LGA (2015) https://www.england.nhs.uk/wp-content/uploads/2015/10/service-model-291015.pdf i) Building the Right Support, NHSE, ADASS, LGA (2015) https://www.england.nhs.uk/wp- content/uploads/2015/10/ld-nat-imp-plan-oct15.pdf j) REACH Standards, Paradigm (2017) ) https://paradigm-uk.org/what-we-do/reach-support- for-living/ k) Making it Real, TLAP (2018) https://www.thinklocalactpersonal.org.uk/makingitreal/ l) Foundation for People with Learning Dibilities: Learning Disability Statistics: Autism (2021) https://www.learningdisabilities.org.uk/learning-disabilities/help- information/statistics/learning-disability-statistics-/187690 m) What is Autism?, National Autism Society (2020) https://www.autism.org.uk/advice-and- guidance/what-is-autism n) Employment Research and Statistic, Mencap (2021) . https://www.mencap.org.uk/learning- disability-explained/research-and-statistics/employment-research-and-statistics o) Caring Behind Closed Doors, Carers UK (2020) https://www.carersuk.org/images/News_and_campaigns/Caring_Behind_Closed_Doors_Oc t20.pdf p) PH England Nov 2020 COVID 19 deaths of people identified as having learning disabilities: summary. www.Gov.uk q) PH England Nov 2020 Press Release People with learning disabilities had higher death rate from COVID-19. www.Gov.uk

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r) PH England 2020: Beyond the data: Understanding the impact of COVID-19 on BAME groups www.gov.uk s) Data collected by the Council’s Policy, Insight and Change team regarding Doncaster’s health and social care services for people with a learning disability and/or autism.

4 Summary of the In August 2018 The Adult, Health and Wellbeing Directorate agreed a business case for the Co- consultation/engageme production and Engagement plan for people with a learning disability, autism or both. Speak Up nt activities and Inclusion North were commissioned to deliver this, which involved engagement with users of services who have a learning disability and/or autism, their carers and professionals.

This work was undertaken in the following stages:  Stage 1 September 2018 – November 2018: Co-production of the materials for the engagement strategy, working with key partners and Experts by Experience from Choice for All Doncaster (ChAD), Doncaster Parent Voice, Family Carers, Doncaster Clinical Commissioning Group and the Strategy and Performance Unit within Doncaster Council.  Stage 2 November 2018 - January 2019: Engagement with people with learning disabilities, autism or both, family carers and staff, who shared their views on what's working well, what's not working and what needs to change in the future to ensure better services and better life opprotunities.  Engagement Sessions: 12 Engagement Sessions were held with a total of 123 people attending. The sessions were attended by people with learning disabilities, autism or both; family carers and members of staff.  Online Questionnaire: Three questionnaires were created (one for people with learning disabilities, autism or both; one for amily carers; one for members of staff). 145 people completed the online questionnaires (78 people with learning disabilities,autism or both; 45 family carers;18 members of staff).

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In addition to the engagement events we created an online questionnaire. In total we heard from 114 people; 53 People came to the events and 61 people had their say via the online questionnaire.

The top 5 priority areas identified were  Diagnosis of Autism  Education and Inclusion  Employment  Family Carers  Housing and Support

3 further areas of high importance were identified as cross-cutting themes that will be embedded and addressed by the 5 priority areas above:  Health Inequalities  Young People in Transitions (into Adult services)  Transforming Care Programme In addition to the above, CYP is consulting on the local Graduated Approach Nov 20- Feb 21. The webpage for the Graduated Approach has now gone live for consultation. It has been stressed in all training sessions that this is still under construction and undergoing an internal review.

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The LD&A Strategy and subsequent delivery plans recognise the 5 areas as the main key priorities along with the 3 cross-cutting themes. Of the remaining 8 work areas, 3 relate to client groups whose needs are addressed within the existing plans (older people, people with autism and people with complex needs). Short Breaks has already been incorporated into the Family Carers priority due to the natural linkages and overlaps, as is the Carer Strategy refresh. Day Opportnities in part is addressed via the Family Carers and Short Breaks work and within Education and Employment.

Following Cabinet agreement of the strategy, we plan to undertake a stocktake of progress so far, the existing plans, opportunities across the system to drive forward the learning disability and autism agenda, and develop a refreshed, timetabled programme of work, including data and information requirements (which incidently is one the remaining areas of work). As part of this programme of work we will also consider workforce development.

In 2019, Members from the Health and Adult Social Care and Children and Young People Scrutiny Panels undertook three fact-finding meetings to contribute to the work being undertaken on the Strategy. This involved Members considering statistical information and work undertaken to date as well as attending the Learning Disability Partnehip Board and met with Carers and people with learning diabilities and autism. The panels made the following recommendations, which were sent as a letter to the Mayor:

1. Investigate whether the Council could provide Supported Internships for people with learning disabilities and autism. 2. Review the “Your Life Doncaster” system alongside people with learning disabilities or autism, who do not have a carer or immediate support.

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3. Ensure that people with learning disabilities and autism have a single pathway of support developed. 4. Highlight within the Strategy the frequency and severity of learning disability amongst people within the prison sector. 5. Give consideration to writing to the Department for Work and Pensions asking for the requirement of people with a permanent disability, not to have to be reassessed on an annual basis when claiming PIP (Personal Independent Payment), but to make the award for a longer period. 6. Ask service users what difference the Strategy has made to them specifically when applying for support, benefits, medical assistance and employment, once the Strategy has been agreed and embedded.

Following this letter to the Mayor, the recommendations made by Scrutiny Panel were acknowledged and accepted by Councillor Blake.

In 2021, Strategic Commissioning have been asked to produce a report, detailing how the recommendations have been addressed,ready for the 18th March Scrutiny Panel.

People with learning disabilities and/or autism and their family/carers will continue to be engaged, checking in regularly to ensure all priorities are being considered and progressed appropriately.

Both the Learning Disability Partnership Board and the Autim Partnership Board have continued to be updated about the progress being made on the priorities within the Strategy. The Boards have approved of the action plans proposed, have been able to pose questions of Officers and have been able to inform and influence work streams. The Partnership Boards have memberships made of local people with lived experience, family carers, Voluntary and Charity groups, professionals and other key stakeholders.

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the prioritiy areas. Carers will also be asked how they might want to be involved in the ongoing development and review of the strategy.

In January 2021, Strategic Commissioning attended the Minorities Partnership Group to discuss the strategy and priority areas,and emerging inequalities specifically related to COVID-19. The Group advised the need to work more closely with communities to shape the work format moving forward. Agreed next actions will be to identify the communities most affected by COVID-19, understand the barriers these communities face when using or accessing services, and how this has been impacted by the COVID-19 pandemic to enable plans to be developed.

25th Feb 2021 An Easy Read version of the Strategy has been developed, to increase access to more people. The Easy Read was developed by colleagues from Strategic Commissioning, Adult Social Care, and a person with lived experience. Inclusion North further developed the document, which was shared with people with lived experience who currently use services.

Feedback from these groups was used to finalise the Easy Read document, a summary document and video, which will be placed on the Councils website Learning Disability and Autism pages.

5 Real Consideration: Population Doncaster has an estimated population of 7,700 people with a learning disability and around 3000 Summary of what the people with autism. The 2011 Census identified that 8.2% of the population was from the Black, Asian and Minority Ethnic (BAME) community and determines that the population is expected to evidence shows and grow by c1.2% by 2030. how has it been used The growth rate will need to inform the development of services for people with LD&A, and also recognise the ageing population, in the development of strategic planning, for example, Housing solutions to be ‘future-proofed’ to meet individuals changing needs.

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The number of Children under the age of 14 is expected to reduce by 5.45% over the next 10 years, while the number of people over the age of 75 years is expected to grow by more than 40%. In addition, the numbers of people diagnosed with Autism are increasing year on year. The impact of these growth rates will need to be factored into services now, and those in development for long term needs.

Learning Disablity and Autism specific needs The needs of people with LD and/or Autism are both addressed within the strategy, with recognition there are similarities and disparities between the broad groups, and that people’s needs are often described in more than one group. Services and provision will be developed that need the broad needs of each group, e.g. employment support, housing needs; in addition to the individual needs each person has that takes account of age, level and complexity of need. The Needs Assessment provides additional information e.g. about how many people have complex needs, the proportion of people with Autism with or without learning disability. Individual, personalised assessment and care are therefore central principles applied to the development and delivery of provision.

People from a Black, Asian & Minority Ethnic background Based on the figures above, it is estimated that there are approximately 900 people in Doncaster from a BAME background and have a learning disability, autism or both, and that this number is also increasing. Further work with communities and public health is needed to understand the barriers and challenges that BAME communities may face when accessing services in Doncaster, and the changes that are needed to ensure their needs are met. Communications and engagement plans also need to reflect that people from BAME background have a representative voice and are involved within the development of the strategy plans and implementation, ensuring plans and responses are effective and appropriate to meet wide ranging needs and requirements.

COVID-19 Evidence from NHS England (referenced in Annex 1 – Doncaster All Age Learning Disability & Autism Strategy) highlights that people with a learning disability and/or autism are a 3.6 times

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more risk from dying of COVID-19 than the wider population. People from BAME groups are also identified at being at greater risk from COVID-19. It is unclear at this point what the combined risk is for people from a BAME background who also have a learning disability and/or autism.

The refresh of the strategy has enabled us to consider the evidence and emerging health inequalities faced by people with learning disabilities and/or autism due to COVID-19, and exploring how health inequalities can be approached and addressed are now reflected and embedded into actions plans moving forward.

Children and Young People The numbers of Children and Young People in Doncaster is expected to reduce over the next 10 years, although it appears the number of people (all ages) diagnosed with Autism appears to be increasing. The number of children with EHCP continues to increase year on year across Doncaster. Further information and data is needed to understand this possible disparity

Evidence and narrative about the needs of CYP across each of the workstreams are included within the Understanding Needs section of the strategy, and included within Annex 1 attached. CYP, including Looked after children in transitions are key priority for housing and support, which is reflected in the Housing and Support plans; and within the Transforming Care programme.

Progress of the Education and Inclusion and Employment plans are driven through the SEND programme , and described in the Education and Inclusion, and Employment summaries within the Learning Disability and Autism Strategy Document.

The summaries reflect the SEND plans and the 6 Areas of Priority, which aim to ensure all children with Special Educational Needs have their needs met and any inequalities are being addressed.

Priority 1 - To ensure that the graduated response to meeting special educational and disability needs is delivered coherently and consistently:

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Priority 2 - Making sure that children and young people (CYP) with SEND with social emotional and mental health (SEMH) needs have their needs identified and met effectively in a timely manner so they can engage and make good progress, particularly in mainstream settings. Priority 3 - Ensuring that children and young people on the autism, attention deficit and other neurodevelopmental pathways have their needs identified and met in a consistently timely manner ASD. Priority 4: Ensuring that Doncaster’s secondary schools provide curricula and teaching that effectively meet the needs of students who have SEND so that they make good progress and are well prepared for their next stage in education and future employment Priority 5 -Improving pathways in employment for young people who have SEND so they are able to access suitable sustainable employment or supported employment Priority 6 - Improving the use of information to inform strategic planning and joint commissioning. The SEND priorities also align with the priorities agreed by people with lived experience during the initial engagement exercises listed above.

Carers National evidence and local Carer experience clearly determines that carers are providing more care now than even a year ago, with less access to support and respite than available before COVID-19. While services have opened where possible offering COVID-19 secure services, Carers have less access and choice of the services available to them. The Carer and Short breaks workstream plans aim to address these challenges.

Overview and Scrutiny Many of the recommendations by Members at Scrutiny Panel reflected the views and priorities of people with lived experienced identified during consultation and the actions as embedded within the strategy. Other recommendations are out of scope of the Strategy and reflect other work that is being progressed by partners.

Responses to the recommendations are detailed in the report to the Overview and Scrutiny Panel dated 18th March 2021. ATTACH FOLLOWING MEETING

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6 Decision Making An overview of the analysis and use of data associated with protected groups has been included in the strategy, the subsequent actions plans and next steps, and is included throughout the evidence base.

A reference has been made to the Due Regard Statement within the Learning Disability/Autism Strategy Cabinet Report for 09th March 2021 ensuring Cabinet are fully aware of the steps taken so far and the plans to be implemented going forward to ensure that due regard is taken of the Equality Duty.

7 Monitoring and Review A programme management approach will facilitate a safe, best practice introduction of new services prior to or alongside the rationalisation of existing services. The Due Regard Statement is a live document and as such should be regularly reviewed, revised and updated to ensure that due regard is taken at all points whilst the project is being implemented. The senior manager identified to sponsor the project will have overall responsibility for the due regard of service users. This manager will continuously monitor, through the care management team and commissioning managers aassigned to the project the needs of service users and the services that have been deployed or commissioned to meet these needs.

Progress against the Learning Disability/Autism Strategy will be assessed via ongoing monitoring of the Delivery Plans, which will be overseen by the respective Partnership Boards, the Carers Action Group, Carers Strategic Oversight Group and the Minorities Partnership Group. This process will ensure that Due Regard continues to be reviewed by people with lived experience, family/carers and key stakeholders. Progress is also reported through the Living Well Delivery Plan reporting system on Pentana and operational delivery is covered under the council’s standard performance management framework.

8 Sign off and approval  By signing this statement off as complete you are confirming that ‘you’ have examined for publication sufficient information across all the protected groups and used that information to show due regard to the three aims of the general duty. This has informed the development of the activity.

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 If this statement accompanies cabinet paper it will be published as part of the cabinet report publication process. Statements accompanying cabinet reports are also published on our website. If this statement is not to be submitted with a cabinet paper please maintain a copy for your own records that can be retrieved for internal review and also in case of future challenge.

Last updated: 24th February 2020, Andrew Buxton, Commissioning Officer, Strategic Commissioning

LDA Strategy Due Regard Appendix 1. 16.02.21 V1.1 This is a short version The BIG Plan is for of the BIG PLAN people with a learning disability and/or autism and family carers

The BIG Plan is for The BIG Plan is from people of ALL Ages 2021 - 2024 The BIG Plan – 2021 – 2024

This BIG Plan is for people of ALL ages, children, young people, adults and older people.

People told us that the following five things were the most important:

1. Finding out if someone is autistic.

2. Learning and being part of our communities

3. Getting a job

4. Carers and short breaks

5. Housing and support What are we doing about these five important things?

We are:

• Making better plans for people to find out if they are autistic and plans to get the right support.

• Making sure everyone gets a good education and has a good future.

• Making sure people can have a job if they want one.

• Making sure carers are listened to about what is important to them, to help them continue to care for family members with the help of short breaks.

• Making sure the right housing and support is available. Other important things you told us were:

• Making health services better

• Moving from children’s services to adult services.

• Making care better

We also want to make sure people with a learning disability do not die young, and have healthy and happy lives.

We also want to make sure people do not get COVID 19 and get a vaccine to protect them.

If you would like to find out more or keep in touch about Doncaster’s ALL Age BIG Plan for people with Learning Disabilities and Autism you can contact: Julia King – Commissioning Manager Doncaster Council 01302 737316 [email protected]

Doncaster’s All Age BIG Plan for People with Learning Disabilities and Autism (2021 – 2024)

Contents Page

What is this information about? 3

What people told us was 5 important to them

Finding out if someone is 8 Autistic

Education and inclusion 10

Employment 12

Carers and short breaks 15

Housing and support 18

The Learning Disability & 21 Mortality Review (LeDeR)

Coronavirus (COVID 19) 23

Keeping in touch 25

What some words mean 26

What is this information about? This information is about the BIG plans that

Doncaster Council, Doncaster Clinical Commissioning Group, people with a learning disability and/or autism and their families, community and voluntary groups have

worked together on. Doncaster’s BIG Plan will support the following people: ✓ People with a learning disability ✓ People with autism

✓ People with a learning disability and autism. The people the BIG plan will support might: ✓ Live with family ✓ Live in supported living ✓ Live in a care setting ✓ Live on their own

The BIG Plan aims to make sure people with a learning disability and/or autism live the best life they can and have the same opportunities as everyone else living in Doncaster.

Doncaster’s BIG Plan is for people of all ages:

✓ Children ✓ Young People

✓ Adults ✓ Older People

The BIG Plan is for the 3 years between 2021 and 2024.

What people told us was important to them

People with a learning disability, autism and

their families and carers helped to develop this BIG Plan with:

• Doncaster Council

• Doncaster NHS Clinical Commissioning Group

• Community groups

People with a learning disability, autism and their families and carers were asked what is important to them.

Some people attended events organised by Speak Up and Inclusion North.

Some people filled in questionnaires online.

From the events held and the questionnaires returned, people told us that the following 5 things were the most important:

1. Finding about whether someone is Autistic (Diagnosis)

2. Education and inclusion

3. Employment

4. Carers and short breaks

5. Housing and support

There were other areas we needed to think about as well as the top 5 important things. These were:

✓ Health inequalities - making health services more equal

✓ Moving from children’s services to adult services

✓ Transforming care – making care better.

Finding out whether someone is autistic (Diagnosis)

Some people are waiting too long to find out if they are autistic.

No-one should wait longer than 18 weeks to find out if they are autistic.

Finding out whether you are autistic will help to get you the right support.

You told us …

✓ Finding out whether someone has autism is very important.

✓ Having the right information is important.

✓ Having the right support is important

✓ You should not have to wait a long time.

✓ Finding out whether you are autistic should be done close to home.

What we have done…

We have a plan to make better the way people find out if they are autistic.

The plan also will help people to get the right support after finding out they are autistic.

Our next steps……..

We will be putting in place better plans for people to people find out whether they are autistic.

Education and Inclusion

Families are worried that people with a learning disability and/or autism might not get the right education or learning opportunities.

You told us……

✓ Teachers need to understand the needs of children with a learning disability and/or autism.

✓ More careers advice is needed to help people get a job.

✓ More support to develop skills to become more independent.

✓ More after school activities

✓ Better transport to help children stay local.

✓ Residential school is not good for some children

What we have done…

Doncaster’s Children and Young People’s services are working with teachers. This will help make children’s experience of special schools better.

Young people are being supported to have better employment and life skills as they grow up. There is a new special school for children and young people in Doncaster.

The school is called The Bader Academy

Next steps…

We will continue to make education better for people with a learning disability and/or autism.

We want to make sure everyone gets a good education and help them to have a good future.

Employment Having a job is important for people with a learning disability and/or autism.

Sometimes it can be hard for people with a learning disability and/or autism to get the right support to get a job.

You told us… ✓ Employers need to make reasonable adjustments to help people with a learning disability and/or autism get and keep a job.

✓ A reasonable adjustment is a change that can be made so that people with a learning disability and/or autism can have the same opportunities as anyone else.

✓ Both Doncaster Council and Doncaster Clinical Commissioning Group should

employ more people with a learning disability and/or autism.

✓ There needs to be more opportunities for people to get a job if they want one.

What we have done… We have started a list of employment support in Doncaster.

We are looking at what opportunities there are for people with a learning disability and/or autism to work at Doncaster Council and Doncaster Clinical Commissioning Group.

Autism Plus is now offering employment support online so that people can get support during COVID 19 pandemic.

Next steps…

Once our list of employment support is ready, we will share this with people.

We are also asking people what other employment support they might need.

Carers and short breaks Some people with a learning disability and/or autism live with their family carers in the family home.

Having a short break from a caring role helps carers.

Usually, it is a planned break and not because of an emergency.

Short breaks can give carers a rest to help them continue to be a carer.

You told us……

✓ Carers wanted to be listened to.

✓ Carers would like to be involved in work to make services better.

✓ Carers said they would like to have ➢ Choice ➢ Flexibility ➢ Availability about short breaks.

What we have done…

Carers are represented at the Learning Disability Partnership Board and the Autism Partnership Board.

Carers have more groups where they are listened to.

Carers have helped to make a questionnaire about short breaks in Doncaster.

Carers are involved in making services in Doncaster better for people with a learning disability and/or autism.

Shared Lives is a local service where people can stay with a family for a short time to give their family carer a break.

We are looking at Shared Lives in Doncaster to make sure more people can use this service.

Next steps…

We will listen to Carers to make short breaks better in Doncaster.

We will make sure the Shared Lives service can be used by more people.

We will make sure services meet the needs of different groups and communities.

Housing and support People with a learning disability and/or autism should have the right housing and support to meet their needs.

People should be supported to have relationships and friends.

We need to think about how we plan for Children when they move to Adult Services.

You told us… ✓ Choosing where and who you live with is important.

✓ Staff need to have the right skills and training to support you.

✓ It is important to have choices and

options about housing and support.

✓ Young people should tell us where they would like to live in the future.

✓ Young people should be asked if they are happy about where they live and who they live with during any assessment.

✓ You should get good support to have relationships and friendships.

What we have done…

We have found out what housing and support people will need in the next 10 years.

2021 2031 We have new supported living flats in Askern that will be ready in 2022.

We have started to speak to young people about where they would like to live in the future.

We have been working with Supported Living Providers to increase the use of technology.

Next steps...

We will work with Landlords to make sure we have the right housing for people.

We will help people to access Council Housing.

We will help people who want to live in Askern to move into the new supported living flats when they are ready.

The Learning Disability and Mortality Review (LeDeR)

The Learning Disabilities Death Review Programme is also known as LeDeR.

The LeDeR Programme is trying to improve care and medical treatment so that people with a learning disability live longer and healthier lives.

When people with a learning disability die, the LeDeR team check to see if things could

have been done better for them.

Next steps……

It is important for us to understand why people with a learning disability have died.

This will help us to make services and health care better for the future

People with learning disabilities will then enjoy long, happy and healthier lives.

Coronavirus (COVID 19)

Coronavirus (COVID 19) is an illness that can make people feel poorly.

Coronavirus (COVID 19) can be passed very easily from person to person.

Some people with a learning disability are more likely to get more poorly than other people.

This is even more likely if they have other health problems.

Next steps…..

We want to understand how we can help protect people with a learning disability or autism from Coronavirus (COVID 19).

We want to make sure people with a learning disability and/or autism have the right information about Coronavirus and know how to keep themselves safe and healthy.

Keeping in touch Some people have asked to be kept up to date, with the work we are doing.

We are making plans about the best way for Doncaster Council to give you regular updates.

We also want to look at the ways for more people to be involved in our work and to tell us what they think.

What do these words mean The “All Age Plan” The All Age plan in Doncaster is for all people of any age in Doncaster with learning disabilities and/or autism.

• Children When the plan talks about children it is talking about 0-18 years old.

• Young People When the plan talks about young people it is talking about people between the ages of 0-25 years old. (if they are in education).

• Adults When the plan talks about Adults, this may mean people between 18 and 65 years of age (if they are not in education at 18).

• Older people When the plan talks about older people it means people over 65 years of age.

Autistic People People who think and see the world in a different way.

People with a Learning This is when people find it hard to disability learn new things – and may need support in daily activities.

Health inequalities This is when health services are not provided to people with a learning disability and/or autism and they don’t get the same equal treatment as other people.

Transition This is when a young person moves into adult services

How national organisations are Transforming Care working together to improve services for people with learning disabilities or on the autism spectrum and who is responsible for what.

Diagnosis Finding out about how our bodies are working.

Reasonable Adjustments A reasonable adjustment is a change that can be made so that people with a learning disability and/or autism can have the same opportunities as anyone else.

Family Carers Family Carers are members of the same family who may support someone with a learning disability and/or autism like Mum, Dad or Aunty or Uncle. Carers Carers are usually paid for the support they provide someone with a learning disability and/or autism

Learning Disability Most local areas have a learning Partnership Board disability partnership Board. They

are made up of people with a learning disability, family carers and other organisations – they make big decisions.

You can find more about Doncaster’s by contacting Julia King. Autism Partnership Board Most local areas have a learning autism partnership Board. They

are made up of people with autism, family carers and other organisations – they make big decisions.

You can find more about Doncaster’s by contacting Julia King. Shared Lives Shared Lives offers people with a learning disability and/or autism the chance to live with an ordinary family. Sometimes for a short break and sometimes as a family home.

How to find out more If you would like to find out more about

Doncaster’s All Age BIG Plan for People with Learning Disabilities and Autism you can contact:

Julia King who is a Commissioning Manager at Doncaster Council If you want to contact by telephone, you can ring us on 01302 737316

Or you can send an email to [email protected]

Or you can write to: Julia King Strategic Commissioning Public Health, Leisure and Strategic

Commissioning Doncaster Council

Civic Office

Waterdale Doncaster DN1 3BU

This BIG Plan was made with the pictures from the Photosymbols Picture Bank.

Doncaster All Age Learning Disability and Autism Strategy 2021 / 24 Plan on a Page

Our Vision “We believe that children, young people and adults with a learning disability and/or autism have the right to the same opportunity as anyone else to live satisfying and valued lives, and to be treated with dignity and respect. They should have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives ”

Our Approach • To work in partnership across the health and care system. • To work collaboratively with Voluntary, Community and Faith partners. • To put the voice of people with lived experience at the centre of what we do. • All developments are based on the needs of people with lived experience • All developments are based on best available evidence • Approaches are personalised, strengths based, and community focussed. • To make sure all learning is captured, and reflected in delivery.

Our Objectives Our Next Steps 1. Diagnosis of Autism 1. Diagnosis of Autism To reduce waiting times for diagnosis Increasing capacity of the Autism Diagnostic Service of Autism and Post – Diagnostic 2. Education and Inclusion Pathways Ensure secondary schools meet the needs of students who 2. Education and Inclusion have SEND so that are well prepared for their next stage in To embed the Graduated Approach; education and future employment 3. Employment 3. Employment People with LD&A have the right Make sure that the CYP Employment, Education, and support access and maintain real Inclusion Plans work together. Complete the Employment employment opportunities. 4. Carers and Short Breaks Support mapping exercise, start plans to meet the gaps. To increase the availability and range 4. Carers and Short Breaks of short breaks for Doncaster Carers Review the outcomes of the Focus group and survey, 5. Housing and Support recommendations to inform the Carers and Short Breaks To ensure that there is a suitable plans range of accommodation & support 5. Housing and Support based on peoples needs and Set up a framework to source landlords / properties based preferences. on the needs of people with lived experience; start Cross Cutting Themes matching and preparing individuals to the new supported 1. Health Inequalities living apartments at Askern To improve health outcomes and Cross Cutting Priorities reduce health inequalities for people 1. Health inequalities – COVID -19 with LD&A Working partners, develop plans to engage with BAME 2. Transforming Care communities to plan the response to COVID-19 inequalities Supporting people to live their best for people with LD&A . Implement LeDeR outputs life in the community 2. Transforming Care Programme 3. Transitions Continue to support people into community based To improve the experience of young accommodation and support based on their needs. people preparing for adulthood with 3. Transitions a seamless transition into adulthood Continue to prioritise the needs of Young People across each work-stream above. Meeting name Governing Body Meeting date 4 March 2021

Title of paper Equality and Diversity Annual Report 2020/21

Executive / Lisa Devanney, Associate Director of HR & Corporate Services Clinical Lead(s)

Author(s) Alison Edwards, Corporate Governance Manager

Status of the Report

X To approve To consider / discuss

To note

Purpose of Paper - Executive Summary

Background

This report sets out a summary of the activity Doncaster CCG has undertaken during 2020/21 regarding Equality, Diversity and Inclusion. It shares our progress for the Year 2020/2021 with regards to promoting the equality agenda and meeting our legal duties for demonstrating the Public Sector Equality Duty.

The report provides a picture of Doncaster’s demographic make-up by protected characteristics as well as health inequalities and how we engage with our diverse community.

NHS England produces an Equality Delivery System (EDS) toolkit which supports the CCG to improve the services provided for the local communities, consider health inequalities in Doncaster and provide better working environments, free of discrimination, for those who work within the NHS. Implementation of the EDS is an annual requirement for both NHS commissioners and NHS providers. Once completed we publish a summary report on our website and we also include a summary in our Equality and Diversity Annual Report which is also published on our website.

The EDS is regularly made available during November however it has yet to be released for 2020/21. NHS England have informed us that changes are being made to the toolkit however we have no further details. Section 9 in the Equality and Diversity Annual Report 2020/21 is a reminder of the 2019/20 findings and the identified actions. The action plan and progress made for 2019/20 can be found in Appendix 5.

In order to provide the Governing Body with updated information for 2020/21 we have reviewed and revised the 2019/20 responses to reflect the current years activities (see Appendix 6).

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Recommendation(s) The Governing Body are asked to - Approve the Equality and Diversity Annual Report 2020/21 - Note the Equality Delivery System 2020/21 updates

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Positive – we aim to make changes and target areas for improvement to Quality impact achieve the score ‘Excelling’. Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. X Equality An Equality Impact Analysis/Assessment has been completed and approved by the impact lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Neutral impact Financial Nil implications Legal Duty to record, report and engage. implications Management of Conflicts of None identified. Interest Consultation / Engagement (internal Communication and Engagement Team, Healthwatch Doncaster and departments, Commissioning Leads clinical, stakeholder & public/patient) Report previously Engagement and Experience Committee presented at Risk Failure to publish data the Equality Delivery System report could place analysis the CCG outside of our statutory and legal duties. Assurance 1.1, 2.4 Framework

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EQUALITY AND DIVERSITY ANNUAL REPORT 2020/21

Last Review Date N/A Approving Body Engagement and Executive Committee Date of Approval Date of Implementation Next Review Date N/A Review Responsibility Head of Corporate Governance Version V1.0

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REVISIONS/AMENDMENTS SINCE LAST VERSION

Date of Review Amendment Details January 2021 New - Equality and Diversity Annual Report 2020/21

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CONTENTS

Title Page Number Executive Summary 4 Introduction 5 Legal Duties 6 How we meet these duties 7 How we meet these legal duties - Staff 8 Equality Objectives 9 Knowing Our Patch – Nine Protected Characteristics 10 Knowing Our Patch – Health Inequalities 13 Doncaster CCG Quality and Outcomes Framework (QOF) 15 Prevalence 2020 Indicators Index of Multiple Deprivation 16 Summary of our Engagement 17 Our Outcomes 21 Equality Delivery System (EDS) Self-Assessment 2019/2020 22 Feeding back to us on Equality and what to do if you think we are 23 not meeting our duties Appendix 1 – Core data and information 24 Appendix 2 –NHS Doncaster CCG Staffing Equality Data 26 Pay Band Staffing Appendix 3 – CCG Engagement Delivery Plan Template 28 Appendix 4 – Equality Impact Assessment 30 Appendix 5 – Equality Delivery System Action Plan 32 Appendix 6 – Equality Delivery System 2020/21 38

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Executive Summary

Welcome to our annual Equality and Diversity Report 2020/21 for NHS Doncaster Clinical Commissioning Group (CCG).

This report sets out a summary of the activity Doncaster CCG has undertaken during the financial year 2020/21 regarding Equality, Diversity and Inclusion. As a public sector organisation, we are required to publish relevant, proportionate information to show how we meet the Equality Duty.

We continue to work together with our external partners and with our internal colleagues across the commissioning function of the CCG. By doing this we can create collective actions which can make the most impact for our outcomes.

Doncaster CCG believes that equality, diversity and inclusion should include addressing health inequalities as well as being embedded into all business and commissioning plans. Improving access to services is one mechanism to address health inequalities, another is involving people in decisions surrounding their own healthcare and also ensuring people’s experiences of the services we provide are improving. Doncaster CCG believes that equality is about creating a fairer society and diversity is about recognising and valuing difference in its broadest sense.

Equality and Diversity is all about people, and how we can provide everybody with equal opportunities to thrive, succeed and feel respected and valued whatever their background, culture or characteristics. Getting this right is at the heart of providing a patient-led service and ensuring that we treat people with respect, dignity and fairness

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1. Introduction

Doncaster has a population of approximately 325,592 (April 2020) and 39 GP practices in Doncaster are members of the CCG which provides us with the opportunity to work with our patients to improve services and the overall health of the town. Our GP practice membership ensures the needs and priorities of our population are clearly identified and addressed by delivering the right care in the right place, at the right time by the right people.

This report shares our progress for the Year 2020/2021 with regards to promoting the equality agenda and meeting our legal duties for demonstrating the Public Sector Equality Duty.

1.1. Equality, Diversity and Inclusion is central to the work of Doncaster CCG to ensure that we commission equity of access to services and treatment. The promotion of equality, diversity and human rights is central to the NHS Constitution and other national drivers to reduce health inequalities and increase the health and well-being of the population. We are committed to embedding values of equality and diversity into our commissioning processes, policies and procedures that secure health and social care for our population and into our employment practices.

1.2. At the same time, it has a wider social duty to promote equality through services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.

This report shows our journey for embedding equality, diversity and inclusion within commissioning decisions and our day to day work. The report demonstrates a high level of compliance for all equality related duties, both legal and mandated requirements from NHS England.

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2. Our Legal Duties

2.1. The key piece of equality legislation we are required to comply with is the Equality Act 2010 which brought with it Public Sector Equality Duty (PSED). Public bodies are required to declare their compliance with the duties on an annual basis. Section 149 of the Equality Act 2010 outlines the general duties to have due regard to the following in the exercising of our functions:

• Eliminate unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Act • Advance equality of opportunity between people who share a protected characteristic and people who do not • Foster good relations between people who share a protected characteristic and people who do not

2.2. For the specific duty we are required to:

• Publish information to demonstrate compliance with the general duty, on the make-up of our workforce, and on those affected by our policies and procedures • Publish one or more equality objectives covering a four year period.

2.3. The CCG has continued to demonstrate how it is taking into account the PSED nine protected characteristics. In the context of the PSED the protected characteristics are defined as:

• Age • Disability • Gender • Race • Religion and Belief • Sexual orientation • Pregnancy and maternity • Gender reassignment • Marriage and civil partnership

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3. How We Meet these Legal Duties

3.1. Engagement and Experience Committee (EEC): is a formal Committee of our Governing Body and has responsibility for embedding patient experience within commissioning and ensuring that due regard is paid to our public sector equality duties. Our monthly Engagement and Experience Committee oversees engagement, experience, communication and equality within the CCG and across Doncaster. The Committee includes representatives from Healthwatch Doncaster, the Chairs of our patient and public involvement groups, the Health Ambassador scheme, the Patient Participation Group Network and representatives from across our organisation. It is chaired by our Lay Member for Patient and Public Involvement. The minutes of the Committee are reported to our public Governing Body and are available on our website.

3.2. Equality Analysis: It is important for us to ensure that our decision making, particularly when it is likely to impact on patients, carers and our local communities, is informed by equality analysis and inclusive engagement. The Engagement in CCG Delivery Plans template includes a section specifically related to Equality and Diversity engagement. These plans are presented at the monthly Engagement and Experience Committee meeting (see Appendix 4)

3.3. Equality Impact Assessments: All policies, strategies, service redesign and newly commissioned services undergo an equality analysis of the potential impact of our commissioning plans to ensure that we pay due regard to our equality duties (see appendix 4)

3.4. Standard Contract: Equity of Access, Equality and Non-Discrimination is a core standard which is embedded within the Standard NHS Contract which we use with our providers.

3.5. Procurement Strategy: All bidders are required to meet the requirements of the Equality Act 2010 as a pre-qualification criterion; this is tested during the procurement process and becomes a standard requirement in any resulting contracts.

3.6. The Equality Delivery System (EDS): The EDS is a toolkit which has been designed to help NHS organisations in assessing and grading their equality performance each year. The EDS allows the CCG along with our relevant partners, to improve equality and diversity performance in relation to patients and staff with protected characteristics. EDS applies to Commissioners and Providers and consists of four areas: 1. Better health outcomes 2. Improved patient access and experience 3. A representative and supported workforce 4. Inclusive leadership

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The EDS3 has been delayed for 2020/21 and we are awaiting further details as to when this will be released. The EDS information included in this report is the data that was submitted in 2019/20 (see page 22).

4. Staff

4.1. Workforce Race Equality Standard (WRES): is equality data relating to our staffing which is captured in an annual return. This tool enables us to monitor our workforce in terms of representativeness across the protected characteristics.

4.2. PSED: our team members gain knowledge of the PSED through mandatory e- learning training and face-to-face training for Governing Body members as our key decision makers.

4.3. Championing Equality: we have a number of leads across the organisation including a Lay Member lead, two clinical leads, an Executive lead and an Operational lead.

4.4. Equality Opportunities Policy: everyone is different and everyone’s individual experience, knowledge and skills bring a unique contribution to our organisation, and we value all contributions equally. Our Equal Opportunities Policy is published on our website as our corporate commitment.

4.5. Disability: We recognise that in order to remove the barriers experienced by disabled people we need to make reasonable adjustments which we do on a case by case basis and involve Occupational Health Services as appropriate.

4.6. Recruitment: selection processes are transparent and include consideration of equality. The breakdown of our organisation by protected group is broadly representative of the community which we serve (see Appendix 3).

4.7. Opportunity for all: the CCG is committed to equality of opportunity for all employees and potential employees. It views diversity positively and in recognising that everyone is different. The unique contribution that each individual’s experience, knowledge and skills can make, is valued equally.

4.8. Policies and Procedures: The promotion of equality and diversity is actively pursued through policies and procedures which ensures that employees and potential employees are not subject to direct or indirect discrimination

4.9. Staff and patient complaints: Ensuring effective and sensitive support mechanisms for staff and patient complaints systems for anyone experiencing discrimination

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5. Equality Objectives

5.1. We believe that our current Equality Objectives are relevant and useful indicators to measure ourselves on our journey to success. The current objectives are:

Objective 1: Utilise information and feedback gleaned from our patients, public and third sector partners to inform and influence the commissioning of healthcare services which are appropriate and responsive to our local population and their needs, ensuring better health outcomes for the Doncaster population by ongoing monitoring and assessment.

Objective 2: Ensure appropriate and accessible targeted communication with local communities to raise awareness and understanding of healthcare options.

Objective 3: Improved patient access and experience ensuring patient and public engagement at the start of each commissioning cycle as determined by the equality impact analysis and embedding equality and diversity considerations into the decisions and culture of the CCG.

5.2. Equality does not mean treating everyone the same because some people are disadvantaged to begin with through differences like disabilities. Ensuring that everyone has an equal opportunity may mean making different adaptations for different people – like targeting communication campaigns into specific communities in appropriate formats. Equality is therefore not about treating everyone the same, but about treating people according to their needs so that we reduce disadvantage.

5.3. Diversity literally means “difference”. There are many things that make us all different such as our age, our education, our past experiences, our health status, our ethnicity, or any disabilities we have. Valuing diversity is about creating a working culture and working practices that recognise, respect, and harness differences for the benefit of those for whom we commission services, for our staff, for our partners and for our organisation.

5.4. Inclusion is seen as a universal human right. It is the practice or policy of providing equal access to opportunities and resources for people who might otherwise be excluded or marginalized, such as those who have physical or mental disabilities and members of other minority groups. The aim of inclusion is to embrace all people irrespective of race, gender, disability, medical or other need.

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6. Knowing Our Patch - Nine Protected Characteristics

6.1 Age and Gender 2020: Source NHS Digital • The Doncaster resident population as at April 2020 was 329,552 people (150,100 men and 153,500 women). • People 65+ has risen by 4,298 since the 2011 Census

The table below shows the Doncaster resident population in Age / Sex breakdown as at the 1st April 2020

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6.2 Disability: Source Census 2011 In Doncaster 21.7% (65,535) of people have some form of disability compared to the national average of 17.9%. Of these 11.1% residents indicated that their day‐to‐day activities were limited and 10.5% residents indicated that they were limited a little.

6.3 Ethnicity: Source Doncaster Metropolitan Borough Council (DMBC) Black and Minority Ethnic Health Needs Assessment ‘indicators of diversity’ (2016) • Doncaster has 6% of the overall population in Yorkshire and Humber. • In Doncaster, 8% of the community are non-British, a rise on the previous years, raising it above the Yorkshire and Humber regional average of 6%. • 9% of the population were not born in the UK, an increase on the previous year, and now on par with the Yorkshire and Humber as a whole. They have settled particularly in Central, Wheatley and Town wards. • Just over 3100 pupils at school in Doncaster have a first language that is not English. • This is equivalent to 9% of primary pupils and 7% of secondary pupils; both figures are small increases on the previous year but remain much lower than the Yorkshire and Humber averages of 17% and 13% respectively. • 6 in every 1000 new GP registrations in Doncaster are made by people who previously lived abroad, compared with an average of 9 per 1000 across Yorkshire and Humber.

Data Source: CCG registered population, October 2016, NHS Digital.

Total 3,16,461 White 301,575 BME 14,886 Asian 6,839 Indian 1,977 Pakistani 2,866 Black 2,107 African 1,348 Caribbean 758 Other 5,940

6.4 Gender Reassignment: Source Census 2011 The 2011 Census did not include a specific question in respect of gender reassignment. It is estimated from national research that 1 in 10,000 are referred to as being transgender or transsexual.

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6.5 Marriage and Civil Partnership: Source Census 2011 The proportion of people over the age of 16 who were married in Doncaster is 46.91% which is similar to the national average of 46.6% and 0.2% were in a civil partnership.

6.6 Pregnancy and Maternity: Source Census 2011 Doncaster has a higher proportion of babies born with low birth weight at 9.7% compared to the national average of 7.4%. Teenage conceptions in Doncaster were at a rate of 39.7 per 1000 women, this is above the national rate of 30.0 per 1000 women.

6.7 Religion and Belief: Source Census 2011 Most of the population of Doncaster in the 2011 Census stated their religion as Christian at 65.9% compared to 59.3% nationally. A further 24.4% stated they had no religion, 2.9% was made up of other religions and 6.9% did not state their religion.

6.8 Sexual Orientation: Source Census 2011 There is no specific question on the 2011 Census regarding sexual orientation.

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7. Health Inequalities

7.1. What is the definition of health inequality? Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age. These conditions influence our opportunities for good health, and how we think, feel and act, and this shapes our mental health, physical health and wellbeing.

Health inequalities fall into at least four dimensions: socio-economic groups and deprivation, protected characteristics in the equality duty, vulnerable groups of society and geography.

Sources: Local Authority Health Profile 2019 and Doncaster CCG Place Plan 2019 - 2021 Health in summary: The health of people in Doncaster is generally worse than the England average. Doncaster is one of the 20% most deprived districts/unitary authorities in England and about 22.6% (12,995) children live in low income families.

Health Inequalities: Life expectancy for both men and women is lower than the England average. Life expectancy is 10.9 years lower for men and 8.2 years lower for women in the most deprived areas of Doncaster than in the least deprived areas.

Gypsies and Travellers: Source DCCG website April 25, 2019 There are an estimated 4,000 – 6,000 Gypsies and Travellers (GT) living in the Doncaster area in 2019. The average life expectancy for this group is likely to be at least 20 years lower than for the general population. Research has shown that the reason for this lower life expectancy is a mixture of lower education within the community around how to look after their health but also because of the community accessing health services significantly less frequently than the Gorja (GT term for settled people) community.

Child Health: In year 6, 20.6% (751) of children are classified as obese. The rate for alcohol-specific hospital admissions among those under 18 is approximately 18 admissions per year.

Alcohol: Doncaster is ranked 120/152 areas for Alcohol-Related Hospital admissions

Self-Harm: The rate for self-harm hospital admissions is worse than the average for England and represents 720 admissions per year.

Smokers age 16+: Estimated smoking prevalence in adults (aged 18+), levels of excess weight in adults (aged 18+), and physically active adults (aged 19+) are worse than the England average.

Physically inaction: 33.6% of the Doncaster population are physically inactive.

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Diagnosis of Cancer: 2.2% of the Doncaster population

Diagnosis of Coronary Heart Disease: 3.8% of the Doncaster population

Diagnosis of Chronic Obstructive Pulmonary Disease (COPD):2.6% of the Doncaster population

Diagnosis of Diabetes: 7.7% of the Doncaster population

Carers: Source Census 2011 In 2011 11% (33,150) of Doncaster’s population provided unpaid care compared to the England average of 10.4%, 19,229 of these carers are women. Caring for a loved one, a friend or neighbour can be a very rewarding experience. However, it can also be extremely isolating and carers may feel depressed, anxious and vulnerable. Combining caring with working can also cause stress and additional pressures

Young Cares: Source Doncaster Council website There are at least 720 young carers, aged up to 25 years of age. One in 20 young carers miss school because of their caring responsibilities. 63% of young carers in Doncaster care for a parent and 21% care for a sibling. Young carers often help family members to get up, get washed or get dressed, do lots of household chores like shopping, cleaning and cooking. They stay in the house a lot and provide emotional support. In some cases, they can also support a family member who misuses drugs and/or alcohol.

Homeless: Source State Of The Borough 2017 Reducing the number of homeless people in priority need remains a challenge. The Doncaster average was greater than similar authorities. There were 276 people (2.1 per 1,000 people) accepted as being homeless however this is less than the national rate by the equivalent of 54 people.

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Doncaster CCG Quality and Outcomes Framework (QOF) indicators 2020

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8. Summary Of Our Engagement 2020/21

2020/21 has been one of the most challenging years most of us have experienced. The impact of the coronavirus pandemic has been unprecedented. Below is a summary of some of the key events, announcements and activities that have taken place. • We have liaised extensively with Doncaster’s BAME communities asking them how they would prefer to receive information to help them be aware of the latest information and guidance locally for Coronavirus. We attend the Minorities Partnership Board Meeting every fortnight and contributed to a newsletter aimed at our BAME communities. We have been highlighting local members of the Doncaster BAME community in our communications for the Covid-19 vaccine. • In November 2020 we held the first meeting of our Primary Care Network for BAME staff and 66 people joined the call. We held the second meeting in January 2021 and are planning meetings to take place every couple of months. • We also held our first BAME Network for staff working in the CCGs across South Yorkshire and the Integrated Care System (ICS). 15 people attended the meeting and we have re-issued our survey to get a better understanding of what staff want from a BAME Network. The survey is available at this link: https://www.surveymonkey.co.uk/r/C5H3VZ9 • Our work engaging with Doncaster’s Gypsy and Traveller communities has resulted in a successful bid for funding to the Better Care Fund and we are currently recruiting a full time Gypsy Traveller Link worker (January 2021). • We have also been leading work with our primary care colleagues to identify how to better support unpaid carers, both adults and children. We know carers can find it difficult getting the support they need for their own health and well-being, as well as for the person they care for. We undertook a survey with practices to identify where we could provide further support and the results of the survey will help us move forward, (this work was put on hold because of coronavirus and the focus on rolling out the vaccine programme, but we hope to pick it up soon). The report is available here • There was staff engagement as part of the Frailty testing prototype in Thorne. This is forming part of the evaluation and next steps and is being linked to the Local Solutions neighbourhood approach to support the Place Plan. • 11 out of 39 practices are accredited veteran friendly GP Practices. • Before the lockdown in March there was local engagement within cancer services. • Last year more than 770,000 people gave their feedback on 7,000 primary care practices across England. We asked our colleagues in primary care practices across Doncaster to display a poster to encourage patients to complete the survey if they receive one. The poster was available in 15 different languages.

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• In January 2020 the CCG was invited to present to a regional workshop in York on our approach to engagement, for which we received a green star accreditation for our patient and community engagement indicator, as part of our Improvement and Assessment Framework (IAF) Annual Assessment. • As part of the national ‘Inspiring the Future’ Programme, we were invited to Rosedale Primary School to talk to a Year 5 class about working in the NHS. The presentation used visual aids and clues to the skills required for working in communications and engagement. These talks have been suspended due to the pandemic, but we have attended a Christmas Zoom Party and look forward to picking these engagement events up when it is safe to do so. • We engaged with members of the Sunday Sanctuary to ask how it benefits them. We also delivered a meal to nearby neighbour who used to attend but is now housebound. • We attended a special event at Sir Thomas Walton College and a Mental Well-being Alliance event at Intake Library. We posted a Tweet and included short film clips on our Facebook page to support the campaign. • We attended the ‘Your Health’ event in Rotherham Leisure complex to support people with Learning Difficulties (LD) and / or Autism. • In February we held two focus groups to discuss potential prescribing changes to gluten free products. We spoke with members of the People Focus Group (PFG), some of which have experienced mental health issues. We also spoke with the Doncaster Young Advisors who are aged between 16 and 18. • In March we supported the national no smoking day through our website and social media accounts. • From March 2020 our engagement work focused on the coronavirus. We have published information on our website in easy read versions and community languages. We are working with our partners across the health and social care system in Doncaster and also with our colleagues across South Yorkshire and Bassetlaw to help provide access to services and information about how to stay safe and avoid potentially life-threatening situations by staying at home, social distancing and following good hand hygiene. • We engage with our staff through a weekly email newsletter, twice weekly staff blogs and special engagement campaigns, linked to well-being. We are keen to promote a wide range of resources available to staff to support working at home and have featured a ‘desk challenge’ where staff submitted photos and descriptions of their home working environments and a Summertime special, advocating the benefits of gardens and nature for wellbeing, including forest bathing and mindfulness. • In December 2020 we held two-hour long mindfulness workshops for staff to support well-being and promote relaxation. Slides from the sessions are available on our staff intranet site. • We supported a series of radio adverts to help support members of the public and we are working in partnership with providers of health and care as well as

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the voluntary and community sectors to ensure these messages are understood and followed. • In February 2020, we attended the Patient Participation Group (PPG) network to seek the views of members of the primary care campaign and discuss their questions about the development of Primary Care Networks in Doncaster • Over 100 local people, including patients, members of the public, staff and partner organisations joined the first online Annual General Meeting to celebrate and recognise a number of achievements and challenges faced during 2019-20. Due to the Coronavirus situation, NHS Doncaster CCG moved the event to an online format in order to keep people safe and socially distanced. • Voices of Doncaster - A project team that work together to discover and recommend the most effective structure to represent the Voluntary and Community Faith (VCF) sector in Doncaster. Voices of Doncaster are committed to sharing their skills, insight and experience gained over many years of working in the VCF sector. Healthwatch Doncaster have continued to work closely with NHS Doncaster CCG throughout the Covid-19 pandemic and have:

• Facilitated patient stories at the Governing Body by Zoom videos and presentations

• Talked to 320 local patients about their experiences of accessing digital appointment in Primary Care – the outcomes of the report were discussed and reviewed at the Primary Care Commissioning Committee

• Talked to 275 patients about their experiences of accessing digital outpatient and therapy appointments at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust – the outcomes of the report were discussed and reviewed at the Planned Care Board

• Developed and implemented a review of the experiences of patients who accessed Urgent and Emergency Care services during the Covid-19 pandemic – the outcomes of the report were discussed and reviewed by the Urgent Care collaborative partnership

• Delivered online information and engagement sessions through Healthwatch Doncaster’s Daily Dose programme – colleagues from NHS Doncaster CCG have provided videos and interviews that have been shared through Zoom and Facebook Live for local people

• Stories and experiences of asylum seekers and refugees in the early stages of the Covid-19 pandemic and lockdown were shared and discussed at the Engagement and Experience Committee

• Healthwatch Doncaster have had extensive conversations with patients about their experiences of the Cancer pathways, a report is being finalised and will be published in Spring 2021

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• Close collaboration, relationships and partnership working enable Healthwatch Doncaster to raise questions and issues highlighted by local people and communities directly to NHS Doncaster CCG with swift responses and information then supplied and shared

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9. Our Outcomes

Doncaster CCG are committed organisationally to using the principles of the Equality Delivery System (EDS) within the CCG. The EDS is a toolkit produced by NHS England that supports CCG to improve the services provided for the local communities, consider health inequalities in Doncaster and provide better working environments, free of discrimination, for those who work within the NHS.

NHSE produces an Equality Delivery System (EDS) toolkit which supports the CCG to improve the services provided for the local communities, consider health inequalities in Doncaster and provide better working environments, free of discrimination, for those who work within the NHS. Implementation of the EDS is an annual requirement for both NHS commissioners and NHS providers. Once completed we publish a summary report on our website and include a summary in our Equality and Diversity Annual Report.

The EDS3 2020/21 has yet to be made available therefore the information below is a reminder of the 2019/20 self-assessment scores and the action plan (see appendix 5).

The CCG self-assessed itself as ‘Achieving’ against the EDS2 self-assessment, with some areas ‘Excelling’ for 2019/20.

Undeveloped if there is no evidence one way or another for any protected group of how people fare, or evidence is not available. UNDEVELOPED Undeveloped if evidence shows that the majority of people in only two or less protected groups fare well.

Developing if evidence shows that the majority DEVELOPING of people in three to five protected groups fare well.

Achieving if evidence shows that the majority of ACHIEVING people in six to eight protected groups fare well.

Excelling if evidence shows that the majority of EXCELLING people in all nine protected groups fare well.

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Summary EDS Self- Assessment 2019/20

Self-assessed Overall score Organisation Goal Ref Description score per Goal rating U D A E U D A E U D A E

1.1 Commissioning, procurement, design and delivery A

Goal 1 1.2 Assessing health needs A Better health → 1.3 Care pathway transitions E → A outcomes 1.4 Patient safety A 1.5 Health Promotion A

2.1 Access to services E Goal 2 Improved → 2.2 Informing, supporting and involving patients in care decisions E → A patient access 2.3 Patient Experience of care A

and experience 2.4 Complaints E Amber/Green → (seeAchieving Equality 3.1 Recruitment and selection A Objectives)

3.2 Equal pay A Goal 3 A representative → 3.3 Training and development A → A and supported 3.4 Staff safety A workforce 3.5 Flexible working A 3.6 Staff experience A

Goal 4 4.1 Board Leadership A Inclusive → 4.2 Identification of equality impact E → A leadership 4.3 Line management E

Key: U Undeveloped D Developing A Achieving E Excelling

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NHSE has informed us that the system is to be updated to EDS3 for 2020/21 therefore we are anticipating there will be changes to some of the 18 outcomes. In order to provide the CCG and Governing Body members with an informed picture for 2020/21 we have duplicated the 18 outcomes from the EDS2 2019/20 and provided information from the past year. (see Appendix 6)

10. Feeding Back To Us On Equality, And What To Do If You Think We Are Not Meeting Our Duties

We wish to hold ourselves accountable to our staff, our partners and members of the public for whom we commission services.

If you have any concerns or feedback (positive or negative) about equality then please contact the Head of Corporate Governance, on 01302 566300 or email [email protected].

If you think we are not meeting our equality duties, and would like to make a complaint please contact the Patient Experience Manager, on 01302 566300 or email [email protected].

January 2021

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Appendix 1: Core Data and Information

Source Brief description Use within organisation

NHS Doncaster A summary within the CCG Annual Used to collate a summary of equality CCG Equality Report capturing summary equality activity and identify any emerging themes. Information in activity within the preceding year. Available on our website: the CCG www.doncasterccg.nhs.uk Annual Report

The Joint Strategic Needs Used to identify commissioning priorities Joint Strategic Assessment (JSNA) is a process and areas of health inequalities to target Needs that identifies the current and interventions. Published on the Team Assessment future health and wellbeing needs Doncaster website under the Data (JSNA) of a local population. Observatory: http://www.teamdoncaster.org.uk

There are 88 Community Profiles, Used to identify areas of health inequalities one for each community in within communities. Published on the Community Doncaster. Team Doncaster website under the Data Profiles Observatory: http://www.teamdoncaster.org.uk

Health Needs Assessments are Needs assessments allow us to obtain an commissioned through our in-depth understanding of the needs of a Health Needs agreement with the Public Health specific population group for which we are Assessments Team in Doncaster identify the key responsible for commissioning healthcare. needs of the population. http://www.teamdoncaster.org.uk

The Data Shine project seeks to Used to identify areas of health inequalities promote and develop the use of and target community engagement. The Data Shine large and open datasets amongst data takes us down to community level the social science community. across data collected in the 2011 Census. http://datashine.org.uk

Yorkshire and Humber Public Used to identify areas of health inequalities. Yorkshire and Health Observatory (YHPHO) PHE Data and Analysis Tools Humber Public produces information, data and Health intelligence on people's health and Observatory health care for practitioners, policy makers and the wider community.

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Source Brief description Use within organisation

The Census has collected The statistics collected from the Census information about the population are used to understand the similarities and every 10 years since 1801 (except differences in the populations’ Census 2011 in 1941). The latest census in characteristics locally, regionally and England and Wales took place on nationally. 27 March 2011.

Data recorded by our Providers on The data is recorded by protected activity by protected characteristic and used to identify themes, characteristics. support the commissioning process, and to monitor Provider activity. Provider Doncaster and Bassetlaw Teaching equality data Hospitals NHS Foundation Trust

Rotherham Doncaster and South Humber NHS Foundation Trust

Engagement Data on themes emerging from Themes and trends arising from activities and patient and public engagement engagement are received by the findings activity. Engagement and Experience Committee.

Specification included at Appendix Monitoring of the workforce in terms of 2. representativeness across the protected Workforce Data characteristics. Published within our quarterly Corporate Assurance Report.

An annual national survey of our Used to develop an action plan which Staff Survey staff in terms of satisfaction. supports making improvements in the workplace for staff moving forwards.

A self-assessment of our activity The summary results are included in this Equality against the national voluntary report and published in full on our website. Delivery Equality Delivery System The data is used for self-assessment System outcomes. across all standards, and for a deep dive into specific clinical areas.

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Appendix 2: NHS Doncaster CCG Staffing Equality Data and Staffing Profile

(as at 31 December 2020)

Disability Disability Flag Headcount % FTE No 144 86.2 129.09 Not Declared 10 6.0 8.12 Prefer Not To Answer 1 0.6 1.00 Yes 12 7.2 10.14 Grand Total 167 100.0 148.36

Ethnicity Ethnic Group Headcount % FTE White - British 145 86.83% 131.68 White - Irish 1 0.60% 1.00 White - Any other 3 1.80% 2.32 White background Mixed - White & Black 1 0.60% 0.80 Caribbean Mixed - White & Asian 1 0.60% 1.00 Mixed - Any other 1 0.60% 0.32 mixed background Asian or Asian British - 4 2.40% 2.44 Indian Asian or Asian British - 1 0.60% 0.65 Pakistani Asian or Asian British - 1 0.60% 0.37 Any other Asian background Black or Black British - 1 0.60% 1.00 Caribbean Black or Black British - 3 1.80% 2.60 African Black or Black British - 1 0.60% 0.80 Any other Black background Chinese 1 0.60% 1.00 Not Stated 3 1.80% 2.37 Grand Total 167 100% 148.36

Religion Religious Belief Headcount % FTE Atheism 25 14.97 21.44 Christianity 107 64.07 96.37 Hinduism 2 1.20 0.64 Islam 1 0.60 0.65 Not Disclosed 19 11.38 17.97 Other 12 7.19 10.48 Sikhism 1 0.60 0.80 Grand Total 167 100.00 148.36

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Gender Gender Headcount % FTE Female 132 79.0 118.20 Male 35 21.0 30.16 Grand Total 167 100.0 148.36

Age Band Age Band Headcount % FTE <=20 Years 2 1.20 2.00 21-25 6 3.59 5.80 26-30 5 2.99 4.29 31-35 17 10.18 15.05 36-40 33 19.76 29.25 41-45 17 10.18 15.41 46-50 26 15.57 23.07 51-55 29 17.37 25.99 56-60 18 10.78 15.33 61-65 10 5.99 8.80 66-70 3 1.80 2.57 >=71 Years 1 0.60 0.80 Grand Total 167 100.00 148.36

Sexual Orientation Sexual Orientation Headcount % FTE Gay or Lesbian 4 2.40 4.00 Heterosexual or 154 92.22 135.99 Straight Not Disclosed 9 5.39 8.37 Grand Total 167 100.00 148.36

Pay Band Profile

Pay Grade Headcount % Band 2 1.80% Band 3 12.57% Band 4 7.78% Band 5 12.57% Band 6 19.76% Band 7 12.57% Band 8 - Range A 14.97% Band 8 - Range B 3.59% Band 8 - Range C 2.99% Band 8 - Range D 1.80% Band 9 1.20% Other 8.38% Grand Total 100.00%

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Appendix 3 - Engagement in CCG Delivery Plans Template

This template is designed to help you take into account all the elements of the commissioning cycle, as captured in the diagram below:

Name of Delivery Plan:

CCG Lead Officer:

Date of EEC Review:

Please give of summary of the engagement which has already been undertaken1

What has been the impact of this engagement?

What, if anything, has changed as a result?

How have these changes been communicated back to stakeholders?

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What further engagement is planned and when?

Do you have any further comments regarding your approach to engagement and involvement or how this can be improved?

Equality and Diversity Which of the nine protected characteristics have you engaged with:

Age Religion or Belief Sexual Orientation

Race Disability Pregnancy and maternity

Sex Gender Reassignment Marriage and Civil Partnership

What type of engagement will you undertake to ensure protected characteristics are engaged with:

Health Inequalities Have you utilised any intelligence on health inequalities? If yes please state:-

Illustrate your benchmarking against the Heat Map and NHS RightCare Pack.

What type of engagement involved members of the communities that face health inequalities?

What is the outcome of this engagement and what improvements have been made to reduce health inequalities?

Has complaints / experience data been used in this commissioning?

Yes No

If Yes please provide a reference number

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Appendix 4 – Equality Analysis Form

Subject of equality analysis

Type Tick Policy Strategy Business case Commissioning service redesign Contract / Procurement Event / consultation Owner Name: Job Title: Date Assessment Give a brief summary of the area you are assessing Summary

Stakeholders Tick Staff General public Service users Partners Providers Other Data What data is available to you to support your analysis? collection and Has there been any consultation to inform your analysis? consultation

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Negative: What are the Protected risks? Positive Neutral Negative characteristic Positive: What are the benefits / opportunities?

Age

Disability

Gender

Race

Religion & Belief

Sexual

Orientation

Gender

reassignment

Pregnancy &

Maternity

Marriage & Civil

Partnership

Social Inclusion / Community Cohesion

Conclusion & Recommendations including any resulting action plan

Review date

Please return the Equality Analysis Form to the Corporate Governance Manager: [email protected]

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Appendix 5 – EDS Action Plan

Equality and Diversity Action Plan for NHS Doncaster CCG – April 2020 - March 2021

No Action Responsible Person / Role Date which Measures of success action is expected Current Progress complete 1. To gain assurance that services are commissioned, Commissioning Leads / Managers March 2021 Managers complete regular procured, designed and delivered to meet the health Senior Contracts Manager assessments and provide assurance to needs of local communities our monthly Engagement and Experience Committee (EEC) members that services are commissioned and reviewed with key equality and diversity metrics in mind.

The Engagement in CCG Delivery Plan Template is completed to ensure that experience outcomes for patients and residents of Doncaster are considered within planning and presented as outcomes where appropriate. These Delivery Plans are presented at EEC meetings.

We continue to liaise with our Health Ambassadors to engage seldom heard groups.

We liaise with Doncaster’s BAME communities asking them how they would prefer to receive information.

Engagement with the Gypsy Traveller community has secured funding to the Better Care Fund for the recruitment of a full time Gypsy Traveller Link worker.

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There has been the development of specification for carpal tunnel procurement.

There is a wound care service redesign.

A survey was undertaken to recognise To ensure findings from local / national research are Comms and Engagement, Healthwatch, what local people understand and taken into account when designing services Commissioning Managers what is important them from their local urgent care service.

Latest national requirements for urgent and emergency care were taken into account.

A GP Patient Survey was presented to Primary Care Commissioning Committee around access to Primary Care.

A public consultation has taken place regarding the merger of two GP practices.

There was staff engagement as part of the Frailty project.

Healthwatch Doncaster have had extensive conversations with patients about their experiences of the Cancer pathways.

Healthwatch spoke to patients about their experiences of accessing digital outpatient and therapy appointments at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust.

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Delivered online information and engagement sessions through Healthwatch Doncaster’s Daily Dose programme.

2. To gain evidence that individual people’s health needs Commissioning Managers, Comms and March 2021 Equity of Access, Equality and Non- are assessed and met in appropriate and effective ways Engagement and Healthwatch Discrimination (Service condition 13) is embedded within the Standard NHS Contract which we use with our providers.

Development of easy to read appointment cards for those accessing Dental Practices, Primary Care and Local Practices.

Liaison with Doncaster’s BAME communities asking them how they would prefer to receive information to help them be aware of the latest information and guidance locally for Coronavirus.

We have published Covid19 information on our website in easy read versions and community languages.

Shielding patient lists work has been undertaken for people who are clinically extremely vulnerable to COVID-19. GPs have been supporting efforts to add adults with Down’s syndrome to the Shielded Patient List.

MDTs for care homes.

Learning Disability Health Checks work. Support is now available to

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increase this through the General Practice Covid19 Capacity Expansion Fund and from the Quality Outcomes Framework (QoF) Quality Improvement module.

Stories and experiences of asylum seekers and refugees in the early stages of the Covid-19 pandemic and lockdown were shared and discussed at the Engagement and Experience Committee.

3. To review NHS services to evidence that the safety of Quality & Patient Safety Team March 2021 The Quality and Patient Safety people is prioritised and they are free from mistakes, Committee receives a number of mistreated and abuse reports on care in the areas of patient experience, clinical effectiveness and patient safety.

Regular Clinical Quality Review Group (CQRG) meetings are held with our main providers (DBTHFT and RDaSH) to consider quality themes and trends.

We review our providers, GPs and Care Homes Care Quality Commission (CQC) ratings.

The Governing Body receives a monthly quality and performance report, which provides assurance around the quality of care being received by the main providers (DBTHFT and RDaSH) and the levels of performance against national standards and targets.

4. To gain evidence that screening, vaccination and other Commissioning Leads, Comms and March Work is being undertaken to test out health promotion services reach and benefit all local Engagement 2021 whether we can also vaccinate the

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communities. homeless in Doncaster. New Street Outreach Guidelines have been - To support key campaigns and engagement activities to produced to support teams who are increase screening and vaccination rates across hard to developing plans to deliver the vaccine reach groups. on an outreach model.

A survey was undertaken to ask our local population how they would prefer to receive their flu vaccination.

The Healthbus was commissioned to deliver services in the community.

Local flu group linked to ICS flu board, conversations with PCNs about At Scale Plans through Primary Care Cell.

Work to improve coverage of shingles vaccination with MSD - case study being finalised.

5. To gain assurance that boards and senior leaders March 2021 Equality and Diversity ESR training routinely demonstrate their commitment to promoting Board Members compliance is sent to CCG on a equality: regular basis from Learning and Development Department.

6. To review if feedback is collected from an E&D Patient Experience Manager July 2020 The Patient Experience department perspective with regard to complaints and CHC. This will requests E&D information via a form include positive feedback. that is send out to complainants. CHC collect E&D information which is used to complete their complaints and outcomes are reported to NHS Digital.

7. To make contact with CCG E&D Leads to discuss the Corporate Services Manager September EDS2, other E&D work and partnership working with a 2020 This has been delayed due to Covid19 view to ICS

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9. To review how the CCG gets public comments from an Communications and Engagement Team Sept 2020 Feedback options are available on the E&D perspective: website using the following link:- https://www.doncasterccg.nhs.uk/get- Comms and engagement involved/ Revise the feedback option on the DCCG website to ensure all groups can leave feedback as and when they like The engagement database can be access using the following link:- Services http://nww.connect.doncasterccg.nhs.u To ensure services seek feedback with any service led k/communications-and-engagement/ engagement activities and incorporate into the engagement database.

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Appendix 6 – Equality Delivery System 2020/21

BETTER HEALTH OUTCOMES

1.1 - Services are commissioned, procured, designed and delivered to meet the health needs of Local communities (2019/20 Achieved) Our commissioners continue to receive information via our staff intranet linked to training course, ’10 Steps to Even Better Engagement’ which is run by NHS England and delivered at our CCG for commissioning managers in Doncaster. Whilst this hasn’t happened in 2020 due to pressures linked with the Coronavirus, we have ensured that the principles are still followed. One of the key ways we do this is to ensure commissioning managers complete regular assessments when they are assessed at our monthly engagement and experience committee to ensure services are commissioned and reviewed with key equality and diversity metrics in mind.

Despite the Coronavirus pandemic, we have continued to engage with a wide range of communities, making the most of online platforms. We have liaised extensively with Doncaster’s BAME communities asking them how they would prefer to receive information to help them be aware of the latest information and guidance locally for Coronavirus.

Every year the CCG publishes an Annual Report, which is shared with staff and partners at our Engagement and Experience Committee (EEC) and our Governing Body. A copy of this report is available on our website here: https://www.doncasterccg.nhs.uk/documents/patient-and-public-annual-report-2019- 20/ - the latest annual report was published in September 2020.

We also use data collected by our Patient Experience Team to support the on-going work of the Engagement and Experience Team and receive a regular report looking at feedback, including complaints and compliments.

We continue to liaise with our Health Ambassadors to engage seldom heard groups, including members of the BAME groups, Cancer service users and survivors, Homeless people, members of the Deaf community, People with learning disabilities, Refugees and asylum seekers, Sex workers, Lesbian, Gay, Bisexual and Transgender people and those from the Armed Forces / Veteran Community.

We have recently had funding approved for a two year Gypsy and Traveller Link Worker which followed on from the recommendations of a project which looked at the health and well-being of Doncaster’s Gypsy and Traveller Communities, estimated to be around 4,000-6,000 people. The details of this project and a copy of the report is available on our website here: http://www.doncasterccg.nhs.uk/11617/report-co-produced-from-our-engagement- with-the-gypsy-and-traveller-communities-in-doncaster/

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1.2 - Individual people’s health needs are assessed and met in appropriate and effective ways (2019/20 Achieved) As a Commissioner, we continue to require that providers take account of patients’ individual needs and make reasonable adaptations to meet these needs, through our contractual mechanisms. We seek patient experience data and challenge providers on the results. We have a focus on care closer to home within communities in response to patient feedback and in line with the ambitions of the Doncaster Place Plan. Equity of Access, Equality and Non-Discrimination (Service condition 13) is embedded within the Standard NHS Contract which we use with our providers.

From March 2020 our engagement work focused on the coronavirus. We have published information on our website in easy read versions and community languages. We are working with our partners across the health and social care system in Doncaster and also with our colleagues across South Yorkshire and Bassetlaw to help provide access to services and information about how to stay safe and avoid potentially life-threatening situations by staying at home, social distancing and following good hand hygiene.

Our 2020 Annual General Meeting took place in September online using Microsoft Teams Live where more than 100 people attended. Representatives from Lesbian Gay Bisexual and Transgender (LGBT) communities also attended and asked questions about the Doncaster ‘Place Plan’ (Place Plan) and what the direction of travel means for specific groups and communities. We reflected on the Place Plan activities data and the range of communication and engagement activities that have taken place. Answering questions in an open forum meant that individuals from specific communities could ensure their voices were heard and fed back through networks and forum meetings.

Our Governing Body continue to hear patient stories facilitated by Healthwatch Doncaster. Some have been via video and some in the form of a presentation by Healthwatch. Their experiences are used to further improve services.

1.3 - Transitions from one service to another, for people on care pathways, are made smoothly with everyone well informed (2019/20 Excelled) We place a requirement upon providers to work in partnership to ensure seamless care. Large scale, integrated service specifications are developed and discussed with patients, with feedback monitored by protected characteristics. The Place Plan aims to support the provisions of integrated care across all provider organisations in Doncaster. We try to directly target under-represented groups by engaging with their local interest groups.

As a commissioner, the CCG recognises the importance of patients and carers being well-informed and involved in the smooth transition between services and/or pathways in order for them make meaningful choices about the care they receive.

Continuing Healthcare (CHC) - Personal Health Budgets (PHB): The CCG adheres to the National Framework for CHC and Funded Nursing Care revised 2012 with accompanying equality analysis. The policy framework is intended to be inclusive in this respect with no individual being treated differently on the basis of their condition, diagnosis, gender, race or religion. The CCG informs patients /

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significant others in writing of their eligibility outcome following assessment. Patients meeting the eligibility criteria are involved in their plan of care and the offer of a PHB is available to all who meet the eligibility criteria.

Patients are kept informed at every stage through face to face visits, printed information leaflets about their care and the process. This also includes involvement in their transition from health to social care, planned discharge or integrated discharge planning. CHC also takes into consideration views of the family / carers whether that means care at home or in an alternative suitable setting.

1.4 - When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse (2019/20 Achieved) The Quality and Patient Safety Committee receives a number of reports on care in the areas of patient experience, clinical effectiveness and patient safety, ie: primary care quality, controlled drugs, serious incidents, complaints, deprivation of liberty safeguards, learning disabilities mortality review, safeguarding, care homes, specialist placements, transforming care programme, infection prevention control, continuing healthcare, CQUIN (Commissioning for Quality and Innovation) outcomes.

Regular Clinical Quality Review Group (CQRG) meetings are held with our main providers (DBTHFT and RDaSH) to consider quality themes and trends. CQUINs aim to address gaps or / shortfalls. We review our providers', GPs and Care Homes Care Quality Commission (CQC) ratings. The minutes of the Committee are presented to the Governing Body to provide assurance on these areas.

The Governing Body receive a monthly quality and performance report, which provides assurance around the quality of care being received by the main providers (DBTHFT and RDaSH) and the levels of performance against national standards and targets.

1.5 - Screening, vaccination and other health promotion services reach and benefit all local communities (2019/20 Achieved) There has been liaison with Doncaster’s BAME communities asking them how they would prefer to receive information to help them be aware of the latest information and guidance locally for Coronavirus.

Coronavirus vaccinations have been successfully administered in Doncaster as the vaccination programme continues to roll-out. Doncaster is on track to deliver first dose Coronavirus jabs to the majority of those over 80, 75, 70 and frontline health and social care workers in February 2021. This also includes care home residents, their respective staff, as well as those who are defined as ‘extremely clinically vulnerable’ due to an existing or long-standing health condition. We have roving vaccination teams who are safely visiting those who are housebound, ensuring they get access to the vaccination. Vaccination centres have been set up to enable jabs to be given as close to people’s homes as possible.

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Work is being undertaken to test out whether we can also vaccinate the homeless in Doncaster. New Street Outreach Guidelines have been produced to support teams who are developing plans to deliver the vaccine on an outreach model.

A survey was undertaken to ask our local population how they would prefer to receive their flu vaccination. NHS in Doncaster launched its biggest winter campaign yet to encourage patients, members of the public, health and care staff to get their flu vaccine. The campaign launched in November 2020 and has helped improve vaccination rates amongst some of our eligible cohorts already: https://www.doncasterccg.nhs.uk/calling-all-doncaster-to-be-winter-well-this-year

Health Promotion and Screening is led by Doncaster Council and Public Health England. In support of this, as a CCG our early cancer diagnosis awareness campaigns have targeted bowel cancer, prostate cancer (including a campaign targeted at people with learning disabilities), lung cancer and breast cancer.

We continue to work in partnership with Doncaster Council to make Doncaster Dementia Friendly. Campaign work for 'DonMentia' is still taking place and CCG colleagues have had the opportunity to attend Dementia Awareness Training held by a Dementia Friends Volunteer to support their understanding in health promotion.

We continue to work with the ‘Be Cancer Safe’ team and delivered cancer awareness sessions to participants of Club Doncaster Foundation’s ‘Fit Rovers’ programme. The programme aims to increase the health and wellbeing of Doncaster residents taking part in a free fitness programme from the Keepmoat Stadium. The sessions were delivered to groups of men and women covering topics such as prostate cancer and cervical screening.

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IMPROVED PATIENT ACCESS AND EXPERIENCE

2.1 - People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds (2019/20 Excelled) We engaged and continue to engage with a wide variety of age groups in Doncaster to signpost where people can access mental health support over the winter period.

Extensive engagement took place with the Gypsy and Traveller Communities in Doncaster, which provided a number of recommendations to help improve access and experience to health and care services. The full report can be viewed: http://www.doncasterccg.nhs.uk/11617/report-co-produced-from-our-engagement- with-the-gypsy-and-traveller-communities-in-doncaster

As part of the 2019 national Learning Disability Awareness Week, a new innovative scheme was been launched in Doncaster, set to make it much easier for people with a learning disability and/or autism to access and receive care and treatment they need across primary care. This programme continues to go from strength to strength and training and development continues to be offered to local practices led by the Doncaster LD Health Action Team. http://www.doncasterccg.nhs.uk/your- care/transforming-care-partnership/living-with-a-learning-disability/learning-disability- awareness-week-2019

Healthwatch Doncaster Survey: We have been working closely with Healthwatch Doncaster, Primary Care Doncaster and our GP Practices to gain feedback from Doncaster patients who have accessed healthcare appointments from their local practice via video or telephone calls during the Coronavirus pandemic. Feedback from these experiences will inform and shape the development of future services provided in the local community.

2.2 - People are informed and supported to be as involved as they wish to be in decisions about their care (2019/20 Excelled) We have a Communication and Engagement Strategy which confirms our organisational commitment to this area. Our strategy was refreshed in December 2019 and you can download a copy from our website here: http://www.doncasterccg.nhs.uk/documents/communications-and-engagement- strategy-2019-21/

We have a range of engagement methodologies and an engagement and experience tracker which is overseen by our EEC. Provider contracts embed the requirement to engage patients in their own care. We have consulted on learning disabilities (LD) and autism, working with our colleagues at ‘Speak Up’ and are in the process of publishing a new LD and Autism Strategy.

Health and care organisations across Doncaster and Bassetlaw went mental health system perfect in a week-long exercise which looked at how health and social care pathways function when all hands are on deck and everything is working exactly as it should. More than 740 people shared their views on current mental health services

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and how they could be improved: http://www.doncasterccg.nhs.uk/11325/were- going-mental-health-system-perfect

The result of this led to the launch of Safe Space in December 2019 which provides a safe haven for people to access mental health support when they are in crisis. It has also helped reduce the number of people accessing mental health support at the ED department which is not the best place for patients to go.

2.3 - People report positive experiences of the NHS (2019/20 Achieved) We recognise the value of both positive and negative feedback and embrace the concept that any feedback is helpful within commissioning. We receive a regular report at our EEC highlighting the feedback we have received from patients and members of the public and identifying themes and trends. We work closely with Healthwatch Doncaster to identify and analyse patient experience themes and trends which are emerging across the breadth of services we commission, and these are reported to our EEC. Healthwatch Doncaster has an online Feedback Centre where people's experiences of accessing local health and care services can be recorded. People from a range of diverse backgrounds leave their feedback and comments. Healthwatch Doncaster continues to use this information to identify common themes for detailed projects and work.

During lockdown, NHS Doncaster CCG has worked closely with Healthwatch Doncaster and the Voluntary Community and Faith Sector to engage with hard to reach groups. We have supported Healthwatch Doncaster’s daily outreach programme which involves zoom daily dose sessions. This enables individuals to reach out and access services and support where they need it. Work has taken place with the Doncaster Conversation Club to ensure that we continue to reach out to Asylum Seekers and Refugees.

We have embedded the requirement for patient experience surveys within provider contracts. We are reviewing patient experience themes and trends at the EEC and ensuring a feedback process is provided to Commissioners, in order to improve commissioned services. The results from these monthly ‘deep dives’ are shared with the public on our website here: http://www.doncasterccg.nhs.uk/get-involved/our-approach-to- engagement/engagement-in-our-commissioning/

The CCG continues to monitor data around access to Primary Care, such as GP Patient survey and impact on other services, such as A&E, UTC, same day health centre and out of hours and have discussions with practices where necessary.

Inclusion clinics continue to be provided by Primary Care Doncaster as part of extended access in a COVID safe way. Weekly clinics run for homeless patients, asylum seekers and vulnerable people in the centre of Doncaster.

Local practices who are signing up to become ‘veteran friendly’ under a new national scheme to improve medical care and treatment for former members of the armed services that has been backed by NHS England and the Royal College of GPs. Practices can qualify for veteran friendly status by offering extra support for ex-

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military personnel who may face additional challenges when they return to civilian life.

2.4 - People’s complaints about services are handled respectfully and efficiently (2019/20 Excelled) We have an open complaints policy in place which is published on our website and supported by a patient leaflet 'Listening, Responding, Improving' which explains the complaints process and responsible organisations for complaints in an accessible format. The Patient Experience Manager works proactively dealing with issues at the lowest levels, rather than waiting for a formal complaint. Patients and families are supported through the CHC process, to improve service and ultimately reduce formal complaints. CHC service users are proactively contacted. The outcome has seen a reduction in miscommunication between CHC and the patient / patient families, it has allowed families the opportunity to voice their opinions and use these in benchmarking / lessons learnt to improve practice.

The views on healthcare services are received by the CCG and a report ‘We Asked, You Said, We Did’ is presented to the EEC. The reports are published on the internet: http://www.doncasterccg.nhs.uk/get-involved/we-asked-you-said-we-did/

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A REPRESENTATIVE AND SUPPORTIVE WORKFORCE

3.1 - Fair NHS recruitment and selection processes lead to a more representative workforce at all levels (2019/20 Achieved) The CCG has a Recruitment and Selection Policy which complies with NHS Employment Check Standards (2008, revised 2019). The policy and procedures contained within it provide recruiting managers with a systematic, robust, effective framework for recruitment and selection which seeks to eliminate any potential for discriminatory practice.

Those responsible for shortlisting have online access to all applications forms for posts which are advertised on NHS Jobs. To ensure the process is fair and transparent, whilst the advert is live all applications are given a reference and personal details cannot be viewed. After shortlisting is completed candidates confirm an interview slot and when this process is fully complete the appointing officer is provided with the names of the candidates. Candidates are asked by the central recruitment team if they have any specific interview requirements or if any adjustments are required and these are made known to the recruiting manager/panel prior to the interview. Interview questions are agreed by the interview panel in advance and each candidate is asked the same set of questions. There is an interview marking system in place and the appointable score is set prior to the interviews taking place. A HR representative is present on the majority of interview panels and where appropriate external representatives are invited to the panel.

3.2 - The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations (2019/20 Achieved) National Agenda for Change terms and conditions are applied. Remuneration Committee review Governing Body remuneration benchmarked to national guidance and local benchmarks. Roles are formally evaluated using the NHS job evaluation scheme and this process is overseen by the South Yorkshire and Bassetlaw Staff Side Coordinator. Job evaluation panels include a trade union representative and a HR professional who are trained in job evaluation and may include additional trained panel members.

3.3 - Training and development opportunities are taken up and positively evaluated by all staff (2019/20 Achieved) All staff complete as a minimum mandatory and statutory training. Running alongside that there is a training programme covering a range of topics which staff can access. The CCG has a People and OD Strategy and all staff are encouraged to pursue personal and professional development. This process is supported by the Personal Development Review and Talent Management Process. These reviews are mandated on an annual basis. There is funding support available for professional study and for attendance at conferences and seminars. Topical training is commissioned by the CCG when appropriate, for example on cyber security. .

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3.4 - When at work, staff are free from abuse, harassment, bullying and violence from any source (2019/20 Achieved) The CCG has a zero tolerance approach and this is supported by the application of the following policies: - Harassment & Bullying At Work Policy. - Grievance & Dispute Policy. - Disciplinary Policy. - Equal Opportunities Policy. - Domestic Violence & Abuse Policy.

Support is available for all staff via HR, Staff Side, Occupational Health and the Employee Assistance Programme. The NHS staff survey collects feedback on this area and is monitored and action taken where necessary. The CCG incorporates health and wellbeing conversations in one to one meetings and during the PDR process. We have defined a set of behavioural competencies that all staff must adhere to, these are trust, respect, understanding, supportiveness and teamwork.

3.5 - Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives (2019/20 Achieved) The CCG has a Flexible working policy that sets out a range of flexible working options that can be applied for. Any member of staff can request to work flexibly. Options include flexi-time, part time, compressed hours, term time, annualised hours, carers leave, agile working, career break and flexible retirement. The CCG has a Workplace Wellbeing policy and a number of other policies and procedures to support a health work/life balance and to promote wellbeing. Examples of how these apply include paid time off to support exercise, in work time health and wellbeing events such as mini health MOT’s, menopausal support and support for those living with cancer.

Agile Working Pilot: The CCG is working with the Trust and South Yorkshire & Bassetlaw Integrated Care System (ICS) to take part in a pilot looking at agile working. The pilot will help us to understand the impact of agile working on our staff and will provide an opportunity to share good practice with a view to building on agile working for the future.

3.6 - Staff report positive experiences of their membership of the workforce Colleague Engagement Group Meetings (2019/20 Achieved) The Coronavirus pandemic has changed the way staff engagement is conducted and any face to face methods have been paused. The CCG has continued to hold regular staff briefings via Microsoft teams and all staff have had wellbeing conversations and risk assessments with their managers. We continue with participation in the NHS Staff Survey, staff suggestion scheme, newsletters, Connect and exit interviews.

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INCLUSIVE LEADERSHIP 4.1 - Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations (2019/20 Achieved) - Constitutional commitment. - Lay Member for Patient & Public Involvement including equality is a Governing Body member and chairs the Engagement and Experience Committee - Clinical Leads - Equality & Diversity Internal Audit - significant assurance. - Member of the partnership Inclusion & Fairness Forum. - Partnership working on health inequalities. - Senior Management liaison with Healthwatch - Integrated Care Partnership working on health inequalities through the Health and Wellbeing Board. The Chair of the Doncaster CCG Governing Body is the Vice Chair of the Health and Wellbeing Board. - Ageing Well, the Governing Body review progress made across health and care services for people aged around 65 and above in Doncaster – the patient story highlights how changes are having an impact: http://www.doncasterccg.nhs.uk/your- care/providing-joint-health-and-care-services/ageing-well/ Integrated Care System partnership working and member of the Joint Committee of CCG’s

4.2 - Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are to be managed (2019/20 Excelled) A Stakeholder Engagement in CCG Delivery Plans is presented by Commissioners to EEC on a monthly basis. For example, engagement on planned care focused around informing the public of changes to the referral criteria in line with evidence which supported the introduction of clinical thresholds and links with Healthwatch Doncaster focusing around education to the practice population regarding choices when being referred to a secondary provider. - A communications plan was developed within the Integrated Care System to enable the sharing of consistent key messages to patients and the public regarding the South Yorkshire and Bassetlaw (SYB) Infertility policy. The document is uploaded on to the CCG website for public viewing and engagement was done across the region to ensure there was no inequity of access. - The Mentally Well Alliance includes service users of mental health services allowing people to have their views heard. The document is uploaded on to the CCG website for public viewing. All papers that come before the board and other major committees have a cover sheet including delivery against strategic goals, strategic risks and the CQC domain and impact including equality and diversity implications.

4.3 - Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination (2019/20 Excelled) Compliance with E&D ESR training to ensure there is a good level of understanding about religious and cultural beliefs and managers are accommodating if their staff have any needs. Yearly Performance Development Reviews and regular 1:1 supervision where concerns from staff are discussed and action taken.

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Workforce Race Equality Scheme - Equality data relating to our staffing is captured in an annual return called Workforce Race Equality Standard (WRES). This tool enables us to monitor our workforce in terms of representativeness across the protected characteristics. Annual staff survey independently undertaken and action plans drawn up and implemented as necessary.

This is supported by the application of the following policies: - Harassment & Bullying At Work Policy. - Grievance & Dispute Policy. - Disciplinary Policy. - Equal Opportunities Policy. - Domestic Violence & Abuse Policy.

- Governing Body Meetings and Committee coversheets include an equality analysis - Equality Analysis published on the CCG website - New and revised policies include an equality impact assessment and analysis - Business Cases for commissioning services include equality and quality impact analyses - Equal Opportunities Policy - Flexible Working and Leave for Domestic, Carer, Personal and Family Reasons Policy - HR Manager and Associate Director of HR and Corporate Services – available for staff to discuss their needs. - Volunteering Policy - Workplace Wellbeing Policy - Uniform and Dress Code Policy. All policies are available: http://www.doncasterccg.nhs.uk/about-us/public- information/policies-and-procedures/employment-policies

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Meeting name Governing Body Meeting date 4th March 2021 Title of paper Quality & Performance Report

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

Status of the Report

To approve To consider / discuss

To note x

Purpose of Paper - Executive Summary This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (DCCG) Governing Body which due to reporting restrictions or information potentially identifiable to a patient level have not been included within the main report. This report reflects 2020/21 performance and includes a focus on 2020/21’s Living Well Delivery Plan.

Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Further details on the reporting ceased which have been agreed with DCCG’s main providers can be found here: https://www.england.nhs.uk/coronavirus/publication/reducing-burden-and-releasing- capacity-at-nhs-providers-and-commissioners-to-manage-the-covid-19-pandemic/.

Please note all data is validated and quality checked internally within DCCG and with Providers as necessary. Where there is a data quality concern on any of the data or metrics presented in the following report, this will be stated in the narrative accompanying the data. Measures which also form part of the NHS Oversight Framework have been identified as (OF) within this report.

The overall response will impact a number of measures, and the ability of providers to report information, in the coming which will be detailed in future reports.

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

NHS Doncaster Clinical Commissioning Group (DCCG) • Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance deteriorated to 64.6% during January and remains below the 92% target (Page 6). The total waiting list size now exceeds the target. • 52 week waits – There were 1082 DCCG patients waiting over 52 weeks for treatment at the end of January. (Page 12). • Patients waiting less than 6 weeks for a diagnostic test – Performance in January failed to meet the 99% target at 57.2% (Page 14) • Cancer 2 week waits – Performance during Quarter 3 failed to meet the 93% target at 83.8% (Page 19). • 2 week wait for first outpatient appointment for patients referred urgently with breast symptoms – Performance during Quarter 3 failed to meet the 93% target at 26.7% (Page 21). • New measure: Cancer 28 days faster diagnosis standard – Performance during December was 86.9% (Page 22) • Cancer 31 day waits – Performance during December failed to meet the 96% target at 97.0% (Page 22). • Cancer 62 day waits – Performance during December failed to meet the 85% target at 71.7% (Page 24).

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) • Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance deteriorated to 62.5% in January (Page 6). • 52 week waits – There were 1635 patients at the Trust waiting over 52 weeks for treatment at the end of January 2020 (Page 12). • Patients waiting less than 6 weeks for a diagnostic test – Performance during January 2020 deteriorated to 56.1% below the 99% target (Page 14). • Accident and Emergency – Performance deteriorated in January 2021 to 80.7% remaining below the 95% target (Page 17). • Cancer 31 day waits – Performance during Quarter 3 met the 96% target at 98.7% (Page 22). • Cancer 62 day waits – Performance during Quarter 3 failed to meet the 85% target at 78.1% (Page 24). • Stroke 4-hour access - Performance in November failed to meet the 75% target at 47.1% (Page 28)

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH) • Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service was below the December 2020 target (14.4%) at 13.0% (Page 29)

Other Commissioned Services Yorkshire Ambulance Service – Only Category 1 90th centile performance met target during January 2021 at 13 minutes and 34 seconds against a target of less than 15 minutes (Page 27).

Performance is currently being adversely impacted by the rise in Covid-19 infections 2

and hospital admissions in Doncaster which is limiting the capacity of local Providers to undertake non-urgent services which have been restored as much as possible after being stood down during the first wave of Covid-19.

Delivery Plan Reporting Full summary Living Well November 2020 position (Page 35)

Recommendation(s) The Governing Body is asked to:

Note the Quality and Performance Report Report Exempt from Public Disclosure If yes, detail grounds for exemption: Yes No x

Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report.

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result Impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Nil impact Financial Nil implications Legal Nil Implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.

Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) Report previously N/A presented at Risk Risks are captured in the Executive Summary. Analysis 3

Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework

Covid-19 Vaccinations

Since commencing the Covid vaccination programme on 15th December 2020 COVID vaccinations are being offered to all people across Doncaster in Joint Committee on Vaccination and Immunisation (JCVI) cohorts 1-4 (detailed below). Various delivery models have been used to vaccinate the different staff and patients groups. The majority of patients have been vaccinated across the five local vaccination sites in Doncaster. Vaccination Roving teams have also been established in each Primary Care Network and have visited Care Homes to vaccinate both staff and residents however there has also been the opportunity for staff to also visit local vaccination sites. Roving Teams have also been able to vaccinate those that are housebound and fall into one of the below cohorts.

Hospital vaccination hubs have been established at Doncaster Royal Infirmary and Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and have taken on the responsibility of vaccinating health and care staff across the borough including other community provider health care staff

1 Residents in a care home for older adults Staff working in care homes for older adults 2 All those 80 years of age and over Frontline health and social care workers 3 All those 75 years of age and over 4 All those 70 years of age and over Clinically extremely vulnerable individuals (not including those under 16 years of age)

From the time period of December 2020 to 14th February 2021 there have been a total of 72,697 1st doses administered (41,521 of which to people aged 70 and over) and a total of 2,414 2nd doses administered.

In line with national guidance, the priority is to now vaccinate cohorts 5 (All those 65 years of age and over) and 6 (Adults aged 16 to 65 years in an at-risk group), and this will include the additional people that have been added to the Shielded Patient Lists as identified via the QCovid model.

Doncaster Clinical Commissioning Group commissioning leads have also been working with the Complex Lives teams to vaccinate some of our most vulnerable homeless population. As the majority of this population is currently in temporary accommodation across the borough, we have been able to take the Vaccination Roving team out to the places of accommodation to vaccinate.

5 Further work is being planned with the Vaccination Roving team to vaccinate other identified patients who have severe and complex mental health conditions/learning disabilities.

1.1: NHS Constitution Measures

1.1.1 Referral To Treatment (RTT) Performance (Oversight Framework Measure - OF)

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks June- July- Commissioner Jan-20 Feb-20 Mar-20 Apr-20 May-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 20 20 Doncaster CCG 89.2% 90.5% 89.7% 82.6% 73.5% 61.4% 52.9% 57.7% 64.1% 67.9% 68.9% 67.0% 64.6%

Rightcare Peer Group 86.5% 86.4% 83.5% 75.5% 65.3% 52.9% 46.5% 55.4% 64.9% 70.9% 73.1% 72.5% Doncaster and Bassetlaw Teaching 88.8% 90.4% 90.1% 82.2% 72.3% 58.8% 49.2% 54.0% 60.7% 64.9% 66.1% 64.6% 62.5% Hospitals Foundation Trust (DBTHFT) England 83.4% 83.1% 79.6% 71.5% 62.7% 53.0% 48.2% 54.8% 61.6% 66.3% 68.7% 68.3%

Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

Performance for Doncaster Clinical Commissioning Group (DCCG) patients at all Trusts was 64.6% in January 2021, below the 92% target. Performance was below control limits suggesting performance is under expected levels for the service.

6 Patients on incomplete pathways who have been waiting no more than 18 weeks

90% 80% 70% 60%

50%

Jul-17 Jul-18 Jul-19 Jul-20

Apr-17 Oct-17 Apr-18 Oct-18 Apr-19 Oct-19 Apr-20 Oct-20

Jun-17 Jan-18 Jun-18 Jan-19 Jun-19 Jan-20 Jun-20 Jan-21

Mar-19 Mar-18 Mar-20

Feb-18 Feb-19 Feb-20

Aug-17 Sep-17 Nov-17 Dec-17 Aug-18 Sep-18 Nov-18 Dec-18 Aug-19 Sep-19 Nov-19 Dec-19 Aug-20 Sep-20 Nov-20 Dec-20

May-18 May-17 May-19 May-20

% waiting under 18 weeks Avg LCL Target

The chart above shows that RTT performance has deteriorated over the last 2 years with 3 clear stages of continual deterioration. Latest performance is below the normal range of the service, affected adversely during the Covid-19 pandemic. Seventeen specialties failed to meet the 92% standard for DCCG:

• Cardiology (84.2%) • Cardiothoracic surgery (947%) • Dermatology (91.8%) • Ear, Nose & Throat (51.6%) • Gastroenterology (89.2%) • General Medicine (78.4%) • General Surgery (62.5%) • Geriatric Medicine (89.1%) • Gynaecology (81.9%) • Neurology (91.7%) • Neurosurgery (83.3%) • Ophthalmology (57.0%) • Other (81.1%) • Plastic Surgery (71.6%)

7 • Rheumatology (87.7%) • Thoracic Medicine (86.8%) • Trauma and Orthopaedics (T&O) (50.3%) • Urology (48.8%)

Benchmarking data from December 2020 (latest benchmark) shows DCCG performance was below the England average in 3 specialties, General Medicine, ENT and T&O. The waiting list shape for Doncaster CCG patients at any provider is shown below. The CCG monitors the waiting list weekly and is in regular contact with DBTHFT and North Lincolnshire and Goole Foundation Trust for the most up to date position on patients waiting over 40 weeks, in order to try to reduce long waiters, including those who may breach 52 weeks.

8 DBTHFT’s January 2021 position deteriorated to 62.5%. Twenty specialties failed to meet the 92% standard for DCCG:

• Breast Surgery (96.9%) • Cardiology (87.8%) • Clinical Haematology (99.1%) • Dermatology (92.0%) • Diabetic Medicine (91.5%) • Ear, Nose & Throat (51.5%) • General Medicine (79.9%) • General Surgery (62.3%) • Geriatric Medicine (89.7%) • Gynaecology (83.5%) • Medical Ophthalmology (71.1%) • Nephrology (95.6%) • Ophthalmology (53.5%) • Oral Surgery (60.6%) • Orthodontics (66.3%) • Paediatric Cardiology (88.3%) • Paediatrics (95.7%) • Pain Management (83.7%) • Podiatry (66.3%) • Respiratory Medicine (88.8%) • Rheumatology (89.9%) • Trauma and Orthopaedics (T&O) (49.6%) • Upper GI Surgery (33.9%) • Urology (48.8%) • Vascular Surgery (74.1%)

9 There are many issues that have affected Referral to treatment target for DBTHFT. These included:

Outpatient departments with reduced capacity of all face to face activity due to COVID Safe Working and Respiratory & Pain management activity was reduced to accommodate staff supporting wards with Covid 19. There has been a step down of all Elective/Day case (non-urgent) elective activity due to OPEL 4 guidelines Treatment of out of area category 2 patients as part of mutual aid arrangements

DBTHFT have submitted an improvement plan, which includes the need for sustainable video consultation solution. A refresh of the performance assurance framework and related meetings to focus on recovery. Mutual aid arrangements are in place for Ophthalmology & Breast at both Barnsley and Rotherham hospitals. A surgery outpatient recovery plan which will increase activity and reduce the long waiting patients is currently in development and it is hoped to be ready at the end of February 2021. Insource and outsourcing plan to assist the backlog for recovery and the patients waiting over 52 weeks. A single patient list is being developed to ensure that all patients are visible and effectively managed. This is hoped will be ready by March 2021. Ward S10 will reopen in February with Parkhill able to manage more category 3 and 4 patients. Elective operations will be stepped up to support the management of routine operations in line with all performance standards. The capacity planning work with Foureyes is progressing, with completion due March 2021.

10 The graph is showing Doncaster CCG activity against the trajectory in the phase 3 plan that was submitted to NHS England. Less activity going through hospitals means the waiting list size will increase as fewer patients are being seen. The follow up ratios are being affected by COVID and the mix of activity going through DBTHFT, with little activity in Patient Led Follow-up. DBTHFT are hoping more specialities will be rolled-out (and hence less patients are followed up in the longer term).

1.1.2 Waiting List Size (OF)

Doncaster registered patients on incomplete RTT pathways

26000 24000 22000 20000

18000

Jul-18 Jul-19 Jul-20

Jan-19 Jan-20 Jan-21

Jun-18 Jun-19 Jun-20

Oct-19 Oct-18 Oct-20

Apr-18 Apr-19 Apr-20

Sep-18 Feb-19 Sep-19 Feb-20 Sep-20

Dec-18 Dec-19 Dec-20

Aug-18 Aug-19 Aug-20

Nov-18 Nov-19 Nov-20

Mar-19 Mar-20

May-18 May-19 May-20

Doncaster CCG Target

The expectation nationally has been revised to ensure that the number of patients on incomplete pathways is maintained below or at the waiting list size at the end of January 2020 by March 2021. The number of DCCG patients on incomplete RTT pathways decreased in January 2021 by 1379 patients to 23423. This exceeds the waiting list target (22206) by 1217 patients. The Trust are currently working with North of England Commissioning Support Unit (NECS) to work on cleaning up the Patient Tracking List (PTL) and validating all the Patients on the PTL over the next few months.

11 1.1.3 52 Week Breaches (OF)

52 Week Waits –Incomplete Pathways

Provider Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 July-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21

Doncaster CCG 1 0 0 6 20 50 104 184 235 281 426 664 1082

DBTHFT 1 1 1 10 27 52 157 278 345 393 631 986 1635

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

The number of breaches has increased since April 2020 primarily due to Covid-19. The number of DCCG patients waiting over 52 weeks increased to 1082 in January 2021. Due the large increase during the month a review of referral numbers has been completed. There was a slightly larger number during January 2020 which may have contributed to this increase in comparison to previous months however no further explanation has been identified other than recued capacity due to social distancing, elective operations being cancelled and staff being deployed to support COVID. This has meant the trust has been unable to complete the activity it would have done previously.

Of the people waiting over 52 weeks, 972 were at DBTHFT, 30 at Sheffield Childrens’s Hospital, 18 at Sheffield Teaching Hospitals, 13 at Rotherham Hospital, 8 at Hull University Teaching Hospital, 6 at Leeds Teaching Hospitals, 5 at North Lincolnshire and Goole Hospitals, 4 each at Barnsley Hospital, Claremont and Barlborough, 2 at University Hospitals of Leicester NHS Trust, Manchester University Hospital, Mid Yorkhire Hospitals NHS Trust and The One Health Group. These other providers just have 1 person who is waiting over 52 weeks; Imperial college Healthcare NHS Trust, Cambridge University Hospitals NHS Foundation Trust, Harrogate and District NHS Foundation Trust, Queen Victoris Hospital, Barts Health NHS Trust, Mid and South Essex Foundation Trust, South Tees Hospitals NHS Foundation Trust, Guy’s and St Thomas NHS Foundation Trust, University hospitals of Derby and Burton NHS Foundation Trust and Airedale NHS Foundation Trust.

Comparative data for 52 week wait breaches, for December 2020 shows DCCG performance was 2.30 breaches per 1000 patients and England 2.05 breaches per 1000 patients.

The graph below shows the number and length of waits as at January 2021.

12 Number of patients on RTT pathway who have waited over 52 weeks. 140

120

100

0 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 81 82 84 85 86 87 90 102 103

The table below gives the breakdown of the total breaches for DCCG in January by specialty:

Trauma & General Ear, Nose & Plastic Provider Orthopaedics Urology Other Surgery Ophthalmology Throat (ENT) Neurosurgery Gynaecology Surgery Cardiology Total DBTHFT 518 167 28 118 56 81 0 4 0 972 Other provider 26 7 45 3 5 6 1 7 6 4 111 Total 544 174 73 121 61 87 1 11 6 4 1082

DBTHFT are currently reporting 1635 people waiting 52 weeks or longer for treatment at the end of January 2021.

13 1.1.4 Diagnostics (OF)

Patients waiting less than 6 weeks for a Diagnostic test

Commissioner Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21

Doncaster CCG 94.6% 99.2% 90.0% 38.2% 29.2% 36.0% 49.6% 54.7% 58.4% 58.5% 61.8% 60.6% 57.2%

Rightcare Peer Group 95.3% 97.3% 91.8% 38.9% 37.7% 50.5% 61.9% 65.6% 71.7% 76.2% 77.2% 75.3%

DBTHFT 95.4% 99.1% 89.9% 36.9% 28.4% 35.5% 50.0% 54.4% 58.4% 58.8% 61.8% 60.4% 56.1%

England 95.6% 97.2% 89.8% 44.6% 41.5% 52.2% 60.4% 61.9% 66.9% 70.8% 72.5% 70.8%

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

Patients waiting less than 6 weeks for a diagnostic test 100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

Jul-17 Jul-18 Jul-19 Jul-20

Apr-17 Apr-18 Oct-17 Oct-18 Apr-19 Oct-19 Apr-20 Oct-20

Jun-17 Jan-18 Jun-18 Jan-19 Jun-19 Jan-20 Jun-20 Jan-21

Feb-18 Mar-18 Feb-19 Mar-19 Feb-20 Mar-20

Nov-17 Dec-17 Nov-18 Dec-18 Nov-19 Dec-19 Nov-20 Dec-20

Sep-20 Aug-17 Sep-17 Aug-18 Sep-18 Aug-19 Sep-19 Aug-20

May-17 May-18 May-19 May-20

% waiting under 18 weeks Avg LCL Target

14 Performance for DCCG in January 2021 deteriorated to 57.2% of patients waiting less than 6 weeks for a test (3770 breaches) below the 99% target. Performance is below the statistical process control limits on the chart above which indicates performance is outside the normal variation expected for the service. Since March performance has been severely impacted by the COVID-19 pandemic.

DBTHFT’s January 2021 position deteriorated to 60.4% against a standard of 99%. The table below shows the diagnostic modalities that were impacted by Covid-19. Due to the National and Local response to the pandemic from 18th March 2020, the majority of the Trust’s routine activity ceased, limiting their ability to see patients already in the system and those referred in within the 6- week timeframe. There has been an increase in 2ww referrals, urgent and routine referrals for both MRI and Non-Obstetric Ultrasound (NOUS) at DBTHFT since December 2020. This has added to the backlog of patients waiting for NOUS and injections caused by staffing shortfalls over a prolonged period. The recovery plan is for the mobile MRI unit to do additional days in February and March, with further additional sessions to be run in house. Activity will be monitored on a weekly basis, where the impact on performance can be seen. Staff vacancies have had approval to be recruited to, as currently staffing levels are at 70% and are further reduced capacity due to COVID safe working.

Due to COVID SAFE guidelines most modalities are not able to provide pre-Covid activity levels. There has been a slight deterioration in performance during January, compared to the previous month. Services have been adversely affected by COVID related absences, administration, impacting booking and pre-calls.

Full details of individual testing pathways are shown in the table below.

16 1.1.5 A&E attendance to admission, transfer or discharge (OF)

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

Provider Jan-20 Feb-20 Mar-20 Apr-20 May-20 June-20 Oct-20 Nov-20 Dec-20 Jan-21 Jul-20 Aug-20 Sep-20 DBTHFT (all attendances, based on 84.8% 85.4% 88.0% 90.9% 94.7% 93.2% 91.9% 88.8% 82.6% 76.0% 76.9% 79.0% 80.7% daily reported figures)

DBTHFT (Type 1 attendances) 79.4% 80.4% 84.4% 92.5% 93.9% 91.7% 90.0% 85.7% 78.1% 70.8% 71.8% 74.9% 76.7%

England (all attendances) 81.7% 82.8% 84.2% 90.4% 93.5% 92.8% 92.1% 89.3% 87.3% 84.4% 83.8% 80.3% 78.5%

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

17 Although performance remains under target during January there was improvement to 80.7% during the month. Performance remains below statistically anticipated levels within the service. Performance for January was 2.2% above the England average.

Covid-19 has continued to impact on both EDs with Departments split into 2 areas to manage 2 simultaneous pathways responding to Covid-19 symptoms and non-Covid-19 symptoms.

There were 11319 in January which is fewer than in December but surges with high number of attendances within short timeframes placing additional demand on the service during the month. Some issues were also encountered through Covid-19 specific pathways where some discharges were delayed while awaiting test results to ensure safe discharges.

Weekly escalation discussions are in place between the Trust and the Yorkshire Ambulance Service to address ‘batching’ concerns in a wider ‘System Forum’. Both sites are seeing an increase in both inappropriate and escalated acuity attendances with patient feedback indicating inability to access face to face primary care consultations. Ongoing discussions with the CCG continue to highlight concerns.

Increased Senior Management presence and support is in place at Bassetlaw to improve clinical patient flow and pathways. The Emergency Assessment Unit continues to be well utilised and supports performance and flow throughout the department. Ongoing work continues with the Teams to build and embed relationships and foster more effective patient pathways both within the Division and in the wider Trust. This is a long term project.

A ‘system perfect’ week took place from 4th to 10th January which included expanding senior community nurse, additional resource in the Integrated Discharge Team, ensuring appropriate direct lines for health and social partners to the Same Day Health Centre. Council wellbeing officers were also based in ED for turnaround in relation to social care etc along with social prescribers in the department and available to wards.

1.1.6 Cancer Measures

DBTHFT are participating in the testing phase of the Clinically-led Review of Standards (CRS) for cancer as 1 of 13 sites nationally. As part of the testing there will be a change in reporting with 2 week wait for Breast Symptomatic reporting no longer available for the Trust to be benchmarked. An additional Faster Diagnosis Standard will be trialed during this period and is defined as a ‘Maximum four weeks (28 days) from receipt of urgent General Medical Practitioner, General Dental Practitioner or Optometrist referral for suspected cancer, breast symptomatic referral or urgent screening referral, to the point at which the patient is told they have cancer, or cancer is definitely excluded’.

18 Work has been completed across Intelligence Teams within the Integrated Care System to ensure that the impact of Covid-19 can robustly be monitored in relation to cancer treatment. From April 2020 onwards Trusts have been requested to assign Covid-19 related 2 week wait breaches to ‘Other Reason’ which will include, anyone diagnosed with Covid-19, isolating due to symptoms or family reasons and capacity attributed directly to Covid-19. For all other measures ‘Other reasons’ relate to all miscellaneous reasons.

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

Q4 Apr- May- Jun- Q1 Aug- Sep- Q2 Oct- Nov- Dec- Q3 Commissioner Jul-20 19/20 20 20 20 20/21 20 20 20/21 20 20 20 20/21

Doncaster CCG 94.4% 92.5% 97.9% 95.5% 95.5% 90.0% 86.8% 88.8% 88.5% 91.5% 79.6% 80.7% 83.8%

Rightcare Peer Group 94.8% 83.8% 96.5% 96.2% 93.1% 96.1% 92.8% 93.37 94.1% 94.6% 93.8% 95.6% 94.7%

Cancer Alliance 94.6% 89.1% 98.0% 95.7% 94.7% 95.0% 92.0% 96.4% 93.7% 95.5% 90.4% 90.4% 92.0%

England 91.6% 88.0% 94.2% 92.5% 92.0% 90.4% 87.8% 86.2% 88.0% 87.9% 87.0% 87.54 87.5%

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

In Q3 2020/21 performance of 83.8% is below the 93% target. A total of 509 people who waited more than 2 weeks within the quarter, of which 307 were due to inadequate outpatient capacity, 100 resulted from patient choice, 49 were associated to Covid-19, 26 were due to clinic cancellations and 27 associated to administration delays.

4 tumour groups performed below the target: Head and Neck (89.6%), Upper GI (89.8%), Lung (87.9%) and Breast (42.9%). A total of 3138 people were seen in quarter, 40% below the pre-covid levels. The longest an individual had to wait to be first seen was 103 days from referral. This was due to patient choice.

Performance in December 2020 was 80.7% which is below the target of 93%. A total of 211 people waited over 2 weeks in December; 18 were due to patient choice, 139 due to inadequate outpatient capacity, 34 were associated to Covid-19, 10 were administration delay and 10 due to clinic cancellations. These waits were spread across the following 8 tumour groups: Breast (172), Gynaecology (3), Head and Neck (10), Lower GI (3), Lung (6), Skin (10), Upper GI (6) and Haematological malignancy (1). 4 tumour groups that performed below the 93%, Breast (3.37%), Lung (75.0%), Head and Neck (89.0%) and Haematological (90.9%) respectively. The longest breach for first seen was 45 days from referral. This was due to Patient choice relating to the first outpatient appointment.

20 The Performance Intelligence Team are working closely with the Cancer Team at DBTHFT monitoring cancer referrals, showing that referrals and booked appointments are starting to recover to normal volumes from the first week of June. The numbers of referrals increased in August, and this pattern has continued into December showing an increase of 20% above pre-covid average referral levels. All waits above target are monitored and discussed at the Cancer Programme Board.

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

Q4 Apr- May- Jun- Q1 Aug- Sep- Q2 Oct- Nov- Dec- Q3 Commissioner Jul-20 19/20 20 20 20 20/21 20 20 20/21 20 20 20 20/21

Doncaster CCG 96.5% 100% 87.5% 88.9% 93.1% 100% 100% 80.6% 85.1% 59.6% 18.2% 3.6% 26.7%

Rightcare Peer Group 93.5% 89.1% 88.2% 85.8% 87.4% 93.3% 95.4% 82.6% 90.0% 94.0% 83.5% 88.8% 88.4%

Cancer Alliance 91.3% 90.9% 97.4% 98.1% 95.7% 93.3% 90.6% 88.6% 90.7% 86.4% 76.3% 80.1% 81.0%

England 85.6% 80.9% 93.7% 90.6% 89.5% 86.4% 82.3% 77.2% 81.9% 77% 67.8% 67.0% 70.4%

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

The Breast Symptomatic 2 week wait data is excluded from the 2week wait measure for suspected cancer measure.

Performance deteriorated to 26.7% during quarter 3 when 99 out of 135 people waited longer than 2 weeks. Although there has been an increase in referrals into the breast service the numbers referred remain under previous baselines for 2019/20. The main impact of breaches has been due to social distancing and a reduction in the number of radiographers that are currently working. The Breast service is going to be working with other providers through mutual Aid, where patients attend other provider for their first outpatient appointment to enable DBTHFT to reduce the number of patients waiting to be seen. These additional clinics were offered in January and February.

21 Maximum four weeks (28 days) from receipt of urgent General Practice (General Medical Practitioner, General Dental Practitioner or Optometrist) referral for suspected cancer, breast symptomatic referral or urgent screening referral, to point at which patient is told they have cancer, or cancer is excluded. Commissioner Q4 Apr- Jun- Q1 Sep- Q2- Nov- Dec Q3 May-20 Jul-20 Aug-20 Oct-20 19/20 20 20 20/21 20 20/21 20 20 20/21 Doncaster CCG 81.2% 71.4% 85.3% 82.6% 80.5% 79.7% 73.5% 78,3% 76.8% 72.7% 73.0% 70.9% 86.9%

The standard operating contract for the 2020/21 financial year indicated that the 28 Day Faster Diagnosis Standard (FDS) performance target will be held at 75%. However, after discussions with local services, it has been agreed to maintain the local target of 80%. During the Covid-19 pandemic the national pilot period for 28 Day FDS has been paused but Trusts are still required to report against performance. Doncaster CCG achieved 86.9% for quarter 3.

31-day wait from diagnosis to first definitive treatment for all cancers Q4 May- Q1 Aug- Q2 Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Dec-20 19/20 20 20/21 20 20/21 20/21 Doncaster CCG 95.0% 92.9% 92.9% 99.0% 94.8% 99.2% 97.2% 95.5% 97.3% 97.6% 95.6% 97.9% 97.0%

Rightcare Peer Group 96.4% 97.9% 95.4% 94.6% 96.1% 96.3% 95.4% 94.9% 95.5% 97.2% 95.9% 96.9% 96.7%

Cancer Alliance 96.5% 95.7% 94.2% 96.5% 95.5% 96.1% 95.7% 95.2% 95.6% 96.8% 96.0% 97.1% 96.6%

DBTHFT 99.1% 98.5% 97.9% 100% 98.8% 99.2% 100% 96.0% 98.0% 100% 96.7% 99.3% 98.7%

England 95.9% 96.3% 93.9% 93.8% 94.7% 95.1% 94.5% 94.5% 94.7% 95.7% 95.2% 96.0% 95.6%

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

The Q3 performance of 97.0% is above the target of 96%. There were a total of 12 people waiting over 31 days within the quarter, 6 of which were associated to Covid-19 related breaches. The remaining breaches were as follows; Out-patient capacity inadequate (4), Elective capacity inadequate (1) and Treatment delayed for medical reasons (1). There have been a total of 1082 treatments year to date, a reduction of 20% compared to pre-covid levels.

It is expected that the impact of the Covid-19 pandemic on treatments will be seen in the coming months as the total number of patients requiring a first treatment increases.

23 31 day wait for subsequent treatment Q4 May- Q1 Aug- Q2- Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Dec-20 19/20 20 20/21 20 20/21 20/21 Surgery - Doncaster 90.2% 100% 90.3% 100% 94.9% 96.3% 92.9% 90% 92.8% 95.0% 94.4% 94.4% 94.6% CCG Radiotherapy - 91.4% 95.4% 93.3% 78.3% 88.8% 85.5% 89.3% 91.9% 88.2% 91.7% 97.1% 100% 96.4% Doncaster CCG Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% Drug Regimen - 99.0% 100% 87.0% 97.8% 95.5% 100% 100% 100% 100% 100% 100% 100% 100% Doncaster CCG Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

All treatment types performed above their respective targets.

As above all waits above target are monitored and discussed at the Cancer Programme Board.

62-day wait from urgent GP referral to first definitive treatment for cancer (OF) Q4 May- Q1 Aug- Q2- Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Dec-20 19/20 20 20/21 20 20/21 20/21 Doncaster CCG 79.2% 72.6% 72.5% 94.0% 80.1% 91.5% 72.5% 71.0% 77.8% 63.4% 71.9% 79.2% 71.7%

Rightcare Peer Group 77.0% 78.7% 73.5% 75.1% 76.0% 77.7% 77.2% 75.2% 76.6% 76.8% 75.6% 72.2% 74.8%

Cancer Alliance 77.0% 77.6% 71.7% 78.6% 76.2% 74.1% 72.4% 67.4% 71.1% 66.8% 68.6% 68.8% 68.0%

DBTHFT 82.0% 79.3% 81.6% 93.7% 84.4% 79.6% 79.5% 74.9% 79.9% 66.7% 79.2% 81.3% 78.1% Sheffield Teaching Hospitals Foundation 72.9% 67.2% 70.1% 70.9% 67.4% 74.0% 65.2% 60.0% 64.4% 55.8% 61% 59.6% 59.3% Trust (STHFT) England 75.6% 74.3% 69.9% 75.2% 73.3% 78.4% 77.9% 74.7% 76.9% 74.5% 75.6% 75.2% 75.1%

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

24 During quarter 3, 71.7% of DCCG patients were seen within 62 days of their GP referral for first definitive treatment. There was a total of 60 people who waited longer than 62 days in the quarter, 17 of which were associated to the breach reason ‘other reason’ and 5 were due to complex diagnostic pathways. There were 7 tumour groups that performed below the 93% standard and these tumour groups would be respectively Gynaecology (61.9%), Haematology (81.8%), Head and neck (33.3%), Lower GI (43.5%), Lung (64.7%) Sarcoma (0), and Upper GI (52.4%). The breaches were across a range of tumour groups which are monitored in detail through the Cancer Programme Board.

During Q3 there were a total of 16 delays over 104 days, with the longest wait at 191 days, in Gynaecology due to the patient self-isolating for 4 months due to COVID.

The 104 plus day breaches are being monitored by Cancer Programme Board and assurances will be provided by the Cancer Leads and will continue to be presented at Clinical Quality Review Group on a quarterly basis. The Performance and Intelligence Team has been in discussion with the Cancer Team at DBTHFT regarding the 62 Day Patient Tracking List (PTL) and current referral levels. The details below provide assurance that DBTHFT are capturing the required patients. The PTL shows the number of patients that have had a first appointment but are still on the pathway without a decision to treat date and therefore can be awaiting diagnostics etc. for either a confirmation or ruling out of cancer.

25 62-day wait from referral from an NHS screening service or Consultant Upgrade to first definitive treatment for all cancers Q4 May- Q1 Aug- Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Q2-20 Oct-20 Nov-20 Dec-20 19/20 20 20/21 20 20/21 Doncaster CCG – 88.9% 100% 0% 50.0% 71.4% 0% 100% 88.9% 75.0% 88.9% 100% 100% 92.9% screening service Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Doncaster CCG – 70.0% 66.7% 71.8% 60.0% 60% 71.4% 60.0% 90% 84.6% 92.3% 68.2% 87.9% 82.3% consultant upgrade

Doncaster CCG performed at 92.9% against the 90% screening target in Quarter 3 2020, with 1 lower Gi breach in surgery, due to the person shielding due to Covid.

Doncaster CCG performed at 82.3% against the 85% consultant upgrade target, with a total of 12 breaches in Quarter 3 2020.

The breaches were within 3 specialties, Lung (9), lower GI (1), Urology (1) and Other (1) tumour groups. The following breach reasons: Other reason (4), Admin delay (1), Complex diagnostic issues (1), Health care provider initiated a delay to diagnostic or treatment (2), and Outpatient capacity inadequate (3) and treatment delayed for medical reasons (1). The longest an individual had to wait was 129 days and due to Other reasons in Urology. Further details relating to this breach is awaited.

26 1.2 NHS National Contract Key Performance Indicators

1.2.1 Yorkshire Ambulance Service (YAS)

May 20 June 20 July 20 Aug 20 Sept 20 Oct 20 Nov 20 Dec 20 Jan 21 Category 1 (Life threatening injuries and illness) target of 00:07:10 00:06:59 00:06:59 00:07:23 00:07:45 00:08:42 00:08:13 00:08:03 00:08:00 average time less than 7min Category 1 target 90% of times less than 15 min 00:12:16 00:12:15 00:12:01 00:12:44 00:13:22 00:15:00 00:14:07 00:13:54 00:13:43 Category 2 (Emergency) target of average time less than 18 00:12:23 00:13:37 00:15:34 00:18:30 00:22:43 00:29:13 00:24:35 00:24:03 00:24:30 min Category 2 target 90% of times less than 40 min 00:22:37 00:25:32 00:30:54 00:38:07 00:47:33 01:01:57 00:52:07 00:50:47 00:52:00 Category 3 (Urgent) target 90% of times below 2 hours 00:45:58 00:56:44 01:12:10 01:35:46 02:23:12 03:26:08 02:35:10 02:34:30 02:34:57 Category 4 (Less urgent) target 90% of times below 3 hours 01:36:37 01:45:33 02:12:28 02:48:10 03:04:05 04:09:00 03:23:35 03:45:36 04:08:47 Category 5 (Lowest acuity) target 90th centile Target TBC 00:25:16 00:40:19 00:30:12 00:45:18 01:53:58 01:57:45 01:13:06 01:19:53 01:50:42

With the exception of the Category 1 90th centile measure all measures failed to meet target during January 2021, though there were improvements across the majority.

Representatives from YAS continue to attend meetings around joint pathways in Doncaster to ensure that any issues can be addressed and continue to work closely with DBTHFT. Challenges with extensive queueing across all hospitals including Doncaster Royal Infirmary were reported. YAS staff members were based within A&E at the start of December to help reduce handover times and has worked well. In addition, lateral testing for Covid-19 was rolled out for asymptomatic staff during the month.

YAS representatives attending the Daily Partners escalation calls which include all partners in Doncaster.

27 Section 2: Provider Exception Report

The following section of the report details performance by exception (those measures either rated Red or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH and other commissioned services. Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance for DBTHFT and Doncaster sites for RDASH, which does not simply relate to services provided to DCCG. Due to the COVID-19 pandemic NHS England and NHS Improvement have directed NHS organisations to reduce routine reporting requirements to free up capacity and manage responses. Some areas agreed with Providers are included below.

2.1 Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT)

This section only includes measures in the DBTHFT contract currently not meeting target which are not included in the constitution measures in Section 1.

Latest Measure Month Target Update performance Proportion of November 47.1% 75% Trust level performance for direct admission to patients directly 2020 the Stroke Unit within 4 hours, deteriorated admitted to further in November 2020 to 47.1% against the hyper acute 75% target (27 breaches out of 51). stroke unit within 4 hours of clock There is ongoing work at DBTHFT around start – No reviewing and updating the Stroke operational further update policies that will be undertaken by the Stroke received Clinical Governance Lead. This will include new patient pathways and protocols. The Inter Cranial Haemorrhage pathway is now in place in the Emergency Department. There is ongoing funding for the RAPID software which allows DBTHFT to access MRI to facilitate thrombolysis of “wake up strokes” Clinical staffing issues remain, which have impacted on service delivery. The Advanced Clinical Practitioner (ACP) role has increased specialist outreach to Emergency Department to aid early identification of stroke patients.

28 2.2 Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)

This section only includes measures in the RDASH contract currently not meeting target which are not included in the constitution measures in Section 1.

Latest Measure Month Target Update performance Improving Dec 13.0% 14.4% Performance for access into the service remained Access to 2020 below trajectory in December 2020 at 13.0% Psychological cumulatively. A revised trajectory taking into Therapies account the impact of Covid-19 has been (IAPT) – submitted to NHS England with access targets at Cumulative 4.6%, 4.9% and 5.1% for Quarters 2 to 4. Against percentage of this revised trajectory performance for Q3 was people entering only 0.8% below this aim (290 people). treatment as a proportion of The Service is offering additional telephone and people with digital interventions and a meeting has been anxiety or scheduled with the CCG to discuss recovery into depression (OF) 2021/22 in March 2021. Face to face treatment (RDASH specific has been ceased at the current time. DCCG data) IAPT – The Dec 50.8% 50% The service will continue to be monitored with the percentage of 2020 Trust through Finance, Performance and people who Information Groups held with DCCG. have completed treatment are The recovery rate and waiting time targets for the moving to service were both on track in December. recovery

29 IAPT – The Dec 96.3% 75% percentage of 2020 people who received treatment within 6 weeks of referral (incomplete treatment)

2.3 Joint Pathway

Latest Measure Month Target Update performance Dementia – the Dec 20 64.1% 67% The percentage of people estimated to have percentage of dementia in Doncaster who have received a patients diagnosis decreased in December 2020. This estimated to pathway includes both DBTHFT and RDASH have Dementia with diagnostic testing and consultant services within Doncaster required. Covid-19 has impacted the ability to who have provide computerised tomography (CT) scans received a and face to face assessments which means diagnosis diagnoses have slowed since April 2020.

Resumption of scanning has resumed with the pathway altered to RDASH staff visiting patients in home settings to reduce risk.

A meeting between DBTHFT and RDASH staff has been arranged to discuss this pathway and how to effectively prioritise patients to provide positive outcomes, though capacity has been impacted by ongoing pressures related to Covid- 19. Data for November shows that RDASH are assessing 92.6% of patients within 6 weeks (2 people waiting longer). RDASH have been requested to share their patient lists with the Doncaster GP Practices to ensure that registers are accurate.

30 Section 3 Phase 3 NHS England Submissions

Following the submission of trajectories and activity across a range of measures, for DCCG, to NHS England (NHS E) in September 2020 a number of areas were identified as risks for achievement. These measures have been included below for monitoring and performance management going forwards with the exception of IAPT, Cancer and RTT which have been included in the Provider sections of this report.

3.1 Serious Mental Health (SMI) Physical Health checks (annual rolling figure)

As at the end of Quarter 3 2020/21 there have been a total of 29.4% (slight improvement from 29.0%) (665 people) of people on a GP register with SMI who have had a completed physical health and remains above the England average of 21.6%. A trajectory of 1350 by March 2021 has been submitted (60.4%) to NHS E. A new pathway across Primary Care and RDASH is due to begin in Quarter 3 which will allow increased capacity and sharing of data which will ensure a robust and accurate performance figure is available. There has been an issue of recording onto some GP systems from RDASH staff and this will be raised through contracting meetings to ensure that this is resolved during Q4.

3.2 Mental Health - The number of inappropriate Out of Area Placement bed days for adults

The trajectory submitted to NHS E aims to reduce inappropriate beds days to 270 days by the end of March 2021, with most recent figures at November at 630 days (over a rolling 3-month period), a decrease of 115 days from the previous timeframe (now 10 patients). Due to Covid-19 there has been a nationwide slowing of transfers of patients as it has provided difficult to discharge patients home because of reduced community services. RDASH’s Chief Operating Officer now has weekly meetings with ward managers key personnel.

3.3 Number of women accessing specialist community perinatal mental health services

A trajectory has been submitted for the remainder of 2020/21 which aims to have 4.5% of women accessing the service on a rolling 12- month basis. This is below the aspiration of 7% indicated nationally. Currently information for 2020/21 is being developed and validated.

3.4 The number of adults (18 and over) who have a Learning Disability and/or autistic spectrum syndrome that are in inpatient care for mental and/or behavioural healthcare needs.

A trajectory has been submitted to reduce the number of adults in an inpatient setting to 5 or fewer by the end of March 2021. As of December there were 10 people identified within these settings. Work continues to identify appropriate placements within community

31 settings and risk review meetings are in place with a multi-disciplinary team to ensure that appropriate actions are in place to stop the escalation in acuity of people already within the community.

3.5 The number of Annual Health checks carried out for person aged 14 plus on GP Learning Disability Resisters

As at Quarter 2 (latest information) 178 people with Learning Disabilities had received their annual health check. During the quarter GPs and other health care professionals had taken opportunities to complete checks through other appointments available as there was an impact by Covid-19. A revised trajectory has been submitted to raise the number of checks to 360 by March 2021. This is below the stated aim at the start of 2020/21 however it is unlikely that services will have the capacity to fulfil more checks at the current time.

Section 4 Other Quality Elements

Safeguarding

Safeguarding Adult Reviews / Rapid Reviews

There have been no new Safeguarding Adult Reviews / Rapid Reviews commissioned during this reporting period.

Doncaster CCG continues to support the Safeguarding Adult Reviews and Rapid Reviews that remain on going within the partnership.

There is currently one Children’s Rapid Review being considered by the Doncaster partnership.

Lessons Learnt Reviews

There have been no new Lessons Learnt Reviews commissioned by the Doncaster Safeguarding Adults Board during this reporting period.

Domestic Homicide Reviews

Since the last Governing Body, there have been no further Domestic Homicide Reviews considered or commenced. Doncaster CCG continues to support the three reviews that are underway.

32 Section 5: NHS Oversight Framework

Indicator 2018-19 Ratings NHSE Dashboard Feb 2020 Latest Performance Performance Period Performance Rank (191) Period Performance Reducing low priority prescribing New in 2019-20 19-20 Q2 Amber MH - Investment standard Green 19-20 Q2 Green No change CYP eating disorders investment New in 2019-20 In-year financial performance Green 19-20 Q2 Amber Worse Expenditure in areas with identified scope for improvement Red 19-20 Q2 Amber Better Primary care workforce 1.03 Sep-18 1.03 No change 85 Probity and corporate governance Green 18-19 Q4 Fully Compliant Staff engagement index 3.71 2018 3.71 No change 140 Progress against WRES 0.1 2018 0.10 No change 46 Working relationship effectiveness 74.4 2018-19 74.4 No change 54 Quality of CCG leadership Green Star 19-20 Q2 Green Star No change

CCG compliance with standards of public and patient Green Star 2018 Green Star participation (not available) No change Personal health budgets 32 19-20 Q2 40 Better 116 19-20 Q3 162 Better Emergency admissions for UCS conditions 3057 19-20 Q2 2,753 Better 130 A&E admission, transfer, discharge within 4 hours 92.54% Mar-19 92.54% No change 26 Mar-20 87.96% Worse Delayed transfers of care per 100,000 population 7.5 Dec-19 8.20 Worse 71 Feb-20 8.8 Worse Hospital bed use following emergency admission 470 19-20 Q2 901.0 Worse 54 Patient experience of GP services 82.10% 2019 81% Worse 133 Patient experience of getting an appropriate GP appointment New in 2019-20 7 DS - achievement of standards 2 2017-18 2 No change 56

0% 19-20 Q2 0% No change 1 19-20 Q4 0% No change % NHS CHC full assessments taking place in acute hospital setting Utilisation of the NHS e-referral 99.60% Jul-19 99.94% Better 106 % 10-11 classified overweight /obese 34.77% 15/16 to 17/18 34.77% No change 102 Injuries from falls in people 65yrs + 2352 19-20 Q2 2,193 Better 117 Inequality Chronic - ACS & UCSC 2695 19-20 Q2 2257 Better 96 AMR: appropriate prescribing 1.086 Nov-19 1.054 Better 147 Mar-20 1.052 Better AMR: Broad spectrum prescribing 5.67% Nov-19 5.55% Better 10 Mar-20 5.6% Better MH - Health checks 38.50% 19-20 Q2 22.20% Worse 134 Maternal smoking at delivery 15.30% 19-20 Q1 16.58% Worse 164 19-20 Q4 17.22% Worse Diabetes patients who achieved NICE targets 43.42% 2018-19 45.47% Better 5 Attendance of structured education course 8.12% 2017-18 17.09% Better 47

9.28% 2017 9.28% No change 157 % deaths with 3+ emergency admissions in last 3 months of life Quality of life of carers 56% 2019 57.80% Better 91 High quality care - acute 60 19-20 Q1 62 Better 70 High quality care - primary care 69 19-20 Q1 68 Worse 23 Cancers diagnosed at early stage 48.92% 2017 48.92% No change 157 Cancer 62 days of referral to treatment 84.47% 19-20 Q2 84.97% Better 34 Mar-20 88.46% Better One-year survival from all cancers 70.50% 2017 71.20% Better 159 Cancer patient experience 8.7 2018 8.90 Better 57 IAPT recovery rate 52.60% 19-20 Q2 53.04% Better 76 Mar-20 48.03% Worse IAPT Access 4.63% 19-20 Q1 4.54% Worse 107 Mar-20 3.55% Worse EIP 2 week referral 85.70% Sep-19 83.87% Worse 67 Sep-19 83.87% Worse MH - OAP 12 Nov-19 82 Worse 114 MH - DQMI 88% Oct-19 97.08% Better 17 LD - reliance on specialist IP care 49 19-20 Q2 37 Better 44 LD - annual health check 43.68% 2017-18 43.68% No change 153 2018-19 37.17% Worse Completeness of GP LD register 0.53% 2018-19 0.61% Better 43 LD mortality reviews New in 2019-20 Neonatal mortality and stillbirths 4.23 2017 4.33 Worse 105 Experience of maternity services 83.5 2018 83.50 No change 74 Choices in maternity services 57.9 2018 57.90 No change 142 Dementia diagnosis rate 72.60% Jan-20 71.54% Worse 55 Dementia post diagnostic support 74.78% 2018-19 77.32% Better 123 18 week RTT 89.30% Dec-19 87.45% Worse 51 Mar-20 89.67% Better Overall size of waiting list New in 2019-20 Dec-19 22425 128 Mar-20 19935 Patients waiting over 52 weeks New in 2019-20 Dec-19 1 62 Mar-20 0 Sepsis awareness Green 2018 Green No change 6 week diagnostics 1.25% Dec-19 4.22% Worse 137 Mar-20 10.04% Worse Evidence based interventions New in 2019-20 19-20 Q2 Amber CCG in best performing quartile in England CCG in worst performing quartile in England

33 Section 6: South Yorkshire and Bassetlaw Integrated Care System Assurance Report (no update available)

Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Due to this, further updates on the Integrated Care System Assurance Report are not available at this time.

Meeting name Governing Body Meeting date 4th March 2021 Title of paper Living Well Life Stage Report

Executive / Clinical Lead(s) Performance and Intelligence Team Author(s)

Status of the Report

To approve To consider / discuss

To note x

Purpose of Paper - Executive Summary This report sets out the key quality and performance updates to be noted by the Governing Body from the quarterly updates provided by DCCG and Doncaster Council staff in relation to the Living Well Life Stage Strategic Delivery Plan. This report reflects 2020/21 performance and delivery areas.

Of the 24 actions within this life stage 1 has been completed however 3 are now overdue:

• Development of whole system flow dashboard, building on the learning from the Covid dashboard developed. • Review of floating support offer including mapping of existing provision (commissioned, non-commissioned, St Leger Homes, Complex Lives Alliance), where they are delivering it, identifying duplications and gaps to develop commissioning intentions. • The DCCG and Council Performance Teams will work to provide a more advanced experience based approach for reporting against delivery plan key identifiable priorities.

Of the performance indicators within this life stage there are 8 now that are off track against target:

• Ensure that at least 60% of Doncaster patients on a GP SMI register receive Physical Health Checks • Doncatere patients that are discharged at their first outpatient appointment. • Proportion of Doncaster Adults living Independently • Increase the amount of Doncaster patients accessing IAPT services against estimated need

35 • Ensure at least 85% receieve their first treatment for cancer within 62 days following an urgent referral for suspected cancer. • Ensure at least 53.3% of patients with cancer diagnosed at Stage 1 or 2 by the end March 2021, working towards the 58% by 2024 ambition set by SYB ICS • Reduce out of area inappropriate MH out of area placements to zero • Reduce the number of Out of Area placements for LD persons.

Recommendation(s) The Governing Body is asked to:

Note the key quality performance areas for attention.

Report Exempt from Public Disclosure

x If yes, detail grounds for exemption: Yes No

Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report.

Tick relevant box

An Equality Impact Analysis/Assessment is not required x for this report.

An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Equality Governance / Corporate Governance Manager. As a impact result of performing the analysis/assessment there are no actions arising from the analysis/assessment.

An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Nil

36 impact Financial Nil implications Legal Nil implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.

Consultation / Engagement (internal N/A departments,

clinical,

stakeholder and public/patient) Report previously N/A presented at Risk Risks are captured in the Executive Summary. analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework

37 Section 1: Living Well Delivery Plan 2020/21

1:1 Actions

Action Due Date Completion (%) Update Low level interventions, based in our neighbourhoods 31/10/20 85% Meetings have progressed this work with a multi-disciplinary team agreeing measures and patient pathways which require monitoring. The Super surge escalation framework was signed off by senior leaders in October. The Escalation Framework dashboard went live at the end of October for daily monitoring by the Daily Partner call. More detailed drill downs went live mid- Development of whole December to replace the Daily Pressures report. The broader System flow system flow dashboard, aspect of the dashboard is in development, a prototype has been built and building on the learning feedback gathered from the System Flow Weekly Meeting, and from Rupert from the Covid dashboard Suckling and Carolyn Nice. Further developments to be made before presenting developed back to the COOs and a go live date set. Review of floating support offer including mapping of existing provision (commissioned, non-commissioned, St Leger Homes, Complex Lives Alliance), where they are delivering it, identifying duplications and gaps to develop commissioning intentions

31/3/2021 50% In light of pre-Christmas tier 3 restrictions and the current lockdown measures, the Minister for Homelessness and Rough Sleeping has actively encouraged Successful resettlement of Council’s to continue to accommodate rough sleepers/those at risk of rough homeless individuals sleeping/homelessness under the ‘Everyone In’ regime. As a result, Doncaster accommodated as part of has continued to utilise hotels as emergency accommodation for individuals due COVID19 emergency to continued demand. Mobile testing of hotel population being implemented w/c response 1 February 2021.Vulnerability assessment work of hotel population underway including GP registration along with progressing move on plans where possible. Work closely with system 31/03/21 75% Work continues virtually with partners of this agenda and culminates in a partners on Cancer quarterly meeting with partners across place and system level including; prevention and awareness Commissioners, Local Authority, Cancer charities, Public Health England and raising including the SYB Cancer Alliance. There are a number of projects ongoing both locally improvement in rates of and led by SYB Cancer Alliance, supported at place level. Recent reporting smoking/alcohol, diet, published by Cancer Research United Kingdom (CRUK) has deemed Doncaster

38 obesity, exercise - linking at place level at outlier when focusing on; deprivation score, number of new too hard to reach groups. cases treated, persons screened for bowel cancer, two week wait referrals Continue to monitor resulting in a diagnosis and two week wait referrals. CRUK facilitator support to impact on Be Clear on PCNs and practice level continues including a specific focus on increasing Cancer campaign screening uptake and minimising harm through proactive pathway management recruiting community as a result of Covid-19. champions to share messages of awareness raising with the population Deliver suicide 31/03/21 100% Complete. bereavement service across Doncaster Borough 31/03/21 70% Draft delivery plan agreed by Homelessness Board. Dave Richmond, Chief Develop a delivery plan Executive of St Leger Homes, has been identified as Senior Responsible Officer for whole systems of the Prevention work stream. Prevention workshop had been planned but did 'Prevention' strand of the not take place due to COVID19 lockdown (to be rearranged). A draft strategy homelessness strategy implementation plan has been developed and submitted to Directors for feedback. Develop the 31/03/21 75% Team Doncaster Locality Management Groups (Silver) set up one for each neighbourhood delivery locality underneath which sits local solutions teams at community level with model, including "local particular areas of focus. solutions", ensuring that Monthly meetings held between Provider Alliance lead, DMBC and CCG on primary care networks are progress with locality working and regular updates to Doncaster Integrated Care embedded into the Partnership Group. approach, recognising that this action cuts across Starting, Living and Ageing Well. Once developed, deliver the actions agreed, with a focussed approach on the agreed neighbourhood outcome for Living Well.

Review of alcohol care 31/03/21 15% No update received and diabetes prevention services 31/03/21 50% Project continues to progress, meeting held in Sept 2020 with brain in hand business manager CALDT and commissioning colleagues to identify the next Increase opportunities steps in the project. Identified and agreed cohort to trial brain in hand with. offered by technology, Commissioning colleagues currently exploring procurement of the system exploring technologies including business case to be submitted to the technology governance board. such as Brain in Hand Referral forms for the project are being developed. Target date for implementation to be up and running by start of March 2021 31/03/21 90% The community helpline was established in the Spring of 2020, the partnership Reduce social isolation working with the SIA and DMBC saw positive results. The Alliance quickly through the further mobilised into a humanitarian response. During the past 10 months the SIA have development of the Social supported Foodbanks, undertaken positive conversation calls and supported Isolation Alliance vulnerable people with shopping and prescriptions.

Co-ordinated access to services when needed Reduce follow-up 31/03/21 Patient Initiated follow-up is both a workstream locally at place level incorporated appointments, within the Outpatient Transformation Programme, in addition to a focussed encompassing patient workstream at SYB ICS. Currently DBTH are leading this work, however it is initiated follow-up as anticipated a new Outpatient Transformation Board will monitor achievements alternatives to across place and learning will be applied to a greater number of specialities, conventional face to face including extending scope to include PIFU following surgery. follow-ups. Collaborate across SYB to 31/03/21 75% This piece of work has been put on hold due to COVID-19. The SYB Outpatient implement e-RS Capacity Transformation key priorities are Advice & Guidance, Patient led Follow-up and Alerts to offer choice at Virtual Consultations. the point of referral, facilitating improved access to elective services thereby reducing the need to offer choice to patients at 26 weeks.

Expand IAPT (Improving 31/03/21 75% Expansion investment decisions made. Additional HEE training capacity being

Access to Psychological accessed for expansion and workforce retention / resilience. LTC and Core Therapy) capacity in line condition / demographic focus areas progressing but some natural COVID with national mandated related hesitancy and engagement issues. Service reach mapping and protected prevalence trajectories. characteristic analysis underway to support continued engagement with Continue expansion of stakeholders across Doncaster. IAPT covid related anxieties pilot underway on IAPT regarding Long DBTH and RDaSH sites focused on healthcare students – medical / nursing / Term Condition offers and allied / TNA, evaluation March 2021. lowering age (<18) and increasing age (>75) offer and uptake. Maximise use of 31/03/21 60% 1) Face to face primary care appointments continue to be available alternatives to urgent care where required, but all local practices are continuing with phone through: and video consultations. - Increasing the availability and use of The More Choice More Appointments service continues to deliver primary care its clinics: appointments, through provision of and - Inclusion Health communication about - First 2 Physio: continued throughout with remote appointments extended access, on line - Extended Access Hubs consultations and direct - Same Day early morning, evening and weekend appointments booking from NHS 111 - Reducing ambulance In light of the Covid vaccine roll-out, Extended Access conveyance rates to A&E appointments has been re-purposed to support this. and increasing see & treat or use of alternative GP Practices are still continuing to provide telephone appointments conveyance pathways for 111 to book directly in to for patient triage. - Developing the

Doncaster CAS

(Community Assessment 2) The YAS Covid Hub will continue throughout winter, to assist with Service) to respond to NHS 111 calls and additional pressures. provide local clinical advice to either resolve YAS and DBTH are continuing to work collaboratively to reduce the call or direct patients conveyance rates.

41 to the most appropriate We held a System Perfect week (w/c 4 January 2021) which was local alternatives predominantly focussed on attendance/admission avoidance and - Ensuring 2 hour home timely/efficient discharges. As part of this, the CCG provided a list response appointments of alternative services/pathways for their crews to contact/signpost made available to to, to avoid conveyance to DRI. This is currently being evaluated. ambulance services and other locally identified services for appropriate This will also be built into the work around developing the local patients in the community CAS.

As part of the diversionary pathways work, YAS has recently mapped the pathways they have access to for each place. This has been shared with each place. A piece of work has been carried out to ensure locally that all appropriate pathways are available to YAS. This has been done in West Yorkshire, and has also been shared with each place, so we can compare services.

3) FCMS, on behalf of the Provider Alliance, piloted all calls for children under 5 to be directed to their CAS from 111, if they require further clinical advice. FCMS has now extended this to all children aged under 11. Again, the learning from this will be built into the development of the local CAS.

4) Any further development of the local CAS has been delayed in year, due to the impact of the Covid-19 pandemic; however, work has now recommenced, and a plan is under development for delivery during 2021/22

5) The 111 DOS review is continuing and progressing well. The CCG has signed off several amendments to urgent & emergency care services profiles and requested that these are made by the DOS Team. There are some queries which need to be discussed with individual providers.

6) Work is continuing on the Rapid Discharge pathway, to ensure a timely discharge into the community. A System Perfect week was held w/c 4 January 2021 which was predominantly focussed on avoiding attendances/admissions to DRI and timely/efficient discharges, with support from all partners throughout the week. A full evaluation is underway which will look at admission avoidance and early supported discharge, as well as coordinating the most appropriate care pathways for our patients.

31/03/21 75% Flu vaccinations commenced in September 2020 and continue to be administered. The data is monitored on a weekly basis and circulated to the Flu & COVID Vaccination Steering Group and Practice Managers. A monthly report is presented to the A&E Delivery Board.

The current uptake (across Doncaster - all 5 PCNs) as at week 02 (w/c 11.01.21) is: - Aged 2 years (not at risk): 52.9% - Aged 3 years (not at risk): 57.2% - Over 65s: 88% Optimise the take up of - Aged 6 months - 64 years (all): 25.1% population screening and - Aged 6 months - 64 years (at risk only): 57% immunisation - Pregnant women: 42.6% programmes, including flu

We have started to monitor the 50-64 years cohort, however this is not measured against a target. The uptake for this cohort, as at week 02 (11.01.21) is: 45.9%

Healthwatch Doncaster held their planned focus on flu for their Daily Dose sessions w/c 23 November, which concentrated on encouraging members of the public in the lower uptake cohorts to have their vaccination.

We continue to see small increases in each cohort, week on week. Increase in integrated 31/03/21 25% Since the last update further users have been added to the IDCR as part of

Doncaster Care Record adhoc boarding activities (iDCR) usage The IDCR has been a pivotal tool for the COVID Vaccination Programme, where we have needed to identify information about patients quickly.

Scoping and discovery work to the development of the IDCR to support the SY&B Prison Suicide Prevention Programme and Locality MDTs with Care Homes has begun. Stakeholders have been contacted and this work is expected to produce a requirements specification by end of March and produce recommendations for usage.

Additional funding has been secured to bring in business analyst resource to look at how the existing data shared from DBTH into the IDCR can be increased to improve information sharing across our Partner organisations. This work will be focused on improving sharing of discharge information to ensure patients get the best care packages for their needs and reduce any delayed transfers of care.

FCMS intend to onboard an additional 30 users by 31st March 2021.

Single sign on functionality will be delivered in March which will allow our member practices to launch the IDCR from within their usual systems (EMIS or SystmOne). We are also looking to ensure all Partner organisations will have this capability by September 2021, and discussions with FCMS will be taking place this month to plan.

Holistic delivery of care and support Review of floating support 30/09/20 60% Care and Support delivery plans of linked to the Homelessness and Rough offer including mapping of Sleeping Strategy agreed by the Homelessness Board. Mark Wakefield existing provision identified as Senior Responsible Officer. Project Group(s) to be convened in (commissioned, non- order to agree scope and roles/responsibilities. commissioned, St Leger Homes, Complex Lives Alliance), where they are delivering it, identifying

44 duplications and gaps to develop commissioning intentions 31/03/21 90% . The third and final report of the LWABC Programme was published February 2021 and is available for review, as required. As per the Evaluation, the programme’s interventions began in mid-2017 after a period of scoping and planning, and took a structured programme approach, intended to support the change being implemented in each of the localities, and enable the spread of good practice and learning across the localities. Each of the localities aimed to implement all elements of the Living With and Beyond Cancer (LWABC) model Fully implement the across Breast, Colorectal and Prostate tumour sites: Risk stratified pathways of Macmillan LWABC care, The Recovery Package – access to Holistic Needs Assessment (HNA), Programme including: e- Treatment Summary, Cancer Care Review, and patient education and support holistic needs assessment and Supported Self-management – including support to manage the (eHNA) and care plan; e- consequences of treatment and support for healthy lifestyles. treatment summaries shared with patients and The final evaluation focuses on the implementation of the LWABC in Doncaster GP; Cancer Care Review drawing together the findings from the whole evaluation period. There have by GP or practice Cancer been several challenges associated with the implementation of the LWABC Champion for 100% model in Doncaster, including the absence of a Project Manager for a significant applicable patients; "Right part of the project period, and competing priorities within the stakeholder team. By You" programme However, recruitments of the Cancer Care Coordinators have made an impact on pathways and practice in the later stages of the programme. The extra capacity they provided, was starting to make a difference with the offer of HNAs becoming more consistent in all three tumour sites. The additional capacity also meant there was potential for further work to be completed, including embedding the HNA template into Infoflex and using HNA data to develop patient support and wellbeing events once the pandemic is over.

Full review of current adult 31/03/21 50% Strategic Strategic Transformation Lead start date delayed. and older adult Transformation Living Well Lead not being pursued by joint commissioners. Community Mental Health Lead (joint models to prepare and RDaSH / It should be noted that Community delivery has significantly modified due to align with both LTP DCCG), COVID, with this presenting potential accelerated gain opportunities.

45 expectations and local Commissioner requirements from 2021. Living Well Lead (joint DCCG DMBC) 31/03/21 30% Commissioning Managers are now working with providers to develop the next stand of work looking at all age propels. New leads for All age Attention Deficit Develop all age adaptive Hyperactivity Disorder (ADHD)on all age Eating Disorders have been identified models for functional to progress work. MH - including ADHD,

Eating Disorder Good progress between joint adult / CYP commissioners and operational teams proposals, At Risk Mental to identify a direction of travel for each of the 4 themes and to create context for State (EIP), IAPT, Adult these services within the community MH / PCN transformation programme. Work Crisis reach and equity progressing. A fifth plan will be agreed shortly for non-psychosis transition / integration. 31/03/21 75% Personalised care remains the central focal point when looking to meet the needs of the patient receiving Continuing Health Care Funding. This is achieved Increase personalised through the development of a Personal Health Budget, which provides inherent care and support personalisation in its approach and delivery. If this is not suitable, the care planning, personal health package developed looks to meet the individual holistic needs of the individual. budgets and consider the Other opportunities being explored for appropriateness under this umbrella. future development of Social Prescribing, linking Primary Care Networks actively recruiting personalised care roles. in with local Primary Care MDTs established for care home residents Networks Training support available for staff to access and training and workforce hub established webinars on different staff roles supporting this agenda

Build on the work started 31/03/21 10% New discharge pathway put in place following national guidance; a review is now in 2019/20 across the underway to determine how to lock in the opportunities from this change and health and social care determine the model moving forwards. Note due to the impact of Covid-19 system (including the High expectations regarding bed occupancy levels may change. Impact Change Model) to reduce length of stay, work towards 92% bed occupancy rates and reduce delayed transfers

46 of care 31/03/21 60% Previous work that came under the Homes for All Board now feeds into the Housing Renewal Group, more specifically the 5 Year New Homes Delivery Plan - Specialised Housing

Work is ongoing to develop the evidence base going forward and some of that work will be picked up via the Market Shaping (Market Position Statement). Work on hold from a commissioning perspective during Covid 19, this is due to Develop Physical the lead officer overseeing Domiciliary Care, plans will be developed during Disability accommodation recovery to ensure move back to BAU. offer and wrap round care and support services Prior to lockdown presentation to portfolio holders (Racheal Blake and Glyn Jones) had taken place and next steps discussed.

Overview of work to date shared with Karen Lythe as new chair of the Homes for All Board.

Develop the place-based 31/03/21 50% Whole Systems Partnerships have been commissioned to undertake the workforce strategy, to development of the workforce strategy and work is progressing. A Place based include future workforce workforce lead has been appointed and will commence in post in January 2021 requirements and the and will take the strategy and underpinning action plans forward. design/ delivery of training and education to reskill existing staff and train new staff Deliver identified actions 31/03/21 50% The Strategy is being refreshed for sign off in March by the CCG and Local against the priority areas Authority. Each of the work streams and their plans will be updated with current set out within the Learning data and revised priorities. Disability and Autism The Strategy was presented to Strategy Organisation Development Forum in Strategy: December and will be presented to the Minorities Partnership Group in January. - Diagnosis - education and inclusion Diagnosis - employment Awaiting options paper dependant of level of investment which outlines delivery - family and carers - and risks. Item added to Finance, Performance & Information Group and

47 housing and support contracting board. (including short breaks) - health inequalities - Health and Inequalities transitions The refresh of the strategy needs to reflect the emerging inequalities faced by people with learning and/or BAME background disability because of COVID.

Housing Needs Assessment Validation has been completed leading to 3 priority areas of work. • Transitions - • Individuals living with carers • Transforming Care Programme Work to develop a landlord framework has commenced, new development at Askern on track to deliver 38 new units by March 2022.

Short Breaks The Carers/Short Breaks work-stream has been set up and making good progress through 3 task and finish groups. a. In-house respire services - a review of Short Breaks and Needs Assessment has been completed. Review and Development of in-house respite services is underway. b. Shared Lives - expansion and recruitment plans are being implemented with provider, jointly with Adult Social Care and Operational Commissioning across all shared Lives offers including short breaks. Strategic Commissioning are undertaking a strategic Service Review of the Shared Lives service model to inform future development of the service. c. Carer Engagement – Focus groups held with Carers on what works well or not for Short Breaks. A survey has been developed for carers and people with lived experience of their views and experience of existing respite services and is being co-ordinated by Speak Up. The survey is live, and being promoted by comms, partners, providers, and the Carer networks. Regular updates and discussions take place regarding the workstream at the Learning Disability and Autism Partnership Boards.

Employment

Work stream plan is in draft to be picked up the identified lead in Children’s.

Education In September the new special school opened. Educations skills consultation is underway with a cross cutting theme of equitable working. Pathways are in place for transition to support employability and life skills.

Responsive and accessible care in a crisis 31/03/21 70% Recruitment largely complete and delivering gain. Active acute liaison pathway and liaison model design have been temporarily suspended due to COVID. Good progress on partnership development as a consequence of COVID, and commitment to further pathway mapping for UEC connected agencies – tying together CCG, RDaSH, SYP, YAS, Adult Social Care, PH. Alternative third sector models progressing – with full operation of Safe Space and gradual but delayed mobilisation of High Intensity User and Suicide Attempt Response & Embed new statutory & Prevention programmes. third sector assets for

Crisis Resolution / Home Further investment proposal submitted for alternative services as part of LTP Treatment / Alternative Transformation initiatives (to focus on bespoke pathways linked to inequality / Places / Acute Psychiatric covid analysis and the use of peer led MH crisis de-escalation). Liaison / Suicide

Prevention & Response Psychiatric Decision Unit to open February 2021. Support.

Further acute psychiatric liaison and U&EC MH pathway mapping to commence in 2020/21 Q4 (delayed from 2020).

Section 76 signed for 2020/21 and work started on development of S76 for 21/22 in context of the Transformation programme. Scale, scope and common principles being worked through by key partners. Review in Feb 21. Implement the Homeless 31/03/21 50% Draft delivery plan agreed by Homelessness Board. Mark Wakefield identified as and Rough Sleeping Senior Responsible Officer of the Accommodation work stream. Strategy, with a focus on: • Housing First - two additional accommodation providers identified with - rapid re-housing the potential of delivering up to 30 additional units of accommodation - hostel re-modelling for use as Housing First with Complex Lives providing the wraparound including assessment hub support. 49

- substance misuse • Substance Misuse - significant progress made re: subsuming the accommodation and Riverside supported housing contract into the wider Aspire treatment support contract to allow a pilot of an integrated service delivery model to - expansion of Housing inform future commissioning. First Person centred support for people with complex needs 31/12/20 40% This work progressed between the two teams but stalled as a technical development due to other emergency work (e.g., Flood, Covid etc). The DCCG and Council Performance Teams will Future joint work between DCCG and DMBC in this field is likely to be more work to provide a more influenced by the legacy of the joint working established through the Covid data advanced experience- cell – e.g. flow models, population segmentation. based approach for reporting against delivery As opportunities arise with reviews of pathways or development of new plan key identifiable specifications the opportunity to develop new patient outcome measures is being priorities taken e.g., serious mental illness reviews. Population Health and Inequalities Intelligence Group is now established and a work plan is being developed’ please. 31/03/21 80% • Enhanced Community Framework o Complex bid awarded from NHSE of 100k to build 6 apartment hubs for Transforming Care patients. Mobilisations started with Review of forensic LD the provider, housing associations and Clinical Commissioning pathway aligning to Groups. regional and national o Review of the framework presentation delivered to NHSE PMO inpatient trajectory with a in December to discuss and feed into recommendations. focus on building appropriate and Amendments to framework likely to start 2021/22. Presentation sustainable community to be delivered to provider forum in January 2021. provision • Doncaster CCG working with Bespoke Health and Social Care to discharge patients from inpatient services to the community.

• Doncaster CCG requesting formal consultation and communication for

possible Ward closure of Jubilee. Working with local CCGs to establish a pathway for patients within the service.

• Doncaster CCG and RDaSH are reviewing an unused property to ascertain suitability to develop a further community option of discharge.

31/03/21 40% Jan 2021. Campbell Tickell commissioned by SYICS delivered a Strategic Work alongside the housing needs assessment for LD and MH. The data has been reviewed locally Mental Health Alliance to and sense checked, to inform planning. Housing workstream will oversee the undertake a distinct piece development and delivery of housing and support plans from Feb 2021, informed of work linked to Mental by the Transformation of MH services programme. Health & Housing to understand issues, Mental Health Alliance Meetings are taking place again virtually so moving barriers and develop forward it will be through this route the work will progress. action plan as appropriate

1.2 Performance measures and outcomes

A number of information and outcome lines are currently unavailable due to continuing prioritisation due to the Covid-19 pandemic. These lines will be developed and reported as workflows return to normal.

Ensure that at least 60% of Doncaster patients on a GP SMI register receive Physical Health checks

80% 60% Trajectory 40% 2020/21 20% 0% Qtr 1 Qtr 2 Qtr 3 Qtr 4

A reporting issue has been identified affecting GP practice information using the EMIS clinical system. Due to this information from these practices are not currently included within the above figures. RDASH and Primary Care Doncaster are working together to ensure that this is rectified as soon as possible.

Increase the amount of Doncaster patients accessing IAPT services against estimated need

6.00%

4.00% Trajectory 2.00% 2020/21

0.00% Qtr 1 Qtr 2 Qtr 3 Qtr 4

Revised trajectories submitted national for Q2-Q4 following impact of Covid-19. The IAPT service continues to be monitored through the Finance, Performance and Information Group and the Clinical Quality Review Group.

Ensure at least 85% receieve their first treatment for cancer within 62 days following an urgent referral for suspected cancer. 90% 85% 80% Target 75% 2019/20 70% 2020/21 65% Qtr 1 Qtr 2 Qtr 3 Qtr 4

Ensure at least 53.3% of patients with cancer diagnosed at Stage 1 or 2 by the end March 2021, working towards the 58% by 2024 ambition set by SYB ICS 60%

50% Target Actual 40% Ambition

30% Q1 18/19 Q2 18/19 Q3 18/19 Q4 18/19

Due to Covid-19 there has been a nationwide slowing of transfers of patients as it has provided difficult to discharge patients home because of reduced community services. RDASH’s Chief Operating Officer now has weekly meetings with ward managers key personnel.

Reduce the number of out of Area placements for LD patients

Target 5 2019/20 2020/21 0 Qtr 1 Qtr 2 Qtr 3 Qtr 4

Risk register meetings are scheduled to agree pathways for patients within inpatient settings and those at risk within the community of increasing acuity.

Proportion of Doncaster Adults living independently 60% 50% 40% 30% Target 20% Actual 10% 0% 18/19 19/20 20/21

Meeting name Governing Body Meeting date 4 March 2021

Title of paper Finance Report January 2021 (Month 10)

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

Status of the Report

To approve To consider / discuss

To note X

Purpose of Paper - Executive Summary

This report sets out the financial position as at the end of January 2021 and the forecast for the year end. It also provides a brief update on 21/21

The CCG has been working with an interim financial regime for April – September (Month 1-6) due to the Covid-19 pandemic and is now under a new regime for the remainder of the year.

The report also outlines:

• The risks that the CCG is currently facing • The CCG’s Financial Summary (Appendix 1) • The CCG’s current spend related to Covid-19 (Appendix 2) • The CCG’s summary of allocations (Appendix 3)

Recommendation(s)

The Governing Body is asked to:

• Receive the report and note any risks and issues as highlighted in the report.

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Page 1 of 4

Impact analysis Quality impact N/A

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x Equality An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability NIL impact The CCG is showing a surplus of £3m against target, it is now expected Financial that at least £1.4m of this will be clawed back by NHSE and further implications clarification is awaited. Legal NIL implications Management of Conflicts of N/A Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) Report previously None presented at Risks have significantly reduced since the planning for Month 7-12 was Risk completed and are now considered minimal to achieving the year end analysis position. Corporative Objective / CO4 - maintain spend within allocations overall. Assurance Framework

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NHS DONCASTER CCG

2020/21 FINANCE REPORT MONTH 10 – JANUARY 2021

1. Introduction

This report provides the financial position for NHS Doncaster CCG for 2020/21 as at the end of January 2021 (Month 10) and includes a forecast for the year end.

The CCG now has a fixed allocation with the exception of specific pass through funding for hospital discharge and acute independent sector activity above the M1-4 baseline. The CCG is expected to manage within its own allocation for the remainder of the year including any further expenditure incurred in relation to Covid.

2. Current Position

At Month 10, the CCG is showing a positive variance of £3m against the year to date deficit target of £0.8m and the same forecast variance against the annual deficit target of £1.3m. This is after the assumption that the funding for the Hospital Discharge Scheme for M9-10 is awarded plus funding for Independent Sector activity, these equates to £432k.

The two main areas where the CCG has a positive variance are prescribing £2m and Service Development Funding (SDF) £0.9m.

In relation to prescribing, the CCG was prudent in its assessment of the costs at Month 6 due to the fluctuating and volatile spend incurred up to the end of July. Now the actual data has been received up to the end of November the actual costs are lower than expected and it is felt that this will continue to the end of the year. NHSE have now advised that the prescribing variance will be clawed back and this is expected to be confirmed for Month 11. This will therefore reduce the £3m positive variance.

Also, in relation to SDF funding the CCG has reviewed the requirements of providers to received funding above their block contracts and determined that no further funding needs to be transferred to them as it is already included in their baselines, therefore the CCG has £0.9m of funding that is not required. At the time of writing NHSE have not confirmed whether this will be clawed back.

A full summary of the position is outlined in Appendix 1.

Other CCG’s in SYB are showing similar variances and as a system the financial position has improved overall for both commissioners and providers.

3. QIPP

Included in the plan for Month 7- 12 is an expectation of delivering QIPP of £3.2m across numerous budget lines including CHC, prescribing and running costs. Detailed schemes have not necessarily been developed in all areas but monitoring of

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actual spend against plan is demonstrating that the expenditure is being contained within the budget set, and therefore the QIPP is being delivered. Work is underway to assess baselines as we move into 2021/22 and start to think about planning.

4. Risks

When completing the plans for Month 7-12 several risks were identified regarding the ability to deliver a balanced position. As year-end is approaching it is felt that the risks have been managed and reduced significantly and are now not posing any risk to delivering the position. There are some areas of overspend but these are being managed within the overall allocation.

5. 2021/22 Financial Regime/Planning

NHSE have confirmed that the current financial regime will continue into next financial year until at least the end of Quarter 1. CCG allocations are yet to be confirmed for this period or the rest of 2021/22 and further guidance is awaited. The CCG has started work on baseline planning of future costs to enable this work to progress once guidance is released.

6. Conclusion

The Governing Body are asked to note the current financial position to the end of January, the forecast and the current position for 2021/22.

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NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 1

SUMMARY FINANCIAL POSITION MONTH 10 2020/21

Month 10 Total incl Covid Forecast Budget Actual Variance Budget Actual Variance £'000 £'000 £'000 £'000 £'000 £'000 Revenue Resource Limit (in year) 482,006 482,006 0 586,757 586,757 0

Acute services - NHS (Block) 226,091 226,091 0 275,128 275,139 11 Acute services - Independent/commercial sector (outside of Nationally procured) 8,172 8,318 146 9,868 10,339 472 Acute services - Other non-NHS 0 29 29 0 0 0 Acute Services - Other Net Expenditure -568 -135 432 560 928 368 Acute Services 233,695 234,302 607 285,555 286,406 851

MH Services - NHS (Block) 34,841 35,479 637 41,557 41,559 2 MH Services - Independent / Commercial Sector (outside of Nationally procured) 23,037 21,949 -1,088 27,620 26,747 -873 MH Services - Other non-NHS 415 605 190 532 531 -1 MH Services - Other net expenditure -855 -794 61 -324 -252 72 Mental Health Services 57,439 57,238 -201 69,385 68,585 -800

Community Health Services (ISFE) 42,982 42,816 -166 52,951 52,976 25

Continuing Care Services (ISFE) 33,349 33,947 597 39,652 39,552 -100

Prescribing 54,125 51,025 -3,100 64,916 61,808 -3,107 Community Base Services 4,483 4,680 197 5,862 6,161 299 Out of Hours 0 0 0 0 0 0 £1.50 per head PCN Development Investment 429 406 -23 522 488 -34 GP IT Costs 1,535 1,408 -127 1,937 1,933 -4 PC - Other 999 984 -15 1,189 1,185 -3 Primary Care Services (ISFE) 61,572 58,504 -3,068 74,424 71,575 -2,849

General Practice - GMS 22,745 22,671 -74 27,601 28,571 970 General Practice - PMS 4,712 4,776 64 5,641 5,726 84 Other List-Based Services (APMS incl.) 1,797 1,974 177 2,245 2,319 74 Premises cost reimbursements 5,400 5,240 -160 6,518 6,390 -128 Primary Care NHS property Services Costs - GP 0 0 0 0 0 0 Other Premises costs 49 50 1 59 63 4 Enhanced services 1,048 1,096 49 1,264 1,294 30 QOF 3,475 3,437 -37 4,221 4,174 -47 Other - GP services 1,104 1,038 -66 2,211 1,071 -1,140 Primary Care Co-Commissioning (ISFE) 40,329 40,283 -46 49,760 49,608 -152

Other Programme Services (ISFE) 8,559 8,364 -195 10,488 10,988 499

Total Commissioning Services 477,925 475,454 -2,471 582,215 579,689 -2,526

Running Costs (ISFE) 4,918 4,755 -163 5,796 5,756 -40

Total CCG Net Expenditure 482,843 480,209 -2,634 588,011 585,445 -2,566

In Year Underspend/(Deficit) -837 1,797 2,634 -1,254 1,312 2,566

M9 & 10 Hospital Discharge Funding expected 105 105 318 318 Independent Sector variance 327 327 405 405

Revised variance -837 1,902 3,066 -1,254 2,035 3,289 NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 2

SUMMARY OF COVID COSTS MONTH 10 2020/21

Total April May June July August Sept Nov Dec Jan Category Oct £000 YTD £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 OOH capacity/CHUB * 0 122 38 15 13 8 14 18 24 18 270 PPE (scrubs) 25 9 0 0 0 0 0 0 0 0 34 Hospital Discharge Programme 124 332 432 527 585 503 494 414 167 -63 3,515 Daycare Support 0 0 83 33 0 0 0 0 0 0 116 Care Home Digital Support 0 0 79 0 0 0 0 0 0 0 79 Sickness Cover 0 10 1 0 0 0 0 0 0 0 11 Renal Transport Costs (bulk heads and additional resources for all SYB) 87 80 57 86 119 178 -43 27 3 40 634 Cygnet Support Costs - nationally approved 0 0 0 0 0 20 0 0 0 3 23 GP Bank Holiday Cover 52 0 0 62 70 0 0 0 0 184 Primary Care Additional Costs 0 0 86 0 9 95 0 8 -1 -2 195 Community Equipment Costs 0 38 18 -18 0 20 -20 3 0 0 41 SMS costs 0 89 0 0 0 0 0 0 0 -74 15 Minor costs incl. comms 0 1 0 0 0 0 0 0 0 0 1 Total costs 288 681 794 705 796 824 445 470 193 -78 5,118

Notes: NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 3

SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 10 JANUARY 2021

Recurrent Non Recurrent Total £000's £000's £000's Published Baseline Allocation -493,117 0 -493,117 Running Cost Allowance -6,103 0 -6,103 Co-Commissioning -46,295 0 -46,295 Year end adjustments -670 0 -670 Total Resources Available at Plan Stage -546,185 0 -546,185

Adjustments to the Resource Limit:

Month 01 April No adjustments 0 0 0 0 0 0

Month 02 May Transfer 8 months Programme Allocation to central reserve 0 329,191 329,191 Prospective 4 months Programme Non-recurrent Adjustment 0 2,483 2,483 Transfer 8 months delegated allocation to central reserve 0 30,863 30,863 Prospective 4 months delegated Non-recurrent Adjustment 0 996 996 Transfer 8 months Running Costs allocation to central reserve 0 4,069 4,069 Prospective 4 months running costs Non-recurrent Adjustment 0 539 539 0 368,141 368,141

Month 03 June Retrospective adjustment Covid Costs -969 -969 0 -969 -969

Month 04 July Retrospective adjustment Covid Costs -793 -793 Retrospective adjustment Non Covid Costs -245 -245 0 -1,038 -1,038

Month 05 August Transfer 2 months Programme allocation from central reserve -82,298 -82,298 Prospective 2 months Programme Non-recurrent Adjustment 1,242 1,242 Transfer 2 months delegated allocation from central reserve -7,716 -7,716 Prospective 2 months delegated Non-recurrent Adjustment 498 498 Transfer 2 months Running Costs allocation from central reserve -1,017 -1,017 Prospective 2 months running costs Non-recurrent Adjustment 270 270 Month 4 Retro Top-up Allocation signed off COVID -706 -706 Month 4 Retro Top-up Allocation signed off Non COVID -1,516 -1,516 0 -91,243 -91,243 Month 06 September Month 5 Retro Top-up Allocation signed off COVID -795 -795 Month 5 Retro Top-up Allocation signed off Non COVID -451 -451 0 -1,246 -1,246 Month 07 October CYPMH Green Paper -945 -945 Error related to IPS in Mental Health (Corrected from NHS111 First) -327 -327 Targeted Lung Health Checks -703 -703 CCG NR Adjustments to Model Breakeven 6,084 6,084 Transfer 6 months delegated allocation from central reserve -23,148 -23,148 Transfer 6 months Programme allocation from central reserve -246,884 -246,884 Transfer 6 months Running Costs allocation from central reserve -3,052 -3,052 STP Plan Transfer - System top up distribution to other CCGs -14,977 -14,977 STP Plan Transfer - System Covid distribution to other CCGs -16,309 -16,309 STP Plan Transfer - Growth funding distribution to other CCGs -2,221 -2,221 Learning Disabilities Mortality Review Programme (LeDeR) -68 -68 Community/CETR -354 -354 CYP Keyworker -233 -233 0 -303,137 -303,137 Month 08 November Digital Primary Care (DPCT1-20/21-3-SYB-02) -330 -330 LD Complex Case Funding 20/21 (Bid 3 South Yorkshire TCP) -14 -14 LD Complex Case Funding 20/21 (Bid 4 South Yorkshire TCP) -14 -14 LD Long Term Planning Funding 20/21 (Bid 8 South Yorkshire TCP) -35 -35 Dynamic Support Registers -9 -9 Winter Pressures -125 -125 CYPMH Green Paper 395 395 Flash Glucose Offer to Patients with Learning Disability -5 -5 Impact and Investment Fund -134 -134 Care Homes Premium -109 -109 Increase in practice funding -55 -55 Children's & Young People's Palliative and End of Life Care Match Funding 20/21 -17 -17 RETRO Non-COVID for month 06 -5603 -5,603 RETRO COVID for month 06 -824 -824 0 -6,879 -6,879 Month 09 December GPFV GP RETENTION -61 -61 GPFV ONLINE CONSULTATION -79 -79 GPFV PRACTICE RESILIENCE -42 -42 GPFV RECEPTION & CLERICAL -53 -53 GPFV PRIMARY CARE NETWORKS -169 -169 FAIR SHARE CSF H2 -861 -861 Ageing Well - EHCH training and development funding -8 -8 MHST Correction from Month 8 -395 -395 Winter Initiatives 1 Funding-HSCN uplift -5 -5 Clinical Leads Oximetry @Home -10 -10 CYP Respite -26 -26 0 -1,709 -1,709 Month 10 January Transfer Diabetes allocation to NHS Doncaster CCG -5 -5 Diabetes Treatment and Care -80 -80 Suicide prevention funding -56 -56 SMI Outreach -25 -25 Inpatient discharge flow proposal - RDASH (Doncaster) -224 -224 Wellbeing Support & Staff Training for Critical Care - DBHFT pass through -87 -87 HSLI funding for DBHFT - Electronic Patient Record - e Observations -251 -251 HSLI funding for DBHFT - Electronic Patient Record - clinical noting -209 -209 Doncaster and Bassetlaw Teaching Hospital 2020 Winter Volunteers -15 -15 LD Complex Case Funding 20/21 (Bid 32 South Yorkshire TCP) -100 -100 Out of Envelope Reimbursement Mth7 & Mth8 - Hospital Discharge Programme -906 -906 Pension (6.3% uplift ) based on Mth09 BSA data and forecast for full year -341 -341 CYP Respite -24 -24 Flash Glucose Monitoring – Final Annual Allocation. Contact [email protected] fo -169 -169 0 -2,492 -2,492

Revised Resources available as at Month 10 January 2021 -546,185 -40,572 -586,757

Meeting name Governing Body Meeting date 4 March 2021

Title of paper Chair and Chief Officer Report

Executive / Dr David Crichton, Clinical Chair Clinical Lead(s) Jackie Pederson, Chief Officer Author(s) Cheryl Rollinson, Head of Corporate Governance

Status of the Report

To approve To consider / discuss

To note X

Purpose of Paper - Executive Summary

1. Introduction The purpose of this report is to update the Governing Body on issues relating to the activity of the Doncaster Clinical Commissioning Group (DCCG) of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper.

2. This month the paper includes updates on the following areas:

CCG Update: • NHSE/I Response to the Engagement on Integrating Care: Next Steps • CCG Improvement and Assessment Framework in 2020/21 • Covid19 Vaccination Update • Targeted Covid-19 Vaccination Communication and Engagement • EU Exit / Transition • Lung Health Check Programme Go Live Confirmed • February LGBT+ History Month • South Yorkshire and Bassetlaw Cancer Alliance

National Update: • Department for Health and Social Care has published its White Paper on working together to improve health and social care for everyone • Covid19 Vaccination Update • Help Us, Help You: Lung Cancer • Census 2021

Recommendation(s)

The Governing Body is asked to note the report.

Page 1 of 5

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Quality impact Neutral Neutral

Tick relevant box

Equality An Equality Impact Analysis/Assessment is not required for this report. X impact An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of Paper is for information. No relevant interests. Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Nil analysis Assurance CO1 - 1.1 Framework

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Chair and Chief Officer Report 4 March 2021

1. CCG Update

1.1. NHSE/I Response to the Engagement on Integrating Care: Next Steps On the 26 November 2020, NHS England and NHS Improvement commenced a 6-week engagement processes on the options around the proposals for legislative reform. In response to the engagement, which gathered views from the NHS, local government and wider stakeholders, NHS England and NHS Improvement have made five specific recommendations to Government on the question of how to legislate Integrated Care Systems (ICSs) on a statutory footing. These recommendations seek to build on the successful integration, collaboration and partnership efforts of ICSs to date. In addition, a letter from Amanda Pritchard, Chief Operating Officer of NHS England and NHS Improvement set out next steps for the NHS. Further information can be accessed here.

1.2. CCG Improvement and Assessment Framework in 2020/21 A simplified approach to the annual assessment of CCGs’ performance for 2020/21 will be followed as a result of the differential and continued impact of Covid-19. This will provide scope to take account of the different circumstances and challenges CCGs face in managing recovery across the phases of the NHS response to Covid-19 and will focus on CCGs’ contributions to local delivery of the overall system recovery plan. A narrative assessment, based around performance, leadership and finance, will replace the ratings system previously used for CCGs. It is anticipated that the suggested year end KLOEs and Operating Manual for the year end assessment will be released shortly.

1.3. Covid19 Vaccination Update Doncaster have continued to make excellent progress in vaccinating the majority of our most vulnerable residents and front-line health and care staff with vaccination services taking place 7 days a week across the Doncaster Borough. From Monday 15 February, people in cohorts 5 and 6 are being invited by the NHS to have their vaccine. More information is available on our website here.

• Cohort 5 – all those 65 years of age and over • Cohort 6 – all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality

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1.4 Targeted Covid-19 Vaccination Communication and Engagement We worked with partners across Doncaster to help Healthwatch run a Covid-19 vaccination ‘daily dose’ focus week to inform and encourage uptake of the vaccine across communities. Extensive work is taking place with the Council and Public Health to help us increase vaccine uptake amongst BAME and hard to reach groups.

1.5 EU Exit / Transition The CCG has been part of a Doncaster wide meeting to consider potential and emerging risks related to EU Exit/Transition and this issue is a standing item on the Executive Committee and Governing Body agendas. The meeting met for the final time in February 2021 with the Chair and members assured of stability in the system. On that basis EU Exit/Transition will be removed from the aforementioned agendas and will be reported upon by exception.

1.6 Lung Health Check Programme Go Live Confirmed The Lung Health Check Programme has been confirmed to go live in the South of Doncaster at the end of March with communication and engagement work well underway to promote the service to those patients who are eligible. Invitations will be sent to patients from a small number of GP Practices initially before the programme is rolled out across the borough over the next 12 months. More information about the Doncaster programme can be found at www.lunghealthchecks.co.uk

1.7 February LGBT+ History Month Equality and Diversity is central to the Work of the NHS and Doncaster Clinical Commissioning Group (CCG), we are proud to honour LGBT+ History Month during February. LGBT+ History Month is an annual event in the United Kingdom taking place every February. The event came in the wake of the abolition of Section 28 in 2003, the Employment Equality (Sexual Orientation) Regulations 2003 as well as the government’s proposals to bring in a single equality act and a public duty, although this, in fact, did not come to fruition until 2010. The Month is intended as a means to raise awareness of, and combat prejudice against the LGBT+ community while celebrating its achievement, diversity and making it more visible. This year’s theme was ‘Body, Mind and Spirit’. More information is available on our website.

1.8 South Yorkshire and Bassetlaw Cancer Alliance World Cancer Day took place on Thursday 4 February and as part of the commitment to providing high quality, personalised care for patients who experience cancer, the South Yorkshire and Bassetlaw Cancer Alliance has launched an important new initiative to help shift the focus of health and care professionals from, “What is the matter with you” to “What matters to you?”. In partnership with Voluntary Action Rotherham (VAR) the What Matters To You initiative provides an online learning platform for any health and care professional in contact with people with a cancer diagnosis to become a Certified Care Professional. Page 4 of 5

2 National Update

2.1 Department for Health and Social Care has published its White Paper on working together to improve health and social care for everyone On the 11 February 2021, the Government published its white paper setting out legislative proposals for a Health and Care Bill, the new proposals aim to join up health and care services and build on the NHS Long Term Plan.

2.2 Covid-19 Vaccinations The Government have announced that people aged over 70 or Clinically Extremely Vulnerable can now contact the NHS to book a vaccine if they haven’t already has one. If you or a relative fulfil this criteria please do book an appointment online or call 119. Public Health England have a suite of COVID-19 explainer videos to answer some of the frequently asked questions about the types of vaccines, eligibility, safety, at-risk groups, rollout, intervals, common side effects, importance of two doses and who needs the vaccine. There are over 40 videos from various health care professionals across the country. To see the full collection please visit the Public Health England YouTube channel.

2.3 Help Us, Help You: Lung Cancer NHS England and NHS Improvement, together with Public Health England, have launched the ‘Help Us, Help You’ lung cancer campaign to encourage people with a cough lasting three weeks or more and who don’t have COVID- 19, to contact their GP practice. Visit nhs.uk/cancersymptoms for more information.

2.4 Census 2021 The Office for National Statistics (ONS) runs the census in England and Wales and is independent from government. Your details are protected by law and information published is always anonymous. Census Day is Sunday 21 March 2021. If you need help or have any questions, visit http://www.census.gov.uk/

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Enclosure B

Chief Executive Report

Health Executive Group

9 February 2021

Author(s) Andrew Cash Sponsor Is your report for Approval / Consideration / Noting

For noting and discussion

Links to the ICS Five Year Plan (please tick)

Developing a population health system Strengthening our foundations

Understanding health in SYB including Working with patients and the prevention, health inequalities and public population health management Empowering our workforce

Getting the best start in life

Better care for major health Digitally enabling our system conditions

Innovation and improvement Reshaping and rethinking how we flex resources

Building a sustainable health and care Broadening and strengthening our system partnerships to increase our opportunity

Partnership with the Sheffield Delivering a new service model City Region

Transforming care Anchor institutions and wider

contributions Making the best use of

resources Partnership with the voluntary sector

Committment to work together

Are there any resource implications (including Financial, Staffing etc)?

N/A

Summary of key issues This monthly paper from the System Lead of the South Yorkshire and Bassetlaw Integrated Care

1 System (SYB ICS) provides a summary update on the work of the SYB ICS for the month of January 2021.

Recommendations

The SYB ICS Health Executive Group (HEG) partners are asked to note the update and Chief Executives and Accountable Officers are asked to share the paper with their individual Boards, Governing Bodies and Committees.

Chief Executive Report

SOUTH YORKSHIRE AND BASSETLAW INTEGRATED CARE SYSTEM

Health Executive Group

9th February 2021

1. Purpose

This paper from the South Yorkshire and Bassetlaw Integrated Care System System Lead provides an update on the work of the South Yorkshire and Bassetlaw Integrated Care System for the month of January 2021.

2. Summary update for activity during January

2.1 Coronavirus (COVID-19): The South Yorkshire and Bassetlaw position

As at the end of January, the latest figures show that for South Yorkshire and Bassetlaw over 170k people in the highest priority groups had now been vaccinated. Just over 60k of those are 80 years old or over which is around 80% of the total number of people in this category we need to. The remainder of the 170k are either people 75 years and above, people who are classed as clinically extremely vulnerable and patient facing NHS and social care staff. The numbers are, of course, changing all the time. The latest statistics for South Yorkshire and Bassetlaw are published weekly here: https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/

All local primary care centres continue to vaccinate as planned and additional vaccination capacity has opened at Sheffield Arena. The Arena team is vaccinating 7 days a week, 12 hours a day and the first week of operation saw all available appointment slots taken up. The majority of care home residents across the region have now been vaccinated and vaccinations for patients registered as housebound with their GP practice have also commenced. Patient facing NHS and Social Care staff across the region also continue to be vaccinated.

Partners in each of our places, including NHS, Local Authority and Community, Voluntary and Faith groups are working together to ensure vaccination myths are dispelled and community leaders are helping to support positive messaging around the vaccination campaign, particularly in our communities that have been identified as most vaccine hesitant or who are seldom heard. Partners are also sharing Covid-19 vaccine facts resources to help combat a rise in the incidence of vaccine fraud.

All five places in South Yorkshire and Bassetlaw have been chosen to receive £1.4 million national funding for the Community Champions scheme, which awards councils and voluntary organisations funding to deliver a wide range of measures to protect those most at risk - building trust, communicating accurate health information and ultimately helping to save lives. This will include developing new networks of trusted local champions where they don’t already exist and will also support areas to tackle misinformation and encourage vaccination take-up.

In terms of COVID-19 cases, the trend is a slowly downward. The lockdown is starting to have an effect, albeit slowly, with progress slow because the rates were high before the lockdown and the newer (more contagious) Covid-variants that have since been identified. Across the five places in SYB, rates are all falling with fewer outbreaks reported, and death rates continue to decline. Cases

3 of COVID-19 in the over 80s are also declining which, it is hoped, is an early sign that the vaccination programme is having an impact.

2.2 Regional update

The North East and Humber Regional ICS Leaders have been meeting weekly with the NHS England and Improvement Regional Director to discuss the ongoing COVID-19 incident, planning that is taking place to manage the pandemic and where support should be focused. Discussions during January focused on Wave 3 surge plans, the COVID-19 response and vaccination programme.

In addition to operational issues, ICS Leaders have been involved in discussions about the development of integrating care across four workstreams. These workstreams mirror the development work that is taking place in SYB: Place-based partnerships; provider collaboratives; how the nature of commissioning will change; and the integrated care system.

2.3 National update

NHS England and NHS Improvement (NHS E/I) issued their Phase Four letter on 23 December in which the operational priorities for winter and 2021/22 were set out. Key elements from the Letter include managing the ongoing demand from COVID-19, rapid implementation of the COVID-19 vaccination programme, maximising capacity to provide treatment to non-COVID-19 patients, preparedness to respond to the seasonal winter pressures and supporting the wellbeing of our workforce.

It also set out clear ambitions around how systems should address pandemic-related population health concerns as a direct result of COVID-19 in the areas of reducing health inequalities, expanding mental health provision and prioritising investment in primary and community care services.

There is also a clear framework for how systems should follow the new financial framework around funding (consistent with the NHS’ Long Term Plan). A helpful summary by the NHS Confederation can be read here.

As part of national efforts to support all regions with the ongoing challenges of COVID-19, Amanda Pritchard, Chief Operating Officer for NHS England and NHS Improvement (NHS E/I) sent a further letter to NHS leaders on Tuesday 26th January.

The letter titled ‘Reducing burden and releasing capacity to manage the COVID-19 pandemic’ explains that systems should ensure they make pragmatic decisions about how best to free up management capacity and resources to focus on additional competing priorities around the vaccination programme and continued non-Covid care.

The letter encourages NHS trusts and foundation trusts to consider options including the pausing of all non-essential oversight meetings, streamlining assurance and reporting requirements and only maintaining those existing development workstreams that support recovery.

2.4 Safe Maternity Services during the COVID-19 Pandemic

The South Yorkshire and Bassetlaw Local Maternity and Neonatal System (LMNS) has published its ‘Safe Maternity Services during the COVID-19 Pandemic’ strategy. The document offers best practice guidelines to midwives and midwifery teams to ensure the care for women (and families) during the pandemic remains as unaffected as possible.

The LMNS has been ensuring service users are engaged with during these unprecedented service adaptions. By providing the most up to date evidence based information, the LMNS is working with partners to enable women to make choices that are personalised to their individual needs, wishes 4 and requirements.

The full document is published here: https://www.healthandcaretogethersyb.co.uk/application/files/9516/0994/1635/Covid_Safety_Strat egy_LMS_210104_v7_-_final.pdf

2.5 Sheffield City Region

The Sheffield City Region Mayoral Combined Authority and Local Enterprise Partnership approved their 20-year Strategic Economic Plan (SEP) on 28th January. The Plan sets out local leaders’ blueprint to drive the region’s recovery from COVID-19 and transform South Yorkshire’s economy and society for people, businesses and places.

The SEP paves the way to a stronger, greener and fairer economy as the region looks to unlock its potential and create prosperity and opportunity for all. The ambition of the 20-year Strategic Economic Plan is for the South Yorkshire economy to look very different in 2041, with an extra £7.6bn Gross Value Added (GVA), 33,000 extra people in higher level jobs, reduced income inequality and improved wages by over £1,500 for the lowest paid, and a net zero carbon economy.

2.6 Mental Health White Paper

The government has published the Reforming the Mental Health Act White Paper, which sets out proposed changes to the Mental Health Act 1983. The paper also sets out proposals and ongoing work to reform policy and practice to support the implementation of a new Mental Health Act. The proposals take forward the majority of the recommendations made by the Independent Review of the Mental Health Act 1983.

The government is seeking views, until 21 April 2021, on the implementation and impact of the reforms. Feedback will inform the drafting of the Bill to amend the Act, which will be brought forward when parliamentary time allows.

2.7 SYB Recovery Plan

The pandemic has caused an unprecedented rise in waiting times for hospital and diagnostic care, interrupted ongoing care in the community for mental health and other long-term conditions and assessments for social care support. The impact has been devastating on our population, particularly on health inequalities which continue to widen. Our plan has always been to address inequities in access and outcomes through a collective partnership approach and we must now accelerate our efforts.

Before the Pandemic, South Yorkshire and Bassetlaw (SYB) had one of the lowest number of people nationally waiting over 52 weeks and today the region continues to hold a comparatively smaller over 52-week waiting list. Nonetheless, we are keen to address any delays and reduce the impact on our population.

The innovation and resourcefulness that helped to enable SYB's health and care system to continue delivering safe patient care during the pandemic will also be integral to our future plans. Our close partnership with the Yorkshire & Humber Academic Health Science Network will see the continuation of our co-developed Rapid Insights research - with a view to implementing recommendations where opportunities exist across the system.

As a partnership, we are now starting to shape the development of priorities for the coming year utilising the expertise and experience of our wider health and care partners to meet these challenges in the months and years ahead.

2.8 Sheffield Olympic Legacy Park

Proposals for the Sheffield Olympic Legacy Park (SOLP) were unveiled in January. The project, which involves and is supported by SYB partners, is set to yield significant economic and health benefits within SYB and across the UK.

It joins up a number of prestigious commercial (IBM and Canon Medical Systems Europe) and regional public sector partners on the 35-acre site benefiting from the cluster of specialised health and care, academia, clinical research and sports engineering centres.

Situated in the east of Sheffield, newly unveiled plans over the next five years are set to see a further 5,600 high value jobs created whilst generating over £2bn in Gross Value Added (GVA) benefits to support a post-pandemic and post-Brexit UK economy.

This development site is already home to a number of established research and development hubs including the English Institute of Sport Sheffield (EISS), Advanced Wellbeing Research Centre (AWRC) and National Centre of Excellence for Food Engineering (NCEFE), alongside the Oasis Academy Don Valley and the FlyDSA Arena, ensuring that it provides excellent transport links to the M1, tramway inter-connectivity to Sheffield and Rotherham but also with the possibility of greener links via the Sheffield & Tinsley Canal.

Perhaps one of the standout facilities on the Park will be development of the new national Centre for Child Health Technology (CCHT), thought to be the first of its kind globally, tasked with focusing on addressing issues that affect children and young people – with the added benefit of delivering over £200m in savings to the NHS in the next ten years.

In addition, Canon Medical Systems Europe will also host a world-leading diagnostic imaging lab and research centre, delivering ultramodern digital research and development capabilities to support the enhancement of diagnostics in the NHS.

I would like to acknowledge SYB partners Sheffield City Council, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Hallam University, Sheffield City Trust, Sheffield Children’s NHS Foundation Trust and Yorkshire & Humber Academic Health Sciences Network for their exceptional work in supporting this key transformational project.

2.9 Anchor Networks

The impact the NHS has on people’s health extends beyond the role as a provider of treatment and care. As large employers, buyers, and capital asset holders, our health care organisations are well positioned to use their spending power and resources to address social, economic and environmental factors that widen inequalities and contribute to poor health.

Anchor institutions are key to making a strategic contribution to the health and wellbeing of the local population and the local economy and include the NHS, along with local authorities, universities and other non-profit organisations. An Anchor Network goes one step further to bring the institutions together and early discussions are now taking place with the national team on what this means for SYB. A proposal is being developed with the four North ICSs taking a collective approach which will be informed by a system-wide event.

3. Finance update

At Month 9 the system is reporting a forecast surplus of £36.1m compared with a plan deficit of £3.9m. This is a significant improvement on the Month 8 forecast and reflects a reassessment of the forecast position at Month 9 and the continued impact of under-performance on elective activity and reduced cost pressures on CCG budgets.

Capital slippage has increase in Month 9 to a forecast £21.6m on planned spend of £163m or 13.2%. The slippage is due to the challenges of delivering a capital programme during the 6 pandemic, significant additional capital allocations for COVID-19 and critical infrastructure and the revisiting of a material business case. The slippage has been offset by a forecast unplanned charge of £9.5m for the Rotherham Carbon Energy scheme.

Because of the ongoing impact of the pandemic the financial framework that is in place for the second half of 20/21 will be rolled forward into at least the first quarter of 21/22. Further details are awaited.

Andrew Cash System Lead, South Yorkshire and Bassetlaw Integrated Care System

Date: 3 February 2021

Minutes of the Virtual Executive Committee Held on Wednesday, 20 January 2021, 9am

Present J Pederson Chief Officer (Chair) Dr D Crichton Chair H Tingle Chief Finance Officer A Russell Chief Nurse A Fitzgerald Director of Strategy & Delivery L Devanney Associate Director of HR & Corporate Services

In J Satterthwaite PA to Chair and Chief Officer attendance: A Molyneux Head of Medicines Management (Items 6 – 8) K Roberts Primary Care Manager (Item 6) R Fletcher Commissioning Officer Learning & Opportunities: Children and Young People (Item 9) E Serfozo Strategy Manager Urgent Care (Item 10) H Akroyd Senior Officer, Strategy & Delivery (Item 10) C Glazebrook Lung Health Check Programme Manager (Item 11)

Action 1. Apologies

There were no apologies received.

2. Declarations of Interest

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

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

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups: None declared.

Declarations of interest from today’s meeting:

Dr Crichton declared a pecuniary Conflict of Interest in respect of Item 6, Update on Minor Ailment Scheme Pharmacy LES and Pharmacy Urgent Repeat Medicines (PURM) as he is a practising GP in Doncaster.

The Executive Committee agreed that Dr Crichton may remain in the meeting for Item 6 and would not be excluded from discussions however would be exempt from final decisions made.

3. Minutes from Previous Meeting held on 16 December 2020.

The minutes of the meeting held on 16 December 2020 were approved as a correct record.

4. Matters Arising not on the Agenda

Leger Clinic

Dr Crichton reported that he has provided feedback to the Area Prescribing Committee and the Local Medical Committee. A paper should be presented to the Primary Care Commissioning Committee to consider if it should be added as a Local Enhanced Service.

A Fitzgerald agreed to take this for discussion at the Primary Care A Fitzgerald Commissioning Committee.

5. Notification of Any Other Business

There was no other business notified.

6. Update on Minor Ailment Scheme Pharmacy LES and Pharmacy Urgent Repeat Medicines (PURM)

Minor Ailments Scheme Pharmacy Local Enhance Service (LES)

A Molyneux explained that the aim of the service is to provide a minor ailments service to patients registered with a Doncaster practice or those patients who routinely reside in Doncaster. This will include where necessary, the supply of medicines for the treatment of the minor ailment, for those people who would have otherwise gone to their GP practice for a prescription.

Doncaster has been running a minor ailment service in certain areas of Doncaster for several years. We now need a consistent message about

self-care and that public funding is not appropriate. Community pharmacy remains an important part of the strategy and encouraging

2 people to use it is an important way to help the public take control of their health and wellbeing. The updated minor ailments service focuses on medicines that are normally obtained on prescription that could be supplied by a community pharmacy. The aim is to:

• Educate patients to seek advice and treatment from the most appropriate healthcare setting • Improve patient’s access and speed of access to advice and appropriate treatment for these ailments via Community Pharmacy • Reduce GP practice workload for these ailments allowing greater focus on more complex and urgent medical conditions • Educate patients with aim of reducing requests for inappropriate

supplies of antibiotics • Promote the role of the pharmacist and self-care • Improve working relationships between doctors and pharmacists

Due to high costs of some over the counter products, and their demand, it is proposed to maintain some from the previous minor ailments scheme, with claims and remuneration conditions continued over from the previous scheme.

Contractors providing this service will be required to:

• Participate in any NHS Doncaster CCG initiatives to promote the service, specifically by displaying a sign to say they offer the service. • Signpost to other providers if service is unavailable. • Establish links with local practices.

• Provide the service to appropriate patients who either “walk in” or are signposted from another organisation. This is to reduce GP care navigation impact. • Ensure that all personnel engaged in the delivery of this service are aware of the requirements and content of this agreement. • Consider the use of a consultation room. • Ensure that for each consultation an approved template is completed if the patient is exempt from prescription charges.

The provider will work to an indication and set drugs list approved by NHS Doncaster CCG.

Patients ordinarily resident in Doncaster will be eligible and proof of this can be requested for example a driving license or utility bill.

This agreement is for the period 1April 2021 to 31 March 2023, however may be subject to an earlier review if deemed necessary.

Any pharmacy that has signed up and is participating in the scheme may terminate the agreement by giving written notice of their intention at least

28 days before cessation to NHS Doncaster CCG. No reason needs to be given for termination of the agreement. NHS Doncaster CCG may

3 terminate the scheme by giving written notice to all participating pharmacies and relevant Local Pharmacy Committees (LPCs). A minimum of 28 days written notice will be provided.

If the pharmacy does not fulfil its obligation to provide all Essential Services under the Pharmacy Contractual Framework, the pharmacy will become ineligible to provide this Enhanced Service and the Service Level Agreement would be terminated with immediate effect. NHS Doncaster CCG has a responsibility to ensure that all participating pharmacies deliver the scheme in accordance with the Service Level Agreement. If it is found that a Contractor fails to meet any of the obligations of the agreement, they will be notified in writing of the nature of the breach. Where the breach is not remedied within appropriate timeframes or NHS Doncaster CCG deems it is not capable of remedy, NHS Doncaster CCG will be entitled to terminate this agreement with immediate effect.

The service shall be supervised by an appropriately trained Practising and Accredited Pharmacist, registered with the General Pharmaceutical Council and provided by an appropriately trained Pharmacy Practitioner.

Prior to provision of the service, all pharmacy staff providing the service must have completed the CPPE Minor Ailments course or equivalent training.

NHS Doncaster CCG will be responsible:

• For developing, authorising, and updating the PGDs within the scheme to ensure they are appropriate legal and that relevant governance arrangements are in place.

• For ensuring timely payments are made to Community Pharmacies which are participating in the scheme and will be responsible for dealing with operational and payment-based queries. • NHS Doncaster CCG will, alongside relevant CCG partners and LPCs, undertake audits of the scheme, including review of consultation data and budget analysis. Post payment verification checks may also be made.

In order to minimise any risks to patients and staff and to learn from mistakes, near miss and local incident reporting systems must be utilised.

Pharmacy Urgent Repeat Medication Supply (PURMS) Scheme Review

A Molyneux informed the Executive Committee that the purpose of the PURM Service is to ensure that patients can access an urgent supply of their regular prescription medicines where they are unable to obtain a prescription before they need to take their next dose. The service may be needed because the patient has run out of a medicine, or because they have lost or damaged their medicines, or because they have left

4 home without them. The aim of this service is to relieve pressure on urgent and emergency care services.

The specification is for weekends between the hours of 6pm Friday through to 6pm Sunday and covers all public holiday periods where the same principle will apply (i.e. the service will commence at 6pm the night before the period until 6pm of the last day of the period.) The national NHS Urgent Medicine Supply Advanced Service (NUMSAS) was established early 2019 which all but mirrored that of the local Doncaster PURM service and was accessible via NHS 111. Initially there was some uncertainty about the NUMSAS service on how long it would be in place and the feedback that the service would receive so the local Doncaster PURM remained in place.

The evaluation of the NUMSAS service saw positive results and the NUMSAS service has now been fully integrated into the Community Pharmacist Consultation Service (CPCS) which launched across England on the 29 October 2019.

This means that there are two similar services available for Doncaster and although there are some nuances in how both the schemes work it is now thought that the NHS 111 CPCS is a point that would effectively serve the need for Doncaster and negates the need for the local PURM service.

Currently Doncaster patients access the PURM service by going into a participating pharmacist when required who is able to dispense based upon the specification. The major change with the CPCS service is that patients will be required to contact NHS 111 to arrange via a participating pharmacist. This is likely to cause some potential issues and possible patient complaints due to process required; however this should be seen as part of the patient education process as PURM in reality was a solution to an unwanted problem and is more aimed reducing attendances within key services at busy times. There has been an expectation nationally to move towards the use of 111 as single point of contact and as that happens more the less of an issue the use of the CPCS becomes over the use of PURM.

Given the time of the year and move into Winter as well as the unprecedented challenges currently being faced locally and nationally if approved the aim would be for the Doncaster PURM service to stop from the 31 March 2021 but with messages/education to patients who use the PURM service to start from the new calendar year advising of the CPCS service and how to access it.

It is recommended that the monies for this scheme are re-allocated. There are 2 non-mutually exclusive proposals for reallocation:

• That some funding is used to support the implementation of an electronic discharge service between trusts and community pharmacies. • That the remaining funding is diverted to support the new proposed PDG based minor ailment scheme.

The Executive Committee was asked to:

• Approve the recommendation to terminate the Minor Ailment Scheme and replace it with the Community Pharmacy with effect from 1 April 2021. • Approve the recommendation to cease the Doncaster PURM service

with effect from 31 March 2021 to enable the current LESs to be amended from April 2021.

H Tingle acknowledged that the Community Pharmacy scheme was a good idea in principle and correlates with what the CCG is trying to achieve to encourage the Doncaster population to self-care however expressed concerns regarding limiting access and the financial risk and suggested that a 9 month review could be undertaken to it ascertain if the scheme contributes to the self-care national agenda.

A Russell queried how we can ensure Care Navigators in practices utilise the system. K Roberts reported that there is a Care Navigator User Group that holds regular meetings this would be a suitable forum to promote the scheme.

The Executive Committee:

• Approved the recommendation to terminate the Minor Ailments A Molyneux Scheme and replace it with Community Pharmacy with effect from 1 April 2021 with the proviso that a review is undertaken in 6 months and the results of the review is presented to the Executive Committee. • Approved the recommendation to cease the Doncaster PURM service with effect from 31 March 2021 to enable the current LESs to be amended from April 2021.

7. Medicines Management Delivery Plan update

A Molyneux gave the following update on the Medicines Management Delivery Plan:

• Savings of £800k during a 12-month period have been made • There have been several areas where key progress has been made • Sign off of the vaccination sites • Collaborative work has been undertaken with Local Enhanced Service (LES) refinement

• The Medicines Management Team has been diverting to support care homes as required. • The Team will continue with the Delivery Plan and roll over to 2021/22 • Continue to deliver on ceasing 3rd Party ordering • Indicative budget planning for Quarter 1

A Fitzgerald commented that there are still opportunities for savings and efficiencies to be made and planning for next year should continue and explore how this can be best facilitated.

J Pederson thanked A Molyneux and the Medicines Management Team for the achievements they have made.

The Executive Team noted the Medicines Management Delivery Plan update.

8. Transfer of Care Around Medicines

A Molyneux presented the business case regarding the Transfer of Care Around Medicines (TCAM) by improving the communication between Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) and community pharmacy specifically, through securely and safely referring, through an IT interface, discharged patients to their community pharmacy.

TCAM is an electronic system for referring patients with complex ailments from hospital to their community pharmacy for follow up. This

referral, when actioned by the community pharmacy:

• Improves medicines optimisation • Improves patient knowledge of their medicines • Reduces medication errors post-discharge • Reduces hospital readmissions • Reduces length of stay for those patients who are subsequently re- admitted • Reduces medicines wastage.

Patients referred can receive nationally commissioned services which are already available from community pharmacies such as the New Medicine Service for patients started on medicines for certain conditions

and the Medicines Usage Review Service. The system can also be used to refer to other available pharmacy services e.g. CCG pharmacists, GP practice or care home pharmacists for clinical medication review.

PharmOutcomes is in use in other CCGs in South Yorkshire and has the

backing of the local Local Pharmacy Committee (LPC) based on familiarity with the system and its use as a single interface for many community pharmacy activities including enhance service recording and our own minor ailment scheme. It can be web based so no installation is

required but this would result in a manual transfer of information from the Acute Trust system to the web and is not the preferred option.

It is not possible to predefine exactly what IT work is required as this will depend on the Acute Trust IT system e.g. message brokering system, security mechanisms and other factors. Experience from other implementers indicates 2-3 days of Acute Trust IT resources should be

sufficient for creating understanding, testing and undertaking implementation. It has already been ascertained that this system is compatible with the Acute Trust. The TCAM has been tested and evaluated in a number of regions within the United Kingdom with excellent results.

It would also be necessary to obtain agreement from NHS Bassetlaw CCG.

The Executive Committee was asked to approve the recommendation to

support the roll out and maintenance of TCAM using the Pharmoutcomes model funded by the discontinuation of the PURMS Pharmacy LES.

H Tingle queried why the cost would not be shared with DBTHFT as it also would benefit savings made. There is also the added element that NHS Bassetlaw would also have to agree the business case.

Dr Crichton expressed concerns regarding the future of Clinical Commissioning Groups and what would happen as a result as Pharmaoutcomes are funded by NHS England. A Molyneux stated that Pharmaoutcomes is the recommended option as eRS is not the

preferred option by pharmacists.

J Pederson acknowledged that the proposal is a good one however the responsibility does not lie with the CCG and should be discussed in more depth at the DBTHFT Contracting Board meeting. It would also be

beneficial to discuss the proposal with K Dowson, Director of Digital to gain further clarity on the inter-provider with DBTHFT and pharmacists.

The Executive Committee deferred the decision to approve the recommendation to support the roll out and maintenance of TCAM using

the Pharmoutcomes model funded by the discontinuation of the PURMS Pharmacy LES pending further discussion and the DBTHFT Contracting A Molyneux Board, clarification from K Dowson and NHS Bassetlaw CCG.

The busines case to be presented to the Executive Committee in February 2021.

9. Bluebell Wood’s Grant Agreement for 2020/21

R Fletcher explained that Bluebell Wood has been supporting the palliative and end of life care needs of children and young people and their families with life limiting conditions from Doncaster since its opening

8 in 2008, with only around 15% of their funding coming from the government. A small token of gesture, through a yearly grant from each of the CCG’s across South Yorkshire and Bassetlaw (SY&B), really helps support these important and ongoing care services.

In November 2019 the Executive Team agreed plans for NHS Doncaster CCG to submit an expression of interest in the NHS England & NHS Improvement match funding towards Children’s Palliative and End of Life Care services, which included the funding of Bluebell Wood for hospice services.

In February 2020 all CCG’s across SY&B received confirmation of match funding from NHS England & NHS Improvement for 2020/2021 onwards, to support the development of Children’s Palliative and End of Life Care services locally in line with the NHS England specification.

The continued funding of Bluebell Wood supports the ongoing services that the CCG relies upon for children and families with life limiting conditions, whilst also supporting the national agenda of increasing services available for children’s Palliative and End of Life Care.

The Executive Committee was asked to:

• Note the commitment that was made as part of the NHS England & NHS Improvement match funding submission in terms of services provided by charity hospices from 2020/2-21 onwards. • Approve the plans to award the grant to Bluebell Wood for 2020/2021 to support service continuity and development, whilst fulfilling the match funding submission made by NHS Doncaster CCG to NHS England & NHS Improvement in November 2019.

The ongoing grant will continue to contribute towards the aim of maximising current resources and services, reducing the inequity of service provision for Children and Young People and their families with life limiting conditions.

All SY&B CCG’s are working together to ensure a consistent approach and assurance of current services, as well as driving the development of services locally. These developments are both in line with the NHS England specification and are being co-produced with key stakeholders across SY&B.

A Fitzgerald highlighted that all grants will need to be reviewed going forward.

The Executive Committee:

• Noted the commitment that was made as part of the NHS England & NHS Improvement match funding submission in terms of services provided by charity hospices from 2020/2-21 onwards.

• Approved the plans to award the grant to Bluebell Wood for 2020/2021 to support service continuity and development, whilst fulfilling the match funding submission made by NHS Doncaster CCG to NHS England & NHS Improvement in November 2019.

10. Choose Well App

The Choose Well App was first developed by MyOxygen and published in 2013. The benefits for patients is to provide and easily accessible and comprehensive guide to all urgent and Primary Care service in Doncaster.

Recently MYOxygen has approached NHS Doncaster CCG regarding the hosting and maintenance of the APP going forward. Currently there is no Service Level Agreement (SLA) in place between the CCG and MyOxyegn for them hosting the APP on their server and providing regular maintenance and updates to ensure the App is kept up to date in line with the App Store policies. Any amendments the CCG would like to make to the App are chargeable and a quote for the work to be carried out is provided on an ad hoc basis as and when changes are required.

Unfortunately, we are unable to provide any data to demonstrate the number of downloads or traffic through the App. The App has been and continues to be widely publicised since its development to encourage usage across all ages. NHS Doncaster CCG now has a greater following on social media via its organisational website and a dedicated page now provides key information about local services and general advice and guidance for the public.

There are three options to be considered:

• Option 1 - NHS Doncaster CCG hosts the App on the RDaSH portal and takes ownership via the Apple and Google play stores. MyOxygen would need to retain responsibility for updating the App on the CCG’s behalf and updating the content of the App as required. • Option 2 – MyOxygen continues to host the App on its server and retains ownership of the App. MyOxygen would also retain responsibility for updating it on our behalf and updating the content as required. • Option 3 – Decommission the App altogether therefore it would no longer be available for download from either Stores. The App would still work for existing users however some content would not be displayed, for example details of GP Practices, Pharmacies and Dental Practices.

The costs for Options 1 and 2 are particularly high. It was recommended that:

• The Executive Committee approve Option 3 to decommission the App. Work will be undertaken to ensure the CCG organisational website is up to date with relevant information for our population.

The Executive Committee approved Option 3 to decommission the App and that work be undertaken to ensure the CCG organisational website is up to date with relevant information for our population.

11. Rapid Diagnostics Service

C Glazebrook attended the Executive Committee meeting to provide an update on the Rapid Diagnostics Service (RDS).

During 2019/2020 all Cancer Alliances were required to set up at least one RDC per Alliance for patients with non-specific symptoms (vague symptoms) and for a cohort of patients with site-specific symptoms who are currently serviced by an underperforming 2 week wait or 62-day pathway.

Work on the programme had already started in Doncaster and Bassetlaw in 2019 with the development of the Vague Symptoms pathway plus the Upper and Lower GI pathways. The service was to be based at Mexborough Montagu Hospital. The aim was to reduce diagnostic inequalities and improve patient experience by developing pathways with one point of contact and reduced attendances. This work was paused in March 2020 due to COVID-19. It has now restarted with a new emphasis on Rapid Diagnostic Services (RDS) rather than a specific centre.

The initial focus for the RDS in Doncaster and Bassetlaw will be for NG12 suspected cancer referrals via three pathways the Vague Symptoms pathway, the Upper GI 2week wait pathway and the Lower GI 2 week wait pathway. Whilst the pathways are for patients with cancer- related symptoms, many patients seen through the pathways will not have cancer. A key wider benefit will, therefore, be diagnosing serious non-cancer conditions.

For those patients who are diagnosed with cancer, this means treatment can be offered earlier. For those who are not diagnosed with cancer, the communication of an ‘all clear’ reduces the anxiety felt at a very stressful time. The national ambition is that all 2 week wait pathways will follow a rapid diagnostic approach in line with the 7 specified components by 2024. The 7 components are:

• Early identification • Timely referral • Symptom assessment • Coordinated testing • Timely diagnosis • Onward referral

• Excellent patient coordination and support

The COVID-19 pandemic has heightened the importance and complexity of cancer diagnostics. To support the COVID-19 and wider diagnostics recovery, the rapid diagnostics programme will play a central role.

The aim is that the new rapid diagnostic pathways will give:

• Improved patient experience on the cancer diagnostic pathway • Shortened interval from presentation to diagnosis with a standardised efficient and smooth service • Quick complete accurate referral from primary care • Decrease use of inpatient beds during cancer diagnosis • Reduce the number of accident & emergency or GP visits before a cancer diagnosis • Diagnose cancer at an earlier stage • Appropriately staffed service with minimal time waiting for tests. • Reduce health inequalities • Leading to a comprehensive plan of care, with effective communication to the patient throughout the service

Several staff roles will be key to coordinating the pathways and supporting the patients through their diagnostic journey. The Accountable Care Partnership (ACP) will provide clinical triage and clinical support to the patient; the Cancer Pathway Navigator will ensure appointments, tests, scans etc. are coordinated and will act as a single point of contact for the patient. They will also liaise closely with the patient’s GP. They will provide information and support to the patient throughout their journey, from referral to diagnosis, treatment and discharge. The admin role will work closely with the Cancer Pathway Navigator and ACP to ensure appointments are booked for the patient and to ensure all data, including test results, is entered to ensure that speedy and accurate patient tracking can take place, including feedback to primary care.

These roles, working together, will ensure the patient experience will be improved. They will also link closely with Primary Care Networks (PCNs) to ensure effective communication and coordination and to flag/resolve any issues. The SY&B ICS Cancer Alliance announced in late October 2020 that it was in a position to release transformational funding to aid the delivery of the SY&B rapid diagnostic pathways. The Alliance requested each place develop their plan for how they could effectively utilise the funding to deliver the RDS priorities.

The funding template was completed and agreed by the RDS Steering Group prior to submission in early December 2020. The funding was formally approved by the Cancer Alliance Board on 8 January 2021. The proposal is that the funding flows into Place via Commissioners for

appropriate Place distribution. The funding requested covers the key roles to ensure the pathways are implemented, co-ordinated and evaluated.

The funding for the roles is for 12 months and will inform costings for a future model and whether the model is sustainable. A thorough evaluation and monitoring of data and patient feedback will be central to this review. This in turn will inform if a business case needs to be reviewed/developed going forward. The development of any future model will be through a partnership approach involving DBTHFT, the Cancer Alliance, CCGs and PCNs to develop any future model. Further funding beyond 12 months has not been agreed by the SY&B ICS Cancer Alliance or Bassetlaw and Doncaster CCGs and therefore timely evaluation is imperative.

The Executive Committee was asked to:

• Note the update on the RDS programme. • Note the approved funding from SY&B ICS Cancer Alliance.

Dr Crichton queried if the Community Diagnostic Hub is linked into the RDC. C Glazebrook advised that DBTHFT is keen for Mexborough Montagu Hospital to be used as a Community Diagnostic Hub.

The Executive Committee:

• Noted the update on the RDS programme. • Noted the approved funding from SY&B ICS Cancer Alliance.

12. Clinical Reference Group Terms of Reference

L Devanney informed the Executive Committee that the Clinical Reference Group reviewed the Terms of Reference at the meeting held 26 November 2020.

One minor addition had been added under section 3.3 Attendees: • Representatives from NHS Bassetlaw CCG

As per section 11, any resulting changes to the Terms of Reference or membership shall be submitted to the Executive Committee for approval.

The Executive Committee was asked to approve the reviewed Terms of Reference.

Dr Crichton acknowledged that it had been valuable to have a good range of colleagues and attendance from NHS Bassetlaw CCG on the Clinical Reference Group.

The Executive Committee approved the reviewed Terms of Reference.

13. Corporate Risk Register

L Devanney presented the Corporate Risk Register to the Executive Committee for consideration and discussion. The four very high risks delegated to the Committee were:

• CO2-SD14 – Executive Committee risk - (non-achievement of cancer 62 day target posing a potential risk to the timely treatment of Doncaster patients). Review update: November 2020 data-DCCG performed at 71.9% against the 85% target. There were 18 breaches within 10 specialties, Breast (3), Haematological (1), Sarcoma (1), Gynae (2), Skin (2), Head and Neck (1), lower GI (2), Upper GI (3), Lung (2) and Urology (1) tumour groups.

• CO2-SD19 – Executive Committee risk - (more patients are waiting longer for planned treatment (Referral To Treatment (RTT) 92% / waiting list size increasing). Review update: November 2020 RTT position was 68.9% up from 67.9% in October. There are 426 breaches over 52 weeks, of which 357 are

accountable to DBTH.

• CO1-CS19 – Executive Committee risk – (there is a risk to the business continuity / service provision within the CCG and providers due to Covid- 19). Review update: Risk scoring increased to 5x5 (25) due to impact on staff capacity and staff absences related to COVID-19 and risk to service capacity and demand due to Wave 2.

• CO3-PCP017 – Executive Committee risk – (there are fewer people accessing IAPT services (anxiety and depression) than set out in national target). Review update: Request made to RDASH to establish geographical data based on localities to be made available. A meeting across all partners in Doncaster arranged 18 January 2021 to discuss population and health inequalities data and will be raised there also. COVID-19 - discussions underway to provide literature/posters etc re COVID-19 will be focused on COVID-19 vaccination centres as promotion to over 80s/vulnerable groups. Student focus pilot underway to support within hospital settings. Issues relating to placement and COVID-19 linked anxieties will be focused on.

L Devanney added that the risks on the Corporate Risk Register flow through to the Board Assurance Framework.

A Fitzgerald advised that C Rollinson, Head of Corporate Governance is adding a standing line regarding review of the risks and agreed to liaise further with C Rollinson. A Fitzgerald

The Executive Committee noted the Corporate Risk Register

14. Planning and Contracting

The following Planning and Contracting update was received by the Executive Committee:

Planning

• The letter detailing the Operational Priorities for Winter and 2021/22 was received on 23 December 2020. The five main areas include: o Responding to ongoing COVID-19 demand o Implementing COCIV-19 Vaccination Programme o Maximising capacity in all settings to treat non COVID-19 patients o Responding to emergency demand and managing winter pressures o Supporting the Health and Wellbeing of our Workforce • We are confident that we are already concentrating on these areas. The letter has been discussed in the DBTFT and RDaSH Contracting Boards. • Our Delivery Plans will concentrate on: o Recovery of Pre COVID-19 positions across all services o Embedding Transformation o Efficiency / Quality, Innovation, Productivity and Prevention (QIPP)

It is proposed that the refreshed Delivery Plans will be more ‘light touch’ and will be presented to the Strategy & Organisational Development Forum meeting in February for discussion.

Dr Crichton endorsed this approach and acknowledged that we need to be realistic regarding our ambition. The Acute Trust is already working on the recovery of services to prevent deterioration.

Contracting

• The letter issued 23 December 2020 confirms: o Published Allocations for 2021/22 with additional funding to offset efficiencies not delivered during 2020/21 however it is uncertain how much this will be. o Baseline contracts set at 2019/20 outturn with adjustments for growth , service changes and non-recurrent items.

The Executive Committee noted the Planning and Contracting update.

15. Performance update

• Starting Well Delivery Plan

A Fitzgerald gave the following update to the Executive Committee

• Attention Deficit Hyperactivity Disorder (ADHD) waiting times continue to be of concern. This has been raised at the RDaSH Contracting Board meeting and M Veitch, Chief Operating Officer, RDaSH is developing a proposal to improve the positon. A Fitzgerald • There are also concerns regarding the increase in Children & Young People’s mental health issues. The Doncaster Partnership is considering the response and issues are being escalated through agreed governance routes.

The Executive Committee noted the update.

16. Items for inclusion in the next Governing Body Chair & Chief Officer’s Report

The following items were identified for the February Governing Body Chair & Chief Officer Report:

• CCG Response to Proposals: Integrating Care - Next steps to building strong and effective integrated care systems across England. • Operational priorities for winter and 2021/22. • Operational Guidance: Using all of our national health system, people and resources. • Flood preparation. • EU Exit. • COVID-19 Vaccination sites go live.

17. EU Exit Update L Devanney gave the following EU Exit update:

• There were no items to escalate. • The CCG receives daily EU SITREPS. • The Doncaster EU Exit Group will continue to meet in February and March 2021 then it will meet on an ad hoc basis.

The Executive Committee noted the EU Exit update.

18. Escalation of Risk

There were no risks identified.

19. Bring forward Agenda

Executive Committee

February 2021 • Quarter 3 Corporate Assurance Report

Future Agenda Items

• Medicines Management Investment • Communications Healthwatch Review • Cognitive Stimulation Therapy (CST) Service

Strategy & Organisational Development Forum

February 2021 • 2021/2022 Review of Contracts

Future Agenda Items • Healthwatch Primary Care Access Report

Governing Body

February 2021 • Climate Commission Report • Staff Survey results

March 2021 • Planning/Contracting

Future Items • Doncaster All Age Learning Disabilities and Autism Strategy • Commissioning Principles for CHC and Individual Placements • Liberty Protection Safeguard Partnership

20. Any Other Business

There was no further business discussed.

21. Date and Time of Next Meeting

Wednesday 17 February 2021, 9am

Engagement & Experience Committee (EEC) Meeting Thursday 3 December 2020, 10.00 am – 11.30 am via Microsoft Teams

Present: S Whittle (Chair) Lay Member for Patient & Public Involvement, NHS Doncaster Clinical Commissioning Group (CCG) P Hemingway Head of Communications & Engagement, (CCG) (from 10.30am) A Fitzgerald Director of Strategy & Delivery, CCG (from 10.30am) Dr M Pande GP Lead, South Locality A Smith Senior Communications & Engagement Officer, CCG

(from 10.30am) R Mather Senior Communications & Engagement Officer, CCG A Edwards Corporate Governance Manager, CCG K McGuire Patient Experience Officer, CCG A Goodall Chief Operating Officer, Healthwatch Doncaster L Robson Public Health Theme Lead

In attendance: E Price Head of Strategy and Delivery - Children’s Mental Health and Maternity, CCG K North Interim Commissioning Manager (Commissioning and Market Development), Children’s Commissioning Doncaster Council K Connolly Senior Corporate Services Support Officer (Minute Taker), CCG

Agenda Subject Action Ref Required By 1. Welcome and Introductions

S Whittle welcomed everyone to the meeting.

2. Apologies for Absence

S Whittle noted apologies of absence from the following:

• A Coggan Head of Performance and Intelligence, CCG • H Joerning, Patient Experience Manager, CCG

3. Declarations of Interest

S Whittle reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).

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The meeting was noted as quorate.

Declarations of interest from sub committees / working groups:

None declared

Declarations of interest from today’s meeting:

None declared

4. Minutes From Previous Meeting

The minutes from the previous EEC meeting, held on 5 November 2020, were approved as a correct record.

5. Action Log Update

Both the open & closed action logs were updated :

• 7 actions closed • 2 action remains open • 6 new actions

The updated open action log is circulated with the minutes of this meeting.

6. Notification of Any Other Business

There were 4 notifications of further business for discussion.

7. Priority Area – Deep Dive on Starting Well

S Whittle welcomed E Price and K North to the meeting to provide Committee members with an overview of the Starting Well Strategy.

The following update was provided:

The Doncaster Summer Staycation was a collaboration with partners across Doncaster, to deliver a comprehensive programme of activities for Children and Young People, incorporating face to face activities based no more than 3 miles from school settings, to ensure Children and Young People were able to access and a comprehensive digital offer, which provides a 12-month learning platform for families, thus lasting much longer than the Summer.

Due to the pandemic and the lockdown restrictions from March 20,

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the delivery of education for those not deemed vulnerable and/ or the. Children of vulnerable workers moved online to virtual platforms, in line with national guidance. The collaboration from educational

settings including early years providers and child minders was

immense, meaning that there was always sufficient capacity in the Borough to meet need.

Without a doubt, the COVID-19 pandemic has created a period of huge disruption and uncertainty for Children. School closures and other measures in response to the pandemic have already caused damage; beyond falling behind in their school work, interruption to Children’s education has negative consequences for their social lives and emotional wellbeing, for which the long-term effects are yet unknown. This is being felt locally across the partnership with increased demand at the Front Door and the impact being felt by those already deemed vulnerable. The Summer Staycation was developed to provide a programme of summer activities to improve health and wellbeing, and to help

support Children and Young People to return to education. The aim

was to provide safe entertainment and activity to Children and Young People, whilst addressing social isolation.

The Summer Staycation included a mixture of arts and crafts, sports and physical activity, employability sessions for older Children, reading challenges. Children and Young People could access resources, activities and ideas for staying home, such as the Doncaster ‘101 things to do indoors’ guide.

Many of the activities were virtual due to the restrictions of social distancing and safety and hosted online.

Children and Young People had access to activities in 20 venues across the borough which were accessible for face-to-face activities –

each within a travelling distance of 3 miles.

The programme was developed with partner agencies and

stakeholders, including Young People and Young Advisors across the

borough and funded from £97,614.33 Schools Forum, £64,846 from Opportunity Area and £31,353.13 from Expect Youth. Other partners donated in kind resources, such as staffing from the Partnership & Engagement team to help coordinate and support this programme.

S Whittle asked if a video is available for the website. K North to feedback. K North

EEC Members thanked K North and E Price for the extremely

informative update.

8. Complaints Update

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K McGuire provided EEC members with a verbal update on enquiries, complaints and concerns from the last month.

The key points were as follows:

• 194 contacts

o 8 complaints • Supporting the Continuing Healthcare (CHC team) with investigations

A Fitzgerald requested that all partners are sending the same message out.

EEC members noted the update and thanked K McGuire.

9. Healthwatch Doncaster Update

A Goodall provided EEC members with a verbal update on Healthwatch Doncaster.

The key points were as follows:

• Discussions are ongoing with K Dowson, Diretor of Digital for Doncaster CCG around people in Doncaster who are digitally excluded and isolated. A shared workshop is planned. • Online Daily Dose is continuing, covering flu, safeguarding, staying well in winter, carers, volunteering.

S Whittle thanked A Goodall for the update.

10. BAME and Equality Report Update

L Devanney provided the following update, via email, to EEC

members on BAME and Equality.

The scoping exercise for the CCG BAME network has concluded and across South Yorkshire and Bassetlaw there were 10 expressions of interest. The numbers are low but we are really keen to support staff

with a network so intend to meet in January to hold an informal session to share lived experiences and to discuss how we want to take the network forward and the proposal is we join with the local authority network which too is in very early stages of formation.

The primary care BAME network had its first meeting on 16 November and was well attended, 66 attendees in total. The network heard the journey of two colleagues and their lived experiences of racism, we had two guest speakers who were very inspirational and gave guidance on effective networks and we had a presentation on

the findings of a survey that the CCG and LMC had led on. The network has requested support from the CCG and a paper is going to Governing Body on 3 December 2020 detailing that request along

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with the survey results. The report from Governing Body will come to K Connolly EEC in January/February 2021.

A Fitzgerald suggested a focus on BAME and Equality for a future K Connolly meeting. To add to the forward planner. (completed)

11. Engagement & Experience Committee Self-Assessment Report 20/21

P Hemingway informed EEC members the Engagement & Experience Committee Self-Assessment Report 20/21 should have been sent out with the papers for today’s meeting. They will be sent out with the K Connolly minutes of the meeting. (completed)

The main points from the report are as follows:

• Future meetings to be extended from 60 to 90 minutes • Formalise the forward plan – P Hemingway, S Whittle and K P Hemingway Connolly to meet to discuss S Whittle K Connolly • Improve flow of meetings, take onus off actions – actions to be updated prior to meeting • Patient voice perspective – strengthen voice of PCNs • Look at introducing minutes from Health Ambassador meetings

S Whittle thanked P Hemingway for the update.

12. Any Other Business

There were 6 notifications of further business for discussion

• S Whittle congratulated NHS Doncaster CCG for celebrating its fourth consecutive ‘outstanding’ rating from NHS England and NHS Improvement for 2019-20. NHS Doncaster CCG is now one of just a few CCGs nationally to achieve the top rating four years in a row. The 2019-20 assessment noted: “The outstanding status for NHS Doncaster CCG represents a sustained and significant achievement.”

• S Whittle also congratulated the Communications and Engagement Team for receiving a ‘green star’ from NHS England for their commitment to engaging with patients and members of the public. S Whittle requested the ‘green star’ P Hemingway (completed) rating to be added to the website.

• A Fitzgerald advised EEC members that the Senior Management Team (SMT) at Doncaster CCG want to give a little something back to staff for all their hard work and dedication through the pandemic. An extra day’s leave has already been awarded. A recognition badge is being discussed

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but ideas are welcome.

• Communication is vital now as the Covid-19 vaccine is shortly being rolled out. Expectations around the vaccine must be managed. Waiting on messages from NHS England and NHS Improvement. Local messages are being agreed as these need to be right. A local Communications and Engagement Plan is being drafted by P Hemingway, this will be circulated once finalised.

• January meeting – to be confirmed if going ahead

• S Whittle informed EEC members this is P Hemingway’s last EEC meeting. He is taking on a new position in Norfolk as Director of Communications and Engagement. S Whittle thanked P Hemingway for his excellent work since joining Doncaster CCG. Interviews for Paul’s successor will be completed before Christmas.

13. Date & Time of Next Meeting:

Thursday 7 January 2020, 10am – 11.30am, via Microsoft Teams - TBC

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Minutes of the Primary Care Commissioning Committee (Public) Held on Thursday 10 December 2020 at 12.30 pm Live Streamed via Zoom

Voting L Tully Lay Member (Chair) Members H Tingle Chief Finance Officer, CCG Present: A Fitzgerald Director of Strategy and Delivery, CCG S Whittle Lay Member

Non-Voting C Ogle Associate Director for Primary Care & Commissioning, Members CCG Present: K Roberts Primary Care Manager, CCG Dr M Pande South Locality Lead GP Dr V Kumar Local Medical Committee (LMC) Representative A Ibbeson Head of Quality & Designated Nurse for Children’s Safeguarding & LAC, CCG S Barnes Interim Estates Lead, CCG J Telford Healthwatch Representative P Barringer NHS England Representative

In A Small Senior Finance Manager, CCG Attendance: K Smith Senior Officer, Digital Primary Care (Technical Support), CCG K Connolly Senior Corporate Services Support Officer, CCG (minutes)

Meeting Start 12.30 pm Action 1. Apologies for Absence

Apologies for absence were received from:

• J Pederson Chief Officer, CCG • A Russell, Chief Nurse, CCG • Z Head, Lead Nurse Primary Care Quality, CCG • Dr N Alsindi, Clinical Lead Primary Care, CCG • Dr D Eggitt, GP - Chief Executive Officer, LMC

2. Declarations of Interest

Declarations of interest from sub committees / working groups: None noted.

Declarations of interest from today’s meeting: S Barnes noted that he is also undertaking a similar role for estates for Rotherham CCG. The chair decided that there was no risk of undue gain or influence for all parties concerned.

3. Notifications of Any Other Business

No items were raised.

4. Minutes From Previous Meeting

The minutes of the last meeting held on 12 November 2020 were approved as an accurate record.

5. Matters Arising not on the Agenda

• AP100 – To amend the ‘action for’ from Z Head to A Ibbeson. Ongoing piece of work – to move to February 2021 on action KS tracker. • AP123 – completed.

The Primary Care Commissioning Committee noted the update for actions AP100 and AP123.

6. Action Tracker

The Primary Care Commissioning Committee discussed and updated each item on the Action Tracker. The latest updates can be viewed on the Action Tracker.

7. Finance and Contracting

7.1 Interim Exception Report

H Tingle provided the Primary Care Committee with a verbal update; she explained that there was no paper this month as a full report was presented at last month’s meeting.

Due to the Covid-19 pandemic one of the changes to the financial regime was to split the financial year into two parts, months 1-6 and months 7-12. The expectation is to break even for months 1–6, we are waiting on

month 6 allocation to get to a break even position. There is a plan in in place for months 7 – 12. A detailed piece of work in regards to forecasting is also currently being undertaken within the CCG.

It was highlighted that it was felt financial risks have reduced since the last meeting so will look to reduce those risks on the corporate risk register in January 2021.

The financial plan was submitted and approved at Governing Body last week. It was acknowledged there are some risks in the plan in terms of delivery of a balanced position for Month 7-12 including risk of overspends in areas such as Individual Placements, CHC and Prescribing. It was highlighted that our plan is consistent with that of the other four CCGs across the patch.

The Primary Care Committee were assured of the improved financial position and robust system in place.

7.2 Primary Care Estates Implementation Plan Update

S Barnes provided a monthly update to the Committee on the implementation of the CCG Estates Strategy. He confirmed that the Programme Business Case for the primary care capital programme had been approved by the ICS and would be submitted to NHS England.

Work is ongoing for the following projects:

1. Bentley Hub Project – feasibility study to conclude in January 2. Rossington Health Centre - Task and Finish Group set up 3. Mexborough GP Led Project – District Valuer engaged 4. Scott Practice Extension and Reconfiguration 5. 4 Doncaster PCN Transformation 6. Petersgate Practice Extension and Reconfiguration 7. Field Road Surgery Quotes - for business as usual spend

S Barnes advised work is progressing well on all projects. Rossington Health Centre is not fully funded at present but will be opportunities through slippage on the Capital Programme.

Dr Kumar requested notice is given before projects start of any extra charges that practices may incur. S Barnes noted the request from Dr Kumar.

The Primary Care Commissioning Committee thanked S Barnes on the informative report and noted the contents.

8. Quality

8.1 Interim Exception Report

A Ibbeson provided the Primary Care Committee with a brief verbal update.

The Quality team are working very closely with the Primary Care team, they are working on assurance and responding to challenging needs as they arise. Quality and safety are central to all work they undertake.

The Primary Care Commissioning Committee thanked A Ibbeson for the update and noted the progress and challenges in respect to quality care.

9. Strategy and Planning

9.1 Primary Care Delivery Plan 2020/2021

K Roberts presented the 2020/21 Primary Care delivery plan to the Primary Care Committee. In September 2020 committee members were advised of a revised delivery plan as a result of COVID and Staffing which highlighted some of the actions that were likely to be delayed or stopped.

The CCG have made some really good positive progress this year, some areas are completed and some are still in progress. There are further challenges to come especially around the vaccination and testing programmes - the biggest issue is around capacity.

C Ogle informed the Committee the focus for the Engagement and Experience Committee in February is Primary Care followed by Governing Body in March.

The Primary Care Committee considered the information provided on the 2020/21 Primary Care Delivery Plan update.

9.2 Primary Care Cell Update

K Roberts updated the Primary Care Committee on the Primary Care Cell.

He provided Committee members with an overview of the decisions taken at the Primary Care Cell that has been put in place as a response to

COVID-19 and its effect across Doncaster Primary Care provision. There is also an element to asking Committee members to consider some of the decision making processes/chain in particular reference to the Doncaster Primary Care COVID response.

The headline areas and work undertaken by the Primary Care Cell are:

• GAP Analysis • Winter & Flu Planning • Pulse Oximeters in Support of COVID • CCHUB Arrangements • Escalation Framework & Supporting Documents

• Mass Testing • Covid Vaccinations

• GP Funding for the second wave • Managing Practice Pressures & Key Messages • Risk Register

A Fitzgerald advised the Committee a quick decision will be made on income protection for enhanced services.

The Primary Care Commissioning Committee noted the informative update.

9.3 Outcome of the Strategy Session

The Primary Care Commissioning Committee self-assessment ran from 11-Aug-2020 until the 28-Aug-2020. The response rate was 56% of

members who were invited to participate. The report covered key findings, the impact of COVID, suggested actions and recommendations.

As part of this process it was decided to run a session at the November’s Strategy & OD Forum to discuss:

• The relationship between PCCC and the Executive Committee • The sharing of decisions with primary care • The future of the primary care cell

• Communication between primary care stakeholders

L Tully advised the Committee as a result of the Strategy session the following 4 questions were raised:

1. PCCC Vs Exec/GB CR Decisions come to PCC first but if a financial decision will go to Executive Committee. It was suggested that C Rollinson compare our response to other CCGs and feedback. AF 2. Communication to practices re decisions made A Fitzgerald to consider with the Head of Communications, the updates to primary care staff have been increased

3. Future of primary care cell Primary Care Cell will continue whilst Covid pressures continue

4. Defining roles CCG, PCCC, PCN, PCD To add to the forward planner and discuss at February’s meeting

10. Forward Planner

The Primary Care Commissioning Committee noted the Forward Planner.

The following items were added:

• Defining roles – CCG, PCCC, PCN and PCD – February 2021 • Update on integrated care system development – February 2021 onwards

11. Any New Potential Risks

The Primary Care Commissioning Committee agreed there were no new potential risks identified for Primary Care.

12. Any Other Business

No items were raised.

13. Date and Time of Next Meeting

Thursday 14 January 2021 at 12.30pm - live streamed via Zoom.

Meeting Closed 13:20pm