Questions from members of the public will be received under Item 4; if submitted in advance in line with the protocol on the CCG’s website: http://www.blackburnwithdarwenc cg.nhs.uk/about-us/governing- body-meetings/
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
Wednesday 5th September 2018 at 1 pm Meeting Rooms 1 and 2, Blackburn Central Library Town Hall Street, Blackburn BB2 1AG
A G E N D A (REVISED)
Item No: Agenda Item Member Responsible Report PUBLIC PARTICIPATION 1. Chair’s Welcome Mr Graham Burgess Verbal
2. Apologies for Absence and Confirmation of Quoracy Mr Graham Burgess Verbal
3. Declarations of Interest relating to items on the agenda Mr Graham Burgess Verbal Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Governing Body Secretary in advance of the meeting.
4. Questions from Members of the Public Mr Graham Burgess Verbal
5. Life Expectancy Trends 2002-17 Professor Dominic Presentation Harrison PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 6. Minutes of the Meeting held on 4th July 2018 Mr Graham Burgess Attached 6.1 Extract from Part 2 of the Minutes of the Meeting held on Attached 4th July 2018
7. Matters Arising Mr Graham Burgess 7.1 Action Matrix Attached
8. Clinical Chief Officer’s Report Dr Penny Morris Attached
9. Chief Finance Officer’s Report Mrs Jill Marr Attached
10. Contract, Quality and Performance Report Mrs Jill Marr/ Attached Mrs Janet Thomas 11. Governing Body Assurance Framework Update Mr Iain Fletcher Attached
STRATEGY 12. Communication and Engagement Strategy Mr Iain Fletcher Attached
FOR INFORMATION 13. Pennine Lancashire Volunteer Strategy and Action Plan Mr Iain Fletcher Attached
14. Pennine Lancashire Accident and Emergency Delivery Mrs Janet Thomas Attached Board Update 15. Lancashire and South Cumbria Perinatal Mental Health Mrs Jill Marr Attached (Community) Report 16. Annual Report of the Audit Committee Mr Paul Hinnigan Attached 16.1 External Audit Annual Audit Letter Attached 17. Sub-Committees and Groups’ Minutes Mr Iain Fletcher Attached
18. Review of Governing Body Register of Interests Mr Iain Fletcher Attached
19. Communication and Engagement Report Mr Iain Fletcher Attached
20. Any Other Business All Verbal
21. Date and Time of Next Meeting: Mr Graham Burgess Verbal Wednesday 7th November 2018 at 1 p.m. in Meeting Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG
Annual General Meeting – Wednesday 26th September 2018 at 12.45 p.m. in the Hornby Theatre, Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960)
PART 2 (APPROXIMATELY 3 PM) A/18 Minutes of Part 2 of the Meeting held on 4th July 2018 Mr Graham Burgess Attached
B/18 Matters Arising Mr Graham Burgess B/18.1 Action Matrix Attached
C/18 Pennine Lancashire Clinical Commissioning Groups’ Mrs Janet Thomas Attached Confidential Provider Update
D/18 System Update Mr Graham Burgess Verbal D/18.1 Developing the Integrated Care Partnership for Pennine Attached Lancashire E/18 Draft Estates Strategy Dr Penny Morris Attached
F/18 Mental Health Commissioning and Improving Access to Mrs Janet Thomas Attached Psychological Therapies G/18 Adult Community Services Update Mrs Janet Thomas Verbal
H/18 Any Other Business All Verbal
Types of Conflict of Interest
Type of Interest Description Financial This is where an individual may get direct financial benefits from the consequences of a Interests commissioning decision. This could, for example, include being: • A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; • A shareholder (or similar owner interests), a partner or owner of a private or not-for- profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. • A management consultant for a provider;
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Type of Interest Description • In secondary employment (see paragraph 56 to 57); • In receipt of secondary income from a provider; • In receipt of a grant from a provider; • In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider • In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and • Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). Non-Financial This is where an individual may obtain a non-financial professional benefit from the Professional consequences of a commissioning decision, such as increasing their professional Interests reputation or status or promoting their professional career. This may, for example, include situations where the individual is: • An advocate for a particular group of patients; • A GP with special interests e.g., in dermatology, acupuncture etc. • A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); • An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE); • A medical researcher.
Non-Financial This is where an individual may benefit personally in ways which are not directly linked to Personal their professional career and do not give rise to a direct financial benefit. This could Interests include, for example, where the individual is: • A voluntary sector champion for a provider; • A volunteer for a provider; • A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; • Suffering from a particular condition requiring individually funded treatment; • A member of a lobby or pressure groups with an interest in health. Indirect This is where an individual has a close association with an individual who has a financial Interests interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include: • Spouse / partner; • Close relative e.g., parent, grandparent, child, grandchild or sibling; • Close friend; • Business partner.
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Subject to approval at the next meeting
CLINICAL COMMISSIONING GROUP (CCG) Item 6 Minutes of the Governing Body (GB) Meeting held on Wednesday 4th July 2018 2018 at 1 p.m. in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG PRESENT: Mr Graham Burgess Chair Mr Roger Parr Deputy Chief Executive/Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Quality and Primary Care Dr Adam Black GP Executive Member Dr Preeti Shukla GP Executive Member Dr Zaki Patel GP Executive Member Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Dr Nigel Horsfield Lay Member Mrs Janet Thomas Executive Nurse/Associate Director of Quality and Commissioning Professor Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council (BwDBC) Miss Claire Jackson Director of Commissioning Operations
IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Ms Jacquie Allan Executive Support Mrs Caroline Edwards End of Life Executive Nurse (Item 18.055 only)
Min No: 18.051 Chair’s Welcome
The Chair opened the meeting by welcoming all attendees and members of the public to the meeting.
He apologised to those in attendance that the audio equipment had malfunctioned and requested that members speak clearly and concisely and advised those in attendance to inform him if they could not hear the discussions.
18.052 Apologies for Absence and Confirmation of Quoracy
Apologies for absence had been received in respect of Dr Penny Morris, Chief Clinical Officer, Dr John Randall, GP Executive Member and Mr Paul Hinnigan Lay Member – Governance.
The Chair noted the Professor Dominic Harrison, Director of Public Health, BwDBC, would be arriving late to the meeting.
The Chair confirmed that the meeting was not quorate but could commence as the first item was for information only.
18.053 Declarations of Interest Relating to Items on the Agenda
The Chair reminded 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 BwD CCG.
Declarations declared by members of the GB are listed in the CCG’s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following
link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/.
Mr Roger Parr declared a non-financial personal Conflict of Interest (CoI) in Item 5, End of Life Care Update. It was agreed that Mr Parr would remain in the meeting but take no part in the discussion.
The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.
18.054 Questions from Members of the Public
No questions had been received from members of the public.
Later in the meeting a member of the public declared that he had sent questions into the CCG that had not been included. As the CCG had not received these in line with the protocol, these were deferred. It was agreed the questions would be resubmitted to the CCG and the CCG would respond accordingly.
18.055 End of Life Care Update
Mrs Janet Thomas presented an update on the End of Life Care provided in BwD CCG between July 2017 and July 2018, and was an annual update in terms of progression.
She introduced Dr Preeti Shukla, as the Clinical Lead for BwD CCG and Mrs Caroline Edwards as the Executive Nurse for End of Life Care.
End of Life Care profiles from Public Health England (January 2018) show that BwD was above the national average for people dying in hospital and below the national average for people dying in care homes; whilst achieving the national average for people dying at home.
The presentation highlighted the priority areas for the CCG for 2017/18, and how these had been achieved.
• Priority 1: Communication and co-ordinated care: • Priority 2: Reducing inequalities and ensuring equitable access: • Priority 3: Education and training.
These priorities would remain the same in 2018/19 with the addition of Priority 4: Adherence to patient wishes, which is crucial at looking at future models of care, and influencing the pathway.
The next steps are to continue to build on and embed the 4 priorities; including promoting the proactive planning of End of Life Care for all in line with patients’ wishes. Pennine Lancashire End of Life Care Health and Well-being Improvement Programme Plans are in place to implement this strategy locally.
The CCG was working closely with the hospital and care homes in implementing the Red Bag scheme, which ensured the correct records travel with the patient.
Mrs Thomas reiterated that BwD will continue to work closely with its Pennine Lancashire partners to promote quality care, effective and efficient services for all. There was a strategy through which the CCG would be able to programme manage services with a clear plan and timescales.
Questions and answers then followed.
Miss Claire Jackson confirmed that End of Life is part of the New Models of Care and was embedded in the neighbourhood teams.
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The Chair thanked Mrs Thomas for the presentation and asked that she return with an annual update including the performance measures in July 2019.
ACTION: Mrs Janet Thomas to report back to the GB with an annual update, including performance measures, in July 2019.
18.056 Minutes of the Meeting held on 9th May 2018
Dr Adam Black joined the meeting and quoracy was confirmed.
The minutes of the meeting on 9th May 2018 were reviewed and accepted as an accurate record.
RESOLVED: That the minutes of the meeting held on 9th May 2018 were approved as an accurate record.
18.057 Matters Arising/Action Matrix
Matters Arising
There were no Matters Arising which were not listed on the Action Matrix.
18.057.1 Action Matrix
The Action Matrix was reviewed and the following were noted:
Minute 18.023.1 (ii)/18.040.1 (ii) Action Matrix – Contract, Quality and Performance Report It was agreed to defer this item to the next meeting in the absence of Dr John Randall.
Minute 18.026 (i) Contract, Quality and Performance Report Miss Jackson had met with the lead commissioner, Greater Preston and Chorley South Ribble CCG who had put a plan in place. This had not resulted in a service improvement, therefore, a recovery report was being produced which would be available for the September meeting.
Minute 18.043 (iii) Contract, Quality Performance Report Dr Malcolm Ridgway had clarified with the North West Ambulance Service (NWAS) the protocol for dealing with different types of calls. He quoted that they were dealt with by the priority of the call. Drs Adam Black and Zaki Patel disagreed with this, as the response time appeared to be longer if the person had a Clinician with them and they provided examples. The Chair asked the Executive GPs to forward examples to Dr Malcolm Ridgway in order for him to discuss with NWAS.
ACTION: The Executive GPs to forward examples of cases to Dr Ridgway for him to discuss with NWAS.
18.058 Clinical Chief Officer’s Report
Dr Malcolm Ridgway presented the Clinical Chief Officer’s Report in the absence of Dr Penny Morris and highlighted the following items:
• Department of Health: o NHS 5 Year Funding Plan; o Local Mental Health Crisis Services; o Unpaid Carers; o Independent Review into General Practice Partnership Model; o Antimicrobial Resistance.
• NHS England: o Suicide Prevention and Reduction;
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o Health and Care Information; o GP Retention; o Mental Health Care for Sexual Assault Victims; o Improving Patient Care; o Chief Financial Officer.
• Care Quality Commission: o Driving Improvement – Case Studies from 10 GP Practices.
• Lancashire and South Cumbria: o Joint Committee of CCGs; o Digital Strategy; o Shared Care Records; o Lancashire Care NHS Foundation Trust.
• Pennine Lancashire: o Together a Healthier Future Programme.
• BwD CCG: o GP Locality Leads o NHS70 o Governing Body.
• Healthwatch: o Public Meeting
• News and Events: o NHS70 Parliamentary Awards; o Queen’s Birthday Honours; o NHS Windrush 70 Awards; o Future Focused Finance; o Volunteers Week Award Ceremony.
Questions and answers followed.
RESOLVED: That the GB noted the content of the report.
18.059 Chief Finance Officer’s Report
Mr Roger Parr presented the report for month 2 and highlighted key elements.
He stated that this was the first meeting since the draft month 12 position had been reported. He pleased to report that the CCG had delivered all of its business rules, which had been subject to external audit scrutiny prior to being signed of as a true view, giving the CCG a strong base to go into a new financial year.
Mr Parr remarked that, as this was only the month 2 report, not all of the plans had been finalised. The CCG was reporting a breakeven position in line with the financial plan.
The CCG has actioned 12.6% of its Quality, Innovation, Productivity and Prevention (QIPP) savings to date and was on plan to meet the full year savings of £6m; with an internal stretch target of £7m.
The risks identified were in acute activity, Continuing Healthcare and complex care packages and volatile expenditure.
The CCG was on plan to deliver its year end forecast breakeven position.
Questions and answers followed.
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RESOLVED: That the GB noted the contents of the financial summary and financial position of the CCG at the end of May 2018.
18.060 Contract, Quality and Performance Report
Mr Parr presented the contracting section of the month 1 report and then deferred to Dr Ridgway to highlight the key points related to quality and performance.
Mr Parr highlighted the following:
Lancashire Care NHS Foundation Trust (LCFT) Mental Health Services (MHS): • Psychological Therapies – Mr Parr reported that the CCG did not have the figures yet but they were forecast to be above target. The activity, expected to be at a rate of 5.1% of estimated prevalence annually, would be added at a later date.
East Lancashire Hospitals NHS Trust (ELHT): • The Annual Plan had not yet been agreed with ELHT. Activity variances were currently displayed versus last year’s activity plan; • Referral to Treatment had decreased from the previous month; • Out Of Hours activity was down compared to the plan.
LCFT Community Services • Areas had been highlighted that were above and below a 10% threshold and the reasons for the performance.
Dr Ridgway highlighted the following:
LCFT • Attention Deficit Hyperactivity Disorder (ADHD): There were numerous causes for the referral performance, including service users transitioning and limited capacity. This was reported to the Performance Exception Group at its meeting held on 7th June 2018. LCFT presented a highlight report on a new model for ADHD therapy, with the potential to deliver significant increases in capacity and patient throughput, via the establishment of shared care working with colleagues in Primary Care; • Psychological Therapies: The factors contributing to long waits continue to be discussed with the Trust; • Out of Area Placements (OAPs): The OAPs position and the impact of admission avoidance schemes were reported on a monthly basis via the LCFT Operational Resilience Group.
Professor Dominic Harrison joined the meeting.
ELHT • Accident and Emergency (A&E) 4 Hours: The 95% 4 hour waiting time target for A&E was not met in April 2018; • Ambulance Handovers: There was a reduction in delayed handovers during the reporting period; • 12 Hour Breaches: A number of 12 hour breaches were reported. Several of these were due to the lack of availability of mental health beds. A breach analysis had been carried out and would be presented to the A&E Delivery Board; for review and comment on the key findings and trends and for system wide actions to be identified.
Primary Care: • Following an inspection, a GP Practice in BwD had been rated as ‘inadequate’. The CCG was working with the practice to rectify the issues. The practice had also been offered support by the Royal College of Practitioners (RCGP).
LCFT Staffing: • There were still some issues with staffing. LCFT were identifying ‘hotspots’ in order to detect where vacancy and sickness rates could be improved.
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Ambulance: • Targets had changed for monitoring purposes – there were now 4 targets. BwD had met the first target but had not met the other 3. A Performance Improvement Plan (PIP) was in place which included a 2-year additional non-recurrent investment for additional capacity. The plan provided detailed trajectories for improvement in performance and was monitored by Blackpool CCG.
Referral to Treatment: • There were 2 patients reported as waiting over 52 weeks.
Questions and Answers followed.
RESOLVED: That the GB noted the content of the report and supported the actions as identified.
18.061 360o Survey Feedback
Mr Iain Fletcher gave a presentation which provided a summary of the key findings and recommendations arising from the independent 360° stakeholder survey conducted by Ipsos MORI and commissioned by NHS England. All CCGs were required to participate in the survey. The results of the survey were analysed by the Communications and Engagement Team.
The results of the survey were also used by NHS England in its annual yearly CCG assurance ratings.
The CCG achieved an excellent response rate to the survey (33). Mr Fletcher gave a breakdown of the stakeholders by category of response.
Members noted that there had been some year on year improvement.
RESOLVED: The GB noted the contents of the report and supported its recommendations.
18.062 The Pennine Plan: Improving Health, Care and Well-being in Pennine Lancashire
Miss Jackson presented the Pennine Plan to the GB Members and acknowledged that this had been shown in different iterations over the last 18 months.
The final version had now been produced and the key changes from the published draft version were: • Updating of terminology such as replacing references to Accountable Care Systems and partnerships with Integrated Care Systems (ICS) and partnerships; • Simplification of the language used where engagement highlighted particular concerns, for example in relation to food poverty and finance; • Included further detail which more accurately reflects the scale of opportunities and ambition for Pennine, for example in relation to digital developments; • Explained how key areas of work will be taken forward through agreed or developing strategies and framework such as the Pennine Lancashire Volunteer Strategy; • Included reference to making sure we support people to be more aware of what services can support them, to help people to make the right choices, particularly by promoting the NHS Choose Well campaign.
The BwD Local Integrated Care Partnership was launched on the 26th June 2018, focusing on neighbourhood working. The first formal meeting was planned for July.
The public launch of the Pennine Plan was due on 19th September 2018.
ACTION: Miss Jackson asked GB Members for feedback or comments before 13th July 2018 to allow the GB to support the plan formally.
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Questions and answers followed.
It was agreed that the CCG needed to improve its engagement with all areas of the community.
RESOLVED: The GB agreed that the Chair and Clinical Chief Officer (CCO) could endorse the paper on behalf of the CCG, once comments have been reviewed.
18.063 Midlands and Lancashire Commissioning Support Unit Single Contract
Mr Fletcher presented a report outlining the recommendations for the Lancashire and South Cumbria (L&SC) CCGs to continue to contract with Midlands and Lancashire CSU (M&LCSU) through a single contract to deliver commissioning support. Overarching Strategic Partnership Principles were being developed to underpin the single contract and the partnership working between the CCGs and the M&LCSU. The single contract will also include the criteria for making commissioning support decisions to align with the development of the Integrated Care System (ICS) and Integrated Care Partnerships (ICPs) and place-based commissioning.
At the LSC Customer Forum on 19th March 2018, support was given to progress the implementation of a single contract for CSU Services between M&LCSU and the LSC CCGs within the L&SC Integrated Care System. This would replace 8 separate agreements.
There were three options:
• Option 1: Do nothing - roll over the existing Service Level Agreements (SLAs) for another 12 months • Option 2: Proceed with procuring commissioning support services at the earliest opportunity • Option 3: Direct award a new single contract between the L&SC CCGs and the M&LCSU
Mr Fletcher recommended:
i. The L&SC CCGs continue to contract with M&LCSU recognising the procurement considerations (in line with option 3); ii. Use the NHS Standard Contract for a period of 2 years but with a locally agreed variation clause based on agreed principles and enabling flexibility to respond to changing requirements within each CCG; iii. Chorley and South Ribble CCG to host the contract and chair the LSC Customer Forum.
Questions and answers followed.
RESOLVED: The GB agreed to the recommendations; subject to Legal Advice being received.
18.064 Stroke Services Update
Miss Jackson presented a report for information, providing an overview of outlining the significant improvement to current performance along with updates of community services redesign. This followed a presentation to the GB in February 2018.
The work being undertaken supported the ICS priority of improving Stroke Services as endorsed by the Lancashire Collaborative Commissioning Board at its June 2018 meeting. At a local level, this work supports the Pennine Lancashire Health and Well Being Improvement Partnership focus on ‘Healthy Hearts’.
Considerable work had been undertaken with both Community Stroke Teams to understand the current pathways, benefits and gaps.
There are currently 2 areas of focused work undertaken for improvements by ELHT:
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• Stroke Unit access to Stroke Unit within 4 hours; • Thrombolysis delays in access to Acute Stroke Unit within 4 hours.
Areas showing improved performance by ELHT:
• Specialist Assessments access to stroke consultant; • Therapy Teams and Multi-Disciplinary Teams
Focus was now on analysing the demand for services and the current performance of the community services; in particular examining if there is any evidence of how the current pathways impact negatively (or positively) on outcomes for patients.
It was recognised that significant improvements have been made within the local Acute Trust in terms of stroke care. The CCG was working with providers of both acute and community services to ensure the patient pathway offers a seamless transfer of care on discharge back to the community sooner, but with no loss of quality to patient care.
The Chair requested that the GB’s thanks were noted and passed on to all those involved.
RESOLVED: The GB noted the contents of the report and supported the move to develop Community Stroke Services.
18.065 Sub-Committees and Groups’ Minutes
Mr Fletcher presented the report, which included the minutes of the GB Sub-Committees and Groups for receipt and note by members; to inform the GB of delegated and key decisions taken and provide information regarding items of particular interest or potential risk.
There were no questions.
RESOLVED: That the GB noted the content of the report.
18.066 Joint Committee of Clinical Commissioning Groups’ Agenda
The Chair circulated the agenda for information. The reports were published on the Healthier L&SC website.
The Chair suggested that, if the papers were sent to the GB members on receipt, then the GB Members would have the opportunity to feedback prior to the Chair or CCO attending the meeting.
ACTION: The papers for the JCCCG Meetings to be sent to the GB Members when received for information.
RESOLVED: That the GB noted the content of the agenda.
18.067 Any Other Business
NHS70 The CCG marked the occasion by giving to the community. Members of staff were challenged with filling 70 NHS 70 bags, with a complete meal for a day, (breakfast, lunch and dinner) for one person. It was originally agreed that this would be done for the Nightsafe Charity. However, before the 5th July 2018, a total of 110 bags were collected, so the additional bags were given to the Women’s Refuge.
ACTION: The Chair asked Mr Roger Parr to pass on his thanks to the staff of BwD CCG.
BwDBC The Chair agreed to write formally to the Chief Executive of the Council to congratulate them on
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winning the award of Council of the Year.
ACTION: The Chair to write formally to the Chief Executive of BwDBC.
18.068 Date and Time of Next Meeting
The next meeting will be held on Wednesday 5th September 2018 at 1 pm in Meeting Rooms 1 and 2, Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG.
The Chair thanked everyone for their attendance and input and the meeting closed.
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960).
Signed ………………………………………………. Chair ……………………………………………… Date
Page 9 of 9 Subject to approval at the next meeting
Item 6.1 CLINICAL COMMISSIONING GROUP (CCG) Extract from the Minutes of Part 2 of the Governing Body (GB) Meeting held on Wednesday 4th July 2018 at 3 p.m. in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG
PRESENT: Mr Graham Burgess Chair Mr Roger Parr Deputy Chief Executive/Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Quality and Primary Care Dr Adam Black GP Executive Member Dr Preeti Shukla GP Executive Member Dr Zaki Patel GP Executive Member Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Dr Nigel Horsfield Lay Member Mrs Janet Thomas Executive Nurse/Associate Director of Quality and Commissioning Professor Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council (BwDBC) Miss Claire Jackson Director of Commissioning Operations
IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Ms Jacquie Allan Executive Support
Re-Confirmation of Apologies for Absence and Quoracy
Apologies for absence had been received in respect of Dr Penny Morris, Chief Clinical Officer, Dr John Randall, GP Executive Member and Mr Paul Hinnigan Lay Member - Governance
The meeting was confirmed as quorate.
Re-Confirmation of Declaration of Interests
The Chair reminded 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 BwD CCG.
Declarations declared by members of the GB are listed in the CCG’s Register of Interests. The Register was available, either via the Secretary to the GB or the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/
The Lay Members declared a financial Conflict of Interest (CoI) in Item E18 – Pay Awards for Local Pay Scales; due to the paper proposing the level of remuneration for Lay Members. It was agreed that the Lay Members would leave the meeting at this point and not take any part in the discussion or decision.
The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.
A/18 Minutes of Part 2 of the Meeting held on 9th May 2018
The Minutes of Part 2 of the Meeting held on 9th May 2018 were reviewed and accepted as an accurate record.
RESOLVED: That the Minutes of Part 2 of the Meeting held on 9th May 2018 were approved as an accurate record.
B/18 Matters Arising
No new matters arising were noted:
B/18.1 Action Matrix
Minute E/18 – January – Any Other Business – Influenza Vaccination Campaign Members discussed the distribution of the vaccinations to GP surgeries and Pharmacies. This was in progress and would be discussed at the August Primary Care Co-commissioning Committee.
Minute C/18 – May - Pennine Lancashire Clinical Commissioning Groups’ Confidential Provider Update Dr Malcolm Ridgway confirmed with colleagues on the reporting process for Never Events.
Minute G/18 – May - Any Other Business – Dissemination of Clinical Ideas Dr Nigel Horsfield requested how clinical ideas are shared. Dr Ridgway replied that there were systems in place for safety issues; NLRS reporting systems. Other areas were:
• GP Team Net; • Federation Support Team; • IHACS – Knowledge and Development • Medical Magazines • Social Media
Dr Ridgway confirmed there was no formal good idea repository.
Members then discussed various other options, including Hot Topics.
C/18 Pennine Lancashire Clinical Commissioning Groups’ Confidential Provider Update
Dr Ridgway presented the report, which provided the GB members with a briefing on new provider performance/quality issues that have occurred since the last meeting.
RESOLVED: That the GB received the report for information purposes.
D/18 Systems Update
The Chair provided a verbal systems update and began by confirming the new appointment of Miss Claire Jackson into the role of Strategic Director of Transformation across Pennine Lancashire (PL).
The CCG was still awaiting the outcome of the ballot for a single Accountable Officer across the PL CCGs. Once this was agreed, the post would be advertised.
E/18 Pay Award for Local Pay Scales
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The Lay Members declared a financial CoI in this item due to the paper proposing the level of remuneration for Lay Members. The Lay Members left the meeting and did not take any part in the discussion or decision.
Mr Iain Fletcher presented a paper on the pay award for the local pay scales.
The Lay Members had to be considered separately by other members of the GB due to their CoI as members of the Remuneration and Terms of Service Committee.
RESOLVED: That the GB agreed to uplift Lay Member pay rates in line with the inflation pay award for Agenda for Change.
The Lay Members returned to the meeting.
F/18 Adult Community Services: Next Steps and Opportunities
Miss Jackson presented the Adult Community Services paper.
The high level milestone plan was in progress and members noted that Mrs Janet Thomas would now be leading on this area of work going forward.
It was proposed that updates would be brought back to the GB in September and the meeting in public in November.
Questions and answers followed.
ACTION: Mrs Janet Thomas to present the high level milestone plan and Adult Community Services paper to the meeting in September.
RESOLVED: That the GB noted the content of the update.
G/18 Any Other Business
No further items were discussed.
The Chair thanked everyone for their attendance and the meeting closed.
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Item 7.1
GOVERNING BODY (GB) MEETING - ACTION MATRIX PART 1
Action Origins Action Owner Due Date Status GB Ref 18.010 (iii) Contract, Quality and Performance Report It was agreed that Professor Dominic Harrison would come back to a future meeting with information on life expectancy and DH JULY SEPTEMBER outcomes. AGENDA
18.023.1 (ii) Action Matrix – Contract, Quality and Performance Report Following an enquiry regarding cancer performance from Dr Horsfield, Dr Malcolm Ridgway agreed to request data relating to Blackburn with Darwen (BwD) patient outcomes for chemotherapy and surgery and how it compared nationally; to be circulated to GB for information, reviewed by the Pennine Lancashire Quality Committee and the assurance fed back to the GB.
18.040.1 (ii) The Chair agreed to contact Dr Neil Smith, General Practitioner Cancer Lead, for details of the survival rates (i.e. how long do patients survive following diagnosis) for BwD patients who have JR SEPTEMBER VERBAL UPDATE been referred with a variety of cancers to each different provider SEPTEMBER MEETING and how the figures compare with national and European average.
18.057.1 It was agreed to defer this item to the next meeting in the absence of Dr John Randall.
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18.024 Clinical Chief Officer’s Report Following an enquiry from Dr Geraint Jones about the commissioning of Perinatal Mental Health Services, Miss Claire CJ SEPTEMBER IN PROGRESS Jackson agreed that the commissioning proposal would be presented to GB when completed. 18.026 (i) Contract, Quality and Performance Report Miss Jackson agreed to feedback the comments from the GB in relation to Neurology Services to the Lead Commissioner, Greater Preston CCG, and report back to the GB. VERBAL UPDATE 18.057.1 Miss Jackson had met with the lead commissioner, Greater CJ MAY SEPTEMBER MEETING Preston and Chorley South Ribble CCG, who had put a plan in place. This had not resulted in a service improvement, therefore, a recovery report was being produced which would be available for the September meeting.
18.026 (ii) Contract, Quality and Performance Report Following a suggestion from Dr Zaki Patel, Dr Adam Black agreed to review the revised template for Neurology Service to see if this AB SEPTEMBER IN PROGRESS could be improved.
18.043 (i) Contract, Quality and Performance Report Following an enquiry from Mr Paul Hinnigan in relation to the out- patient procedure review figure. Mr Parr investigated why there RP JULY COMPLETED was a marked increase in the value of the figure and the spike in figures was down to incorrect coding.
18.043 (ii) Contract, Quality and Performance Report Following an enquiry from Mr Hinnigan about the Lancashire Care NHS Foundation Trust (LCFT) Community Stroke Service MR JULY VERBAL UPDATE Referral to Treatment Incomplete (BwD CCG) figure for February, SEPTEMBER MEETING Dr Ridgway had investigated why there was no data reported. This was revealed to be a reporting issue following a move to a new computer system and should be resolved.
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18.043 (iii) Contract, Quality and Performance Report Following an enquiry from the Chair in relation to the Ambulance Response Programme and emergency calls being received from either a GP’s surgery, an Out of Hours provider or a member of MR JULY the public, Dr Ridgway agreed to clarify the protocol for dealing with different types of call.
18.057.1 Dr Malcolm Ridgway had clarified with the North West Ambulance Service (NWAS) the protocol for dealing with different types of calls. He quoted that they were dealt with by the priority of the VERBAL UPDATE call. Drs Adam Black and Zaki Patel disagreed with this, as the EXECUTIVE SEPTEMBER SEPTEMBER MEETING response time appeared to be longer if the person had a Clinician GPs/MR with them and they provided examples. The Chair asked the Executive GPs to forward examples to Dr Ridgway in order for him to discuss with NWAS.
18.045 (i) Pennine Lancashire Accident and Emergency Delivery Board Following an enquiry from Mr Hinnigan, Mr Roger Parr agreed to obtain clarification of the wording of section 1.2 – assurance in RP SEPTEMBER IN PROGRESS relation to the responsibility for the delivery of key performance measures connected to the Urgent and Emergency Care System and bring back to the next meeting.
18.045 (ii) Pennine Lancashire Accident and Emergency Delivery Board (A&EDB) Following discussion, Mr Parr agreed to feed back the concerns of RP SEPTEMBER COMPLETED the GB in relation to the functionality of the A&EDB and if its membership was sufficiently representative of clinical members from Urgent and Emergency Care.
18.055 End of Life Care Update The Chair requested that Mrs Janet Thomas return with an annual JT JULY 2019 UPDATE IN update including performance measures in July 2019. JULY 2019 18.062 The Pennine Plan: Improving Health, Care and Well-being in Pennine Lancashire Miss Jackson asked GB Members for feedback or comments ALL JULY COMPLETED before 13th July 2018, to allow the GB to support the plan formally.
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18.066 Joint Committee of Clinical Commissioning Groups’ Agenda The Chair requested that copies of the agenda and supporting papers be circulated to the members once received. PM JULY COMPLETED
18.067 Any Other Business – NHS70 The Chair asked Mr Roger Parr to pass on his thanks to the staff of BwD CCG. RP JULY COMPLETED
18.067 Any Other Business – Blackburn with Darwen Borough Council The Chair agreed to write formally to the Chief Executive of the GB JULY COMPLETED Council to congratulate them on winning the award of Council of the Year.
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GOVERNING BODY MEETING
CLINICAL CHIEF OFFICER’S REPORT
Date of Meeting 5th September 2018 Agenda Item 8
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity X To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements X To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access X Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund X Access to Re-ablement and Intermediate Care X Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions X Access to high quality Urgent and Emergency Care X Scheduled Care X Quality √
Clinical Lead: Dr Penny Morris
Senior Lead Manager Mr Iain Fletcher Finance Manager Mr Roger Parr Equality Impact and Risk Assessment The report is for the information of members only. completed:
Is a Data Protection Impact Assessment Yes No Required? Data Protection Impact Assessment Yes No completed: Patient and Public Engagement completed: The report is for the information of members only. Financial Implications The report is for the information of members only. Risk Identified The report is for the information of members only. Report authorised by Senior Manager: Dr Penny Morris Decision Recommendations
The Governing Body is requested to receive this report and to note the items as detailed.
Report of the Clinical Chief Officer – 5th September 2018 Page 2 of 13
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
5TH SEPTEMBER 2018
CLINICAL CHIEF OFFICER’S REPORT
1) Introduction
This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Clinical Chief Officer’s (CCO) efforts have been directed since the last meeting.
2) Department of Health and Social Care (DHSC)
2.1 Secretary of State
Since my last report to the GB, members will be aware that, following a cabinet reshuffle, Matt Hancock MP was appointed as Secretary of State for Health and Social Care on 9th July 2018.
He was Secretary of State for Digital, Culture, Media and Sport from 8th January 2018 to 9th July 2018 and previously the Minister of State for Digital between July 2016 to January 2018.
The Secretary of State set out his ambitions for the future of the NHS and talked about the potential of technology to improve healthcare in an article for the Health Service Journal published on 12th July 2018. He also stated his admiration for the NHS and its staff.
In his first major speech on 20th July 2018, he set out his priorities for the health and social care system; its workforce, technology and prevention.
Further information via: https://www.gov.uk/government/speeches/matt-hancock-writes-in-the-health- service-journal-about-his-admiration-for-the-nhs-and-its-staff
https://www.gov.uk/government/speeches/matt-hancock-my-priorities-for-the-health-and-social-care- system
2.2 Preparations for Brexit
The Secretary of State wrote to all NHS organisations, GPs, Community Pharmacies and other service providers on 23rd August 2018.
The letter provided an update on the Government’s ongoing preparations for a March 2019 ‘no deal’ Brexit scenario and set out what the health and care system needs to consider in the period leading up to March 2019, including:
• the continued supply of medical products in the event of no deal; • business continuity plans.
Further information via: https://www.gov.uk/government/publications/letter-to-the-health-and-care- sector-preparations-for-a-potential-no-deal-brexit
Report of the Clinical Chief Officer – 5th September 2018 Page 3 of 13 2.3 Annual Report and Accounts
The DHSC Annual Report and Accounts gives an overview of the Department’s resources and how it has used them to fulfil its statutory functions during the financial year 2017/18.
The document describes DHSC’s performance against objectives and includes the Secretary of State’s Annual Report on the performance of the health service in England.
The Secretary of State may give financial assistance to any NHS Foundation Trust, including loans, public dividend capital, grants or other payment.
The Secretary of State may also guarantee the payment of any amount payable by a Foundation Trust under an externally financed development agreement. He has similar powers to provide financial assistance to NHS Trusts under Schedule 5 of the NHS Act 2006.
‘Financial assistance under section 40 of the National Health Service Act 2006: 2017 to 2018’ sets out the detail of how this power has been exercised in the financial year 2017/18.
Further information via: https://www.gov.uk/government/publications/dhsc-annual-report-and- accounts-2017-to-2018
2.4 Accounting Officer System Statement
The DHSC has published its Accounting Officer Statement for 2017/18, which is current and forwarding looking, and sets out all of the key accountability relationships and processes within the Department; also making clear who is accountable for what at all levels of the health and social care system.
Further information via: https://www.gov.uk/government/publications/department-of-health- accounting-officer-system-statement
2.5 Social Prescribing
The Government announced that it will invest nearly £4.5 million in programmes to refer patients to local voluntary and community services such as walking clubs, gardening or arts activities.
The practice, known as ‘social prescribing’, aims to improve patients’ quality of life, health and wellbeing by recognising that health is affected by a range of social, economic and environmental factors.
Evidence shows that this approach can reduce demand on NHS services: a UK study found that after 3 to 4 months, 80% of patients referred to a social prescribing scheme had reduced their use of Accident and Emergency (A&E), outpatient appointments and inpatient admissions.
A total of 23 social prescribing projects in England will receive a share of the funding to extend existing social prescribing schemes or establish new ones.
The schemes include a focus on:
• reaching out to people who may be socially isolated, for example because of mental health problems or learning difficulties; • providing support for those impacted by health inequalities, such as transgender people or people from black, Asian and minority ethnic (BAME) backgrounds; • helping people with particularly complex needs who regularly access health services.
Report of the Clinical Chief Officer – 5th September 2018 Page 4 of 13 The funding will come from the Health and Wellbeing Fund, part of a programme of Government investment in the voluntary sector. The projects will be fully funded through the scheme in their first year. Additional joint funding from local commissioners will be agreed for the subsequent 2 years.
A full list of the 23 social prescribing schemes to be funded by the Health and Wellbeing Fund has been published.
Further information via: https://www.gov.uk/government/publications/social-prescribing-schemes-to- be-funded-by-the-health-and-wellbeing-fund-2018/social-prescribing-schemes-to-receive-funding- from-the-health-and-wellbeing-fund-2018
2.6 Staff Remuneration
The Government announced on 24th July 2018 that around 1 million public sector workers were set to benefit from the biggest pay rise in almost 10 years. The 1% cap ended last year in recognition that dedicated public sector workers deserved a pay rise.
A balanced approach to the economy means that the increases are affordable within Government spending plans.
The award included a pay increase of at least 2% for Junior Doctors, Specialist Doctors, GPs and Dentists. Consultants will also get a pay rise of at least £1,150. (From October 2018: 2% for Dentists and Junior Doctors consolidated / 1.5% consolidated for Consultants with an additional 0.5% targeted at performance pay / 3% consolidated pay rise for specialty (SAS) Doctors / backdated to April 2018: 2% for GPs consolidated, with an additional 1% potentially available from April 2019 subject to contract reform).
This follows the 6.5% pay rise over 3 years that was announced in March for more than a million Nurses, Midwives and other Agenda for Change staff, in return for the modernisation of Terms and Conditions. It is vital that public services continue to modernise to meet rising demand for the services they provide, which improve lives and keep the public safe. Secretaries of State will be taking forward work to continue modernising their workforces in the coming years.
The Government has made an additional £800 million available to meet the costs of the Agenda for Change pay deal in 2018/19.
The document, ‘Agenda for Change pay deal: context and funding for 2018/19’, explains how the DHSC is allocating the additional £800 million between:
• NHS providers; • non-statutory non-NHS organisations; • NHS England, CCGs and Commissioning Support Units; • other arm’s length bodies.
Non-statutory non-NHS organisations can check their eligibility for additional funding by completing an ‘eligibility test’ form.
Further information via: https://www.gov.uk/government/publications/agenda-for-change-pay-deal- funding-for-2018-to-2019
2.7 Organ and Tissue Donation
The Government has outlined plans to implement a new system of consent for organ and tissue donation in order to tackle a shortage of donors. This will mean everyone is considered an organ
Report of the Clinical Chief Officer – 5th September 2018 Page 5 of 13 donor unless they have explicitly recorded a wish not to be or they are from one of these excluded groups:
• children under 18; • individuals who lack the mental capacity to understand the changes; • people who have not lived in England for at least 12 months before their death.
The donor register will include an option for individuals to state important religious and cultural beliefs to ensure these are respected. There will also be strict safeguards in place and Specialist Nurses will always discuss donation with families so an individual’s wishes are respected.
The proposed new system is expected to come into effect in England in spring 2020 as part of a drive to help people waiting for a life-saving transplant. There will be a 12-month transition period to allow time for discussion with friends and family about organ donation preferences.
The legislation was introduced in Parliament last July and is expected to return to the House of Commons in the autumn.
While the new system shifts the balance of presumption in favour of organ donation, those who do not wish to donate their organs will still be able to record their decision on the NHS Organ Donor Register, either via NHS Blood and Transplant’s website or by calling their helpline. The NHS app, launching at the end of this year, will make it even easier for people to record their decision.
2.8 Health Education England (HEE)
HEE has published its Annual Report and Accounts for 2017/18 which includes:
• a performance report – this provides a short summary of HEE’s work, its purpose, the key risks to the achievement of the Department’s objectives and how it has performed during 2017/18; • an accountability report – this explains the organisation of HEE’s governance structures and how they support the achievement of the Department’s objectives.
Further information via: https://www.gov.uk/government/publications/health-education-england- annual-report-and-accounts-2017-to-2018
3) NHS England
3.1 National Clinical Advisor for Primary Care
A specialist General Practitioner (GP) has been appointed to help spread NHS innovations which integrate health and social care throughout England.
Dr Karen Kirkham, who runs a practice in Dorset and specialises in women’s health, will work with the wider GP community to spread tried and tested innovation and transformation techniques across the country.
She trained at Middlesex Hospital Medical School, London, has been a GP for 25 years and is now senior partner in a large town centre training practice.
Dr Kirkham has been instrumental in setting up the trailblazing Dorset Integrated Care System, where a new approach to integration of care for patients, bringing together staff from local hospitals, community staff, General Practice and the Local Authorities, is pulling the local health system together.
In her new role as National Clinical Advisor for Primary Care with the NHS England Transformation Team, she will visit places, learn about their innovations and take them to other areas; encouraging health professionals to adapt or ‘lift and shift’ the successful models and spread good practice.
Report of the Clinical Chief Officer – 5th September 2018 Page 6 of 13 In 2013, at the inception of the CCGs, she became a GP commissioner and Locality Clinical Chair with Dorset CCG. She took on a key leadership role and became Assistant Clinical Chair for the CCG in 2015 leading on much of the reconfiguration and re-design work in Dorset over the last three years. She is now part of the leadership team in Dorset and is the Clinical Lead for the Dorset Integrated Care System (ICS).
3.2 Director of Primary Care and Deputy Medical Director
On 5th August 2018, Dr Arvind Madan released a statement confirming his decision to resign from his position as Director of Primary Care and Deputy Medical Director.
Dr Madan stated that, as part of his attempts to challenge the negative views – and even conspiracy theories – held by a small but vocal minority in the profession, he had posted on an anonymous online forum used by GPs. It was never his intention to cause offence but rather to provoke a more balanced discussion about contentious issues acting as a devil’s advocate.
He wanted to make it clear that these comments were not a reflection of NHS England policy, and it was now clear to him that trying to move the debate on in this way was not compatible with his role as Director of Primary Care.
He apologised unreservedly to those who had been upset, particularly in smaller practices, by his actions.
Following Dr Madan’s resignation announcement, the National Medical Director, Professor Stephen Powis confirmed that Dr Nikki Kanani MBE, who was currently Deputy Medical Director of Primary Care, would step up to be Acting Director of Primary Care on an interim basis with immediate effect.
He also confirmed that the substantive role would be advertised externally following the summer break.
3.3 GP Patient Survey 2018
As the NHS treats more patients than ever before, a new nationwide survey shows the vast majority of people are positive about their GP care – with eight out of ten patients rating their overall experience of their GP surgery as ‘good’.
The survey also found that confidence and trust in GPs and healthcare professionals remained extremely high at 95.6%; 93.5% of patients felt involved in decisions about their care and treatment, while 94.8% felt the healthcare professional met their needs.
The GP Patient Survey 2018 compiled responses from almost 760,000 people across the country on their experience of healthcare services provided by GP surgeries, including access to GPs, making appointments, the quality of care received from GPs and other health professionals, waiting times, and satisfaction with opening hours and out-of-hours NHS services. The survey, which has been redesigned to better reflect patient experience and the changing shape of primary care, has also been extended to include 16-17 year olds for the first time.
Further findings include that 83.8% described their overall experience of their GP practice as very or fairly good. The majority of patients (68.6%) rated their overall experience of making an appointment as good. Overall 61.6% of patients got an appointment at a time they wanted or sooner and 66.1% of patients who wanted a same day appointment got one.
Around 7 in 10 patients said it was very or fairly easy to get through to someone at their GP surgery on the phone, while more than 78% of patients who have used their GP practice website said they found it easy to access information or services.
Report of the Clinical Chief Officer – 5th September 2018 Page 7 of 13 When asked about their last appointment, 89.0% of patients said the healthcare professional was good at listening to them, 87.4% felt they were good at treating them and 86.8% of patients said they had been given enough time.
This year’s survey had been extensively redesigned following engagement with over 200 stakeholders, including patients, the British Medical Association (BMA), the Royal College of General Practitioners (RCGP), and clinical and policy specialists from across the NHS, academia, the voluntary and community sector and think tanks. The aim was to help better understand and shape areas for improvement in people’s experiences of General Practice and evolving approaches to delivering GP services. This meant the majority of questions were not comparable with previous years, and that no comparable data will be published by NHS England.
Key findings: • 83.8% described the overall experience of their GP surgery as good; • 68.6% of patients rated their overall experience of making an appointment as good; • Of everyone who wanted a same day appointment, 66.1% got one; • Of those who have a preferred GP, more than half (50.2%) said that they see or speak to them a lot of the time, almost always or always; • 93.5% of patients felt involved in decisions about their care and treatment; • 87.4% felt their healthcare professional was good at treating them; • 78.3% of patients who have tried to use their GP practice website found it easy to access information or services; • Almost 7 in 10 patients (68.7%) reported a good experience of NHS services when they wanted to see a GP but their GP practice was closed; • 91.2% of patients had confidence and trust in all of the people they saw or spoke to when their GP practice was closed.
Further information via: https://gp-patient.co.uk/surveysandreports
3.4 Annual Report and Accounts 2017/18
NHS England has published its Annual Report and Accounts 2017/18.
The report describes the work carried out over the last year and outlines some of the most significant achievements and challenges.
Chief Executive, Simon Stevens, said that the past year had again been one of both progress and pressure but genuine and measurable advances had been secured in many critical services; upgrades to cancer radiotherapy treatment, and steadily improving cancer survival rates, as well as expanded mental health services, particularly for new mums and for young people needing specialist care.
Further information via: https://www.england.nhs.uk/publication/nhs-england-annual-report-2017-18/
3.5 Consultation on Contracting Arrangements for Integrated Care Providers
NHS England has now launched a 12 week consultation on the contracting arrangements for Integrated Care Providers (ICPs). The consultation period runs from 3rd August to 26th October 2018.
The consultation provides more detail about how the proposed ICP Contract would underpin integration between services, how it differs from existing NHS contracts, and how ICPs fit into the broader commissioning system. There is widespread support for ending the fragmented way that care has been provided to improve services for patients and the NHS has been working towards this in a number of ways.
Report of the Clinical Chief Officer – 5th September 2018 Page 8 of 13 ICPs are intended to allow health and care organisations to be funded to provide services for a local population in a coordinated way. Following two recent Judicial Reviews which were dismissed, the High Court has twice now ruled that this proposed contractual approach to developing integrated care is lawful; and in a recent report Parliament’s cross-party Health and Social Care Select Committee said ICPs were part of a ‘pragmatic response’ to pressures in the system. The previous iteration of this contract was referred to as the draft Accountable Care Organisation Contract. The term Integrated Care Provider is in recognition that, as reported by the House of Commons Health and Social Care Committee, previous use of the term ‘accountable care’ has generated unwarranted misunderstanding about what is being proposed – which is a move to more integrated care. The documents and supporting package of materials are available via: https://www.engage.england.nhs.uk/consultation/proposed-contracting-arrangements-for-icps/
4) NHS Resolution
4.1 Annual Report and Accounts 2017/18
NHS Resolution has published its Annual Report and Accounts for 2017/18.
The report reveals that the NHS paid out more than £1.22 billion in clinical negligence damages to claimants in 2017/18, with a further £404 million being paid as a result of the change to the personal injury discount rate. This represents an overall increase of £549 million (33.4%) from the previous year.
This is despite the fact that the numbers of both new clinical and non-clinical negligence claims received in 2017/18 fell in comparison to the previous year. For clinical claims this was a slight reduction from 10,686 to 10,673, and for non-clinical claims a more significant reduction from 4,082 to 3,570. This is in part due to the fact that some of the payments represent claims made in previous years but is also a consequence of significant inflation in damages.
Further information via: https://resolution.nhs.uk/wp-content/uploads/2018/07/NHS-Resolution- Annual-Report-2017-2018_digital.pdf
5) Lancashire and South Cumbria
5.1 Healthier Lancashire and South Cumbria
5.1.1 Executive Team
Following a recruitment and selection process, the following staff have been appointed to the Executive Team of the ICS:
• Amanda Doyle – Chief Officer • Talib Yaseen – Executive Director of Transformation • Andrew Bennett – Executive Director of Commissioning • Gary Raphael – Executive Director of Finance and Investment • Andy Curran – Executive Medical Director • Jackie Hanson – Director of Nursing and Care Professionals • Jane Cass – Director of Performance, Delivery and Assurance
The ICS in the process of developing a Job Description for the Executive Director of Health and Social Care Integration post and will be appointing to this over the next couple of months.
Report of the Clinical Chief Officer – 5th September 2018 Page 9 of 13 5.1.2 Digital Health
During July and August Healthier Lancashire and South Cumbria (L&SC) toured L&SC with Healthwatch’s Chatty Van to talk to people about how technology can be used to improve their health and well-being.
The Chatty Van tour follows the launch of ‘Our Digital Future, a digital strategy for L&SC’, which outlines a number of shared principles for developing digital solutions between the partners of Healthier L&SC, which includes hospital trusts, NHS organisations and Local Authorities.
Understanding how patients and citizens use technology, devices and apps will allow the health and care organisations to make sure technology will support people to manage their health and wellbeing. The activity will provide information about digital technologies currently available, as well as listening to feedback about where digital can improve services.
Further information via: http://www.healthierlsc.co.uk/digitalfuture
5.1.3 Joint Committee of CCGs
Members of the public have been invited to observe the Joint Committee of CCGs (JCCCG), which is set to hold its next formal meeting in public on Thursday 4th October 2018 at 1 pm, venue to be confirmed.
The JCCCG is made up of GPs and Lay Members from each of the CCGs in L&SC. Chief Executives from Lancashire County Council, Blackburn with Darwen Borough Council (BwDBC), Blackpool Council, representatives from District Councils, local Healthwatch are not members of the Committee, but attend the meetings.
Further details via: https://www.healthierlsc.co.uk/joint-committee-ccgs
6) Pennine Lancashire
6.1 Together a Healthier Future (TAHF) Programme
6.1.1 The ICP has already driven a significant amount of change over the past six months, with key elements from all components of the New Model of Care moving forward into detailed design and/or operationalisation.
Project plans have been finalised for the 2018/19 delivery priorities of the ICP. The plans outline how key elements of the New Model of Care, including Neighbourhood Health and Well-being Teams, are to be taken forward this year; highlighting key milestones for delivery and intended benefits of the activity. These plans now form the basis for monthly progress reporting to the Partnership Delivery Group, and allow for matters of concern and risk to be escalated and managed accordingly by workstream leads.
The plans have now been summarised in a draft Delivery Plan, which provides the Partnership Leaders with a clear overview of the breadth of delivery activity for 2018/19. A high level summary of the Delivery Plan will be published, along with the final Pennine Plan, in September.
7) Blackburn with Darwen
7.1 CCG
7.1.1 Assurance Rating
Report of the Clinical Chief Officer – 5th September 2018 Page 10 of 13
NHS England has published its national CCG Assurance Ratings for 2017/18. CCGs were rated as ‘Outstanding’, ‘Good’, ‘Requires Improvement’ or ‘Inadequate’.
I am pleased to report that BwD CCG has achieved a rating of ‘good’ in the assessment of its performance. The CCG also achieved the highest rating (green) for the quality of its leadership and management of its finances.
The CCG is one of 7 of the 8 CCGs in L&SC to achieve a coveted ‘green’ rating. The rating puts BwD CCG in a top performing group of CCGs in the country.
The rating is testament to the hard work and efforts of CCG staff and GP Practices in BwD but also about working in partnership with BwD Borough Council and our health service providers; as well as being more innovative to put patients first and make a difference to people’s lives.
The CCG has made good progress over the last year, particularly in relation to reducing the 18 week waiting time target and, as such, received acknowledgement of this from the Secretary of State for Health and Social Care. The CCG also achieved recognition for its innovative management and commissioning of non-emergency hospital health care for BwD residents.
Having ended the previous year with a financial deficit, the CCG was keen to make 2017/18 a year of stability. I am pleased to say that the CCG achieved this. It was particularly gratifying that NHS England congratulated the CCG on achieving this; while recognising that the CCG continued to face pressures in demand for services, as well as financial pressures.
NHS England also recognised that the CCG was shortlisted in the national Flu Fighter Awards for its innovative communications campaign, which contributed to an improved uptake of the flu vaccine in the winter months and a BwD Practice Manager obtained the much coveted national Practice Manager of the Year Award.
The CCG was also applauded for demonstrating good partnership working particularly with BwDBC; in maternity services, falls prevention, dementia care and diagnosis and in achieving 100% coverage of GP extended access for patients in all 24 of the GP practices in BwD.
7.1.2 Annual General Meeting
The CCG will hold its Annual General Meeting (AGM) on 26th September 2018 at 12.45 pm in the Hornby Theatre, Blackburn Central Library. Prior to the AGM, there will be a stakeholder event, commencing at 11 am, for the CCG’s stakeholders to meet CCG staff and find out more about its activities and the challenges ahead.
Further information via: http://www.blackburnwithdarwenccg.nhs.uk/stakeholder-event- annual-general-meeting-26th-september-2018/
7.2 Primary Care
7.2.1 Care Navigation
GP Practices in BwD have introduced a new scheme in the Borough to help support and guide patients to access the most appropriate service.
Report of the Clinical Chief Officer – 5th September 2018 Page 11 of 13 The scheme is called Care Navigation. Care navigators are GP receptionists and administration staff who have been given specialist training in order to help them direct patients to the right health professional first time. Care Navigation is a tried and tested model of care that improves access to Primary Care Services for patients and reduces GP pressures. It allows front line staff to provide patients with more information about local health and wellbeing services, both within and outside of Primary Care, in a safe, effective way. Care Navigation offers the patient ‘choice, not triage’ to a range of services and to help people access the most appropriate service first, which is not always the GP. It means that patients will find it easier to get a GP appointment when they need one.
When a patient contacts the practice, the care navigator will ask for a brief outline of the problem so they can identify the patient’s need. This will allow the care navigator to refer to information about services in the practice, other NHS providers and the wider care and support sector. Where appropriate, they will direct the patient to these services. Their goal is to ensure that patients get the right care at the right time in the right place with the right outcome. For example, when a patient presents with symptoms that would be better dealt with by another service such as a Pharmacist or Optician, patients can be confidently offered these choices, allowing them to go straight to the service which best meets their health and wellbeing needs.
Care Navigation will support practices and patients to make the best use of valuable NHS resources.
Five services will initially be available for care navigators to signpost to but as Care Navigation develops, more services will be introduced. These are:
• Minor Eye Treatment Service; • Health and Well-being; • Age UK; • Community Pharmacy; • Dental.
8) Meetings
Members may be interested to note the following meetings and events attended by the CCO that have taken place during the course of the last two months:
4th July 2018 Team to Team Meeting with East Lancashire (EL) CCG 4th July 2018 Urgent and Emergency Care Discussion Session 4th July 2018 Roundtable – Clinical Leadership in the L&SC ICS 5th July 2018 Joint Committee of CCGs 5th July 2018 NHS 70 Tea Party 18th July 2018 Accountable Officers/Chief Executives ICS Executive Meeting 18th July 2018 Commissioning Business Group 26th July 2018 Local ICP Board 1st August 2018 Team to Team Meeting with EL CCG 1st August 2018 Care Professionals Board 2nd August 2018 Joint Committee of CCGs 14th August 2018 Pennine Lancashire Clinical Reference Group 15th August 2018 Accountable Officers/Chief Executives ICS Executive Meeting
Report of the Clinical Chief Officer – 5th September 2018 Page 12 of 13 9) Recommendation
The GB is requested to receive this report and to note the items as detailed.
Dr. Penny Morris Clinical Chief Officer 24th August 2018
Report of the Clinical Chief Officer – 5th September 2018 Page 13 of 13
GOVERNING BODY MEETING
Chief Finance Officer Report
Date of Meeting 5th September 2018 Agenda Item 9
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity y To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality
Clinical Lead: N/A
Senior Lead Manager Mr Roger Parr Finance Manager Mrs Linda Ring Equality Impact and Risk Assessment N/A completed: Is a Data Protection Impact Assessment Required? No GOVERG BODGOVERNING BODY MEETING Governing Body Meeting Page 1 of 3
Data Protection Impact Assessment completed: No Patient and Public Engagement N/A completed: Financial Implications As per report Risk Identified As per report Report authorised by Senior Manager: Mr Roger Parr Y
Decision Recommendations The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of July 2018.
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Executive Financial Summary Month 4 – Period Ending 31st July 2018
Year to Date (YTD) Full Year Forecast Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 Funds Available 84,977 84,977 0 259,708 259,708 0
Commissioning 64,763 65,043 (280) 192,405 192,844 (439) Primary Care 17,642 17,656 (14) 54,622 54,660 (38) Corporate 2,356 2,278 78 7,049 7,019 30 Reserves 216 0 216 5,632 5,185 447 Balance 0 0 0 0 0 0
Summary Financial Position – The CCG is reporting a breakeven position in line with the financial plan. The CCG is on plan to deliver its year end forecast breakeven position.
Commissioned Services Risks
• Healthcare Commissioning is reporting a YTD overspend of £280k with • The CCG has a QIPP target of £6.0m and has achieved savings of a year-end forecast overspend of £439k. £1.4m or 23.8% of the total target. There is a risk that some schemes • Primary Care Services are reporting a small YTD overspend of £14k will not fully release the planned savings in year and the CCG continues with a forecast year end overspend of £38k. Prescribing figures have to look for opportunities to mitigate any shortfalls. been received for April and May and expenditure June and July is • Acute activity levels continue to be a key factor in 2018/19. Schemes therefore estimated. are in place to manage demand • Corporate Services are reporting an underspend of £78k and an • Continuing health care and complex packages continues to be a key underspend of £30k is forecast at year end. risk as these are generally high cost and low volume. The CCG continues to closely monitor this area of expenditure. Capital • Prescribing expenditure is volatile and is monitored closely by the Medicines Management Team. The prescribing waste scheme • A combined budget for hardware replacement of the GPIT estates, continues into 2018/19 and is making significant savings. provision of mobile working and the upgrade all practices across Blackburn with Darwen CCG to Windows 10 has been submitted and QIPP approved by NHS England on behalf of the CCG. Expenditure of • The CCG has actioned 23.8% of its QIPP savings to date and is on plan £148k is expected in 2018/19. to meet the full year savings of £6.0m.
Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of July 2018.
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NHS Blackburn with Darwen CCG APPENDIX A
Summary Governing Body Report ‐ July 2018
Annual Forecast Budget to Date Expenditure to Date Variance to Date Annual Budget Annual Forecast Variance £000 £000 £000 £000 £000 £000
Revenue Resource Limit
Confirmed (84,977) (84,977) 0 (259,708) (259,708) 0 Anticipated 000000 Total Revenue Resource Limit (84,977) (84,977) 0 (259,708) (259,708) 0
Expenditure
Commissioning (Page 2) 82,405 82,699 (294) 247,027 247,504 (477) Corporate (Page 4) 1,212 1,158 54 3,542 3,512 30 Reserves (Page 4) 216 0 216 5,632 5,185 447 Healthcare Sub Total 83,833 83,857 (24) 256,201 256,201 0
Running Costs (Page 4) 1,144 1,120 24 3,507 3,507 0 Total Expenditure 84,977 84,977 0 259,708 259,708 0
Surplus/(Deficit) 000000
Better Payment Practice Code YTD Value (%) YTD Volume (%) FOT Value (%) FOT Volume (%) Target (%)
NHS 99.9 99.6 99.0 99.0 95.0
Non NHS 99.7 99.9 99.0 99.0 95.0 NHS Blackburn with Darwen CCG APPENDIX B
Healthcare Commissioning Report ‐ July 2018
Expenditure to Annual Forecast Budget to Date Variance to Date Annual Budget Annual Forecast Date Variance £000 £000 £000 £000 £000 £000
Acute Services
NHS contracts (includes Ambulance Services) 41,518 41,567 (49) 124,523 124,566 (43) Non NHS Providers 2,093 2,077 16 6,137 6,122 15 NHS Contract Exclusions / Cost per Case 223 371 (148) 587 739 (152) Non Contract Activity 532 548 (16) 1,596 1,644 (48) Other 43 67 (24) 102 127 (25) Sub Total Acute Contracts 44,409 44,630 (221) 132,945 133,198 (253)
Mental Health Services
NHS contracts 5,787 5,789 (2) 16,670 16,670 0 Non NHS Providers 437 449 (12) 1,111 1,111 0 IPA ‐ Complex Packages 265 278 (13) 795 881 (86) Non Contract Activity 215 222 (7) 420 442 (22) Other 239 243 (4) 511 511 0 Sub Total Mental Health Services 6,943 6,981 (38) 19,507 19,615 (108)
Community Health Services
NHS contracts 4,809 4,809 0 14,428 14,428 0 Non NHS Providers 491 551 (60) 1,290 1,453 (163) IPA ‐ Complex Packages 118 123 (5) 353 370 (17) NHS Contract Exclusions / Cost per Case 79 58 21 238 174 64 Non Contract Activity 000000
Hospices 377 376 1 1,076 1,076 0 Other 000000 Sub Total Community Services 5,874 5,917 (43) 17,385 17,501 (116)
Total Healthcare Contracts 57,226 57,528 (302) 169,837 170,314 (477)
Continuing Care Services
Continuing Care 2,628 2,433 195 7,885 7,295 590 Free Nursing Care 383 400 (17) 1,148 1,200 (52) Sub Total Continuing Care Services 3,011 2,833 178 9,033 8,495 538
Primary Care Services
Prescribing 8,616 8,616 0 25,849 25,849 0 Enhanced Services 600 608 (8) 1,800 1,825 (25) Primary Care Co‐Commissioning 7,075 7,080 (5) 22,902 22,902 0
Out of Hours 421 421 0 1,262 1,262 0 Commissioning 583 586 (3) 1,769 1,769 0 Other 347 345 2 1,040 1,053 (13) Sub‐total Primary Care services 17,642 17,656 (14) 54,622 54,660 (38)
Other Programme Services
Other Non Acute 2,955 2,948 7 8,821 8,832 (11) Complex Cases & Individual Funding Requests 1,571 1,734 (163) 4,714 5,203 (489) Sub Total Other Programme Services 4,526 4,682 (156) 13,535 14,035 (500)
Surplus/(Deficit) 82,405 82,699 (294) 247,027 247,504 (477) NHS Blackburn with Darwen CCG APPENDIX C
Main Healthcare Contracts ‐ July 2018
Expenditure to Annual Forecast Budget to Date Variance to Date Annual Budget Annual Forecast Date Variance £000 £000 £000 £000 £000 £000
Acute Contracts Main Provider
East Lancashire Hospitals NHS Trust 35,302 35,302 0 105,905 105,905 0
Other Lancashire Providers
Lancashire Teaching Hospitals NHS FT 1,971 1,971 0 5,913 5,913 0 Blackpool Fylde & Wyre Hospitals NHS FT 228 233 (5) 690 695 (5) University Hospitals Morecambe Bay NHS FT 40 40 0 119 119 0 North West Ambulance Service NHS Trust (Block) 2,513 2,524 (11) 7,539 7,571 (32) Sub Total Other Lancashire Providers 4,752 4,768 (16) 14,261 14,298 (37)
Greater Manchester Providers
University Hospital South Manchester NHS FT 000000
Salford Royal NHS FT 149 149 0 442 442 0 Royal Bolton Hospitals NHS FT 113 115 (2) 340 346 (6) Wrightington, Wigan & Leigh NHS FT 310 341 (31) 897 897 0 Central Manchester University Hospital NHS FT 680 680 0 2,039 2,039 0 Pennine Acute NHS Trust 48 48 0 145 145 0 The Christie NHS FT 76 76 0 227 227 0 Sub Total Greater Manchester Providers 1,376 1,409 (33) 4,090 4,096 (6)
Merseyside Providers
Royal Liverpool & Broadgreen NHS Trust 55 55 0 166 166 0 Sub Total Merseyside Providers 55 55 0 166 166 0
Independent Sector Contracts
BMI Healthcare (Beardwood, Beaumont, Gisburne) 1,962 1,947 15 5,741 5,726 15 Ramsay 131 131 0 393 393 0 Sub Total 2,093 2,078 15 6,134 6,119 15
Total Acute Contracts 43,578 43,612 (34) 130,556 130,584 (28)
Mental Health Contracts
Lancashire Care NHS FT (Block) 5,775 5,777 (2) 16,635 16,635 0 Calderstones Partnership NHS FT (Block) 000000 Greater Manchester West NHS FT 10 11 (1) 31 32 (1) Total Mental Health Contracts 5,785 5,788 (3) 16,666 16,667 (1)
Community Health Contracts
Lancashire Care NHS FT (Block) 4,809 4,809 0 14,428 14,428 0 Total Community Health Contracts 4,809 4,809 0 14,428 14,428 0
Surplus/(Deficit) 54,172 54,209 (37) 161,650 161,679 (29) NHS Blackburn with Darwen CCG APPENDIX D
Non Healthcare Commissioning Report ‐ July 2018
Annual Forecast Budget to Date Expenditure to Date Variance to Date Annual Budget Annual Forecast Variance £000 £000 £000 £000 £000 £000
Other Corporate Costs (Non‐Running Costs)
CSU re‐charge 000000 NHS Property Services re‐charge 793 793 0 2,590 2,590 0 Other 419 365 54 952 922 30 Sub Total Corporate Costs 1,212 1,158 54 3,542 3,512 30
Plan requirements & reserves
Reserves 216 0 216 5,632 5,185 447 Sub Total Reserves 216 0 216 5,632 5,185 447
Running Costs
CCG Pay 544 520 24 1,676 1,676 0 CSU re‐charge 436 436 0 1,307 1,307 0 NHS Property Services re‐charge 42 50 (8) 127 134 (7) Other 122 114 8 397 390 7 Running Costs Reserve 000000 Sub Total Running Costs 1,144 1,120 24 3,507 3,507 0
Surplus/(Deficit) 2,572 2,278 294 12,681 12,204 477 NHS Blackburn with Darwen CCG
Statement of Financial Position ‐ July 2018
July Statement of Financial Position £000
Non Current Assets Intangible Assets 9
Total Non Current Assets 9
Current Assets Trade and Other Receivables 1,614 Financial Assets 0 Inventory 474 Cash and Bank 175
Total Current Assets 2,263
Total Assets 2,272
Current Liabilities Trade and Other Payables (9,416) Other Liabilities 0 Provisions (125) Borrowings 0
Total Current Liabilities (9,541)
Total Assets less Current Liabilities (7,269)
Non Current Liabilities Trade and Other Payables 0 Provisions 0 Borrowings 0 Other Liabilities 0
Total Non Current Liabilities 0
Total Assets Employed (7,269)
Financed By General Fund (7,269) Revaluation Reserve 0 Donated Asset Reserve 0 Government Grant Reserve 0 Other Reserves 0
Total Equity (7,269)
GOVERNIING BODY MEETING GOVERG BODGOVERNING BODY MEETING Contract, Quality and Performance Report
Date of Meeting 05 September 2018 Agenda Item 10
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor 9 outcomes and inequalities To work collaboratively to create safe, high quality health care services 9 To maintain financial balance and improve efffficiency and productivity 9 To deliver a step change in the NHS preventing ill health and supporting people to live 9 healthier lives To maintain and improve performance against core standards and statutoryy requirements 9 To commission improved out of hospital care 9 CCG High Impact Changes Delivering high quality Primary Care at scale and improving access 9 Self-Care and Early Intervention 9 Enhanced and Integrated Primary Care and Better Care Fund 9 Access to Re-ablement and Intermediate Care 9 Improved hospital discharge and reduced length of stay 9 Community based ambulatory care for specific conditions 9 Access to high quality Urgent and Emergency Care 9 Scheduled Care 9 Quality 9
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Clinical Lead: Dr Malcolm Ridgway – Directoor of Quality and Performance Mr Roger Parr – Chief Financce Officer Senior Lead Manager Mr Roger Parr – Chief Financce Officer Finance Manager Mrs Jill Marr – Senior Finance Officer Equality Impact and Risk Assessment Not Required completed: Is a Data Protection Impact Assessment Required? Yes No 9 Data Protection Impact Assessment completed: Yes No 9 Patient and Public Engagement Not Required completed: Financial Implications None identified at this stage Risk Identified Fluctuating performance and potential impact on the quality of patient care
Report authorised by Senior Manager: Dr Malcolm Ridgway – Director of Quality and Performance Mr Roger Parr – Chief Finance Officer / Interim Deputy Chief Executive Y
Decision Recommendations To note the contents of the report and support actions as identified.
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Contract & Information Quality & Performance Lancashire Care Foundation Trust (LCFT) Mental Health ‐ Executive Summary Lancashire Care Foundation Trust (LCFT) Mental Health ‐ Executive Summary Month 3 Month 3
Psychological Therapies – Blackburn with Darwen Clinical Commissioning Group (BwD Early Intervention in Psychosis (EIP) ‐ The 53% target for treatment with a NICE CCG) has a monthly access target of 318 (needed to deliver an annual access rate of approved care package within two weeks of referral was achieved at Trust‐level in 19.0% of estimated prevalence during 2018/19). The CCG’s year to date (YTD) June 2018, with performance at 66.67%, based on a total cohort of 27 service users. performance, including the Long‐Term Conditions (LTC) IAPT Service, is below the level The target was also achieved for BwD CCG, with performance at 75.0%, based on a required to achieve this target: cohort of 4.
o LCFT IAPT ‐ Core Service: 759 Patients into treatment At Trust level, the number of service users waiting at the end of June 2018 increased o LCFT IAPT – LTC Service: 48 Patients into treatment to 68, from 52 in May 2018. LCFT reports that this is a result of higher levels of demand (130 referrals received) and an increased number of late referrals, o YTD Total 807 Patients (4.1% of estimated prevalence) indicative of the overall pressure within mental health services. This will create YTD Target: 955 Patients (4.75% of estimated prevalence) o additional pressure within the service to meet the 2‐week target and a decrease in performance is expected for July. Lancashire Women’s Centre (Core Service plus LTC) is now sub‐contracted via LCFT and is included in the above performance. LCFT have provided assurance that the access The Trust reports continued focus on EIP performance, supported by daily SITREPS rate of 19% will be met in Quarter 4. and teleconferences, chaired by senior management and involving front line staff, managers and performance colleagues, with the aim of ensuring that all new Referrals – at Month 3, BwD CCG referrals to LCFT Mental Health Services have referrals are allotted appointments within the 14‐day window. All actions have increased on 2017‐18 levels +50 (+6.9%). When compared to 2018‐19 plans, referrals been incorporated into the transformation project that is tasked with building are above the expected level +35 (+4.7%). sustainability in the EIP service.
Admissions ‐ including Out of Area admissions, are below the number admitted in the ADHD ‐ In June 2018, at Trust level, the proportion of new referrals to the ADHD previous year i.e. 68 in 2018‐19, versus 96 in 2017‐18 ‐28 (‐29.2%). Against plans based service waiting less than 18 weeks for treatment was 24.22%, an improvement on the last 2 years total admissions to LCFT, adjusted for current Mental Health compared with the May position (22.15%). This equates to 117 out of 483 new weighted population, BwD CCG is below plan ‐8 (‐10.2%). referrals waiting under 18 weeks. The proportion of transition referrals th (adolescents approaching their 16 Birthday or adults aged 16 + who are currently Bed Days ‐ including Out of Area bed days and based on plans which take LCFT’s total receiving care from Child and Adolescent Mental Health Services or Community available bed days, BwD CCG patients account for more than BwD CCG’s Mental Health Paediatricians) waiting less than 18 weeks in June was 41.85%, a deterioration weighted population share of bed days +447 (+15.7%). compared with the May position (49.12%). This equates to 136 out of 325 transition referrals waiting under 18 weeks. LCFT has reported that the new assessment Out of Area Placements (OAPs) – OAPs for 2018/19 are (for BwD CCG) 5.9% of waiting list continues to grow due to lack of capacity and the high number of annual admissions and 12.2% of all bed days. For admissions, this is an increase on the same reviews limits capacity to increase the number of clinic appointments to period last year when OAPs accounted for 5.2% of all admissions. For Bed Days, this is accommodate this. However, service users transitioning from CAMHS / Paediatric
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an increase on the same period last year when OAPs accounted for 8.4% of all bed days. services are being prioritised as they are on established treatment. Work to review By comparison, OAPs for all Lancashire CCGs combined are 6.3% of admissions and 9.6% the ADHD Service is ongoing and Commissioners have been involved in workshops of all bed days. This is an increase on the same period last year, when OAPs accounted aimed at developing the service and improving performance. for 5.8% of all admissions and 8.0% of all bed days. Out of Area Placements ‐ At Trust level, there was an average of 26.6 Out of Area Placements (OAPs) in June 2018, against the forecast trajectory of 16. This was a reduction on the average number of OAPs reported for May (38.65). The OAPs position and the impact of admission avoidance schemes are reported on a monthly basis via the LCFT Operational Resilience Group.
Duty of Candour – Work has been ongoing with LCFT to ensure that the Trust's monthly reporting of Duty of Candour compliance is consistently reflective of all Serious Incidents affecting patients, in which harm graded as moderate or above has been caused.
In the Trust's submission for May 2018, the content fully reflected the records maintained by the Host CCG and indicated that the Duty of Candour had been served in all relevant cases. Following the June submission however, a query was raised with LCFT regarding apparent discrepancies between the information summarised in the Trust's report and the CCG's records. The submitted report also indicated 2 Duty of Candour breaches due to the length of time between the reporting of incidents and the provision of written follow‐up notification.
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Contract & Information Quality & Performance East Lancashire Hospitals NHS Trust (ELHT) ‐ Executive Summary East Lancashire Hospitals NHS Trust (ELHT) ‐ Executive Summary Month 3 Month 3
Annual Plan ‐ The Annual Plan has not yet been agreed with ELHT. This issue will be A&E 4 Hour – The 95% 4 hour waiting time target for A&E was not met in June 2018 at ELHT, however an improvement in performance was reported, at 86.59%, resolved in Month 4 data. compared with 86.14% in May 2018. A&E Performance continues to be monitored Referral to Treatment – the number of BwD CCG patients awaiting treatment is 6,365 via the A&E Delivery Board. at M3. This is a slight reduction on the previous month (‐6, ‐0.1%). There are 458 Ambulance Handovers – In June 2018 there was a decrease in the number of patients waiting >18 weeks = 7.2% (target <8%). ambulance handovers over 30 minutes (250), compared with 371 in May 2018. The Referrals – Referrals to the CCG’s main hospital provider (ELHT) have decreased this number of handovers over 60 minutes (55), remained static in June 2018. As year compared to the same period last year ‐405 (‐3.5%). A reduction in referrals from previously reported, Rapid Assessment and Treatment (RAT) processes have been refined which is having a positive impact on reducing longer handovers. GPs account for most of this decrease ‐339 versus 2017/18 (‐4.9%).
12 Hour Breaches – In June 2018, there were 32 Mental Health (MH) and 1 Physical Health (PH) 12‐hour A&E breaches at ELHT. Due to the continued pressures within the Emergency Department, NHS England has requested that breaches within this period are reviewed as a cluster.
An overarching summary report for Quarter 1 2018 will be submitted to the A&E Delivery Board, including themes, trends and actions being taken to address 12‐ hour breaches.
Referral to Treatment (RTT) Incomplete – In June 2018, the referral to treatment incomplete target at ELHT was met with performance of 93.0%. The standard for BwD CCG patients within ELHT was met with performance at 92.8%. 11 BwD CCG patients are currently waiting >36 weeks (of which 0 are >52 weeks).
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Contract & Information Quality & Performance Primary Care ‐ Executive Summary Primary Care ‐ Executive Summary Month 3 Month 3
Out of Hours ‐ Compared to last year’s Month 3 data, total activity for the Out of Hours Care Quality Commission (CQC) ‐ There are currently 24 GP practices in Blackburn service provided by ELMS is over plan YTD by +94 (+2.0%). There have been various with Darwen CCG spread across four neighborhoods. 21 practices have received an service changes since last year, with two elements now being reported, on the basis of overall rating of ‘Good’, one practice ‘Outstanding’ and one practice ‘Inadequate’. “Received Case Type” rather than “Finished Case Type”: Advice (formerly labelled Dr Hollins Grove Practice has changed its contract holder and are currently waiting to Advice, and now incorporating a broader range of Advice types) which is higher than be re‐ inspected; until then the practice is unable to advertise a CQC rating. Umar last year (+1,532, +109.4%), and To Be Seen (formerly Primary Care attendances and Medical Centre received an overall rating of ‘Inadequate’. The practice submitted an Home Visits) which is lower than last year (‐1,438, ‐43.4%). action plan with timeframes to address the areas of improvement. On 31st July 2018, the practice received a ‘focus visit’ from the CQC to ensure that the areas of Year to date ‐ Activity Full Year Forecast ‐ Activity improvement detailed in the enforcement notices had been addressed. The draft 18/19 17/18 Variance Status 18/19 17/18 Variance Status report is with the practice. A full re‐inspection will take place in 6 months’ time.
To be 1876 3314 ‐1438 ‐43.4% G 7412 13,094 ‐5682 ‐43.4% G seen Quality Visits – The BwD CCG Primary Care Group continue to utilise the Pennine Lancashire Primary Care Quality dashboard plus soft intelligence to identify GP Advice 2933 1401 1532 109.4% R 11,014 5261 5753 109.4% R Practices that are raising concerns or showing poor performance around patient experience and clinical outcomes. The visit aims to be supportive and practices are
Total 4809 4715 94 2.0% G 18,426 18,355 71 0.4% G asked to formulate an action plan around the identified areas of improvement. Three practices have been visited this year with the next round of quality visits to be agreed at the next Primary Care Group. Estates Technology Transformation Fund (ETTF) ‐ The West Scheme continues to develop its outline business case stage with an expected date of October for final draft Healthwatch ‐ Healthwatch are continuing to carry out ‘enter and view visits in and overall scheme design. Blackburn with Darwen. Bentham Road Surgery received a visit on Wednesday 13 June 2018 and the report was published on Thursday 19 July 2018. The report in Primary Care Network/ Neighbourhood (PCN) –The Neighbourhood groups are in the general was very positive but practice have agreed to address the recommendations process of establishing and undertaking their first meetings. The membership and made by 31st December 2018. Reports can be accessed on direction of the PCN’s will develop over the coming months and they are presently https://www.healthwatchblackburnwithdarwen.co.uk/ developing projects for this financial year. Medicines management reception Training ‐ All staff working in GP practices that The Primary Care Commissioning Committee recently received the QOEST end of year receive, process and issue prescription requests are receiving structured training by report and financial reconciliation. The Committee thanked Local Primary Care, the GP members of the medicines management team. The training aims to support the federation, for all their hard work in making the scheme a success, particularly the reduction of medicine waste and improve quality and efficiency around the significant improvements in outcomes and reduced variation. For example, cervical prescribing process. Level 1 training is delivered face to face in the practice and cytology rates have increased for the first time since the inception of the CCG. Level 2 training aims to enhance and develop the Level 1 skills through workshops and an online accredited qualification.
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Contract & Information Quality & Performance Lancashire Care Foundation Trust Community ‐ Executive Summary Lancashire Care Foundation Trust Community ‐ Executive Summary Month 3 Month 3
The process for reporting against variances (+/‐10%) as agreed by Chorley and South Referral to Treatment (Incomplete) ‐ The 92% 18‐week referral to treatment (RTT) Ribble CCG (CSR CCG) as lead contractor for LCFT Community Services is for the Trust to Incomplete target was met overall for BwD CCG LCFT Community services patients provide an exception report in the month following the previous quarter. in June 2018, with performance at 98.0%. For BwD CCG, the 92% 18‐week RTT Incomplete target was not met for the Children's Occupational Therapy Service in BwD CCG has 15 service lines – 1 is over performing and 5 are underperforming +/‐10% June 2018, with performance at 76.0%, relating to 12x 18‐week breaches. LCFT with the remaining 9 service lines operating within tolerance. advise that these breaches were due to team delay / capacity issues.
Children’s Learning Disabilities (‐68, ‐27.0%) ‐ Riding the Rapids groups reduced in M2 LCFT is developing an action plan to focus predominantly on Occupational Therapy as 1 facilitator has retired, and another staff member is on long term sick. Further dates underactivity in the Children's Integrated Therapy & Nursing Service (CITNS). The have been organised for September as attendance is traditionally difficult for parents in plan is expected to be delivered by the end of August 2018, in time for the next LCFT summer. Community Contract meeting in September, to provide an improvement trajectory and assurance regarding the actions being taken. Community Stroke Service (‐633, ‐45.4%) – The underperformance in M3 is due to vacancies and long‐term sickness in the service. Recruitment for 4 posts has now taken Quality Assurance Visits (QAV) ‐ The lead CCG has worked with LCFT on a joint place and 3 posts have been recruited to with 1 post unfilled. The exception report approach to quality assurance visits to assure service quality and safety. Recent states that LCFT will be reporting ‐18% at the end of the year. BwD CCG has advised the QAV reports have been shared via LCFT Joint MH & Community Quality & service that recovery is expected by the end of Q3 and has requested narrative on how Performance meetings. No new QAV were conducted in June 2018. this can be achieved. The CCG has escalated this matter formally and expects a detailed recovery plan in September Community & Wellbeing Network Vacancy Rate ‐ The establishment vacancy rate for the Community & Wellbeing Network increased in June 2018, to 12.01% (from DESMOND (‐18, ‐19.4%) – The underperformance at M3 is due to staff long‐term 11.26% in May), against the threshold of 5.0%. The vacancy rate for LCFT as a whole sickness absence, therefore recruitment has commenced to back‐fill the post. With also increased to 12.64% in June, from 12.38% in May. In June, 162 Community & agreement from the CCG, the Trust are delivering 1:1 and small group diabetes Wellbeing Network positions (128.25 FTE) were being actively recruited to, with the education which is giving patients more choice and proving successful, from M4 this will average number of days to recruit standing at 42.15. be report against. The CCG have asked for details of the conversion rates from education to DESMOND Community & Wellbeing Network Sickness Absence ‐ The sickness absence rate for the Community & Wellbeing Network increased to 5.57% in June 2018 (from 5.44% Intermediate Care ACS (‐622, ‐19.3%) ‐ The Trust has advised that the in May), while the rate for LCFT as a whole decreased in month to 5.92%, against underperformance in this service is due to the increase in referrals in Rapid Assessment the Trust’s target of 4.5%. At Network level, approximately 58% of the total are and Home First undertaking admission avoidance and facilitating prompt discharges long‐term absences. Action plans are in place for long‐term sickness cases in the from the hospital. The intermediate care staff are supporting this work, therefore are Network, which are monitored by Care Group managers on a monthly basis. currently ‐19% under plan. BwD CCG has requested further clarity around what impact the additional funding and staffing will have on the recovery target. Staffing – LCFT Community staffing issues are addressed via an agenda item at
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Podiatry (‐690, ‐13.3%) ‐ The service has 2 members of staff on long‐term sickness Quality and Performance meetings chaired by Chorley & South Ribble CCG as host absence which is causing the reduction in activity. The CCG has requested a recovery commissioner. These meetings now take place every 2 months. Work is ongoing plan regarding staffing and recruitment. with the Trust to develop the analysis and timely reporting of key workforce data and significant staffing challenges. The Quality and Performance Committee has Pulmonary Rehabilitation Service (+897, +72.3%) ‐ The overperformance is due to an agreed that LCFT will report on “hot spot services” to provide early warning to the improved uptake onto the programme and improved completion of all the sessions with CCGs of any risk to delivery due to staffing / sickness issues. limited drop out. The CCG has requested a revised baseline plan for 2018‐19.
The overall contract activity total is under plan by ‐888, ‐1.2%.
Staffing challenges are of concern at LCFT, however there are several recruitment and retention initiatives in place, which have been shared via the community contract meeting. LCFT will be providing an update on the People’s Plan at the joint Quality & Performance meetings which aims to provide additional assurance to the CCGs.
Chorley and South Ribble CCG, as co‐ordinating commissioner, have also introduced several initiatives with regards to managing performance through the contract:
• A process for escalation of underactivity. This requests a Remedial Action Plan for those services with 3 consecutive months of underperformance. The Remedial Action plan template does require the provider to give timescales, owner and effect on performance from the individual actions. If the commissioner is not assured with this action plan then this can be escalated through a formal performance notice to the contract. • The development of the hotspot proforma, which allows the provider to sight commissioners early on potential quality or performance issues with their services. The CCG have requested lead commissioners to challenge this process as no hot spot reports have been received for the under‐performing services. • The rationalising performance and activity exercise which seeks to give a more balanced performance reporting based on quality outcomes and activity, this is being done on behalf of all commissioners. • The community contract analysis exercise which has grouped teams into their relevant service lines.
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Contract & Information Quality & Performance Other ‐ Executive Summary Other ‐ Executive Summary Month 3 Month 3
BMI Beardwood + BMI Gisburne Park ‐ Total costs are below plan ‐£22K (‐4.1%). Ambulance Response Programme – In June 2018 for Category 1 calls (time critical and life‐threatening), BwD CCG are close to achieving the mean at 7 minutes 23 • BMI Beardwood: ‐£18K (‐1.4%) seconds against a 7 minute target. The 90th centile measure has been achieved. For • BMI Gisburne Park: ‐£4K (‐3.1%) Category 2 (emergency), the CCG is underperforming against the mean at 28 minutes 4 seconds against a target of 18 minutes, but is achieving the 90th centile
measure. For Category 3 (urgent), and Category 4 (less urgent) calls, BwD CCG is Elective Inpatient Care (EL + DC) position at month 3 shows activity ‐23 spells below th underperforming against the 90 centile targets. Performance against the Category plan (‐2.4%), with cost comparably below plan ‐£23K (‐2.3%). 2 – 4 call measures has improved on the previous month. The only specialties above plan to a notable degree are as follows: A performance improvement plan (PIP) is in place which includes 2‐year additional • Pain Management (also known as Anaesthetics): +27 spells (+6.9%) [+£24K, non‐recurrent investment in additional capacity from commissioners. Handover and +9.4%] turnaround of ambulances above 30 minutes is having an impact on performance • Trauma & Orthopaedics (including Spinal Surgery Service): +27 spells (+16%) and NWAS continue to work with Acute Trusts to improve processes. although costs are close to plan [+£7K, +1.5%]
Hear and treat performance has improved by 43% year on year, which is releasing Outpatient Care position at Month 3 shows below plan activity ‐203 resource to meet conveyance demand. NWAS are looking to facilitate devices on attendances/procedures (‐5.4%) although costs are on plan +£0.1K (+0.03%). This vehicles that will allow crews to use the Manchester Triage System (MTS) which is a imbalance is due to more expensive First Attendances being above plan, and Outpatient clinical risk tool to safely manage patient flow when clinical demand exceeds Procedures being performed being relatively expensive procedures compared to plans : capacity. • Outpatient First Attendance +£15K (+11.3%) [+93 attendances, +11.1%] • Outpatient Procedure +£0.3K (+0.6%) [‐31 procedures, ‐8.4%] Referral to Treatment 18 weeks (Incomplete) – The referral to treatment (RTT) • Outpatient Follow‐Up Attendance ‐£16K (‐10.4%) [‐265 attendances, ‐10.3%] incomplete pathway was not achieved for BwD CCG in June 2018, with performance at 90.5%. Patient flow to Lancashire Teaching Hospitals (LTHTr) continues to impact on BwD CCGs position with 294 patients waiting over 18 weeks which is an increase Across all Points of Delivery (PODs) combined, the only specialties above plan to a on the previous month (234). The main pressure is in Neurology, where there are notable degree are as follows: 124 BwD CCG patients with a wait over 18 weeks. • Pain Management (also known as Anaesthetics) +£24K, +7.9% Referral to Treatment (RTT) – Number of Incomplete Pathways Waiting >52 weeks ‐ For BwD CCG, there were 4 patients reported as waiting over 52 weeks in June 2018. One patient is under the care of Blackpool Teaching Hospitals Foundation Trust. A query has been raised with Blackpool CCG, and they have reported the patient is waiting for treatment under the NHS England Specialised Commissioning Contract and the breach has occurred due to capacity issues. A query has been
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raised to ascertain if the patient has suffered any harm as a result of the delay. Two patients are under the care of LTHTr, 1 in Plastic Surgery who has now been seen; and one in ENT. The updated recovery plan has not been received by Greater Preston CCG and a performance notice has now been issued. The final patient, for Plastic Surgery at Manchester University Hospitals (MUH) has now been seen and MUH have advised no harm has been identified as a result of the wait.
Cancer ‐ % of patients seen within 2 weeks for an urgent GP referral for suspected cancer ‐ For BwD CCG, the standard for 93% of patients to be ‘seen within 2 weeks for an urgent GP referral for suspected cancer’ was not met in June 2018 with performance at 91.11%. There were 37 breaches leading to the underperformance, 13 due to inadequate capacity, with pressured specialties noted as suspected breast and urological cancers.
Cancer ‐ % of patients seen within 2 weeks for an urgent referral for breast symptoms ‐ For BwD CCG, the standard for 93% of patients to be ‘seen within 2 weeks for an urgent referral for breast symptoms’ was not met in June 2018 with performance at 79.03%. There were 13 breaches leading to the underperformance.
Cancer ‐ % of patients receiving subsequent treatment for cancer within 31 days (Surgery) – For BwD CCG, the standard for 94% of patients to receive ‘subsequent treatment for cancer within 31 days (Surgery)’ was not met in June 2018 with performance at 86.67%. There were 2 breaches leading to the underperformance.
Cancer ‐ % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) ‐ For BwD CCG the standard for 94% of patients to receive ‘subsequent treatment within 31 days (Radiotherapy Treatments)’ was not met in June 2018 with performance at 92.31%. There was 1 breach leading to the underperformance; the patient received treatment at day 39.
Cancer ‐ % of patients receiving first definitive treatment for cancer within 62 days For BwD CCG the standard for 85% of patients to receive ‘first definitive treatment for cancer within 62 days’ was not met in June 2018 with performance at 80.77%. There were 5 breaches leading to the underperformance.
Clostridium Difficile ‐ There were 3 cases of clostridium difficile identified for the population of Blackburn with Darwen in June 2018. Year to date there have been 12
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cases against a trajectory of 9.
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Appendix 1
ELHT Referral Data for 2018/19 – GP Referrals
Number of Referrals GP GP Variance Variance Trend Specialty Referrals Referrals Variance % Quantity % (last 13 months) 2017‐18 2018‐19 Cardiology 544 755 211 38.8% 36.5% Community Paediatrics 1 124 95 ‐29 ‐23.4% ‐24.6% Dermatology 517 377 ‐140 ‐27.1% ‐28.3% E.N.T. 592 538 ‐54 ‐9.1% ‐10.6% Gynaecology 942 772 ‐170 ‐18.0% ‐19.4% Medical Specialties 901 813 ‐88 ‐9.8% ‐11.2% General Medicine 202 181 ‐21 ‐10.4% ‐11.8% Diabetic Medicine 16 26 10 62.5% 59.9% Elderly Medicine 27 18 ‐9 ‐33.3% ‐34.4% Gastroenterology 467 405 ‐62 ‐13.3% ‐14.7% Respiratory Medicine 189 183 ‐6 ‐3.2% ‐4.7% Oncology 74 66 ‐8 ‐10.8% ‐12.2% Ophthalmology 734 633 ‐101 ‐13.8% ‐15.2% Other Specialty group 2 199 159 ‐40 ‐20.1% ‐21.4% Paediatrics 3 267 267 0 0.0% ‐1.6% Pain Management group 4 73 38 ‐35 ‐47.9% ‐48.8% Rheumatology 99 102 3 3.0% 1.4% Surgical Specialties 1038 1133 95 9.2% 7.4% Breast Surgery 344 419 75 21.8% 19.8% General Surgery 592 581 ‐11 ‐1.9% ‐3.4% Vascular Surgery 102 133 31 30.4% 28.3% Trauma & Orthopaedics 526 522 ‐4 ‐0.8% ‐2.4% Urology 336 357 21 6.3% 4.5% Grand Total 6966 6627 ‐339 ‐4.9% ‐6.4%
1 Community Paediatrics and Community Paediatric Neurodevelopmental Service 2 A&E, Cardiothoracic Surgery, Child & Adolescent Psychiatry, Clinical Genetics, Critical Care Medicine, Clinical Haematology, Endocrinology, Medical Oncology, Neonatology, Palliative Medicine, Radiotherapy, Rehabilitation 3 Paediatrics, Paediatric Surgery, Paediatric Cardiology, Paediatric Nephrology and Paediatric Respiratory Medicine 4 Pain Management, Anaesthetics
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Appendix 1 - Cont ELHT Referral Data for 2018/19 – Other Referrals
Number of Referrals Other Other Variance Variance Trend Specialty Referrals Referrals Variance % Quantity % (last 13 months) 2017‐18 2018‐19 Cardiology 1233 1320 87 7.1% 5.3% Community Paediatrics 1 197 102 ‐95 ‐48.2% ‐49.1% Dermatology 61 89 28 45.9% 43.5% E.N.T. 213 210 ‐3 ‐1.4% ‐3.0% Gynaecology 356 241 ‐115 ‐32.3% ‐33.4% Medical Specialties 569 573 4 0.7% ‐0.9% General Medicine 8 10 2 25.0% 23.0% Diabetic Medicine 96 88 ‐8 ‐8.3% ‐9.8% Elderly Medicine 7 15 8 114.3% 110.8% Gastroenterology 135 140 5 3.7% 2.0% Respiratory Medicine 323 320 ‐3 ‐0.9% ‐2.5% Oncology 133 126 ‐7 ‐5.3% ‐6.8% Ophthalmology 556 763 207 37.2% 35.0% Other Specialty group 2 491 425 ‐66 ‐13.4% ‐14.8% Paediatrics 3 121 76 ‐45 ‐37.2% ‐38.2% Pain Management group 4 77 66 ‐11 ‐14.3% ‐15.7% Rheumatology 93 125 32 34.4% 32.2% Surgical Specialties 260 241 ‐19 ‐7.3% ‐8.8% Breast Surgery 110 82 ‐28 ‐25.5% ‐26.7% General Surgery 88 89 1 1.1% ‐0.5% Vascular Surgery 62 70 8 12.9% 11.1% Trauma & Orthopaedics 150 144 ‐6 ‐4.0% ‐5.5% Urology 123 66 ‐57 ‐46.3% ‐47.2%
Grand Total 4633 4567 ‐66 ‐1.4% ‐3.0%
Number of Referrals Referral Type 2017‐18 2018‐19 Variance %
GP 1 6966 6627 -4.9% Non‐GP Professional 2 4501 4215 -6.4% Other 3 132 352 166.7% 11599 11194 -3.5% Total 1 From GP 2 From non‐GP professional (e.g. Consultant, Nurse Specialist, Other Practitioner) 3 From non‐GP other (e.g. Following A&E Attendance or Emergency Admission, Self, Ex Private Patient)
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Appendix 2
LCFT Community Contract ‐ LCFT: Service Line Activity Against Plan – June 2018
Year to date ‐ Activity (2018/19) Full Year ‐ Activity Year‐on‐Year Comparison (Planned Activity) Service Line Plan Actual Variance Var % Status^ Plan Forecast 17/18 18/19 Variance Var % Adult Learning Disability Service 1102 1,075 ‐27 ‐2.5% 4824 4300 502 1,075 573 114.1%
Children's Learning Disability 252 184 ‐68 ‐27.0% 1116 736 406 184 ‐222 ‐54.7% Service
Children's Speech & Language 1858 1,963 105 5.7% 7908 7852 1,643 1,963 320 19.5% Therapy
Children's Occupational Therapy 442 401 ‐41 ‐9.3% 1932 1604 389 401 12 3.1%
Community Stroke Service 1394 761 ‐633 ‐45.4% 5508 3044 1,080 761 ‐319 ‐29.5%
Dermatology Service 1281 1,153 ‐128 ‐10.0% 4992 4612 1,344 1,153 ‐191 ‐14.2%
DESMOND (Completed Courses) 93 75 ‐18 ‐19.4% 384 300 59 75 16 27.1%
Diabetes Specialist Nursing 1409 1,306 ‐103 ‐7.3% 5952 5224 926 1,306 380 41.0%
District Nursing 22274 23,034 760 3.4% 92208 92136 24,461 23,034 ‐1,427 ‐5.8%
Out of Hours (District Nursing) 1640 1,257 ‐383 ‐23.4% 6780 5028 2,679 1,257 ‐1,422 ‐53.1%
District Nursing (inc. Out of Hours) 23914 24291 377 1.6% 98988 97164 27140 24,291 ‐2,849 ‐10.5%
Intermediate Care ACS 3226 2,604 ‐622 ‐19.3% 13716 10416 3,000 2,604 ‐396 ‐13.2%
Under Plan Close to Plan Above Plan ^ Status = change in variance to plan (year to date M3 to M2) Reporting Tolerances <‐10% >‐10% to <+10% >+10% % Variance Widened % Variance Narrowed
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LCFT Community Contract ‐ LCFT: Service Line Activity Against Plan – June 2018 ‐ Continued
Year to date ‐ Activity Full Year ‐ Activity Year‐on‐Year Comparison (Planned Activity) Service Line Plan Actual Variance Var % Status^ Plan Forecast 17/18 18/19 Variance Var % Intensive Home Support 7926 7697 ‐229 ‐2.9% 32280 30788 8179 7,697 ‐482 ‐5.9%
Community IV Service BwD 830 348 ‐482 ‐58.1% 2016 1392 247 348 101 40.9%
Complex Case Management 1248 1,245 ‐3 ‐0.2% 5352 4980 1,193 1,245 52 4.4%
Community Respiratory Service 1409 1,849 440 31.2% 6264 7396 1,818 1,849 31 1.7%
Rapid Assessment Team 4439 4,255 ‐184 ‐4.1% 18648 17020 4,921 4,255 ‐666 ‐13.5%
Oxygen Service 881 942 61 6.9% 3324 3768 819 942 123 15.0%
Podiatry 5178 4,488 ‐690 ‐13.3% 21372 17952 4,938 4,488 ‐450 ‐9.1%
Pulmonary Rehabilitation 1241 2,138 897 72.3% 4440 8552 1,719 2,138 419 24.4%
Treatment Room 22011 22,242 231 1.0% 92316 86764 19213 21,691 2,478 12.9%
Treatment Room 20394 20,291 ‐103 ‐0.5% 87840 81164 17,670 20,291 2,621 14.8%
Specialist Ear Care 172 173 1 0.6% 852 692 264 173 ‐91 ‐34.5%
Non‐Serious Injury 374 606 232 62.0% 1728 2424 525 606 81 15.4%
Ulcer & Vascular 452 621 169 37.4% 1896 2484 754 621 ‐133 ‐17.6%
Healthy Legs 318 287 ‐31 ‐9.7% 1110 1148 260 287 27 10.4%
Tissue Viability Service 301 264 ‐37 ‐12.3% 1132 1056 335 264 ‐71 ‐21.2%
Grand Total ‐ Activity with Plans 72208 71320 ‐888 ‐1.2% 301294 285280 71952 71320 ‐632 ‐0.9%
Under Plan Close to Plan Above Plan ^ Status = change in variance to plan (year to date M3 to M2 Reporting Tolerances <‐10% >‐10% to <+10% >+10% % Variance Widened % Variance Narrowed
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Appendix 3
Inpatient Waiting List
Source : ELHT East Lancashire Hospitals Current Month Previous Month Performance Report 0‐<6 6‐<13 13‐<20 20 + Grand 0‐<6 6‐<13 13‐<20 20 + Grand Specialty Variance %age +/‐ Weeks Weeks Weeks Weeks Total Weeks Weeks Weeks Weeks Total General Surgery 569 170 47 14 800 603 149 39 14 805 ‐5 ‐0.6% Urology 327 117 51 42 537 333 146 73 75 627 ‐90 ‐14.4% Breast Care 72 18 2 0 92 57 15 1 0 73 19 26.0% Vascular 106 23 5 3 137 90 26 7 1 124 13 10.5% Orthopaedics 494 372 129 63 1058 626 314 118 66 1124 ‐66 ‐5.9% ENT 230 173 97 62 562 260 162 119 38 579 ‐17 ‐2.9% Ophthalmology 411 234 96 41 782 401 232 88 43 764 18 2.4% Oral Surgery / Maxillo Facial 324 123 49 55 551 302 111 89 45 547 4 0.7% Dermatology 0 0 0 0 0 0 0 0 0 0 0 N/A Medical Oncology 1 0 1 0 2 1 1 0 0 2 0 0.0% Clinical Oncology 2 1 0 1 4 3 0 0 1 4 0 0.0% Surgical Division 2536 1231 477 281 4525 2676 1156 534 283 4649 ‐124 ‐2.7% General Medicine 922 30 1 9 962 841 30 4 11 886 76 8.6% Rehabilitation 0 0 0 0 0 0 0 0 0 0 0 N/A Cardiology 156 49 3 7 215 184 34 8 6 232 ‐17 ‐7.3% Thoracic Medicine 19 1 0 3 23 18 0 1 3 22 1 4.5% Nephrology 1 0 0 3 4 0 0 0 3 3 1 33.3% Medical Division 1098 80 4 22 1204 1043 64 13 23 1143 61 5.3% Gynaecology 320 36 4 1 361 259 51 6 0 316 45 14.2% Family Care Division 320 36 4 1 361 259 51 6 0 316 45 14.2% Pain Management 77 76 55 41 249 74 75 51 22 222 27 12.2% Rheumatology 32 5 2 6 45 43 5 1 6 55 ‐10 ‐18.2% Haematology 4 0 0 1 5 1 0 1 0 2 3 150.0% Diagnostic & Clinical Support 113 81 57 48 299 118 80 53 28 279 20 7.2%
Grand Total 4067 1428 542 352 6389 4096 1351 606 334 6387 2 0.0%
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LCFT MH quality measures currently underperforming against target Appendix 4
Threshold Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar 2018/19 Ref Indicator Level 2018/19 18 18 18 18 18 18 18 18 18 19 19 19 YTD NQR_1 Duty of Candour 0 Trust 0 2 IAPT: Prevalence – Q1 – Q3 4.20% Trust 1.38% 1.39% 1.29% 4.06% LQR_6 Q4 4.74% Notional Q1 Monthly 1.40% BwD 1.31% 1.43% 1.37% 4.10% BwD Notional Monthly 1.31% (M03) ADHD (Adult): seen within 18 weeks – new N/A Trust 23.9% 22.1% 24.2% 23.4% patients LQR_1 ADHD (Adult): seen within 18 weeks – N/A Trust 56.3% 49.1% 41.9% 48.5% CAMHS Transitions Unscheduled Care: 47.03 46.45 49.43 Trust 47.64% MHLT assessment % % % N/A within 1 hour of 51.85 59.77 53.64 BwD 55.09% referral from ED % % % Unscheduled Care: 80.60 80.60 81.01 Trust 80.74% MLHT Assessment % % % N/A within 24 hours from 96.77 62.96 BwD 100% 86.58% ward referral % % Unscheduled Care: Trust 329 272 300 901 All 4‐hour breaches LQR_8 where psychiatric N/A ELHT assessment was 26 25 67 26 site requested Unscheduled Care: Trust 126 133 107 366 4‐hour breaches where psychiatric N/A assessment ELHT 26 22 30 26 was requested within site 2 hours Unscheduled Care: N/A Trust 22 8 43 73
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12‐hour breaches where psychiatric ELHT 13 3 25 13 assessment was site requested Out Area of OAPs 0 Trust 28.30 38.65 26.60 31.18 Placements (average)
KEY RED Under performance GREEN Achieving AMBER Under Review
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Appendix 5 ELHT quality measures currently underperforming against target
Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ref Indicator YTD 18/19 18 18 18 18 18 18 18 18 18 19 19 19 Referral to Treatment E.B.3 92% 92.8% 93.3% 93.0% 93.2% (Incomplete) E.B.4 Diagnostics <1% 0.9% 1.8% 0.3% 1.04% E.B.5 A&E 4 Hour * 95% 84.9% 86.1% 86.7% 85.6% E.B.6 Cancer 2‐week breast 93% 92.0% 92.3% 92.1% Cancer 31 day E.B.9 94% 89.2% 97.5% 93.5% subsequent E.B.S.2 Cancelled Operations 0 1 0 0 1 E.B.S.5 Trolley wait 0 19 3 33 55 Ambulance Handover E.B.S.7a 0 271 371 642 >30min Ambulance Handover E.B.S.7b 0 63 55 118 >60min Missed handover E.B.S.7 0 144 154 298 stamps E.A.S.4 MRSA 0 0 0 1 1 E.A.S.5 Clostridium Difficile 27 2 3 4 9 LQR4 Stroke 4 hour 65% 55% 55%
*Includes Rossendale MIU
*KEY RED Under performance GREEN Achieving AMBER Under Review
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Appendix 6 LCFT Community current quality measure performance against target
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Indicator Target 18 18 18 18 18 18 18 18 18 19 19 19 Referral to treatment (RTT) Incomplete (BwD CCG) 98.9% 98.7% 98.0% Adult Learning Disability Service 100% 60% ‐ Adult Speech and Language Therapy 100% ‐ ‐ Children's Occupational Therapy 97.5% 86.5% 76.0% Children's Speech & Language Therapy 97.9% 99.2% 99.0% Continence Service ‐ ‐ 100% Falls Team 100% ‐ 100% 92% Intermediate Care ACS 100% 100% 100% Nutrition & Dietetics ‐ ‐ 100% Podiatry 100% 100% 100% Pulmonary Rehabilitation 100% 100% 100% Rapid Assessment Team 100% 100% 100% Rheumatology 100% ‐ ‐ Referral to treatment (RTT) Incomplete (BwD 98.9% 98.7% 98.0% Community Stroke Rehabilitation Measures (BwD CCG) Patients assessed with 72 hours of referral 95% 100% FIM/FAM: increase in at least 1 domain at point 95% 94.0% of discharge Mood screen: patients receiving a mood and 95% 100% anxiety screen Goal setting: with written goals in place 95% 100% PROM: improvements in more than one domain 95% 100%
KEY RED Under performance GREEN Achieving AMBER Under Review
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NHS Constitution Appendix 7
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GOVERNING BODY MEETING
GOVERNING BODY ASSURANCE FRAMEWORK UPDATE
Date of Meeting 5th SEPTEMBER 2018 Agenda Item 11
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor Y outcomes and inequalities To work collaboratively to create safe, high quality health care services Y To maintain financial balance and improve efficiency and productivity Y To deliver a step change in the NHS preventing ill health and supporting people to live Y healthier lives To maintain and improve performance against core standards and statutory requirements Y To commission improved out of hospital care Y CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Y Self-Care and Early Intervention Y Enhanced and Integrated Primary Care and Better Care Fund Y Access to Re-ablement and Intermediate Care Y Improved hospital discharge and reduced length of stay Y Community based ambulatory care for specific conditions Y Access to high quality Urgent and Emergency Care Y Scheduled Care Y Quality Y
Clinical Lead: DR PENNY MORRIS
Senior Lead Manager MRS CLAIRE MOIR Finance Manager N/A Equality Impact and Risk Assessment N/A completed: Is a Data Protection Impact Assessment No Required GOVERG BODGOVERNING BODY MEETING 1
Data Protection Impact Assesment N/A completed: Patient and Public Engagement completed: N/A Financial Implications N/A Risk Identified WITHIN THE REPORT Report authorised by Senior Manager: MR ROGER PARR Y
Decision Recommendations
The Governing Body is asked to:
• Note the contents of the report; • Review the Governing Body Assurance Framework Risks; • Note the findings of the 2018 risk appetite exercise.
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NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
WEDNESDAY 5TH SEPTEMBER 2018
GOVERNING BODY ASSURANCE FRAMEWORK UPDATE
1. Introduction
1.1 The purpose of this report is to present the CCG’s Governing Body Assurance Framework for review.
2. Background
2.1 The CCG is required to have in place a system of internal control that supports the achievement of the organisation’s strategic aims and objectives. The GBAF is a key document which links the corporate objectives to risks, controls and assurances and is the main tool that the Governing Body uses to discharge its overall responsibility for internal control.
2.2 The GBAF is designed to ensure the requirements of the annual reporting arrangements i.e. the Annual Governance Statement (AGS) are met and that principal risks to the CCG achieving its Objectives are managed appropriately.
3. Corporate Objective Risks – 2018/19
3.1 The following Corporate Objective risks continue to be held on the CCG’s GBAF:
• CO1.1: There is a risk that ineffective commissioning decisions will prevent the CCG from achieving its corporate objectives, improving health and reducing inequalities
• CO2.1: System-wide capacity issues may emerge that prevent the delivery of the CCG's plans and priorities
• CO3.1: Failure to effectively manage demand, activity and cost pressures across the health system may impact on the CCG delivering its financial targets
• CO4.1: The local health economy may not be sustainable unless there is a programme of change
• CO5.1: There is a risk that providers delivery poor quality care and do not meet standards and outcomes
• CO6.1: Clinical workforce capacity is challenged across the system
4. Review of GBAF Risks
4.1 All GBAF risks have been reviewed and updated as necessary by the risk owner and there are no
3
changes to report in risk ratings.
5. Update on Corporate Objective Risks
5.1 The Governing Body has delegated authority to the Pennine Lancashire Quality Committee (PLQC) for the management of risks of the CCG’s Corporate Risk Register (CRR). A joint risk management report between Blackburn with Darwen and East Lancashire CCG is presented for review by the PLQC (now on a bi-monthly basis).
5.2 As previously reported the following risks are held by both CCGs:
• 95% Accident and Emergency 4 hour standard
• 62 day cancer target which has been revised to incorporate:
o 2017/01: Ability of diagnostic provision to support the 14 day cancer diagnosis. Increasing demand for radiology services is resulting in lengthening waiting times.
o 2017/02: Lack of oncology provision across the Lancashire footprint including Pennine Lancashire. Oncology provision in terms of consultant and medical staffing is a risk due to difficulties in recruiting clinicians.
• Ambulance Response Performance
• Initial Health Assessments for Looked After Children
• Performance against financial targets
• Lack of inpatient beds for Children and Young People with Mental Health Issues
• Loss of residential and nursing home beds from care home sector and impact upon system resilience
6. Mersey Internal Audit Agency (MIAA) Risk Management Arrangements Report 2018/19
6.1 The CCG’s arrangements for risk management based on the CCG Risk Management Strategy and Policy have been reviewed by MIAA resulting in the CCG receiving a rating of “Substantial Assurance”.
6.2 The full report will be reviewed by the PLQC at its next meeting to seek assurance that any outstanding actions are completed within the agreed timescales.
7. Governing Body Risk Appetite Exercise
7.1 The results of the 2018 Governing Body Risk Appetite exercise are attached at Appendix 1. This exercise is undertaken on an annual basis and provides the Governing Body with an overview of its
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appetite for risk against the following areas:
• Financial/Value for Money
• Compliance/Regulatory
• Innovation/Quality/Outcomes
• Reputation
7.2 The results of the exercise (based on 10 responses) show minimal change to last year’s results. There was a very slight increase in the Governing Body’s appetite for risk around compliance/regulatory, and a very slight decrease in appetite for reputational risk. Appendix 2 provides a comparison of results by year.
8. Recommendations
8.1 The Governing Body is asked to:
• Note and discuss the contents of the report; • Review the Governing Body Assurance Framework Risks; • Note the findings of the 2018 risk appetite exercise.
Claire Moir Governance, Assurance and Delivery Manager 24th August 2018
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NHS Blackburn with Darwen Clinical Commissioning Group Corporate Risk Register and Governing Body Assurance Framework 2018/19 Governing Body Assurance Framework Risks 2018/19 MENU
Corporate Objective CO1: Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities
Risk Description CO1.1 Ineffective commissioning decisions may prevent the CCG from achieving its corporate objectives, improving health and reducing inequalities
Initial Current Target Risk Owner Roger Parr Likelihood Possible Possible Unlikely Financial / VFM Consequence Major Major Major Compliance / Regulatory Level 12 12 8 Innovation / Quality / Outcomes Date Apr-17 Aug-18 Mar-19 Reputation Movement ↔ Controls Assurance The CCG has submitted its activity plans and assumptions for 2018/19 to NHS England. Routine contract Internal Assurance monitoring of delivery against these plans will be undertaken (Integrated Business Report, contract and CCG Governing Body receives papers and minutes from Commissioning Business Group performance meetings) Monthly Contracting and Finance report update presented to Governing Body The CCG's Plans developed in conjunction with Health and Wellbeing Board and the Integrated Strategic Monthly Quality and Performance report presented to Pennine Lancs Quality Committee Needs Assessment (ISNA). Health and Wellbeing Strategy also informs CCGs plans and local health issues Minutes of contract and performance meetings and significant barriers to improving health and reducing inequalities. Minutes of the Joint CCG Commissioning Committee CCG Governing Body receives assurance and progress updates on implementation of its annual plans External Assurance Commissioning Business Group and Primary Care Commissioning Committee established with responsibility NHS England Improvement and Assessment Framework for 2018/19 - monthly performance review for developing, approving and monitoring plans and business cases. meetings are held The CCG has full delegated authority from NHS England to co-commission primary care which enables the CCG's activity plans for 2018/19 are being reviewed by NHS England. CCG to provide a strong focus on local clinical leadership and enable optimal decision making on 360 degree stakeholder survey findings are reviewed and areas for improvement built into the investment across primary, secondary and community services CCG's commissioning processes Use of "Rightcare" metrics to support decision making. Areas for greatest potential opportunities have been reviewed and plans for 3 priority areas submitted to NHS England (MSK, Medicines, Respiratory)
Gaps in Controls Gaps in Assurance Fragmentation of the commissioning system may slow down decision making Currently limited contract information on community services, primary care or specialist The frequency and timeliness of performance monitoring data varies according to the measure e.g. commissioning plans or performance monitoring information Potential Years of Life Lost (PYLL) figures are produced annually Health outcomes in certain areas are not improving as expected
ACTION PLAN
Expected Action Assigned to Date of update Action Description Progress to Date completion date To remain in place Implement process for reviewing the effectiveness of CCG's commissioning An assurance framework/commissioning plan tracker has been throughout reporting decisions developed linked to QIPP/Cases for Change 2017/18 Roger Parr period Attend monthly review meetings with NHS England to review performance Next meeting scheduled for 24th August 2018 to be held against CCG IAF indicators jointly with East Lancashire CCG Neil Holt/Claire Moir Monthly Governing Body Assurance Framework Risks 2018/19 MENU
Corporate Objective CO2: To work collaboratively to create safe, high quality health care services
Risk Description CO2.1 System-wide capacity issues may emerge that prevent the delivery of the health economy's plans and priorities
Initial Current Target Risk Owner Roger Parr Likelihood Possible Possible Unlikely Financial / VFM Consequence Major Major Major Compliance / Regulatory Level 12 12 8 Innovation / Quality / Outcomes Date Apr-17 Aug-18 Mar-19 Reputation Movement ↔ Controls Assurance The Pennine Lancashire Health Economy has developed a Health and Social Care Escalation Plan which Internal Assurance ensures a continuous cycle of capacity and escalation planning to ensure the position across Pennine Minutes of Pennine Lancashire Clinical Transformation Board Lancashire remains resilient during periods of increased demand Minutes of Joint Committee of Clinical Commissioning Groups Together a Healthier Future Programme Management Office function (which CCG contributes to) is now in Feedback on external public engagement place to oversee delivery of Pennine Lancashire transformational plans Lancashire Leadership Forum established by NHS England to support the Lancashire and South Cumbria External Assurance change Programme (delivery of care in and outside of hospital). NHS Accelerate Programme developed to External assurance provided through the NHS England Improvement and Assessment Framework explore innovative models of care assurance monthly review meetings A&E Delivery Board established and meets monthly Strong relationships and leadership across the health and social care economy GP Federation has established the GP Access Fund (GPAF) which is now providing 7 day access to 100% of A&E Delivery Board (supported by the A&E Delivery Group) meets monthly and is overseeing plans patients living in Blackburn with Darwen to improve the delivery of urgent and emergency care Lancashire wide forums established to review system wide capacity issues. The CCG is working to support the implementation of national guidance issued on Urgent and Emergency Care and Cancer priorities A&E Delivery Board Plan on a Page circulated to governing body members
Gaps in Controls Gaps in Assurance The frequency and timeliness of performance data varies according to the measure e.g. reducing emergency Health economy-wide Integrated Care System plans/new models of care still developing admissions through urgent care data is produced quarterly, but the comparison of performance is made Pennine Lancashire Local Delivery Plans still developing year on year Currently aligning financial deficit to proposed Sustainability and Transformational plans for Lancashire and South Cumbria
ACTION PLAN
Expected Action Assigned to Date of update Action Description Progress to Date completion date Roger Parr Aug-18 Commissioning Development Framework to deliver 5YFV being developed Further Commissioning Development Framework meeting Integrated Care System vision aligned to Pennine Lancashire plans held with clinicians and senior managers across BwD and Commissioning Organisations working together to identify how common resources East Lancs CCG in June 2018. are governed Governing Body Assurance Framework Risks 2018/19 MENU
Corporate Objective CO3: To deliver financial balance and improve efficiency and productivity
Risk Description CO3.1 Failure to effectively manage the increase in demand, activity and cost pressures across the health system may impact on the CCG delivering its financial targets
Initial Current Target Risk Owner Roger Parr Likelihood Likely Likely Possible Financial / VFM Consequence Major Major Major Compliance / Regulatory Level 16 16 12 Innovation / Quality / Outcomes Date Apr-17 Aug-18 Mar-19 Reputation Movement ↔ Controls Assurance CCG Governing Body approved budget for 2018/19 including contingency reserves Internal Assurance Financial recovery plan submitted to NHS England Demand and activity is monitored throughout the financial year; risk score amended based on the Demand management initiatives in place ; the CCG is systematically working through the Rightcare process increasing (or decreasing) likelihood that targets will be met (wave 2 CCG) with delivery partner support; 3 priority areas for greatest potential opportunities have been QIPP tracker used to monitor performance against transactional and transformational initiatives. identified and plans submitted to NHS England Potential impacts have been quantified and these are monitored and updated on a weekly basis to Referral quality improvement scheme in place track actions undertaken and any financial adjustments. Financial plan underpinning strategic plan in place The CCG has implemented a referral quality improvement scheme which is already showing a Established budgetary control system reduction in activity and costs against a range of procedures of limited clinical value and first Monthly meetings with budget holders outpatient attendances CCG Exec Team assigned responsibilities for QIPP savings programme Finance and Scrutiny Group meet monthly and receive detailed progress reports on QIPP initiatives CCG ET considers overall performance and ensures corrective action taken as required Commissioning intentions for 2018/19 are being developed and associated contract values will be Finance recovery plan monitored through Operational Delivery Group and Executive Team agreed with providers Finance and Scrutiny Working Group (Governing Body representation) scrutiny of CCG recovery plans External Assurance Finance and activity plans has been produced for 2018/19 and submitted to NHS England
Gaps in Controls Gaps in Assurance Continuing to experience underlying growth in activity Impact of schemes/business cases may not be realised immediately Prescribing expenditure costs are impacting on CCG's financial plans. Increasing pressure from drugs classed as No Cheaper Stock Available (NCSO)
ACTION PLAN
Expected Action Assigned to Date of update Action Description Progress to Date completion date QIPP meetings are held Continuing to progress existing QIPP schemes and develop further schemes for both BwD and Work is underway identify further schemes to achieve the QIPP Roger Parr weekly and reported to ET Pennine Lancashire to achieve stretch target in 2018/19 target 2018/19 Continue to utilise Rightcare metrics to identify areas where CCG is an outlier on The BI Team have developed a sophisticated tool to support Roger Parr Review monthly spend and activity. Regular meetings held with delivery partner colleagues explore any of the Rightcare condition metrics. PAGE 6 Latest data analysis is showing a 5% reduction in 1st OP Malcolm Ridgway Review monthly Monitor impact of referral quality improvement scheme attendances based on 2017/18 outturn position Governing Body Assurance Framework Risks 2018/19 MENU
Corporate Objective CO4: To deliver a step change in the NHS in preventing ill health and supporting people to live healthier lives
Risk Description CO4.1 The Local Health Economy may not be sustainable unless there is a programme of change
Initial Current Target Risk Owner Penny Morris Likelihood Possible Possible Unlikely Financial / VFM Consequence Major Major Major Compliance / Regulatory Level 12 12 8 Innovation / Quality / Outcomes Date Apr-17 Aug-18 Mar-19 Reputation Movement ↔ Controls Assurance Pennine Lancashire Integrated Health and Care Partnership Leaders Forum is established with Internal Assurance responsibility for overseeing the Together a Healthier Future (TAHF) Transformation Programme. The Senior Responsible Officers from organisations released to support the development of the plans Forum consists of the Chief Officers/Chairs and leaders of the six statutory health and care organisations and systems for health and care that constitute the Transformation Programme. Updates on transformational plans presented to Joint Committee of Clinical Commissioning Groups System Accountable Officer and Local Leadership (Senior Responsible Officer) arrangements for each External Assurance element of the Pennine Lancashire Cases for Change programme identified Lancashire and South Cumbria Sustainability and Transformation Plan Outcomes of the Solution Design phase are set out in the draft Pennine Plans including the Benefits Accountable Health and Care Partnership Leaders' Forum membership includes senior leaders from Framework, new model of care proposals and quality standards. key organisations (BwD CCG, East Lancs CCG, East Lancashire Hospitals Trust, Lancashire Care End to End Overarching Timeline for completion set with milestones to monitor progress Foundation Trust, BwD Borough Council and Lancashire County Council Resource plan developed This has set the overarching strategic direction for the transformation programme with a key focus External agency providing specialists support to assist in financial modelling (Deloittes on developing plans for new models of care and an Accountable Care System for Pennine Lancashire
Gaps in Controls Gaps in Assurance Process to undertake gap analysis and definition of key priorities to be undertaken Scale of financial challenge and alignment of commissioner/provider plans may impact on delivery of plans
ACTION PLAN
Expected Action Assigned to Date of update Action Description Progress to Date completion date Roger Parr 16/08/2018 Joint meeting (EL and BwD CCG) held on 12 June 2018 to discuss Commissioning Both East Lancs and BwD CCG are working closely together and Development Framework have recently formed a commissioning committee in common to Integrated Care System vision aligned to Pennine Lancashire plans align decisions where appropriate Commissioning Organisations working together to identify how common resources are governed Governing Body Assurance Framework Risks 2018/19 MENU
Corporate Objective CO5: To maintain and improve performance against NHS core standards and statutory requirements
Risk Description CO5.1 There is a risk that providers deliver poor quality care and do not meet quality standards and outcomes
Initial Current Target Risk Owner Janet Thomas Likelihood Possible Possible Unlikely Financial / VFM Consequence Major Major Major Compliance / Regulatory Level 12 12 8 Innovation / Quality / Outcomes Date Apr-17 Aug-18 Mar-19 Reputation Movement ↔ Controls Assurance Joint Pennine Lancashire Quality Committee (PLQC) established and meets monthly Internal Assurance Internal quality structures functioning well as confirmed through internal audit reports (high assurance on Pennine Lancashire Quality Committee minutes performance reporting) Integrated Quality, Performance and Effectiveness Reports and exception reports Monitoring assurance received through contractual route that provider cost improvement plans will not Contract Quality and Performance Report presented monthly to Governing Body negatively impact on quality and safety of services Minutes from Contract and Performance meetings Lancashire Quality Surveillance Group established and Provider Quality Accounts reviewed by PLQC CSU Quality and Performance Team reviewed provider quality accounts Patient experience monitored using patient surveys Quality of Primary Care Services - findings of quality visits discussed at quarterly review meetings Quality and performance lead attends monthly Community Contract Quality and Performance meetings LCFT Quality Improvement Action Plan monitored through PLQC following CQC rating of "requires Primary Care Quality Group established which will monitor primary care quality data/framework improvement" Routine GP practice visits underway. External Assurance CQC inspection visits reports NHS England external assurance meetings (monthly) - quality issues discussed Mersey Internal Audit Agency Review s Healthwatch reports are now received and reviewed via the CCG's Operational Delivery Group
Gaps in Controls Gaps in Assurance Availability of quality data relating to community services still needs improvement Awaiting quality and performance dashboard from NHS England to enable monitoring of general practice
ACTION PLAN
Expected Action Assigned to Date of update Action Description Progress to Date completion date Quality and performance lead from CCG now attends Contract Quality and Contracts update is now a weekly standing item at the Ops Malcolm Ridgway Review monthly Performance meetings Delivery Group Monthly Senior Executive in attendance at Community Contract Management Meetings - The CCG is working with LCFT on a joint approach to quality issues raised regarding poor quality community contract data being received assurance - reports and outcomes of these visits are shared with the CCG Roger Parr Governing Body Assurance Framework Risks 2018/19 MENU
Corporate Objective CO6: To commission improved out of hospital care
Risk Description CO6.1 Clinical workforce capacity is challenged across the system
Initial Current Target Risk Owner Dr Malcolm Ridgway Likelihood Likely Likely Possible Financial / VFM Consequence Major Major Major Compliance / Regulatory Level 16 20 12 Innovation / Quality / Outcomes Date Apr-17 Aug-18 Mar-19 Reputation Movement Controls Assurance Workforce Development Group established to review opportunities for recruitment and retention Internal Assurance (short/medium term) with Health Education North West. Wider system re -design is planned (new models Primary Care Strategy is approved and finalised. 5 year Sustainability and Transformation Plan of care/organisational form) to stimulate workforce recruitment and retention across the health economy. covering a Lancashire and South Cumbria footprint sets out the ambitions for transformational Wider system re-design is planned (new models of care/accountable care system) to stimulate workforce change including workforce requirements. recruitment and retention across the system. Pennine Lancashire Quality Committee monitors and receives assurance of "Safer Staffing" levels CCG has full delegated authority to co-commission primary medical care which enhances the CCGs remit to across providers influence local GP workforce development in conjunction with NHS England including supporting General External Assurance Practice in workforce review, skill mix, and development. New roles in primary care will be encouraged to NHS England has submitted a bid on behalf of all CCGs to assist with GP retention across the create a sustainable workforce across primary care as a whole including increasing Advanced Nurse country. Practitioners and Health Care Assistants to allow GPs to become Expert Generalists. Integrated localities Health Education North West (HENW) has informed the CCG of the Workforce Development Funding will support this through reducing GP workload to allow them to take on more complex work. QOEST Allocations for 2018/19. These will be utilised in Workforce Development upskilling which includes scheme will allow practices to plan ahead in terms of sustainable workforce. Vocational Learning Support, Non-Medical Prescribing and Mentorship and Supervision. Physicians Associates have commenced their training A Digital Supervision Pilot is to commence in BwD in association with NHS Digital and it is anticipated Contractual levers used to ensure commissioned levels of activity delivered. that this will be rolled out across Lancashire and South Cumbria based on the evaluation. LCFT and ELHT are recruiting nationally and internationally using innovative recruitment strategies CCG engages with both HENW and Pennine Lancashire organisations to review opportunities to encourage GP placements in BwD GP Forward View Operational Plan submitted to NHS England which incorporated planning for workforce, capacity and future models of care.
Gaps in Controls Gaps in Assurance On-going financial pressures on NHS resources 2018/19 Capacity and workforce pressures are exacerbating existing recruitment and retention problems Physicians Associates will require 2 year training programme Clinical Workforce capacity is a national issue (reported as 5.9% shortage) Cap on agency spend is exacerbating issues with safe staffing levels which is impacting on service delivery (reduction in local health services)
ACTION PLAN
Expected Action Assigned to Date of update Action Description Progress to Date completion date Engaging with both Health Education NW and Pennine Lancashire organisations to create opportunities to encourage GP placements Malcolm Ridgway Review quarterly Workforce development group established to review recruitment opportunities in BwD Collaboration with Healthier Lancashire Programme to support the development of 5 year STP including workforce requirements System Leader Forum established and workforce identified as one Malcolm Ridgway/Roger Parr Review quarterly of five key tests of the transformation programme
Appendix 2
NHS Blackburn with Darwen CCG Governing Body Risk Appetite Profile August 0 ‐ Avoid 1 ‐ Minimal 2 ‐ Cautious 3 ‐ Open 4 ‐ Seek 5 ‐ Mature 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
6
Appendix 2 Risk Appetite Exercise - Comparison of Results by Year
NHS BwD Risk Appetite [indicative weighted score] April 2013 Aug‐14 May‐16 Aug‐17 Aug‐18
5.0
4.0
3.0
2.0 4.0 3.8 3.70 3.5 3.7 3.7 3.4 3.1 3.2 3.3 3.10 3.1 3.4 3.1 3.1 3.1 3.1 2.9 2.9 2.9 2.80 2.6 2.5 2.5 2.7 1.0
0.0 Financial/VFM Compliance/Regulatory Innovation/Quality/Outcomes Reputation TOTAL (Average)
7
GOVERNING BODY MEETING
COMMUNICATIONS AND ENGAGEMENT STRATEGY 2018-2020 Date of Meeting September 5, 2018 Agenda Item 12
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor x outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity x To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access x Self-Care and Early Intervention x Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 6
Clinical Lead:
Senior Lead Manager Lucie Higham Finance Manager Roger Parr Equality Impact and Risk Assessment EIA was completed on the previous Communication and completed: Engagement Strategy July 2015 Patient and Public Engagement completed: Yes on going Financial Implications Within Budget Risk Identified Engagement risk is reducing Report authorised by Senior Manager: Y
Decision Recommendations
The Governing Body is requested to approve the strategy.
Governing Body Meeting Page 2 of 6
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
SEPTEMBER 5, 2018
COMMUNICATIONS AND ENGAGEMENT STRATEGY 2018-2020
1. Introduction
1.1 This report provides members with the draft communication and engagement strategy for the next 2 years.
2. Purpose / Background
2.1 This report provides members with the draft communication and engagement strategy for the next 2 years.
2.2 Communication and engagement are “enabling” functions that support the business of the CCG and its partner organisations. The specific functions of communication and engagement are:
• External communication including PR, social media, social marketing campaigns, websites, stakeholder bulletins, MP briefings, video and film, awards, feature articles (thought leadership).
• Internal communication including staff, GP and partner bulletins and briefings, and intranet and email communication.
• Engagement – including event management, patient reference groups and patient involvement, coproduction, focus groups, face to face engagement, community engagement, online surveys, market research and membership schemes.
• Internal engagement - including staff, primary care and stakeholder events, activities and projects.
• Consultations – including planning, risk assessment, engagement and communication methodologies, analyses and report writing
• Equality and inclusion – support to ensure equality and inclusion
• Stakeholder management – including communications and engagement methodologies above to reach
• External relations – to establish, maintain and improve beneficial relationships with stakeholders and other organisations across the community.
2.3 The CCG communications and engagement team consists of six staff. This consists of one permanent member of staff (the Head of Communication and Engagement), two directly contracted and temporary members of staff at East Lancs and three staff from whom we contract with Midlands and Lancashire CSU. While all staff work across both CCGs now, as one team, the contractual arrangement with the CSU is for one full time member of staff in BwD (Lucie Higham), supported by two staff (Shelley Whittle Governing Body Meeting Page 3 of 6
and Rashda Iqbal) for 2 days respectively. By bringing together communication and engagement staff across both CCGs there has been much we have achieved through economies of scale, avoidance of duplication and team learning.
2.4 Since last August, the CCG has been not only bringing the two teams together, but also considering moving the temporary staff to permanent roles, and serving notice on the CSU contract and bringing those staff in house. This is still work in progress.
2.5 The CCG is responsible for managing the Together a healthier future programme communication and engagement, as the Head of Communication and Engagement is the current Senior Responsible Officer for the communication and engagement workstream of this programme.
2.6 A notable amount of communication and engagement is undertaken in partnership with partner organisations of the CCGs. The communication and engagement teams for all partner organisations (including both CCGs, ELHT, LCFT and local authorities) have had good, effective working relationships over the last few years; sharing workload and providing mutual support on joint communication and engagement plans such as the winter A&E delivery campaign, other marketing campaigns, joint PR and communications. This varies depending on the nature of the communication and engagement requirement, and ranges from advice, to joint working and mutual aid or support. There has been a willingness and commitment to avoid duplication, ‘do things once’ and ensure consistency and coherence of messaging to avoid confusing or complicating messages.
2.7 Equally, the CCG is also influential in communication and engagement terms, the team were shortlisted for an award for their work in promoting the flu vaccine in BwD last year and have supported GPs, staff and partners to achieve positive media and stakeholder recognition, as well as awards and other recognition and engagement. The CCGs are the lead CCGs for communication and engagement for the pan lancashire and south cumbria review of NHS hearing aids (audiology) and the larger review of CAMHS.
2.8 The Communication and Engagement team has been successful in promoting the work of the CCGs and its member practices, and has achieved notable positive, proactive coverage in the media. Equally it has achieved good engagement on social media with a combined following that has been suggested as the largest social media following for CCGs in the North West, and certainly in Lancashire. The team have supported many of the initiatives of the CCG well, including contentious and challenging issues such as decommissioning of gluten-free prescribing and the promotion of self care prescribing as well as the highly contentious issue of the closure of the walk in centre in Accrington. The communication and engagement team has been brought together to work as one team on areas of common interest and to realise the benefits of economies of scale. The team has also worked closely with other health economy partners including Blackburn with Darwen Council, Public Health, East Lancashire Hospital Trust, Lancashire County Council, the borough council comms teams and Lancashire Care Foundation Trust. This partnership working ensures that there is reciprocal promotion of messages, shared communication and also ensures that organisations are sighted on any salient issues.
2.9 Currently, the CCGs commission Midlands and Lancashire CSU to provide communication and engagement support ostensibly through the provision of staff. Last August, both BwD and East Lancashire CCG executives agreed a proposal to establish an integrated, inhouse team across Pennine Lancashire. The rationale for the inhouse approach was to release the expenditure on CSU overhead to fund and create more capacity to support the work of the CCG and its partners. This process is still in progress. Governing Body Meeting Page 4 of 6
2.10 As part of the process towards integration in the context of the integrated care system (ICS), and to support the implementation and mobilisation of plans arising from Together a Healthier Future; the Head of Communication and Engagement for the CCGs, has worked with the Director of Communication and Engagement at ELHT to develop an integrated communication and engagement service. This is described below as part of the strategy moving forward.
2.11 Following a review of the work and outputs of the team over the last year, this strategy sets out the key deliverables for 18/19 and 19/20. It seeks to build on the successes, adopt learning and capitalise on the opportunities that are available to support effective communication and engagement.
3. Communication and Engagement Strategy
3.1 The strategy for communication and engagement consists of the following goals:
3.1.1 Localities and neighbourhoods are key - communicate, promote and celebrate the work of clinical commissioning including member practices and localities, primary care networks and GP federations and the work of the CCG as whole. 3.1.2 The patient at the heart of everything as a coproduction partner - ensure that the voice of the patient and the public is not only heard but central to everything we do and involve patients at the very earliest point to allow true coproduction 3.1.3 Improving understanding of services, decisions and developments - working with partners to improve the public’s understanding of services that are available, decisions that are made, and actions that are taken, as well as encouraging feedback to us about those services and show that we have listened 3.1.4 Supporting healthier and happier communities - working with partners, to promote self care, resilience and self reliance. 3.1.5 Integrate the communication and engagement team - fully between BwD and East Lancashire CCGs, and in 18/19 operate as an integrated, agile virtual team with ELHT’s communication and engagement team. In 19/20 the team, subject to any further requirements or governance, will integrate completely and operate as a Pennine health and care communication and engagement agency, serving each organisation on an account management basis (see Appendix 1)
3.2 Our objectives to achieve these goals are:
3.2.1 Work with each locality and neighbourhood, PCN and Federation and each PPG locality group to develop a communication and engagement plan and implement it 3.2.2 Update, review and implement the CCG communication and engagement plan against the goals described at 3.1 3.2.3 Support the implementation and mobilisation of the plans for Together a healthier future, along with the ICS (Healthier Lancashire) plans. 3.2.4 Increase proactive media coverage and work hard to promote the work that is being undertaken in Pennine Lancashire, whether at practice, neighbourhood, locality, or at local system level. 3.2.5 Build our following and engagement on social media and support others to maximise the use of social media. 3.2.6 Enhance our web and online information offering to patients and the public 3.2.7 Produce more useful and actionable patient friendly videos 3.2.8 Maximise our use of insight work to understand the patient perspective at all stages of the commissioning process (including surveys, focus groups etc) Governing Body Meeting Page 5 of 6
3.2.9 Ensure that every aspect of commissioning and as we integrate with ELHT, adheres to the maxim of patient engagement and coproduction in developments, and that we are able to evidence this. 3.2.10 Ensure that we communicate and engage with patients and the public on every service we commission, decommission or redesign, at the earliest possible time, allowing the maximum amount of time for people to consider, we make it easy for people to let us know what they think, and more importantly that we act on that feedback. 3.2.11 Action the communication and engagement integration plan (see Appendix 1). 3.2.12 In association with 3.2.11 above, recognise the changing nature of the commissioning/provider landscape and support staff, patients, public and stakeholders to understand and make the most of this change for the better.
4. Conclusion
4.1 The communication and engagement team is actively supporting the work of the CCGs and our partners at all levels of the health economy, working with PPGs, localities, from a CCG perspective, across Pennine lancashire, including together a healthier future, and working at a pan lancashire level.
4.2 Our goals and objectives are geared towards building on a successful track record for communication and engagement, but recognise the changing landscape and capitalise on the opportunities that this presents for patients, clinicians and others.
5. Recommendation
The Governing Body is requested to approve the strategy.
David Rogers Head of Communication and Engagement August 24, 2018
Governing Body Meeting Page 6 of 6
GOVERNING BODY MEETING
PENNINE LANCASHIRE VOLUNTEER STRATEGY AND ACTION PLAN
Date of Meeting 5th September 2018 Agenda Item 13
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality X
Clinical Lead: Dr Penny Morris
Senior Lead Manager Mr Iain Fletcher Finance Manager Mr Roger Parr Equality Impact and Risk Assessment Not by the CCG completed: Is a Data Protection Impact Assessment Required? No GOVERG BODGOVERNING BODY MEETING Governing Body Meeting Page 1 of 2
Data Protection Impact Assessment completed: No Patient and Public Engagement completed: Undertaken by Pennine Lancashire Financial Implications Not to the CCG Risk Identified Non identified for the CCG Report authorised by Senior Manager: Mr Iain Fletcher Y
Decision Recommendations Governing Body Members are requested to acknowledge the development of the Volunteer Action Plan and Strategy across Pennine Lancashire.
Governing Body Meeting Page 2 of 2
Summer 2018
Ribble Valley
Pendle Pennine Lancashire Burnley Hyndburn Volunteer Strategy Blackburn with Rossendale and Action Plan Darwen
Leeds Together a Healthier Future Overview Delivering health and care across Pennine Lancashire is complex and confusing for professionals, patients and their families. This complexity restricts our ability to provide excellent care and, in many cases, is financially unsustainable. As organisations who are responsible for, or have an interest in delivering health and care services, we have agreed to work together to remove this complexity and develop a single shared Vision and Pennine Plan.
Pennine Lancashire has strong local health and care communities with established histories of working together. This puts each of our neighbourhoods and partnership as a whole in a strong position realise our ambitious vision to improve the health of the people of Pennine; build healthy communities that support individuals, families and neighbourhoods and ensure the best possible quality of health and care services within available resources.
In developing our Vision, Pennine Plan and Integrated Care Partnership, we have maximised the value of our collective action and, through our joined up efforts, accelerated our ability to support people as partners in improving their own health and are beginning to transform the way we deliver services. Our plans do not start from scratch, or replace individual partners’ plans – they build on existing plans, taking a common view and identify areas where it makes sense for us to work together and collaborate. At the same time we recognise our place as an integral part of Lancashire and South Cumbria. Working as an Integrated Care Partnership brings to life our commitment to continue to work together on improving health and care. As we set out our proposals for our Integrated Care Partnership, we are bringing to life our Vision, being confident about our place in Lancashire and South Cumbria and setting out how we are working with our regulatory and statutory agencies to shape a future that supports and enables collaboration for the benefit of all.
In short we are committed to increased collaboration, joint planning and integration of services as we continue to focus on what matters – the people of Pennine Lancashire.
Pennine Lancashire Volunteer Strategy
Introduction Volunteering in health and care is far reaching, diverse and makes a significant contribution to an individual’s wellbeing. An estimated 3 million people volunteer across England’s health and care sector, often reaching people at their most vulnerable time, either in hospital or in the community. There are countless examples of volunteering, in both voluntary organisations and the public sector and it is difficult to measure the significant impact this makes. Volunteering brings communities together, prevents individuals from needlessly accessing front line services and acts as an enabler for the volunteer themselves to move into employment and improve their own health and wellbeing.
Together a Healthier Future is a partnership to improve the health and wellbeing of people in Pennine Lancashire, made up of East Lancashire and Blackburn with Darwen. This includes NHS Trusts, Councils and Clinical Commissioning Groups working alongside the voluntary, community and faith sector.
Together a Healthier Future’s vision is “for all of us in Pennine Lancashire to live a long and healthy life. Any extra help and support we need will be easy to find, high quality and shaped around our individual needs.” Our communities across Pennine Lancashire want to do the best they can for each other and their neighbourhoods. Encouraging volunteering and building community capacity to complement public services is a key strategy for improving health and wellbeing through prevention. We have an estimated 114,000 formal volunteers, and we know that there are thousands more informal volunteers and many people who support each other within communities. In order to support these volunteers, the right frameworks need to be put in place to be able to develop and promote volunteering across health and care.
Vision
By working together, we will maximise opportunities for volunteers and organisations to support the health and wellbeing of residents. This strategy aims to:
Ensure that volunteers are consistently trained, recruited and supported in Pennine Lancashire and receive quality volunteering experience Raise the profile of volunteering and the associated benefits Support communities and vulnerable people in their health and wellbeing; either directly from services or through volunteering itself Ensure that appropriate support, resources and guidance is available for the management of volunteers, including sharing challenges, sharing good practice and ensuring the supporting infrastructure is fit for purpose 1
Support the future supply of the health and care workforce.
Drivers
The spotlight was brought to volunteering following the Lampard review of voluntary services within the NHS1. The review recommended that voluntary services are fit for purpose, volunteers are properly recruited, selected and trained and volunteer managers have development opportunities and are properly supported. The Five Year Forward View recognises the contribution volunteers make by stating ‘voluntary organisations often have an impact well beyond what statutory services alone can achieve…The NHS can go further, accrediting volunteers and devising ways to help them become part of the extended NHS family – not as substitutes but as partners with our skilled employed staff.’ 2 With an ageing population and growing health inequalities, the government, public sector and voluntary and community organisations must prioritise volunteering and see its value in promoting and maintaining good health3. Volunteers not only give the gift of time to hard pressed staff to be able to work at the top of their license, but also significantly enhance a patients experience of care. Encouraging volunteering and building community capacity to complement public services is a key strategy for improving health and wellbeing through prevention.4
Definition
For the purposes of this strategy, as defined by the National Council of Voluntary Organisations (NCVO)5, volunteering is defined as ‘any activity that involves spending time, unpaid, doing something that aims to benefit the environment or someone (individuals or groups) other than, or in addition to close relatives’. Central to this definition is the fact that volunteering must be a choice freely made by an individual. It is also important to note that this strategy aims to serve volunteers who work with both adults and children.
Current Provision in Pennine Lancashire
Voluntary provision in Pennine Lancashire is well established, varied and multifaceted. There are hundreds of organisations with thousands of volunteers giving their time each month. The table in Appendix A shows a summary of the provision of voluntary services by organisation, however it is important to remember that there are far more informal grass-roots volunteering organisations and groups contributing to delivery in Pennine Lancashire and supporting residents’ health and wellbeing. The range of volunteering opportunities available in Pennine Lancashire spans the breadth of the Continuum of Volunteering attached in Appendix B.
Whilst each organisation contributes a vast amount of volunteering hours in Pennine Lancashire, reducing vulnerability and enabling people into employment through volunteering it is recognised that there is also silo working, duplication of processes including recruitment, training, and pre-employment checks, and competition between providers. All of which increases the workload for voluntary organisations as well as reducing the capacity of the
1 Department of Health and Social Care (November 2015) https://www.gov.uk/government/publications/jimmy- savile-nhs-investigations-response-to-lessons-learnt-report 2 NHS England (2014) https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf p. 14 3 Local Government Association (February 2017) https://www.scribd.com/document/352350631/Volunteering- and-Health-Literature-Review p.23 4 Together a Healthier Future (2018) http://togetherahealthierfuture.org.uk/pennine-plan/ p.11 5 NCVO (2018) https://www.ncvo.org.uk/policy-and-research/volunteering-policy 2
volunteer to provide more hours and be more flexible in choosing multiple organisations to support.
Recommendations
In consultation with partnership organisations, the following proposals are recommended in Pennine Lancashire which will enable and mobilise volunteers and the organisations they support. Each proposal is outlined below.
1. Implementation of a Volunteer Passport
This standard quality assured, basic training would ensure consistency at a reduced cost to individual organisations, as well as offering a consistent level of support to the volunteer, regardless of which sector they volunteer for. All employers across the public and third sector will recognise this as a quality mark for volunteering.
2. Promote volunteering in health and care
Raising the profile of volunteering and the benefits that brings, either to the person being supported or to the volunteer themselves, is crucial not only for the recruitment and retention of volunteers but also to demonstrate the significant impact volunteers make. We will develop supporting information by scoping the profile of volunteers supporting health and care and develop case studies to use in supporting promotional material as well as host a celebration in Pennine Lancashire to award innovative and inspiring volunteer groups and the impact they have made.
3. Develop supporting infrastructure
Having the right processes, procedures and frameworks in place enables volunteering to take place safely, and ensures it has a positive impact on patients, service users and the volunteer themselves. Implementing online effective volunteer management systems would reduce the workload for the volunteer coordinator in each organisation, reduce duplication and create an online data repository for both the volunteer to use as a record of activity as well the administrators to use in reports to demonstrate the impact volunteers make to ensure continued investment.
4. Create learning and development opportunities for Volunteer Managers and Coordinators
Those who manage and co-ordinate volunteers often work in isolation. It is recognised that managing volunteers takes a different set of skills than those who manage staff. Having development opportunities for those who manage volunteers, as well as creating networking opportunities to ensure they are properly supported as recommended by the Lampard review would contribute towards more effective volunteer management.
5. Develop career progression pathways
Volunteering in health and care is often seen as a means to gaining experience. Be that for those who are unemployed and looking to return to work, for those at university seeking experience to complement their university course or for young people seeking a career in health and care. Gaining experience in this way through volunteering is different from work 3
experience opportunities currently provided and this distinction would need to be made clear. By formalising the coordination of this volunteering placement activity across all sectors, it would increase volunteering numbers, reduce the resources needed and allow for greater exposure to health and care to support the future supply of the workforce.
6. Review current peer support models and scope development of a standard model
Peer support schemes have proven beneficial in many pilot schemes across the UK. In particular, a Practice Health Champion model in Yorkshire6 stated that 94% of patients surveyed had improved mental health and wellbeing when Health Champions were used. By reviewing current peer support models and scoping the potential development, this presents an opportunity to develop a standard model and strong citizen empowered services through social movement in partnership with charitable and voluntary organisations.
7. Develop volunteer benefits
By exploring possible routes to reward a volunteer, this would support volunteers and show appreciation for their time contributed to their community. This route is not without its contention when navigating employment law, however it is clear that people volunteer for many reasons and that by showing appreciation for the contribution they make, it could increase the numbers of volunteers in the system who could soon come to value the experience itself more than the material gain they might be receiving. Examples include time credits, which is based solely on activity and not monetary value; discount cards at local shops and restaurants; reduction in council tax bills; discounted rail fares; free parking from councils and fast track recruitment such as being able to access internal vacancies.
8. Develop corporate social responsibility programmes
Corporate social responsibility is defined as the responsibility of an organisation for the impact of its decisions on society, the environment above and beyond its legal obligations, through transparent and ethical behaviour7. This is often through volunteering schemes for their paid staff, and these programmes have a real potential to increase the numbers of volunteers who contribute their time in health and care. In a generation which is often ‘time-poor’, supporting employees with the gift of time for those who may not otherwise be able to contribute to their community due to family, social and work pressures could unlock real potential. By having a more co-ordinated approach to corporate social responsibility in Pennine Lancashire by working in partnership between organisations, the public, private and third sector, programmes could ‘match up’ groups of volunteers with local volunteering opportunities to create a real impact.
Implementation plan
It is recommended that a phased approach is taken to the above proposals over the course of the two year project. In partnership with public and third organisations in Pennine Lancashire the proposed timescales have been set out in the table below. The ambition of the strategy is
6 South West Yorkshire NHS Trust (2018) http://www.altogetherbetter.org.uk/ 7 Department for Business, Innovation & Skills (2014) https://www.gov.uk/government/consultations/corporate- responsibility-call-for-views 4
to roll out successful proposals wider than Pennine Lancashire in Phase 2. Together a Healthier Future is one of five integrated health and care partnerships within the Lancashire and South Cumbria Integrated Care System8 (ICS) footprint. By pulling together volunteer leads within South Cumbria & Lancashire this will allow for learning to be shared, lessons learnt to be taken into account and recommendations to be adopted in the other four local delivery partnerships.
Development of Volunteer Passport Promotion of Volunteering Phase 1: Develop supporting infrastructure 2018 - 19 Volunteer Manager Development Career progression pathways
Development of peer support models Phase 2: Development of benefits for volunteers 2019 - 20 Develop corporate social responsibility programmes Wider roll out of successful proposals
8 Healthier Lancashire and South Cumbria (2018) http://www.healthierlsc.co.uk/ 5
Delivering the vision for Volunteering in Pennine Lancashire: Action Plan
Strategic Aim Phase 1 Phase 2 What success will look like How progress will be measured
AIM 1: Design Volunteer Passport with key Evaluate Volunteer Passport Volunteers are consistently trained, recruited Number of volunteers trained and using organisations to include: and supported regardless of organisation or the Passport Ensure that volunteers are Core training Explore options for rewarding volunteers sector consistently trained, DBS checks Number of organisations signed up to Pre-volunteering checks e.g. references Volunteers feel appreciated and reward scheme key principles recruited and supported in Test rewards with a pilot group of volunteers is accessed by at least 50% of volunteers in each Pennine Lancashire and Launch Volunteer Passport available to all organisation Number of volunteers accessing reward receive quality volunteering organisations in Pennine Lancashire scheme experience Level of retention of volunteers Scope the profile and numbers of volunteers in Implement communications and engagement Pennine Lancashire residents are aware of the Number of visits to platform Pennine Lancashire and the reasons for plan volunteering options available to them in the AIM 2: volunteering area and the numbers of volunteers increase Event feedback form Research platform to support and promote Raise the profile of Develop innovative case studies linked to the volunteering in Pennine Lancashire A suite of case studies is developed showcasing volunteering and the quadruple aim volunteering in Pennine Lancashire associated benefits Host joint celebration for Volunteers Week Develop celebration in Pennine Lancashire for 2019 Volunteer Week 2019 Evaluate volunteers celebration event AIM 3: Scope corporate social responsibility Launch corporate social responsibility Employees that volunteer through a corporate Number of employees signed up to a programme models programmes in conjunction with local social responsibility programme are matched CSR programme Support communities and organisations, public sector and VCSF appropriately as a group to a local volunteering vulnerable people in their Scope peer support models organisations opportunity to create real impact e.g. working Number of organisations signed up to together to transform a local green space CSR programme health and wellbeing; either Implement peer support model to directly from services or complement existing provision Any peer support model which is implemented Case studies through volunteering itself has a sustained impact on the local community
AIM 4: Launch public sector volunteer offer through Evaluate public sector volunteer management All organisations who requested them, have Volunteer and staff feedback survey Lancashire Volunteer Partnership system updated data management systems, which Ensure that appropriate transforms ways of working. Data collection from project lead support, resources and Scope the development of existing third sector Evaluate volunteer manager training guidance is available for the volunteer centre databases All volunteer data including hours worked, and Return on investment from data courses attended are easily accessible collection management of volunteers, Establish the learning and development supporting both organisations data and including sharing challenges, requirements of Volunteer Managers and co- volunteer profiles Evaluation feedback form sharing good practice and ordinators ensuring the supporting Demand outstrips provision and 60% volunteer infrastructure is fit for Launch training for volunteer managers and managers in Pennine Lancashire receive training purpose coordinators
AIM 5: Scope existing pathways for volunteer placements Advertise and promote via Pennine All organisations are aware of volunteer Numbers of placements taken place as Lancashire Care Academy website placement process and direct as appropriate part of structured programme Support the future supply of Develop co-ordinated volunteer placement Anyone wishing to volunteer for career the health and care pathways in collaboration with local colleges, higher education, VCSF organisations, and public experience knows where to go and has a wealth workforce. sector organisations of opportunities across all sector available to them 6
Appendix A
Summary of the provision of voluntary services by organisation in Pennine Lancashire Public Sector LVP aims to have a single gateway for public sector volunteering in Lancashire. It was created by Lancashire Police and Lancashire County Council and Lancashire Volunteer currently has the following organisations affiliated; Blackburn with Darwen Partnership Council, Blackpool Council, Lancashire Adult Learning, Lancashire Fire and Rescue and Preston City Council. Lancashire County Council Responsibility for volunteers sits with the Lancashire Volunteer Partnership. Voluntary services within the council have recently been brought together under Blackburn with the Lancashire Volunteer Partnership. Blackburn with Darwen Council Darwen volunteers support initiatives such as Your Call which deals with issues in the Local Borough Council neighbourhoods such as litter picking and antisocial behaviour, as well as Authority services such as Youth Justice, Children’s Services and Environment. There are five other district councils in Pennine Lancashire including Burnley, District Hyndburn, Pendle, Ribble Valley and Rossendale. They do not have a Councils formalised structured volunteering programme but there are ad hoc volunteering opportunities available such as art galleries, parks and litter picking. East The management of volunteers sits under the HR directorate in the Trust and Lancashire roles include ward helpers, hospital welcomers, chaplaincy volunteers and Hospital Trust hospital radio volunteers. NHS Lancashire The volunteer service centre supports volunteers who provide non-clinical Care Foundation support to healthcare professionals throughout Lancashire. In particular there is Trust a dedicated wellbeing and mental health helpline supported by volunteers. Blackburn with The CCGs do not have direct volunteering activity taking place in the Darwen organisation. However they do commission projects and activity delivered by CCG East third sector providers. For example these can include social prescribing Lancashire programmes and development of support for young carers. Volunteering in primary care mainly takes places in the form of Patient Participation Groups (PPG), the role of which is to represent the patient Primary Care population, help engage the community and provide feedback to Practices. There can be other local volunteering initiatives in general practice but these tend to be ad hoc and are often in response to funding initiatives. Third Sector There are hundreds of voluntary, community and faith organisations ranging from national charities to local community based groups that provide essential Voluntary, community and valuable services to the residents of Pennine Lancashire. Some are entirely and faith organisations ran and staffed by volunteers, whereas other larger organisations have paid staff in addition to volunteers.
There are three CVS supporting Pennine Lancashire: - Blackburn with Darwen - Burnley, Pendle and Rossendale - Hyndburn and Ribble Valley Council for Voluntary CVS are charities based in a locality who offer a wide range of support and aid Services (CVS) communication for the voluntary, community and faith sector and statutory services. The CVS can also act as a volunteer centre, signposting to volunteering opportunities in the community as well as supporting volunteers within the CVS itself. The Consortium is a member based charitable company which provides a single Families Health and point of contracting and commissioning, providing a structure to support Wellbeing Consortium partnership working across members.
7
Appendix B
8
GOVERNING BODY MEETING
Pennine Lancashire Accident and Emergency Delivery Board Update
Date of Meeting 5th September 2018 Agenda Item 14
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care x Scheduled Care Quality x GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 2
Clinical Lead: Dr David White
Senior Lead Manager Mr Roger Parr Finance Manager Mr Roger Parr Equality Impact and Risk Assessment No completed: Patient and Public Engagement completed: No Is a Data Protection Impact Assessment No Required? Data Protection Impact Assessment No completed: Financial Implications None Risk Identified None Report authorised by Senior Manager: Mr Roger Parr Y
Decision Recommendations
The Governing Body is requested to note the contents of the Pennine Lancashire Accident and Emergency Delivery Board Plan on a Page.
Governing Body Meeting Page 2 of 2
ACCESS ED FRONT DOOR AND STREAMING (SRO ALEX WALKER, DEPUTY ELIZABETH FLEMING) The ambulance service will offer a more equitable and clinically focused response (SRO DR DAMIAN RILEY, DEPUTY NATALIE BROCKIE) that meets patient needs in an appropriate time frame with the fastest response North ED senior leadership team to confirm roles and responsibilities of command/ control for the sickest patients. to reduce known unwarranted variation. A process must be developed to monitor West Pennine Lancashire A&E Delivery Board PL PL deliverables 2018/19: effectiveness and approaches taken by senior Executive leaders to support the team AEDB • Programme of work relating to improved handover position (September to develop a consistent model.
2018) Plan on a Page – July 2018 • Develop plan of action to ensure appropriate healthcare professional PL deliverables 2018/19: utilisation of emergency vehicles (November 2018) • Mobilise and continuous evaluation of command and control structures e.g. PL • Support and monitor the development of the Ambulance Response daily breach meetings, co-ordinator roles, consultant-led 2 hourly board AEDB Programme (March 2019) rounds (continuous) 999 NHS I ELHT NHS E U&EC Discharge Footprint Winter • Monitor the implementation of NWAS Care Home triage tool, commenced in • Extend interim management model for Emergency Medicine until September Department Emergency report Delivery Plan High Impacts Recovery Improvement Continuous Oct 17, as an alternative to 999 (ongoing) 2. 2018. Priorities 1-7 Priorities 1-8 PL AEDB Schemes • Develop a plan for a Frailty Car Service as an alternative to a hospital PL Priorities 1-5 North West admission (November 2018) AEDB Develop a whole-system approach to identifying and managing frailty with an initial • UECN Develop a plan to operate a Mental Health Car service as an alternative to a focus on delivering early functional assessment in ED and commencing a PL hospital admission (September 2018) comprehensive geriatric assessment. AEDB • Development of Acute Visiting Service (AVS) in East Lancashire to support GP In Emergency Departments we will develop new approaches prioritising the needs of services with the aim of preventing hospital admission (November 2018) the sickest patients. Our frail and elderly patients will get specialist assessments at • Development of the Mental Health Decision Unit (MHDU) to enable direct PRIMARY CARE ACCESS PL the start of their care and those patients who could be better treated elsewhere, AEDB NWAS access (October 2018) (SRO SHARON MARTIN, DEPUTY COLLETTE WALSH) will be streamed away from Emergency Departments. There will be testing of innovative new models of service that enable patients to By 1st October 2018 patients and the public will have access to evening and enter their symptoms online and receive advice online or a call back. North weekend appointments with general practice. PL deliverables 2018/19: PL deliverables 2018/19: West Primary PL deliverables 2018/19: 1. • NHS 111 online planned to go live in Lancs & South Cumbria (June 2018) Care • Progress plans to deliver extended primary care access in East • Undertake evaluation of Mental Health Triage Team and review impact on We will continue to develop the response patients receive when they call 111. By NW Lancashire. 100% coverage across East Lancashire required. (October breach numbers. Analyse ECIST Mental Health pathway review (August 2018) the end of 2017/18 the percentage of calls receiving clinical advice will exceed Access • 111 PL AEDB 2018) Commence near patient testing for low risk chest pain pathway at RBH site 50%. (May 2018) PL deliverables 2018/19: PL AEDB • Pilot near patient testing for troponin at BGH UCC (May 2018) PL AEDB • Programme of work to review local Directory of Services (DOS) (ongoing) • Form steering group and define preferred clinical models for Ambulatory • Implementation of direct booking from 111 in to OOHs and Pennine DISCHARGE AND RECOVERY Emergency Care Unit (formally known as MTU/Admin Corridor) (July 2018) 3. Lancashire Primary Care extended access (September 2018) • Define opportunities for Respiratory Pathway for Winter 2018/19 (July 2018) Standardise access to ‘Urgent Treatment Centres’ through booked appointments (SRO ALEX WALKER) Redesign Suite Care Emergency • Define opportunities for Frailty Pathway for Winter 2018/19 (July 2018) via NHS 111. These facilities will have an increasingly standardised offer - open 12 We will speed up the assessment process and ensure that patients are sent • 4. PL AEDB Form steering group and complete treasury business case for STP capital home as soon as possible and if home is not the best place for their hours a day and staffed by clinicians, with access to simple diagnostics. PL funding (June 2018)
immediate care, they will be transferred promptly to the most appropriate PL deliverable 2018/19 AEDB • Conclude draft modelling regarding number and locations of UTCs in Pennine care setting for their needs. Lancashire (Oct 18), next step is public consultation and CCG decision (May PL deliverables 2018/19: 2019) • Discharge to Assess - Home first. Continue delivery of a Pennine • Interim review of OOHs service specification including 24/7 Clinical Lancashire home first principle and deploy a ‘movement’ campaign to Integrated Urgent Care Assessment Service (October 2018) engage staff, patients, carers and loved ones. To sustain a minimum of 50 patients a week and increase utilisation of Home First slots. PL ‘Big 6’ Schemes for Winter 2018/19 FLOW • Discharge to Assess into 24/7 Care Settings. Move to 85% of CHC AEDB (SRO JOHN BANNISTER, DEPUTY TONY MCDONALD) triggers and MDTs taking place outside an acute hospital setting
The systematic implementation of the national SAFER patient flow bundle. The through the delivery of Discharge to Assess pathways in alternative care implementation of the ECIP red and green day improvement tool should be a key setting for further assessment. Shifting assessment for long term need PL AEDB 6. focus area for the organisation under the ‘model ward’ roll out. to be within a wider recovery pathway outside of hospital. 1. PL deliverables 2018/19: • To reduce the number of stranded and super-stranded patients as a Primary Care • Increased utilisation of the Discharge Lounge. Target on a daily basis is to percentage of occupied beds. Initial target is to have less than 158
have 25% of all discharges to be in the Discharge Lounge by 12pm. patients with a length of stay of over 7 days or more. (December 2018) Extended
• Develop a single integrated model of IDS to support the Discharge from (September 2018) Access • Achievement of less than 90% bed occupancy (December 18) Acute setting, Home First, Discharge to assess and Intermediate care PL Management Discharge AEDB • Roll out of SAFER bundle to all medical wards, including community wards 5. pathway. (April 2019) 6. 2. (August 18) Discharge to Conveyance • Complete PJ Paralysis 70 day challenge (August 18) PL AEDB
Clinical Flow and • Assess Avoidance Discharge Process Discharge Roll out of Criteria Led Discharge across ICG (June 2019) • Audit and improvement on compliance with agreed escalation processes at a UECN deliverable 2018/19: • specialty and trust level (October 18) Delivery of Home of Choice policy. Agree and sign off the Home of UECN • Review utilisation of NWAS PTS resources and reduce usage and associated Choice policy developed across Lancashire and South Cumbria. Use the costs with private PTS ambulance (August 18) patient documentation, undertake staff training and agree funding streams to support delivery of the policy (July 2018) ESCALATION AND SYSTEM RESILIENCE PL deliverable in 2018/19: • 5. 3. (SRO KEVIN MCGEE, DEPUTIES JOHN BANNISTER AND ALEX WALKER) Develop a clear plan to realise the opportunities highlighted by the system diagnostic completed in November 2017 to support a reduction To review organisational/ system escalation plans and create action cards to ensure Flow Ambulatory in bed base delivery models. (September 2018) PL a consistent approach is applied to managing internal flow across the organisation. PL AEDB Improvement Emergency Care The action cards should be monitored and effectiveness evaluated to support AEDB continuous improvement. Alongside this: Develop and implement a full capacity Programme Care Unit Intermediate Intermediate protocol at times of heightened escalation. 4. PL deliverable in 2018/19: PL deliverable in 2018/19: PL Respiratory • Ongoing review and development of the Pennine Lancashire escalation plan AEDB
• Evaluate the current models of IHSS and recommend a single model for ensuring alignment with national guidance. This escalation plan is to include st and Frailty Pennine Lancashire (31 October 2018). the teleconference function, Standard Operating Procedures (12 Hour Breach, PL Pathways** AEDB Diversion and Deflection) and OPEL Framework (December 2018) • Review the ELHT escalation plan to ensure this incorporates a full capacity protocol which is implemented at times of heightened escalation (Dec 2018) Service Community Efficiency & Efficiency Notes: PL deliverables in 2018/19: *LGA, ADASS, NHS E, DH, ECIP, Monitor and NHS I. Managing Transfers of Care between Hospital and Home. Teams Integrated • Ongoing monitoring of the process for winter planning for 2018/19 **Frailty and Respiratory pathways are HWIMPS for Together a Healthier Future programme. These groups
System Escalation Function Escalation System PL (December 2018) have separate actions plans which are in addition to the AEDB POAP. • Undertake resilience planning and assurance for peak demand periods e.g. AEDB bank holidays, Christmas break, Easter (ongoing)
Agenda Item No: 368/18
GOVERNING BODY MEETING
Lancashire and South Cumbria Perinatal Mental Health (Community) Report
Date of Meeting 5th September 2018 Agenda Item 15
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 2
Clinical Lead:
Senior Lead Manager Mrs Janet Thomas Finance Manager Mr Roger Parr Equality Impact and Risk Assessment No completed: Patient and Public Engagement completed: No Is a Data Protection Impact Assessment No Required? Data Protection Impact Assessment No completed: Financial Implications None Risk Identified None Report authorised by Senior Manager: Mr Roger Parr Y
Decision Recommendations
The Governing Body is requested to note the contents of the Progress Report for information.
Governing Body Meeting Page 2 of 2
Project Progress Report Form
PERINATAL MENTAL HEALTH (COMMUNITY) Status Date 13/07/2018 Programme Gill Strachan Programme 13/07/2018 Lead (s) Louisa Swift Lead(s) Sign off Date Assurance 13/07/2018 SRO Louisa Swift SRO Sign off 13/07/2018 Meeting Date Date
STATED AIM
To deliver an inpatient and specialist community perinatal mental health which will address the needs of the local population, taking into consideration the local varying demographics to ensure provision of a locally sensitive service, whilst increasing the availability nationally of specialist inpatient capacity.
BRIEF GENERAL PROGRESS TO DATE Initial mobilisation meetings have taken place. Staffing model mapped. The Community Service mobilisation now forms part of the overarching Perinatal Mental Health Steering Group in order to map progress. Mobilisation Plans, action trackers, risk logs and governance structures are all in place to monitor and track progress of the Community Service going forward. Key progress to date. • Team Manager recruited and interviewing for remaining posts • Patient Pathways agreed • Admission / Discharge Criteria Agreed
Key Actions between now and end of August: • Recruit to full establishments (as per table A below) • Set up office and IT requirements • Begin plans for team induction and ongoing supervision requirements • Agree phased approach to mobilisation‐ Initial geographical coverage • Ensure availability of wider Trust policies and procedures to aid staff in their role • Map interface with wider services‐ ensure all pathways are clearly documented and accessible • Development of patient information materials
Table A
Perinatal community mental health team staffing for 18,559 deliveries
Specialist Numbers
Consultant perinatal psychiatrist 2 WTE
Trainee psychiatrists/non‐consultant grade doctor 2 WTE
Community team manager (50% managerial, 50% clinical) 1 WTE
Specialist community nurses 12 WTE
Psychologist 2 WTE
Occupational therapist 2 WTE
Community nursery nurses/Health & Wellbeing Practitioners 6 WTE
Team secretary/administrator 3 WTE
Mobilisation Manager (Year 1) 1 WTE
Link Health Visitor Existing Services
Link Liaison Midwife Existing services
WTE, whole time equivalent
2
MILESTONE STATUS
Below is an extract from the PMO database of the status of Key Milestones associated with this scheme. Updates are required on any milestone showing Red or Amber.
Community Mobilisation Project Plan Complete 30/05/2018 Complete COMMUNITY PHASE 1 ‐ Community Service Contract Signed 31/05/2018 Red Identification of Clinic Space & Locality Bases Two localities established 31/08/2018 Amber in South Cumbria SCPT (Barrow) and East Recruitment of Phase 1 Team 31/08/2018 Amber Lancashire (Burnley) Phase 1 Training Complete 28/09/2018 Amber COMMUNITY PHASE 2 ‐ Recruitment of Phase 2 Team 30/11/2018 Amber Expanding across the whole of South Cumbria and East Lancashire Phase 2 Training Complete 31/12/2018 Amber including Blackburn with Darwen
COMMUNITY PHASE 3 ‐ Recruitment of Phase 3 Team 28/02/2019 Preston, Chorley, West Amber
Lancashire, Blackpool, Fylde and Wyre Phase 3 Training Complete 31/03/2019 Amber
MBU Staff In Post 01/07/2018 Green MBU Staff Trained 20/08/2018 Amber MBU Operational Service Level Agreements In Place 31/07/2018 Amber SOPS Signed Off MBU 31/08/2018 Amber Equipment & Furniture Installation completed 28/09/2018 Amber MBU Handover 28/09/2018 Amber Opening MBU to Admissions 28/09/2018 Amber Peer Support Services Live 28/09/2018 Amber
3
BENEFITS STATUS The team will work with women and their infants in non‐stigmatising settings such as antenatal clinics, community settings and their own homes. Working closely with other professionals and offer a range of interventions which include:
• Telephone triage of referrals within two working days • Joint Psychiatric / Obstetric clinics • Perinatal outpatient clinics • Prompt access to advice for professionals • Specialist psychological and occupational therapies • Pre‐conception counselling • Joint pre‐birth care planning • Care coordination • Parent infant interventions (Including VIG) • Signposting and onward referral A project initiation document and benefits realisation tracker are currently revised and updated.
RISK & ISSUES
An issue is an unexpected occurrence that has not been previously identified as a risk and subsequently mitigated. Issues are more dynamic than risks and may be resolved rather than mitigated. An issue may need to be recorded as a risk if appropriate resolution cannot be found.
ID Risk Current Target Controls Assurances NEW Lack of identified 9 4 Full mobilisation plan Combined Perinatal premises for in place with key MH & Capital Project Perinatal Outreach milestones identified Steering Group Workers may result (Meeting Minutes) Progress is monitored in operational delays in Combined Perinatal Escalation Procedures & Capital Project Steering Group Risks to key milestones are reviewed weekly and escalated as needed Reputational 9 4 Full mobilisation plan Comms & Engagement damage to LCFT as a in place with key Plan result of the delays milestones identified Combined Perinatal to the Perinatal Progress is monitored MH & Capital Project
4
Service mobilisation in Combined Perinatal Steering Group MH & Capital Project (Meeting Minutes) Steering Group Escalation Procedures Risks to key milestones are reviewed weekly and escalated as needed Communications Briefings Robust Comms & Engagement Plan Communication with key stakeholders
Project RAG Approved Low Risk Medium Risk High Risk rating √ Rationale
• Recruitment to establishment still taking place. • Risks to be fully mitigated • Project Milestones to be finalised.
5
GOVERNING BODY MEETING GORNIN
Annual Report of the Audit Committee 2017/18
Date of Meeting 5th September 2018 Agenda Item 16
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity Y To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality G BODGOVERNING BODY MEETING
Page 1 of 23
Clinical Lead: N/A
Senior Lead Manager Mr Roger Parr Finance Manager Mrs Linda Ring Equality Impact and Risk Assessment N/A completed: Is a Data Protection Impact Assessment Required? No Data Protection Impact Assessment completed: No Patient and Public Engagement completed: N/A Financial Implications N/A Risk Identified N/A Report authorised by Senior Manager: Mr Roger Parr
Y Decision Recommendations The Governing Body is asked to note the content of this report.
Page 2 of 23
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
5TH SEPTEMBER 2018
ANNUAL REPORT OF THE AUDIT COMMITTEE 2017/18
1. Introduction
The purpose of this report is to inform the Clinical Commissioning Group (CCG) Governing Body of the role and activities of the Audit Committee during the financial year 2017/18.
2. Role of the Audit Committee
The Audit Committee has operated during the year in accordance with its agreed Terms of Reference. A summary of the audit committee’s responsibilities are set out below and the full Terms of Reference are included as Appendix A.
3. Summary of Audit Committee Responsibilities
The roles and responsibilities of the Audit Committee include the review of the establishment and maintenance of effective integrated governance, risk management and internal control systems across the whole of the CCG’s activities, both clinical and non-clinical supporting the achievement of the CCG’s objectives. It includes the review and monitoring of the internal and external audit functions, counter fraud and monitoring of the integrity of the financial statements of the CCG. The full role and responsibilities of the Audit Committee are shown in the Terms of Reference at Appendix A.
4. Membership of the Audit Committee
Membership during the year has comprised of:
Name Number of meetings % attended
Mr Paul Hinnigan (Chair) 5 100%
Dr John Randall 3 60%
Dr Geraint Jones 4 80%
Dr Nigel Horsfield 5 100%
Invitations to attend the Audit Committee are normally provided to:
Page 3 of 23
• CCG Chief Finance Officer
• Internal Audit Representatives
• Counter Fraud Representatives
• External Audit Representatives
• CCG Chief Clinical Officer
In addition, other officers from within the organisation have been invited to attend Audit Committees where it was felt that to do so would assist the Audit Committee to effectively fulfill its responsibilities.
Administrative support has been provided by the Executive Assistant to the Chief Finance Officer.
5. Appointment of External Audit
Grant Thornton were re-appointed as external auditors for Blackburn with Darwen CCG from 1st April 2017 for a five year period.
6. Meetings during the year 2017-18
During the year 5 meetings were held on the following dates:
25 April 2017
25 May 2017
22 August 2017
28 November 2017
27 February 2018
The agenda for each of these meetings are shown in Appendix B and full minutes can be accessed on the CCG website.
7. Remuneration of the Audit Committee
The fulfilment of Audit Committee responsibilities by Lay Members are expected as part of each individual Lay Member’s contracts with the organisation.
8. Financial Statements
On 24th April 2018, the Audit Committee reviewed the draft 2017/18 Annual Accounts and Annual Report including the Annual Governance Statement. The final version of the Annual Accounts was reviewed on 24th May 2018. The Audit Committee also reviewed the external audit report on the Annual Accounts. The Committee also approved the content of the 2017/18 Management Representation letter. Page 4 of 23
9. Internal Control and Risk Management Systems
At each meeting the Audit Committee has considered various reports from its Internal and External Auditors and the CCG Finance Officer. A full list of the reports received and other agenda items considered by the Audit Committee is contained in Appendix B.
10. External Audit
Grant Thornton are the CCG’s appointed external auditor. The Audit Committee has reviewed the work and findings of External Audit by:
• Discussing and agreeing the nature and scope of the 2017/18 Annual Plan;
• Considering the extent of its co-ordination with and reliance on internal audit;
• Receiving and considering reports derived from the Annual Plan: and
• Receiving and considering the annual audit letter before its submission to the Governing Body.
The Audit Committee has also met in private with External Audit so as to allow the discussion of matters without the presence of executive officers.
11. Internal Audit and Anti Fraud
The Audit Committee has reviewed and considered the work and findings of Internal Audit by:
• Discussing and agreeing the nature and scope of the Annual Plan;
• Receiving and considering regular progress reports from the Director of Internal Audit at Audit Committee meetings;
• Receiving and considering reports derived from the Annual Plan;
• Receiving the 2017/18 Head of Internal Audit’s annual opinion on the system of internal control;
• Receiving the 2017/18 Internal Audit Report;
• Receiving the 2017/18 Anti Fraud Annual Report.
The Audit Committee has also met in private with Internal Auditors so as to allow discussion of matters in the absence of executive officers.
For both internal and external audit, the Audit Committee has ensured that management actions agreed in response to reported weaknesses, have either been implemented or that there has been adequate explanation for delays or non-implementation.
12. Relationships with other Committees
The Audit Committee received minutes and reports from other Clinical Commissioning Group (CCG) Committees, eg Pennine Lancashire Quality Committee and the CCG Primary Care Co-Commissioning Page 5 of 23
Committee. The Audit Committee received reports on the financial planning of the Clinical Commissioning Group, reports on the Quality Innovation, Productivity and Prevention (QIPP) programme, risk register and other corporate registers.
13. Looking Ahead
Internal and External Audit work plans have been agreed and a proposed Audit Committee work plan for 2018/19 is shown in Appendix C which covers the main areas of work to be undertaken.
14. Recommendation
The Governing Body is asked to note the content of this report.
Mr Paul Hinnigan Audit Committee Chair 9 August 2018
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Appendix A
AUDIT COMMITTEE TERMS OF REFERENCE
1.0 Purpose of the Committee
The Audit Committee (the Committee) is established in accordance with Blackburn with Darwen’s (BwD’s) Clinical Commissioning Group’s Constitution. These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution.
The duties of the Committee will be driven by the priorities identified by the Clinical Commissioning Group, and the associated risks.
2.0 Roles and Responsibilities 2.1 Integrated Governance , Risk Management and Internal Control The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the Clinical Commissioning Group’s activities (clinical and non-clinical) that support the achievement of the Clinical Commissioning Group’s objectives.
Its work will dovetail with that of the Pennine Lancashire Quality Committee which the Clinical Commissioning Group established to seek assurance that robust clinical quality is in place and drive improvements to services.
In particular, the Audit Committee will review the adequacy and effectiveness of:
• All risk and control related disclosure statements (in particular the governance statement), together with any accompanying Head of Internal Audit Opinion, external audit opinion or any other appropriate independent assurances, prior to endorsement by the Clinical Commissioning Group.
• The underlying assurance processes that indicate the degree of achievement of Clinical Commissioning Group objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.
• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.
• The policies and procedures for all work related to counter fraud and security as required by NHS Protect. In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from Officers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with Page 7 of 23
indicators of their effectiveness.
This will be evidenced through the Committee’s use of an effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it.
As part of its integrated approach, the Committee will have effective relationships with other key committees so that it understands processes and linkages. However, these other committees must not usurp the Committee’s role
2.2 Internal audit
The Committee shall ensure that there is an effective internal audit function that meets the Public Sector Internal Audit Standards (2013) and provides appropriate independent assurance to the Audit Committee, Clinical Chief Officer and Clinical Commissioning Group Governing Body. This will be achieved by:
• Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.
• Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework.
• Considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources.
• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the Clinical Commissioning Group.
• An annual review of the effectiveness of internal audit. 2.3 External audit
The Committee shall review and monitor the external auditor’s independence and objectivity, the work and findings of the external auditors, and, consider the implications and management’s responses to their work. This will be achieved by:
• Consideration of the appointment and performance of the external auditors, as far as the rules governing the appointment permit (and make recommendations to the Governing Body when appropriate).
• Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co- ordination, as appropriate, with other external auditors in the local health economy.
• Discussion with the external auditors of their evaluation of audit risks relating to both the financial statements and value for money conclusion, and associated impact on the audit fee.
• Review of all external audit reports, including the report to those charged with Page 8 of 23
governance, agreement of the annual audit letter before submission to the Clinical Commissioning Group and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.
• Ensuring there is a clear policy for the engagement of external auditors to supply non audit services
2.4 Other assurance functions
The Audit Committee shall review the assurance framework and the corporate risk register as well as findings of other significant assurance functions, both internal and external and consider the implications for the governance of the Clinical Commissioning Group.
These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).
In addition, the Committee will review the work of other committees within the organisation, whose work can provide relevant assurance to the Committee’s own areas of responsibility. In particular, this will include the work of the Quality, Performance and Effectiveness Committee and the Primary Care Commissioning Committee.
2.5 Counter fraud
The Committee shall satisfy itself that the Clinical Commissioning Group has adequate arrangements in place for countering fraud and security that meet NHS Protect’s standards and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.
2.6 Management
The Committee shall request and review reports and positive assurances from Directors and Managers on the overall arrangements for governance, risk management and internal control.
The Committee may also request specific reports from individual functions within the Clinical Commissioning Group as they may be appropriate to the overall arrangements.
2.7 Financial reporting
The Audit Committee shall monitor the integrity of the financial statements of the Clinical Commissioning Group and any formal announcements relating to the Clinical Commissioning Group’s financial performance.
The Committee shall ensure that the systems for financial reporting to the Clinical Commissioning Group, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Clinical Commissioning Group.
Annual Reports and Accounts
In accordance with the CCG’s Constitution (Scheme of Reservation and Delegation) the Committee is authorised to approve the Group’s annual report and annual accounts. Page 9 of 23
The Audit Committee shall review the annual report and financial statements before submission to the Governing Body (for information), focusing particularly on:
• The wording in the annual governance statement and other disclosures relevant to the Terms of Reference of the Committee; • Changes in, and compliance with, accounting policies, practices and estimation techniques; • Unadjusted mis-statements in the financial statements; • Significant judgements in preparing of the financial statements; • Significant adjustments resulting from the audit; • Letter of representation • Explanations for significant variances • Qualitative aspects of financial reporting.
2.8 Review instances where Standing Orders / Standing Financial Instructions have been waived.
2.9 Review, at least annually, the Clinical Commissioning Group Governing Body’s schedules of losses special payments and register of gifts and hospitality and declaration of Clinical Commissioning Group members’ interests.
2.10 Whistleblowing The Committee shall review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.
3.0 Deliverables 3.1 Reports of assurance to the Clinical Commissioning Group Governing Body that the functions as identified in the Audit Committee Work plan have been performed.
3.2 Minutes recording the decisions reached and the reasons for such decisions shall be maintained and be submitted to the Clinical Commissioning Group Governing Body.
4.0 Constraints/Risks 4.1 Audit reporting and publishing of annual accounts are set within pre-determined dates.
5.0 Membership 5.1 The Committee shall be appointed by the Clinical Commissioning Group as set out in the Clinical Commissioning Group’s Constitution and may include individuals who are not on the governing body.
The Lay Member on the Governing Body with a lead role in governance will chair the Audit Committee.
As a minimum membership shall be made up of:-
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Lay Member for Governance (Chair) Secondary Care Doctor One other Lay Member GP Executive
Members must comply with the requirements of the CCG’s Conflict of Interest Policy. In the event that all clinical members are excluded from decisions due to conflicts of interest clinical input may be sought from elsewhere if and when required.
The Accountable Officer will be invited to attend meetings and discuss at least annually with the Audit Committee the process for assurance that supports the Annual Governance Statement. The Accountable Officer will be invited to attend when the committee considers the draft Annual Governance Statement, the Annual Report and Accounts.
The Chief Finance Officer and other Executives from the Clinical Commissioning Group may be in attendance at the specific invitation of the Chair.
6.0 Governance and Reporting 6.1 The Audit Committee will report to the Clinical Commissioning Group Governing Body on how it discharges its responsibilities.
The Committee will report to the governing body at least annually on its work in support of the annual governance statement, specifically commenting on: • The fitness for purpose of the Assurance Framework • The completeness and “embeddedness” of risk management within the organisation • The integration of governance arrangements • The appropriateness of evidence that show the organisation is fulfilling regulatory requirements relating to its existence as a functioning business
This annual report should also describe how the Committee has fulfilled its terms of reference and give details of any significant issues that the Committee considered in relation to the financial statements and how they were addressed. 6. The Committee shall report after each meeting on all matters within its duties and responsibilities. The report should be completed in line with the agreed template and the full minutes will be submitted to the next meeting of the governing body.
6.3 Quorum Quorum shall be 2 members. 6.4 Frequency The Audit Committee shall meet at least four times per annum and at least once a year will meet with Internal Audit and External Audit with no other officers present. The Chief Finance Officer will arrange secretarial support for the committee. 7.0 Relationships/Interdependencies with other Bodies 7.1 The Audit Committee is informed by corporate business transacted by the Clinical Commissioning Group Governing Body and its Sub-Committees.
8.0 Location of information such as plans, or contact information 8.1 Information relating to the business of the Audit Committee is saved electronically on the
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Corporate Drive.
9.0 Related Policies 9.1 • Being Open Policy • Whistle Blowing Policy • Fraud and Corruption Policy • Conflict of Interest Policy • Standing Financial Instructions • Standing Orders 10.0 Schedule of Meetings 10.1 4 times per annum as a minimum.
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APPENDIX B
CLINICAL COMMISSIONING GROUP (CCG)
AUDIT COMMITTEE
Tuesday 25th April 2017 at 1 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
A G E N D A
Item Agenda Item Member Report No: Responsible 1. Chair’s Welcome Mr Paul Hinnigan
2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan
3. Declarations of Interest Mr Paul Hinnigan Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Audit Committee Secretary in advance of the meeting.
4. Review of Terms of Reference Mr Paul Hinnigan Attached
5. Minutes of the Meeting held on 28th February 2017 Mr Paul Hinnigan Attached
6. Matters Arising Mr Paul Hinnigan 6.1 Action Matrix Attached 7. Risk Management Report Mrs Claire Moir Attached
8. External Audit Mr Chris Whittingham 8.1 Progress Report Attached
9. Internal Audit Mrs Lisa Warner 9.1 Progress Report Attached 9.2 Head of Audit Opinion and Annual Report 2016/17 Attached 9.3 Draft Audit Plan 2017/18 Attached 9.4 Charter Attached
10. Anti-Fraud Mrs Sharon Brock 10.1 Annual Report 2016/17 Attached 10.2 Annual Plan 2017/18 Attached
11. Draft Annual Report and Financial Statements 2016/17 Mr Roger Parr Attached 11.1 Annual Review of Accounting Policies Attached
12. Financial Plan and Detailed Budgets Update 2017/18 and Mr Roger Parr Attached
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18/19 13. Losses and Special Payments Mr Roger Parr Attached
14. Waivers and Standing Orders Mr Roger Parr Attached
15. Corporate Registers Mr Roger Parr Attached
16. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached
17. Audit Committee Work Plan 2017/18 Mr Paul Hinnigan Attached
18. Pennine Lancashire Quality Meeting Mr Paul Hinnigan/ 18.1 Minutes of the Meeting held on 14th December 2016 Dr Geraint Jones Attached 18.2 Minutes of the Virtual Meeting held in January 2017 Attached 18.3 Minutes of the Virtual Meeting held in February 2017 Attached 19. Primary Care Co-commissioning Committee Mr Paul Hinnigan 19.1 Minutes of the Meeting held on 14th February 2017 Attached
20. Any Other Business Mr Paul Hinnigan
21. Date and Time of Next Meeting Mr Paul Hinnigan
25th May 2017 at 2 pm in the Small Meeting Room, Fusion House.
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CLINICAL COMMISSIONING GROUP (CCG)
AUDIT COMMITTEE
Thursday 25th May 2017 at 2 p.m. in the Small Meeting Room, Fusion House Evolution Park, Haslingden Road, Blackburn, BB1 2FD
A G E N D A
Item Agenda Item Member Responsible Report No: 1. Chair’s Welcome Mr Paul Hinnigan
2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan
3. Declarations of Interest relating to items on the Mr Paul Hinnigan agenda Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Audit Committee Secretary in advance of the meeting.
4. Minutes of the Meeting held on 25th April 2017 Mr Paul Hinnigan Attached
5. Matters Arising Mr Paul Hinnigan 5.1 Action Matrix Attached
6. External Audit 2016/17 Mrs Karen Murray/ To Be Tabled 6.1 Audit Findings Report Mr Chris Whittingham
8. Letter of Representation Mr Roger Parr To Be Tabled
9. Any Other Business Mr Paul Hinnigan
10. Date and Time of Next Meeting Mr Paul Hinnigan
August - to be confirmed
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CLINICAL COMMISSIONING GROUP (CCG)
AUDIT COMMITTEE
Tuesday 22nd August 2017 at 1 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
A G E N D A
Item Agenda Item Member Report No: Responsible 1. Chair’s Welcome Mr Paul Hinnigan
2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan
3. Declarations of Interest Mr Paul Hinnigan Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Audit Committee Secretary in advance of the meeting.
4. Minutes of the Meeting held on 25th May 2017 Mr Paul Hinnigan Attached
5. Matters Arising Mr Paul Hinnigan 5.1 Action Matrix Attached
6. Risk Management Report Mrs Claire Moir Attached
7. Annual Governance Statement Mrs Claire Moir Attached
8. Draft Audit Committee Annual Report Mr Paul Hinnigan Attached
9. External Audit Mr Chris Whittingham 9.1 Annual Audit Letter 2016/17 Attached
10. Internal Audit Mrs Liz Squires 10.1 Progress Report Attached 10.2 Insight Assurance Framework Benchmarking Report Attached 10.3 Insight Update Attached 10.4 Annual Review of the Effectiveness of Internal Audit Mr Paul Hinnigan Attached
11. Anti-Fraud Mrs Sharon Brock 11.1 Progress Report Attached 11.2 The Sentinel Attached 11.3 Recent Fraud Cases Attached 11.4 Timesheet Fraud Attached 11.5 Bogus Boss Fraud Attached
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12. Losses and Special Payments Mr Roger Parr Attached
13. Waivers and Standing Orders Mr Roger Parr Attached
14. Corporate Registers Mr Roger Parr Attached
15. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached
16. Audit Committee Work Plan 2017/18 Mr Paul Hinnigan Attached
17. Pennine Lancashire Quality Meeting Mr Paul Hinnigan/ 17.1 Minutes of the Meeting held on 26th April 2017 Dr Geraint Jones Attached 17.2 Minutes of the Meeting held on 24th May 2017 Attached
18. Primary Care Co-commissioning Committee Mr Paul Hinnigan 18.1 Minutes of the Meeting held on 31st May 2017 Attached
19. Any Other Business Mr Paul Hinnigan
20. Date and Time of Next Meeting Mr Paul Hinnigan
To be confirmed
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CLINICAL COMMISSIONING GROUP (CCG)
AUDIT COMMITTEE MEETING
Tuesday 28th November 2017 at 1 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
A G E N D A
Item Agenda Item Member Responsible Report No: 1. Chair’s Welcome Mr Paul Hinnigan
2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan
3. Declarations of Interest Mr Paul Hinnigan Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Audit Committee Secretary in advance of the meeting.
4. Minutes of the Meeting held on 22nd August 2017 Mr Paul Hinnigan Attached
5. Matters Arising Mr Paul Hinnigan 5.1 Action Matrix Attached • Financial Reporting Mr Roger Parr
6. Risk Management Report Mrs Claire Moir Attached 6.1 Governing Body Risk Appetite Presentation
7. Annual Governance Statement 2017/18 Progress Report Mrs Claire Moir Attached
8. External Audit Mr Chris Whittingham 8.1 Progress report Attached
9. Internal Audit Mrs Lisa Warner 9.1 Progress Report To Follow 9.2 Insight Report Attached 9.3 Assessment of Internal Audit Findings Report Mr Paul Hinnigan Attached
10. Anti-Fraud Mrs Sharon Brock 10.1 Progress Report Attached
11. Losses and Special Payments Mr Roger Parr Attached
12. Waivers and Standing Orders Mr Roger Parr Attached
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13. Corporate Registers Mr Roger Parr Attached
14. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached
15. Audit Committee Work Plan 2017/18 Mr Paul Hinnigan Attached
16. Pennine Lancashire Quality Meeting Mr Paul Hinnigan/ 16.1 Minutes of the Meeting held on 28th June 2017 Dr Geraint Jones Attached 16.2 Minutes of the Meeting held on 26th July 2017 Attached 16.3 Minutes of the Meeting held on 23rd August 2017 Attached 16.4 Minutes of the Meeting held on 27th September 2017 Attached
17. Primary Care Co-commissioning Committee Mr Paul Hinnigan 17.1 Minutes of the Meeting held on 18th July 2017 Attached 17.2 Draft Minutes of the Meeting held on 19th September 2017 Attached
18. Any Other Business Mr Paul Hinnigan
19. Date and Time of Next Meeting Mr Paul Hinnigan
To be confirmed
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CLINICAL COMMISSIONING GROUP (CCG)
AUDIT COMMITTEE MEETING
Tuesday 27th February 2018 at 2 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
A G E N D A
Item Agenda Item Member Responsible Report No: 1. Chair’s Welcome Mr Paul Hinnigan
2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan
3. Declarations of Interest Mr Paul Hinnigan Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Audit Committee Secretary in advance of the meeting.
4. Minutes of the Meeting held on 28th November 2017 Mr Paul Hinnigan Attached
5. Matters Arising Mr Paul Hinnigan 5.1 Action Matrix Attached
6. Risk Management Report Mrs Claire Moir Attached
7. Annual Governance Statement 2017/18 Progress Report Mrs Claire Moir Attached
8. External Audit Mr Simon Hardman 8.1 Progress Report Attached 8.2 Audit Plan 2017/18 Attached
9. Internal Audit Ms Louise Cobain 9.1 Progress Report Attached 9.2 Assurance Framework Benchmarking Report Attached 9.3 Insight Update Attached
10. Anti-Fraud Mrs Kerry Ann Wheat 10.1 Progress Report Attached 10.2 Draft Self-Review Toolkit Attached 10.3 CCG Staff Survey Results Report Attached 10.4 CCG Staff Survey Benchmarking Insight Attached
11. Losses and Special Payments Mrs Linda Ring Attached
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12. Waivers and Standing Orders Mrs Linda Ring Attached
13. Corporate Registers Mrs Claire Moir Attached
14. Quality, Innovation, Productivity and Prevention (QIPP) Mrs Linda Ring
15. Primary Care Support Services’ Service Auditor Report Mr Paul Hinnigan
16. Audit Committee Work Plan 2018 Mr Paul Hinnigan Attached
17. Pennine Lancashire Quality Meeting Mr Paul Hinnigan/ 17.1 Minutes of the Meeting held on 25th October 2017 Dr Geraint Jones Attached 17.2 Minutes of the Meeting held on 22nd November 2017 Attached 17.3 Minutes of the Meeting held on 20th December 2017 Attached
18. Primary Care Co-commissioning Committee Mr Paul Hinnigan 18.1 Minutes of the Meeting held on 21st November 2017 Attached
19. Any Other Business Mr Paul Hinnigan
20. Date and Time of Next Meeting Mr Paul Hinnigan
To be confirmed
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APPENDIX C Audit Committee Work Plan 2018 Item Feb April May Aug Nov 2018 2018 2018 2018 2018 INTERNAL CONTROL Risk Assurance Framework & Risk Register 9 9 9 9
Annual Governance Statement 9 9 9 9 Receive the Minutes of the Pennine 9 9 9 9 Lancashire Quality Committee Receive the Minutes of the Primary Care Co- 9 9 9 9 commissioning Committee Review Audit Committee Work Plan 9 9 9 9
Review Draft Audit Committee Annual Report 9 for Governing Body Review effectiveness of arrangements in 9 place for staff to raise concerns Review of Terms of Reference 9 Review of Effectiveness of Internal Audit 9 EXTERNAL AUDIT Audit Plan 9
Audit Findings Report 9
Annual Audit Letter 9
Progress Report 9 9 9
INTERNAL AUDIT Audit Plan 9
Audit Charter 9
Progress Report 9 9 9 9
Head of Internal Audit Opinion 9
ANTI FRAUD Annual Plan 9
Progress Report 9 9 9
Internal Assessment 9
Annual Report 9
OTHER Losses and Special Payments 9 9 9 9
Waivers and Standing Orders 9 9 9 9
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Gifts and Hospitality / Registers of 9 9 9 Interests/Procurement Register 9
Private meeting between Lay Members, 9 Internal Audit and External Audit FINANCIAL REPORTING Draft/Final Annual Accounts and Financial 9(D) 9(F) Statements Annual Review of Accounting Policies 9(D) 9(F)
Annual Governance Statement 9(D) 9(F)
Draft Annual Report 9(D) 9(F)
Page 23 of 23
GOVERNING BODY MEETING GORNIN
External Audit Annual Audit Letter
Date of Meeting 5th September 2018 Agenda Item 16.1
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity Y To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality G BODGOVERNING BODY MEETING
Page 1 of 2
Clinical Lead: N/A
Senior Lead Manager Mr Roger Parr Finance Manager Mrs Linda Ring Equality Impact and Risk Assessment N/A completed: Is a Data Protection Impact Assessment Required? No Data Protection Impact Assessment completed: No Patient and Public Engagement completed: N/A Financial Implications N/A Risk Identified N/A Report authorised by Senior Manager: Mr Roger Parr
Y Decision Recommendations The Governing Body is asked to note the content of this report.
Page 2 of 2 Annual Audit Letter Year ending 31 March 2018
NHS Blackburn with Darwen CCG 23 July 2018 FINAL Contents
Section Page 1. Executive Summary 3 2. Audit of the Accounts 5 3. Value for Money arrangements 8 Appendices A Reports issued and fees
Your key Grant Thornton team members are:
John Farrar Associate Director T: 07880456200 E: [email protected]
Simon Hardman Manager T: 07880456202 FINAL E: [email protected]
Richard Anderson Assistant Manager T: 07920021291 E: [email protected]
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 2 Executive Summary
Purpose Respective responsibilities Our Annual Audit Letter (Letter) summarises the key findings arising from the work We have carried out our audit in accordance with the NAO's Code of Audit Practice, which that we have carried out at Blackburn with Darwen Clinical Commissioning Group reflects the requirements of the Local Audit and Accountability Act 2014 (the Act). Our key (the CCG) for the year ended 31 March 2018. responsibilities are to: • give an opinion on the CCG's financial statements and regularity assertion (section two) This Letter is intended to provide a commentary on the results of our work to the • assess the CCG's arrangements for securing economy, efficiency and effectiveness in its CCG and external stakeholders, and to highlight issues that we wish to draw to the use of resources (the value for money conclusion) (section three). attention of the public. In preparing this Letter, we have followed the National Audit Office (NAO)'s Code of Audit Practice and Auditor Guidance Note (AGN) 07 – In our audit of the CCG's financial statements, we comply with International Standards on 'Auditor Reporting'. We reported the detailed findings from our audit work to the Auditing (UK) (ISAs) and other guidance issued by the NAO. CCG's Audit Committee as those charged with governance in our Audit Findings Report on 24 May 2018.
Our work
Materiality We determined materiality for the audit of the CCG's accounts to be £5,041,000, which is 2% of the CCG's revenue resource limit. Financial Statements opinion We gave an unqualified opinion on the CCG's financial statements on 25 May 2018.
As well as an opinion on the financial statements, we are required to give a regularity opinion on whether expenditure has been incurred 'as intended by Parliament'. Failure to meet statutory financial targets automatically results in a qualified regularity opinion. Based on our review of the CCG's expenditureFINAL we gave an unqualified regularity opinion. NHS Group consolidation template We also reported on the consistency of the accounts consolidation template provided to NHS England with the audited financial statements. (WGA) We concluded that the consolidation template was consistent with the CCG’s audited financial statements.
Use of statutory powers We did not identify any matters which required us to exercise our statutory powers.
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 3 Executive Summary
Value for Money arrangements We were satisfied that the CCG put in place proper arrangements to ensure economy, efficiency and effectiveness in its use of resources. We reflected this in our audit report to the members of the Governing Body on 25 May 2018.
Certificate We certify that we have completed the audit of the accounts of Blackburn with Darwen CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.
Working with the CCG
During the year we have delivered a number of successful outcomes with you: • Sharing our insight – we provided regular Audit Committee updates during the year, including best practice identified from our work with NHS entities across the country. We • An efficient audit – we delivered an efficient audit with you in May, releasing your also shared our thought leadership reports with you. finance team for other work. • Providing training – we provided training on matters related to the financial accounts and • Understanding your operational health – through the value for money conclusion annual report. we provided you with assurance on your operational effectiveness. We would like to record our appreciation for the assistance and co-operation provided to us during our audit by CCG officers. FINAL Grant Thornton UK LLP July 2018
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 4 Audit of the Accounts
Our audit approach The scope of our audit Materiality Our audit involves obtaining enough evidence about the amounts and disclosures in the In our audit of the CCG's financial statements, we use the concept of materiality to financial statements to give sufficient assurance that they are free from material misstatement, determine the nature, timing and extent of our work, and in evaluating the results of whether caused by fraud or error. This includes assessing whether: our work. We define materiality as the size of the misstatement in the financial • the accounting policies are appropriate, have been consistently applied and are adequately statements that would lead a reasonably knowledgeable person to change or disclosed; influence their economic decisions. • the significant accounting estimates made by management are reasonable; and • the overall presentation of the financial statements gives a true and fair view. We determined materiality for the audit of the CCG's accounts to be £5,041,000, which is 2% of the CCG's revenue resource limit. We used this benchmark as, in our We also read the remainder of the Annual Report to check it is consistent with our view, users of the CCG's financial statements are most interested in where the CCG understanding of the CCG and with the accounts included in the Annual Report on which we has spent its allocation in the year. gave our opinion.
We also set lower levels of specific materiality for senior officer remuneration and We carry out our audit in accordance with ISAs (UK) and the NAO Code of Audit Practice. We related party disclosures, £10,000 and £20,000 respectively. believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. We set a lower threshold of £252,000, above which we reported errors to the Audit Committee in our Audit Findings Report. Our audit approach was based on a thorough understanding of the CCG's business and is risk based.
We identified key risks and set out overleaf the work we performed in response to these risks FINALand the results of this work.
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 5 Audit of the Accounts Significant Audit Risks These are the significant risks which had the greatest impact on our overall strategy and where we focused more of our work.
Risks identified in our audit plan How we responded to the risk Findings and conclusions
Operating expenses – purchase of secondary healthcare As part of our audit work we: There were no matters to report following . gained an understanding of the financial reporting conclusion of our work. A significant percentage of the CCG’s expenditure is on contracts for processes used for the purchase of secondary healthcare with NHS providers and non-NHS providers, such as healthcare and evaluated the design of the associated operations and hospital care. This expenditure is recognised when the controls activity has been performed, with accruals raised at the year-end for • confirmed that the main contracts were signed and completed activity for which an invoice has not been issued. confirmed the annual amounts • at interim audit, substantively tested secondary healthcare We identified the accuracy and occurrence of contract variations as a risk costs to month 9, sample tested payments to contracts requiring special audit consideration. and variations to supporting correspondence and other appropriate evidence • at year-end, completed further substantive testing of secondary healthcare costs • reviewed the Department of Health agreement of balances mismatch report
Management override of internal controls AsFINAL part of our audit work we: There were no matters to report The CCG faces pressure to meet external targets, and this could • gained an understanding of the accounting estimates, following conclusion of our work. potentially place management under undue pressure in terms of how they judgements applied and decisions made by management report performance. and considered their reasonableness • obtained a full listing of journal entries, identified and We identified management override of controls as a risk requiring special tested unusual journal entries for appropriateness audit consideration. • evaluated the rationale for any changes in accounting policies or significant unusual transactions.
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 6 Audit of the Accounts
Audit opinion We gave an unqualified opinion on the CCG's financial statements on 25 May 2018, Annual Report, including the Governance Statement in advance of the national deadline. We are also required to review the CCG's Annual Report and the Governance Statement included within the Annual Report. It provided these on a timely basis with the draft accounts As well as an opinion on the financial statements, we are required to give a regularity with supporting evidence. We did not identify any material inconsistencies between the Annual opinion on whether expenditure has been incurred 'as intended by Parliament'. Report, Annual Governance Statement and the CCG’s accounts. Failure to meet statutory financial targets automatically results in a qualified regularity opinion. Certificate of closure of the audit Based on our review of the CCG's expenditure we gave an unqualified regularity We are also required to certify that we have completed the audit of the accounts of Blackburn opinion. with Darwen CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice. Preparation of the accounts The CCG presented us with draft accounts in accordance with the national deadline, and provided a good set of working papers to support them. The finance team responded promptly and efficiently to our queries during the course of the audit.
Issues arising from the audit of the accounts We reported the key issues from our audit to the CCG's Audit Committee on 24 May 2018. FINAL
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 7 Value for Money arrangements
Background Overall Value for Money conclusion We carried out our review in accordance with the NAO Code of Audit Practice, We are satisfied that in all significant respects the CCG put in place proper arrangements to following the guidance issued by the NAO in November 2017 which specified the secure economy, efficiency and effectiveness in its use of resources for the year ending 31 criterion for auditors to evaluate: March 2018.
In all significant respects, the audited body takes properly informed decisions and deploys resources to achieve planned and sustainable outcomes for taxpayers and local people.
Key findings Our first step in carrying out our work was to perform a risk assessment and identify the key risks where we concentrated our work.
The key risks we identified and the work we performed are set out overleaf. FINAL
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 8 Value for Money arrangements Key Value for Money Risks
Risks identified in our How we responded to the risk Findings and conclusions audit plan
There remain risks to the In summary, we considered the During the year the CCG successfully dealt with its financial risks to deliver the appropriate level of surplus and financial position of the arrangements the CCG has in place to meet its statutory targets. Achieving this was not easy, particularly with: CCG that might result in it to: • The need to deliver the QIPP target missing its control totals • identify and address financial risks; this year and in the future. and • The continued pressures on demand on the services commissioned which can then impact on the level of expenditure at the CCG . • develop its financial plans and manage their delivery • Pressures on prescribing expenditure caused by the “No Cheaper Stock Option” issue. During the course of our audit we Overall we found that the CCG identifies and manages financial risks appropriately. The monthly finance report reviewed finance reports presented to to the Governing Body sets out the key risks and the CCG was able to successfully manage these and deliver the CCG’s Governing Body, its financial targets. considered the CCG’s financial planning processes including the Unlike several other CCGs, the QIPP target was successfully delivered and the CCG is on track to identify setting and monitoring of Quality, schemes to achieve the target in 2018/19. The achievement of QIPP will remain an area of focus during the Innovation, Productivity and year to help ensure the CCG achieves its financial duties. Prevention (QIPP) targets and The CCG prepares the financial plans appropriately using the assumptions set out in the planning guidance and discussed the CCG’s financial plans also local knowledge and experience. with senior finance officers and non- executive directors. The monitoringFINAL of the budget helped in the successful delivery of financial targets and key controls within the budget monitoring include: • Budgets having named budget holders to ensure that individual budgets are appropriately managed • Regular budget reports considered by Governing Body and the Finance Scrutiny Committee • Contract Monitoring meetings with providers so any concerns can be addressed.
We were able to conclude that the CCG has appropriate arrangements in place to: • Identify and address financial risks • Develop its financial plans and manage their delivery.
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 9 A. Reports issued and fees
We confirm below our final reports issued and fees charged for the audit and confirm there were no fees for the provision of non-audit services.
Reports issued Fees for non-audit services
Report Date issued Service Fees £
Audit Plan February 2018 None Nil
Audit Findings Report May 2018
Annual Audit Letter July 2018
Fees Non- audit services Planned Actual fees 2016/17 fees • For the purposes of our audit we have made enquiries of all Grant Thornton £ £ £ UK LLP teams that might provide services to the CCG. The table above Statutory audit 38,000 38,000 45,000 confirms no non-audit services were identified. Total fees 38,000 38,000FINAL 45,000
© 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018 10 FINAL
© 2018 Grant Thornton UK LLP. All rights reserved. ‘Grant Thornton’ refers to the brand under which the Grant Thornton member firms provide assurance, tax and advisory services to their clients and/or refers to one or more member firms, as the context requires. Grant Thornton UK LLP is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the member firms are not a worldwide partnership. GTIL and each member firm is a separate legal entity. Services are delivered by the member firms. GTIL does not provide services to clients. GTIL and its member firms are not agents of, and do not obligate, one another and are not liable for one another’s acts or omissions.
©grantthornton.co.uk 2018 Grant Thornton UK LLP | NHS Blackburn with Darwen CCG Annual Audit Letter | July 2018
GOVERNING BODY MEETING
SUB-COMMITTEES AND GROUPS’ MINUTES
Date of Meeting 5TH SEPTEMBER 2018 Agenda Item 17
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity X To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements √ To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access X Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund X Access to Re-ablement and Intermediate Care X Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions X Access to high quality Urgent and Emergency Care X Scheduled Care X Quality √
GOVERNING BODGOVERNING BODY MEETING
Clinical Lead: N/A
Senior Lead Manager Mr Iain Fletcher Finance Manager N/A Equality Impact and Risk Assessment Report for information only completed: Is a Data Protection Impact Assessment Yes No Required? Data Protection Impact Assessment Yes No completed: Patient and Public Engagement completed: Report for information only Financial Implications Report for information only Risk Identified Report for information only Report authorised by Senior Manager: Mr Iain Fletcher
Y Decision Recommendations
The Governing Body is requested to receive and note the content of the report.
Governing Body Meeting Page 2 of 3
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
5TH SEPTEMBER 2018
SUB-COMMITTEES AND GROUPS’ MINUTES
1. Introduction
This report presents the minutes of the Governing Body Sub-Committees and Groups for receipt and note by members.
The minutes inform members of delegated and key decisions taken and provide information regarding items of particular interest or potential risk.
2. Sub-Committees and Groups
2.1 Primary Care Co-Commissioning Committee
The ratified minutes of the meeting held on 19th June 2019 are attached as Appendix 1.
2.2 Commissioning Business Group
The ratified minutes of the meeting held on 23rd May 2018 are attached as Appendix 2.
2.3 Pennine Lancashire Quality Committee
The ratified minutes of the meetings held on 23rd May and 27th June 2018 are attached as Appendices 3 and 4.
2.4 Audit Committee
The ratified minutes of the Audit Committee held on 24th May 2018 are attached as Appendix 5.
3. Recommendation
The Governing Body is requested to receive and note the content of the report.
Iain Fletcher Head of Corporate Business 24th August 2018
Governing Body Meeting Page 3 of 3
CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Primary Care Commissioning Committee (PCCC) held on Tuesday 19th June at 12.30 – 2.00 p.m. in Meeting Room 1, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG
PRESENT: Dr Nigel Horsfield Lay Member (Chair) Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Mr Peter Sellars Primary Care Transformation Manager Mr Paul Hinnigan Lay Member – Governance Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Mr Roger Parr Deputy Chief Executive/Chief Finance Officer Mrs Janet Thomas Executive Nurse/Associate Director of Quality & Commissioning Dr Preeti Shukla General Practitioner (GP) Executive
IN ATTENDANCE: Mr David Massey Cumbria and Lancashire Local Medical Committee Dr Stephen Gunn GP Educational Lead Mrs Catherine Lawless Primary Care Support Assistant (Minutes) Mrs Sarah Danson NHS England Contracts Manager Mrs Anne Greenwood Service Transformation Manager, Scheduled Care Miss Samantha Wallace-Jones Senior Commissioning Manager, Scheduled Care Min No: 1. Chair’s Welcome
The Chair welcomed everyone to the meeting and gave a short briefing with regards to the content of the agenda and members introduced themselves. 2. Apologies for Absence and Confirmation of Quoracy
Apologies for absence were received from:
Mr Graham Burgess
The meeting was confirmed as quorate. 3. Declarations of Interest
The Chair reminded Members of their obligation to declare any interest that they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG. The Chair asked members if they would like to declare any Conflicts of Interest (CoI) relating to items on the agenda.
Declarations declared by members of the PCCC are listed in the CCG’s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/
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The Chair reminded those present that if, during the course of discussion, a CoI became apparent, it should be declared at that point.
Dr Stephen Gunn declared a financial interest relating to Item 9 Primary Care Estates Strategy due to him having a financial interest in Witton Medical Centre premises should any discussion follow around the sale of the building. The Chair agreed for Dr Stephen Gunn to remain in the meeting but to not take part in any discussions for this item
4. Questions from the Public
No questions had been received from members of the public.
5. Draft Minutes of the Meeting held on 20th March 2018
The minutes of the previous meeting were reviewed and accepted as an accurate record.
RESOLVED That the minutes of the meeting held on 20th March 2018 were approved as an accurate record with exception to page 3 last paragraph to be amended to read “a GP or a practice nurse”. ACTION: CL to amend paragraph. 6. Action Matrix / Matters Arising
Matters to be discussed as agenda items. 7. Primary Care Co Commissioning Terms of Reference – Annual Review – For Approval The PCCC noted that there have been no amendments made to the Primary Care Co Commissioning Terms of Reference.
CONCLUSION: That the PCCC approved the Primary Care Co Commissioning Terms of Reference and asked that they be reviewed again in 12 months. 8. Primary Care Update Report
The Chair raised comment around the number of acronyms contained within the document and asked that going forward they all be written in full.
Mr Peter Sellars presented the Primary Care Update report which brought to the attention of members National and Local Primary Care news and information.
Group (Estates and Technology Transformation Fund) The West scheme is still progressing and is being supported by region.
Primary Care at Scale – Primary Care Networks have all now been established. There is to be a further £1 per head from NHS England to develop projects. PS advised of the measures the Networks will have to work towards, which includes utilising the Apex workforce tool which will be beneficial to CCGs, Practices and Primary Care Networks going forward.
Extended Access - Access to GP Services is available to 100% of patients living in Blackburn with Darwen and is providing additional services at weekends such as cervical smears. It was noted that Local Primary Care are also looking at other options to provide extended access.
Medicines Management Update – MR advised the PCCC that compared to the previous year Blackburn with Darwen’s prescribing spend is down by £1 million. MR asked the PCCC to note the graph which outlines the expenditure to date despite the unprecedented number of medicines with stock shortages which drove up prices (No Cheaper Stock Obtainable (NCSO). MR advised the PCCC of a number of schemes which have helped to reduce prescribing costs over the last 12 months which include stopping pharmacies directly ordering
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prescriptions, Medicines Management Optimisation Waste Scheme and the restriction of gluten free prescribing.
GP Forward View (GPFV) Update – Local Primary Care are leading on the training of Care Navigation for practice staff and are now in the 2nd phase which will facilitate every practice to have at least 1 Care Navigator by the end of summer 2018. The General Practice Resilience programme continues to be led by NHS England.
Questions & Answers followed:
RESOLVED: That the PCCC received the report and noted the items as detailed. 9. Primary Care Estates Strategy – SG asked PCCC members to note the contents of the updated Estates Strategy for Blackburn with Darwen which outlines the review undertaken for Blackburn with Darwen neighbourhoods to align the future estate with commissioning requirements. It was noted that the CCG has identified a number of schemes to ensure development and sustainability of primary care and to increase the range and scale of services delivered closer to patient’s homes, to develop hubs in all neighbourhood areas and to help develop 21st century GP practice premises for the residents of Blackburn with Darwen. SG further advised that the Estates Strategy will develop over time to meet the needs of patients and the health care system. SG drew the PCCC to the CCGs priority areas for Blackburn with Darwen which are:
1. New GP and Community Care facility in Blackburn West – 3 GP practices are to be relocated who are currently operating from old converted houses, who also wish to merge.
2. To scope a new GP and Community Care facility in the North locality - 6 practices to relocate. Some practices are operating from small, outdated premises and wish to work more closely together.
3. Extension and refurbishment of Bangor St Health Centre (Shifa).
Questions & Answers followed.
PH queried page 8 Financial Summary – Second Paragraph and asked when will there be a summary of the capital resources required to implement the strategy be brought to the PCCCs attention. After discussions it was agreed that PS would provide the PCCC with a financial summary at the meeting in September. ACTION: PS to provide a financial summary in September.
PH queried page 9 – Second Paragraph – The CCG will develop a risk management framework for the Strategy which will highlight the critical dependencies and risks to implementation and asked when will this be brought to the PCCCs attention. After discussions it was agreed that PS would provide the PCCC with a risk management framework for the meeting in September. ACTION: PS to provide a risk management framework to the meeting in September.
Waterside Surgery - RP provided the PCCC with an update on the Waterside premises from Property Services and advised that Property Services have accepted a vacation notice from 1st January 2018. RP advised that the CCG will now pay for the first 6 month’s rent and then property services will pick up the remaining costs. 10. GP Practice List Sizes – Lancashire & South Cumbria CCG’s. SG drew the PCCC to the contained analysis of the average GP list sizes across Lancashire which where updated in March 2018. SG asked PCCC members to note the variation of list sizes across the region and compared this with Blackburn with Darwen.
Questions & Answers followed
Page 3 of 5
CONCLUSION: That the PCCC noted the variation of GP list sizes across Lancashire. 11. Umar Medical Practice
11.1 Umar Medical CQC Inspection Report – For Information
11.2 Umar Medical CQC Inspection: SD advised the PCCC that following the CQC Inspection visit at Umar Medical Practice on 7th March the practice has been rated as inadequate in the safe, effective, responsive and well led domains and requires improvement in the caring domain, which gives the practice an overall rating of inadequate and puts the practice into special measures. It was noted that a review of all the concerns highlighted in the CQC report has been undertaken with reference to the contractual requirements of the Personal Medical Services Contract. There are a number of concerns which cross reference directly to contractual requirements.
Infection prevention and control compliance Fire safety and building safety (legionella risk assessment) Complaints Procedures Policies and Procedures Safeguarding Training
SD advised the PCCC of the recommendations highlighted in the report and asked the PCCC to consider whether the contractor should be issued with breach and or remedial notices if assurances are not gained from the contractor.
Questions & Answers followed.
Discussions followed with regards to the CCG serving breach and or remedial notices on practices to which PH made comment that there should be a consistent approach and a clear process used for dealing with any practice that is put into special measures. DM suggested that to help the practice with timescales could all the breach and or remedial notices be issued at the same time.
CONCLUSION: That the PCCC agreed to serve the breach and or remedial notices to the practice.
ACTION: MR to contact the practice to inform them that breach and or remedial notices are to be issued. 12. Memorandum of Co Commissioning – For Approval MR gave background information with regards to the Memorandum of Understanding which was developed between NHS England and Lancashire CCGs which sets out the roles, responsibilities and working arrangements for the delivery of primary medical care services across Lancashire and South Cumbria.
CONCLUSION: That the PCCC noted the contents of the paper and approved the task and functions list as a guide to the roles and responsibilities of NHS England and Blackburn with Darwen CCG in the delivery of primary care contracting and commissioning functions. 13. Referral Quality Scheme Payment – AG advised of the purpose of the paper which is to seek approval of the payment mechanism for the Referral Quality Scheme which was introduced in September 2017. AG advised that the scheme is included in the Quality, Outcomes and Enhanced Services Transformation Scheme (QOEST) from April 2018 and will continue to support the primary care key performance indicators related to referrals, compliance with procedures of limited clinical value and collaborative working. It was noted a range of demand management tools incorporated in to the Referral Quality Scheme have successfully delivered an overall reduction in 1st out-patient attendance activity since the scheme commenced compared to the previous year. The PCCC noted that the total savings for the period of the scheme to date is £163,838 with £81,919 being available for reinvestment in to primary care. The GP Federation will coordinate reinvestment in to Primary Page 4 of 5
Care Network schemes subject to agreement by individual practices. AG asked the PCCC to note the contents of the paper and agree to support payment to the Primary Care Networks via the GP Federation.
Questions & Answers followed:
Discussions followed with regards to whether the £81,919 is recurrent funding and whether the CCG should keep the original activity baseline and make it recurrent monies. PS advised the PCCC that the Primary Care Networks are currently looking at developing projects and are putting together business cases for various schemes to which the funding could be used. RP made comment that this could be acceptable and achievable but clarity was needed around governance and decision making.
CONCLUSION: That the PCCC agreed to support payment of savings to the Primary Care Networks via the GP Federation. Items for Information 14. Primary Care Project 16/17 Data Collection:
CONCLUSION: That the PCCC noted the data collection 15. GPFV 2nd Year Anniversary
CONCLUSION: That the PCCC noted the contents of the paper 16. Primary Care Strategy
CONCLUSION: That the PCCC noted the contents of the paper 17. Primary Medical Care Policy & Guidance Manual
CONCLUSION: That the PCCC noted the contents of the Policy & Guidance Manual 18. Primary Care Group Minutes April
CONCLUSION: That the PCCC noted the minutes of the Primary Care Group in April 19. NHS England Support for Primary Care Services
CONCLUSION: That the PCCC noted the contents of the report. 20. Primary Care Work Plan
CONCLUSION: That the PCCC noted the contents of the paper 21. Finance Report Month 2
CONCLUSION: That the PCCC noted the Finance Report Month 2 22. Date and Time of Next Meeting The next meeting was scheduled for Tuesday 24th July at 12.30 - 2.00 p.m. Board Room, Fusion House.
The Chair thanked everyone for their attendance and input and stated that the meeting would now move into Part 2.
Page 5 of 5
BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROOUP (CCG)
Minutes of the Commissioning Business Group (CBG) Meeting held on Wednesday 23rd May 2018 2018 1.00 p.m. – 3.30 p.m. in Darwen Suite, Innovation House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
Members Title 18 . 5 518 . 14.3.18 14.3.18 18.4.18 23 23 Blackburn with Darwen Dr John Randall General Practitioner (GP) Executtive Member, Chair Dr Penny Morris Clinical Chief Officer A Mr Roger Parr Deputy Chief Executive/Chief Finance Officer A Miss Claire Jackson Director of Commissioning Mrs Janet Thomas Executive Nurse A Dr Malcolm Ridgway Clinical Director for Quality and Primary Care A Mr Paul Hinnigan Lay Member (Governance) Dr Geraint Jones Lay Member (Secondary Care Doctor – Retired) Dr Zaki Patel GP Executive Member Dr Adam Black GP Executive Member A Dr Preeti Shukla GP Executive Member A Mrs Karen Cassidy Public Health Specialist A A In Attendance Ms Jacquie Allan Exec Support Shirley Goodhew Public Health NA NA Mrs Kirsty Hamer Commissioning Lead – Children,, Family and NA NA Maternity Services Ms Sam WallaceJones Senior Commissioning Manager – Scheduled NA NA Care Miss Heena Musa Final year student, shadowing Dr Patel NA NA Mr Neil Holt Head of Commissioning Performmance NA NA A Mrs Claire Moir Governance Assurance and Delivery Manager NA NA
Item Action 05/18/01 Welcome and Apologies for Absence Info
The Chair welcomed the members to the meeting.
Apologies were received as above. 05/18/02 Declarations of Interest and Confirmation of Quoracy Info
The meeting was confirmed as quorate.
The Chair reminded members of their obligation to declare any iinterest they may have on any issues arising at Committee Meetings which might conflict with the business of Blackburn with Darwen (BwD) Clinical Commissioning Group (CCG).
There were no conflicts noted,
The chair also informed members that they should, if appropriate, make a declaration if a conflict emerge duuring the meeting and these would be recorded against the relevant ageenda item. 05/18/03 Minutes of the Previous Meeting – 18th Appril 2018 Info
The Minutes of the last Meeting were reviewed and agreed as a truue record.
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RESOLVED: That the Minutes of the meeting held on 18th April 2018 were agreed as an accurate record. Action 05/18/04 Matters Arising - Action Matrix
The action matrix was reviewed:
04/17/13 – Sexual Health update is scheduled for July 2018 09/17/10 – Urgent Care Treatment Centre Review – a paper showing evidence and effectiveness of the plan will be reviewed in May 2018 01/18/08 – STEP, Succeed Thrive Empower Penning Update – a paper including service performance update and Collaboration for Leadership in Applied Health Research and Care (CLARHC) evaluation to be presented in June 07/17/05 – Acute Visiting Service was reopened. Dr Morris will formally identify a clinical lead and bring back to BwD in September 2018. 05/18/05 Declaration of Any Other Business Info
Conflict of Interest Mandatory Training. – This needs to be completed by all CBG members by 31st May 2018. The members were asked to complete level one, but encouraged to complete all three levels. If you are unable to log on or have any queries, please contact Claire Moir in the first instance. For Decision 05/18/06 Pennine Lancashire Joint Commissioning Future Planning
The Chair led a discussion about future meeting requirements to support joined up commissioning decisions across the Pennine Lancashire Footprint. This will support the emerging Integrated Care Partnership and Integrated Care System.
There have been a number of joint meetings with East Lancashire (EL) CCG since March, including a CBG/Sustainability Committee (SC) and two Pennine Lancashire Clinical Reference Group meetings.
The members agreed that continuing to build relationships is important and a single decision making process would be beneficial.
A meeting was held between the Chairs of the respective CBG/SC meetings, governance leads and directors on the 30th April 2018, to discuss proposals for further discussion. There are lots of changes happening within ELCCG that need to be taken into account.
Mrs Claire Moir presented a paper outlining 3 options. Learning from the first meeting it was agreed that option 2 was the preferred option to hold a JR Committees in Common (CIC) meeting between the BwD CBG and EL CCG CM SC. These would be held bi-monthly, with the venue being rotated to allow for quoracy.
This allows joint working relationships to continue to develop within the current governance frameworks. There will also be an agreed objective of the committee, to work towards creating a formally constituted joint commissioning
committee with delegated authority, within an agreed time frame.
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The key objective of the CIC would be to work together to arrive at option 3 by March 2019
Feedback from ELCCG has been requested, but their SC meeting is not meeting again until the joint meeting in June.
Mrs Pauline Milligan was actioned to arrange appointments with both CCGs Lay Chairs.
Regarding decision making, BwD CBG usually agrees decisions by consensus, whilst EL CCG SC holds a vote. It was agreed that this hadn’t worked at the joint meeting and if a vote was to be held, the members may wish to have a closed vote.
In the future it was noted that there will be contracts that require joint decisions and some that will remain as BwD CCG decisions.
Mr Paul Hinnigan observed that the governance processes were still developing but expected the national changes would drive these forward.
ACTION: Mrs Pauline Milligan was actioned to arrange meetings between with BwD Lay Chair and the Lay Chair from ELCCG PM
ACTION: A further meeting needs to be held prior to the next join meeting to address any issues – Ms Jacquie Allan was asked to arrange. JA
RESOLVED: The members agreed to support option 2. 05/18/07 Terms of Reference (TORs)
The TORs distributed with the papers were incorrect. Ms Jacquie Allan is to forward the correct ones to Mr Paul Hinnigan, who took a Chairs action to review and check.
RESOLVED: Mr Paul Hinnigan, took a Chairs action to review and check PH the TOR. : 05/18/08 QIPP
Miss Claire Jackson presented Mr Neil Holts powerpoint presentation on QIPP.
Various schemes were discussed, including.
• No cheaper stock obtainable, these have still not gone back to their normal levels. • Back Injection, we are still seeing continued reduction, although we seemed to have switched from back injections to hip injections. • We are still continuing with QIPP weekly meetings through the Ops Team.
Dr Adam Black highlighted opportunities for various small savings, but Miss Claire Jackson felt that these would be picked up through the QIPP meetings. It was asked that the GPs reflect on this and if there are any examples take this to the Finance Scrutiny Group. Page 3 of 5
The CBG members were asked to :
1. Note the contents of this briefing
Dr Geraint Jones commented that the CBG appreciate the hard work completed by Mr Neil Holt and the Ops Team.
RESOLVED: The CBG noted the briefings.
05/18/09 Activity Planning
Miss Claire Jackson presented a power point presentation on behalf of Mr Roger Parr.
Issues and opportunities need to be taken through the Finance Scrutiny Group.
05/18/10 Miss Claire Jackson presented a paper on the Quality Premium 2018/19.
The Quality Premium (QP) scheme is about rewarding CCGs for improvements in the quality of the services they commission. The scheme also incentivises CCGs to improve patient health outcomes and reduce inequalities in health outcomes and improve access to services.
The 2018-19 Quality Premium guidance was released on 9th April 2018 and is available here [1]: https://www.england.nhs.uk/wp-content/uploads/2018/04/annx-b-quality-premium-april- 18.pdf
This paper was taken for information, and the Ops team had to identify 2 items, and the process was taken through Ops and Executive Team and discussed at Pennine Lancashire level.
CBG members were asked to :
1. Note the contents of this briefing 2. Understand the requirements of the 2018-19 Quality Premium for the CCG 3. Note the selection of the IAPT Mental Health Indicator for 2018-19 4. Note the Right Care Measure for 2018-19
RESOLVED: Paper noted
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Standing Item 05/18/11 Investments Schedule
The investment schedule was presented for information.
RESOLVED: That the CBG noted the content of the schedule.
05/18/12 East Lancashire Medicines Management Board Minutes
The minutes of the East Lancashire Health Economy Medicines Management Board were presented for information.
RESOLVED: That the CBG noted the content of the minutes. 05/18/13 Any Other Business
LCFT had recently had a CQC inspection which has gone from good to requires improvement.
RESOLVED: CBG Members asked to note for information.
For Info 04/18/14 Date and Time of Next Meeting The next meeting was scheduled for Wednesday 20th June 2018 at 1 pm at EL CCG, Walshaw House. Info
The Chair thanked everyone for their attendance and brought the meeting to a close.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
PENNINE LANCASHIRE QUALITY COMMITTEE Minutes of the meeting held on 23rd May 2018 PRESENT:
Name and Title Org. /04 /05 /06 /07 /08 /09 /10 /11 /12
018 018 018
2018 2 2 2018 2018 2018 2018 2018 2018 2 2018 2018
24/01 28/02 28/03 25 23 27 25 22 26 24 28 19 Michelle Pilling – Chair ELCCG A Lay Advisor: Quality and Patient Engagement Geraint Jones: Deputy Chair BwDCCG - A Secondary Care Doctor (retired) Ryan Catlow ELCCG ------Compliance and Resilience Manager Jackie Hanson ELCCG A - Deputy Chief Officer, Director of Quality & Chief Nurse Kirsty Hollis ELCCG - Chief Finance Officer Dr Nigel Horsfield BwDCCG - Lay Member Chair Kathryn Lord ELCCG Associate Director of Quality and Nursing Sharon Martin ELCCG A A Director of Performance and Delivery Claire Moir BwDCCG A A Governance, Assurance and Delivery Manager Dr M Ridgway BwDCCG A A Director of Quality and Performance Dr Paul Taylor ELCCG Secondary Care Consultant Janet Thomas BwDCCG A - - Associate Director of Quality and Commissioning Medicines Management Representative (one needed): Julie Kenyon BwDCCG - - A A Senior Operating Officer, Primary, Community & Medicines Commissioning Lisa Rogan ELCCG - Associate Director of Research, Medicines & Clinical Effectiveness Safeguarding Representative (one needed): Peter Chapman ELCCG - Head of Safeguarding (Adults) and MCA Leads Susan Clarke BwDCCG - - - Head of Safeguarding Debbie Ross ELCCG - A - Head of Safeguarding (Children) Clinical Representatives (two needed): Dr Ridwaan Ahmed BwDCCG - GP Representative Dr Asif Garda ELCCG A A - GP Representative, Pendle Locality Dr Stephen Gunn BwDCCG A - A GP Representative Dr Ash Misra ELCCG - - GP Representative, Burnley Locality Dr Richard Robinson ELCCG A - A A GP Representative, Hyndburn Locality Dr Zeenat Sykes ELCCG - - GP Representative, Rossendale Locality VACANT ELCCG ------GP Representative, Ribble Valley Locality Dr Umesh Chauhan ELCCG A GP Quality Lead : present A: apols L: arrived late E: left early
In Attendance: Debra Atkinson Head of Corporate Business, ELCCG Simon Bradley Quality & Performance Manager, M&LCSU Kim Ciraolo Quality & Performance Manager, M&LCSU Andrew Daniels Quality & Performance Specialist, M&LCSU Judith Johnston Head of Clinical Commissioning, ELCCG Gifford Kerr Consultant in Public Health, BwD Borough Council Cath Lawless Primary Care Support Assistant, BwDCCG – Minutes Vanessa Morris Infection Control Nurse, BwD & ELCCG Caroline Marshall Locality Lead for Quality & Performance, M&LCSU Angela Thornton Head of Scheduled Care, ELCCG
Pennine Lancashire Quality Committee 23/05/2018 Page 1 of 7 Minutes Approved by the Chair: 19/06/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
REF: ACTION 18.083 Welcome & Chair’s Update
The Chair opened the Pennine Lancashire Quality Committee and welcomed all attendees.
18.084 Apologies
Apologies were received from: Michelle Pilling, Dr Geraint Jones, Dr Richard Robinson, Sharon Martin, Dr Malcolm Ridgway, Julie Kenyon and Dr Umesh Chauhan
The meeting was confirmed as quorate 18.085 Declarations of Interest
None Noted 18.086 Minutes of the Meeting Held On 25th April 2018
CONCLUSION: That the minutes were accepted as a true and accurate record.
Caroline Marshall asked that going forward that initials of herself and Claire Moir be identified more clearly and suggested that for the purpose of the minutes Claire Moir’s initials be noted as CMo and herself as CM. Kirsty Hollis also requested that going forward her initials be noted as KHol and Kirsty Hamer’s initial’s to be noted as KHam. 18.087 Action Matrix
18.044 – Mental Health – JH advised that the LCFT CQC Inspection Report was published on 23rd May 2018 and asked the Committee to note that the Trust rating has been downgraded from good to ‘requires improvement’. JH advised that the main concerns are around Mental Health Crisis Services and CAMHS. JH advised that the report will come to the next meeting. ACTION: LCFT CQC Inspection report to the next meeting. JH
18.68 – IAPT – AD advised of the ongoing discussions with the Trust around the importance of supplying a detailed narrative of the areas of concern in order to get a better understanding of the key waiting time issues and pressures.
18.074 - Hepatitis B Pathway – KL advised that the information has been circulated to practices in March 2018. 18.088 Presentations - Seasonal Influenza Review - VM provided Committee members with an overview of the seasonal flu uptake for 17/18, for 6 months to under 65 years at risk, pregnant women, 2 year olds and 3 year olds, and drew Committee members to key pieces of information and key challenges. VM advised of the clinical at risk groups for Lancashire and asked Committee members to note that the England National Average for 17/18 is 48.2% to which Lancashire is above trajectory in all areas. It was noted that for pregnant women the vaccination uptake has slightly risen from 16/17 to 48.9% but is still above the England average of 47.2%. VM advised of the significant uptake increase for 2-3 year olds from 28.1% in 16/17 to 44.0% in 17/18. VM advised members that the Vaccination Team do struggle with uptake for 2 year olds in Blackburn with Darwen to which there is ongoing work to address this. VM advised of the significant increase in vaccination uptake for Health Care Workers from 16/17. VM advised of the vaccination uptake for East Lancashire Hospitals Trust of 92.3%. VM advised of the ongoing work to address reaching the hard to reach groups and gave examples and highlights of good practice.
Questions & Answers Followed:
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
CONCLUSION: That the Committee noted the contents of the Seasonal Influenza Review
COMMENT: PT made comment and congratulated ELHT for their high seasonal flu uptake of 92.3% 18.089 Provider Update
This paper was tabled for reference. The content of this item is for committee members and attendees only, and is not for wider distribution.
The confidential minutes of this part of the meeting will be circulated under separate cover.
Members received and acknowledged this report.
18.090 NHS England Independent Investigation: 2015/21744(RK)
This paper was tabled for reference. The content of this item is for committee members and attendees only, and is not for wider distribution.
The confidential minutes of this part of the meeting will be circulated under separate cover.
Members received and acknowledged this report.
18.091 Pennine Lancashire Quality and Performance Report Month 12
SB asked Committee members to note the contents of the report which provides individual updates on Quality Assurance of General Practice across East Lancashire CCG and Blackburn with Darwen CCG as of month 12. Full details are contained within the report.
A & E Breaches – There was underperformance against the 4 hour A & E target with performance in March 2018 at 80.7% (ELHT).
Ambulance Calls – There is underperformance for both CCGs for Ambulance response Programme Category 1-3 calls. The improvement plan has been published
RTT Incomplete – Blackburn with Darwen CCG - There was underperformance against RTT incomplete standard with performance at 90.34% in March 2018. Year to date the target is not being met at 91.14%. East Lancashire CCG – There was underperformance against the RTT incomplete standard with performance at 91.15% in March 2018. Year to date the target is being met at 92.06%.
RTT> 52 weeks – East Lancashire CCG – There were 5 patients with a wait of over 52 weeks reported in March 2018.
Cancer % patients seen within 2 weeks for an urgent referral for breast symptoms – Blackburn with Darwen CCG – The 2 week target was not met at BwD CCG in March 2018 with performance at 88.8% against a target of 93%. The target for 2017/18 year was met at 94.11%. East Lancs CCG – The 2 week target was not met at ELCCG in March 2018, with performance at 89.61% against a target of 93%. The target for the 17/18 year was met at 95.36%.
Cancer % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) Blackburn with Darwen – The 62 day target was not met in March with performance at 71.88% against a target of 85%. The target for the 17/18 year was not met at 81.73%,
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
Cancer % of patients receiving treatment for cancer within 62 days from an NHS Cancer screening Service – East Lancashire CCG – The 62 day target was not met in March 2018 with performance at 83.33% against a target of 90%. The target for the 17/18 year was met at 96.15%.
Clostridium Difficile – VM advised that for Blackburn with Darwen there were 3 cases of clostridium difficile identified. For 17/18 there were 38 cases reported against a trajectory of 40. For East Lancashire CCG there were 8 cases of clostridium difficile identified. For 17/18 there were 96 cases against a trajectory of 58.
Quality Premium – NHS Constitution Measures - Blackburn with Darwen CCG has underperformed against all three measures and therefore is not entitled to any of the remaining quality premiums. East Lancashire CCG has underperformed against two of the gateway measures and is therefore entitled to the remainder of the scheme.
Lancashire Care Foundation Trust – Mental Health – AD advised of the following indicators who failed to achieve in March or at risk of failing.
Duty of Candour - Discrepancies with the data submitted by LCFT and data held on internal systems have been highlighted to the Trust. An updated position is awaited.
IAPT Prevalence – LCFT has set quarterly internal run rate trajectories through 17/18 in order to achieve a run rate of 4.2% in Q4 for all areas. This equates to a notional 1.40% per month in Jan/Feb and March. The notional monthly rate was achieved at Trust level and for both East Lancashire and Blackburn with Darwen in Month 12, the quarterly rate was not achieved at Trust level, or for East Lancashire CCG at Qtr 4 with prevalence of 3.89% add 3.83% respectively.
Recovery – The 50% recovery target was met at Trust level and at East Lancashire CCG in March 2018 with performance at 56.45% and 54.8%. For Blackburn with Darwen recovery has improved at 52.6% on February’s position, but month 11 performance has impacted on Qtr4 position 49.4% for the CCG.
Early Intervention Psychosis – AD advised of the positive performance for the Trust achieving 71.0% against the EIP target of 50% to be seen within 2 weeks, and an overall compliance of 59% over Qtr 4. Full results and reporting against the QS80 NICE standard is expected during May 2018 and will be reviewed and discussed via the Quality and performance meetings once received.
Questions and answers followed: The Chair noted that there is to be a new cancer pathway and asked for more information. SB advised that the pathway looks at quicker diagnostic tests for GP practices and utilise the resource better. It was noted that GP practices can now book patients directly into a slot within a two week period to which they then get the result back. It was agreed that a member of the Cancer Team be invited to attend a future meeting. ACTION: Cancer Team member to be invited to the quality meeting.
CONCLUSION: That the Committee noted the contents of the Pennine Lancashire Quality and Performance Report. 18.092 Pennine Lancashire CQUIN 2018/2018 and Q4 Payments KC asked Committee members to note the contents of the report which sets out East Lancashire CCG and Blackburn with Darwen CCG hosted provider performance for 17/18 Qtr 4 against each indicator in Providers CQUIN Schemes. It was noted that 17/18 Q1-Q4 reconciliations have taken place for the main hosted providers assessing submitted evidence against the requirements of each indicator and asked the Committee to approve payment of 17/18 CQUIN monies.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
CONCLUSION: That the Committee approved payment of 17/18 CQUIN monies. 18.093 Pennine Lancashire Risk Management Report DA asked Committee members to note the contents of the Pennine Lancashire CCGs Risk Management Report and the Governing Body Assurance Framework for both CCGs in order to enable Committee members to evaluate the assurance on the management of corporate risks and to direct any further action as necessary. DA also drew Committee members to the new format of the Risk Register. It was noted that for Blackburn with Darwen CCG there are currently 11 operational risk and 6 strategic risks held on the register. For East Lancashire there are currently 15 risks on the CCGs Risk Register with 5 of these escalated to the Governing Body Assurance Framework. For Pennine Lancashire there are 7 risks which are included on the Risk Registers of both CCGs. DA advised of a new risk which has been carried over from the previous year for East Lancashire CCG. Failure to achieve the planned trajectory for 4-hour standard of patients admitted, transferred or discharges within Accident and Emergency Services within East Lancashire. DA advised of the 3 risks that have been downgraded and also advised of the 2 risks that are recommended for closure for East Lancashire CCG. It was noted that there are no risks recommended for closure for Blackburn with Darwen. It was noted that the Risk Registers will continue to be reviewed monthly to ensure on-going management and mitigation of risks and the generation of assurance for the CCGs Corporate Committees. ACTION: DA – Amendment to be made to Item 10.2 which should read changes to East DA Lancashire Risk Register.
CONCLUSION: That the Committee noted the contents and the recommendations contained within the report. 18.094 Pennine Lancashire Q4 Complaints Report KL asked the Committee to note the contents of the report produced by Midlands and Lancashire Commissioning Support Unit and drew members to key pieces of information for Qtr 4. KL advised of the steady rise of complaints for Blackburn with Darwen and East Lancashire CCG and added there has been a slight change in the amount of MP letters received. Work is underway looking at the MP letters trying to get an understanding of the issues and commented that there are no themes or trends to be able to monitor. KL advised that there has been a significant rise in complaints for East Lancashire CCG in Quarter 4 which is mainly due to the closure of Accrington Victoria Health Access Centre which was responsible for 48 of the PALS enquiries. For Qtr 4 100% of the complaints were acknowledged within 3 days and there were no breaches of the statutory 6 months to respond to complaints. As part of the lessons learnt the Complaints Team are asking services to complete a lessons learnt log where appropriate and drew the Committee’s attention to some of the complaints received for Qtr 4 and advised that work is ongoing with the Customer Care Team and complainants. AN advised that going forward freedom of information requests quarterly report will also be included in the reports to give a full overview.
CONCLUSION: That the Committee noted the complaints outlined in the report. 18.095 Quality Accounts KC provided Committee members of the positional update for the 2017/18 Quality Accounts for Blackburn with Darwen and East Lancashire CCG hosted contracts. It was noted that the draft quality accounts have been received for all the main hosted providers and are currently being assessed. Responses to the Quality Accounts submissions are currently being drafted. KC drew the Committees attention to the letter in response to LCFTs Quality Accounts 2017/18 and advised that the other letters will be brought to the Committees attention at the next meeting. ACTION: Provider letters to be brought to the Committees KC attention. 18.096 CCG Safeguarding Assurance & Accountability Framework PC advised of the assurance processes Blackburn with Darwen and East Lancashire CCG has to follow when providing assurance to NHS England and the Local Safeguarding Children and Adult’s Board that they have the necessary safeguarding arrangements in place in line with statutory guidance which apply to all NHS organisation commissioning health and social care. PC drew the Committees
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
attention to key pieces of information from the accompanying self-assessment which provides the necessary assurance. PC advised of the 2 areas of development 1. Safer Recruitment Practices – Robust recruitment and vetting procedures should be put in place to prevent unsuitable people from working with children and vulnerable adults. 2. Training – Level 2 Training across both CCGs. It was noted the MLCSU manage the training and when original DSO was set up it did not include level 2 training as they did not at that time come in to contact with patients. PC advised that the Safeguarding Team do have a log of who needs to carry out the level 2 training and are manually contacting staff to get them to do the training. JH made comment that it is important for both CCG’s to complete the Level 2 training and suggested raising at both CCG’s management committees. ACTION: JH/MR to raise the JH/MR Level 2 Safeguarding Training at both CCG exec and management committee meetings. JT asked the committee to note the outcome of the recent outcome internal audit for safeguarding who were significantly in all areas and were given two actions to which one has been completed and the other is ongoing.
CONCLUSION: That the Committee noted the contents of the report and approved the self-assessment status prior to it being submitted to the safeguarding boards and NHS England. 18.097 Health & Safety Policy – KHam asked the Committee to note the Health and Safety Policies Report Update which outlines all the Health & Safety Policies that have recently been reviewed and updated and drew Committee members to the amendments. JT raised comment around the policies and asked that if they are joint CCG policies there should also be a Blackburn with Darwen logo at the top.
CONCLUSION: That the Committee noted the amendments to the Policies and ratified the adoption of the policies.
ACTION: JN - Clarification is needed on whether they are joint policies and if so the JN Blackburn with Darwen logo would need adding. 18.098 Emergency Planning and Resilience Policy KHam asked the Committee to note the Emergency Planning and Resilience Policies Update that have recently been reviewed and updated and drew Committee members to the amendments.
CONCLUSION: That the Committee noted the amendments to the Policies and ratified the adoption of the policies 18.099 Quality Contract Meeting Draft Minutes April 2018 BMI Lancashire – East Lancashire Hospitals NHS Trust – Lancashire Care NHS Foundation Trust
Minutes from provider organisations were circulated prior to the meeting for information.
CONCLUSION: That the Committee acknowledged the minutes and no comments were raised. 18.100 ELCCG Risk Management and Information Governance Group Draft Minutes April 2018
Minutes from provider organisations were circulated prior to the meeting for information.
CONCLUSION: That the Committee acknowledged the minutes and no comments were raised. 18.101 Cancer Tactical Meeting Minutes April 2018
Minutes from provider organisations were circulated prior to the meeting for information.
CONCLUSION: That the Committee acknowledged the minutes and no comments were raised.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
18.102 ELCCG GP Quality Group Minutes April 2918
Minutes from provider organisations were circulated prior to the meeting for information.
CONCLUSION: That the Committee acknowledged the minutes and no comments were raised. 18.103 Any Other Business: The Chair raised comment around Item 6.4 PL Q4 Complaints Report - You said We did Section and suggested that an update on the time lines for Neurology be brought to the Committees attention. ACTION: Cathy Gardner to be invited to a meeting. KL 18.104 Items for the Risk Register
There were no additional items to be added to the risk register. 18.105 Date & Time of Next Meeting
The next meeting has been scheduled for Wednesday 27th June 2018 in Meeting Room 1, Walshaw House.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
PENNINE LANCASHIRE QUALITY COMMITTEE Minutes of the meeting held on 27 June 2018 PRESENT:
Name and Title Org. /04 /05 /06 /07 /08 /09 /10 /11 /12
018 018 018
2018 2 2 2018 2018 2018 2018 2018 2018 2 2018 2018
24/01 28/02 28/03 25 23 27 25 22 26 24 28 19 Michelle Pilling – Chair ELCCG A Lay Advisor: Quality and Patient Engagement Geraint Jones: Deputy Chair BwDCCG - A Secondary Care Doctor (retired) Ryan Catlow ELCCG ------Compliance and Resilience Manager Jackie Hanson ELCCG A - Deputy Chief Officer, Director of Quality & Chief Nurse Kirsty Hollis ELCCG - Chief Finance Officer Dr Nigel Horsfield BwDCCG - Lay Member Chair Kathryn Lord PLCCG E Associate Director of Quality and Nursing Sharon Martin ELCCG A A Director of Performance and Delivery Claire Moir BwDCCG A A A Governance, Assurance and Delivery Manager Dr M Ridgway BwDCCG A A Director of Quality and Performance Dr Paul Taylor ELCCG Secondary Care Consultant Janet Thomas BwDCCG A - - Associate Director of Quality and Commissioning Medicines Management Representative (one needed): Julie Kenyon BwDCCG - - A A - Senior Operating Officer, Primary, Community & Medicines Commissioning Lisa Rogan ELCCG - Associate Director of Research, Medicines & Clinical Effectiveness Safeguarding Representative (one needed): Peter Chapman PLCCG - - Head of Safeguarding (Adults) and MCA Leads Susan Clarke PLCCG - - - Head of Safeguarding Debbie Ross PLCCG - A - - Head of Safeguarding (Children) Clinical Representatives (two needed): Dr Ridwaan Ahmed BwDCCG - GP Representative Dr Asif Garda ELCCG A A - A GP Representative, Pendle Locality Dr Stephen Gunn BwDCCG A - A A GP Representative Dr Ash Misra ELCCG - - A GP Representative, Burnley Locality Dr Richard Robinson ELCCG A - A A A GP Representative, Hyndburn Locality Dr Zeenat Sykes ELCCG A A GP Representative, Rossendale Locality VACANT ELCCG ------GP Representative, Ribble Valley Locality Dr Umesh Chauhan ELCCG A E GP Quality Lead : present A: apols L: arrived late E: left early
In Attendance: Deryn Ashby Executive Assistant, ELCCG - Minutes Simon Bradley Quality & Performance Manager, M&LCSU Kim Ciraolo Quality & Performance Manager, M&LCSU Andrew Daniels Quality & Performance Specialist, M&LCSU Jane Greenwood Urgent Care Commissioning Manager, Pennine Lancashire CCGs (1 item) Kirsty Hamer Commissioning Lead – Children, Family and Maternity Services, Pennine Lancashire CCGs (1 item) Jennifer Mulloy Equality and Inclusion Business Partner, M&LCSU (1 item) Lewis Wilkinson Quality and Performance Support Officer, M&LCSU (2 items) Catherine Wright Primary Care Quality Manager, ELCCG (1 item)
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
REF: ACTION 18.106 Welcome & Chair’s Update
The Chair opened the Pennine Lancashire Quality Committee and welcomed all attendees.
18.107 Apologies
Apologies were received from: Debra Atkinson, Lynn Bentley, Dr Asif Garda, Dr Stephen Gunn, Dr Gifford Kerr, Caroline Marshall, Dr Ashutosh Misra, Claire Moir, Vanessa Morris, Dr Richard Robinson,
The meeting was confirmed as quorate
18.108 Declarations of Interest
None Noted
18.109 Minutes of the Meeting Held On 23 May 2018
No amendments were offered for the minutes of the meeting held on 23 May 2018.
The minutes were accepted as a true and accurate record.
18.110 Action Matrix
18.044: Mental Health The LCFT CQC Inspection Report has been included on the agenda. This action can be closed.
18.65: Memory Assessment Service Update An update is awaited from Dr Sharma and the mental health team.
18.070: Special Educational Needs and Disability Update (SEND) K Hamer confirmed that engagement is in place for parents and carers. This action can be closed.
18.073: Acute Kidney Injury Update Guidance There was significant debate about how to review and improve outcomes for Acute Kidney Injury (AKI). It was noted that there is no single action that could be implemented as this requires a system-wide approach across both primary and secondary care. After discussion it was agreed that a Task and Finish Group, involving primary and secondary care clinicians, will be established. S Martin confirmed that she would ask a member of her team to lead on this and would confirm the name to the committee.
18.076: Serious Incident Policy This action can be closed.
18.087: Mental Health The LCFT CQC Inspection Report has been included on the agenda. This action can be closed.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
18.089.1: CONFIDENTIAL: Provider Report The 12-hour paper has been included on the agenda. This action can be closed.
18.089.2: CONFIDENTIAL: Provider Report This action has been completed.
18.089.3: CONFIDENTIAL: Provider Report This information has been shared. The action can be closed.
18.089.4: CONFIDENTIAL: Provider Report There was discussion about the approach needed to reduce that activity, as BMI remains an outlier as part of the Right Care review. It was noted that there are a number of difficulties with this, and that it was important that the CCGs ensure that there are robust policies in place. Further work is needed and an update will be provided to committee in due course.
18.093: Pennine Lancashire Risk Management Report This action has been completed; the action can be closed.
18.095: Quality Accounts This has been included on the agenda. This action can be closed.
18.096: CCG Safeguarding Assurance and Accountability Framework Level 2 Safeguarding training has been raised at both CCGs. This action can be closed.
18.097: Health and Safety Policies Clarification has been confirmed. This action can be closed.
18.111 CONFIDENTIAL: Provider Update
This paper was tabled for reference. The content of this item is for committee members and attendees only, and is not for wider distribution.
The confidential minutes of this part of the meeting will be circulated under separate cover.
Members received and acknowledged this report.
18.112 Pennine Lancashire Maternity Services Review
K Hamer presented this report, which provides an overview of the Pennine Lancashire Maternity Service Review; this would ensure that the service has the resource and capacity to meet new guidance and continue to deliver best practice care for women and new-borns. It will also enable the review team to identify as many opportunities as possible to improve outcomes, ensure best practice and identify unwarranted variation in outcomes and support a system wide approach to improving maternity services.
The final report and recommendations will be available in December 2018 and will be presented to committee in January 2019.
It was noted that there is a lot of work at Lancashire South Cumbria level, and K Hamer assured members that this review is closely aligned and complements this work. There was discussion about the Rossendale Birthing Centre and members were advised that a public consultation is due to commence on this service.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
There was concern that the review may identify areas that require further financial support, which may increase the financial risk to the CCGs. K Hamer agreed that this was a risk, but assured members that the review would seek to understand what efficiencies and pathway changes could be made, as well as identifying gaps in provision.
The Chair asked about the patient involvement, and K Hamer advised that there is a patient group involved. It was requested that the review paper clarifies this group’s involvement at the earlier stages. K Hamer acknowledged this, and also assured members that Equality Impact Assessments have been completed.
Members received and acknowledged this report.
18.113 Pennine Lancashire 12-hour Breach Report
L Wilkinson and J Greenwood attended to present this report, which provides an overview of the 158 12-hour mental health breaches that have occurred in Pennine Lancashire since November 2015, until 02 May 2018. There have been a total of 9 breaches involving patients awaiting a CAMHS bed up to 02 May 2018. There is no emerging trend in the number of breaches but this may be due to having a small amount of data. However there have been an increased total number of breaches over the last few months. The report provides an analysis of the mental health breach data and outlines key findings and trends over time. It also attempts to understand if the data analysis is demonstrating any impacts following the introduction of transformational changes.
The Mental Health Operational Resilience Group ORG group has recognised that 12-hour breaches are related to capacity to admit immediately from A&E; the key factor in A&E 12 hour breaches is immediate availability of a mental health bed, and that the capacity that would enable this is taken up currently with Super Stranded Patients, which are 180+ day length of stay cases which no longer gain clinical benefit from remaining on the ward. There is a trend emerging of an increase in mental health breaches in the summer months (June- August), however this is only based on two-years’ data, and further monitoring is required to determine if this is a recurring theme. A minimum of three years would be required to confirm whether there is a trend.
There have been an increasing number of mental health breaches since December 2017. The Mental Health Decision Unit and the changes to the handling of Section 136 service users were implemented at this time, however, there would not be any anticipated causal relationship between the changes and the increased number of breaches. Section 136 presentations are excluded from 12-hour breach reporting, and the Mental Health Decision Unit is an admission avoidance scheme, i.e. has reduced the number of patients requiring admission but in its current form will prevent only a small cohort of breaches.
There is debate regarding the total length of stay, as there have been instances where patients under s136 are not having their length of stay counted until they are reviewed by an Advanced Mental Health Practitioner (AMHP); this should be counted from when they first present at A&E. This is adversely affecting a lot of young people.
The data was reviewed and is showing that the transformation services have not been effective, which is of concern as they should have helped to reduce the breaches within the department. Both ELHT and LCFT are stating that there are patients on the wards that are not flowing through the system which is contributing to the problem; however, it was noted that this statement is not being matched by LCFT’s Delayed Transfer of Care (DTOC) figures. It was noted that Pennine Lancashire is an outlier in for 12-hour breaches, which means there is greater scrutiny from NHS England.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
There was discussion regarding the wider LCFT issues about where the attendances are coming from to understand the referral route into A&E. This will inform how best to support these individuals in the community; there was concern that many of these patients were not previously known to mental health services, and this problem needs to be recognised as part of the RCA to understand if the patient could have been managed elsewhere in the system. It was noted that it can be included, as work to date has identified that some people are being directed to A&E by the crisis team, or cannot get hold of crisis team so attend A&E. Dr Z Sykes advised that she had recently been informed that the crisis team cannot see a patient the same day, so this might also be driving this activity. J Greenwood assured members that the team are considering alternatives to A&E conveyance within the pathway.
J Hanson informed members that she had participated in a teleconference earlier in the day which focussed on pulling together the conversations about transforming Mental Health services and how these impact on breaches. There was debate about the scale of the problem, including the acuity of the patients, whether loss of mental health beds had contributed, and about pathways and flow through the system. It was also queried how many patients were involved to understand whether there were patients that presented multiple times and whether they might need additional support.
There was discussion about the LCFT bed modelling and whether this was correct. There was a request to understand how many mental health beds had been taken out of the system over the last 3 years tracked against the number of breaches, with additional detail about the number of beds purchased and how many were actually used.
ACTION: The Quality Team and Urgent Care Team to undertake deeper analysis Quality about the reason patients are being directed to A&E, and other wider Team issues such as flow, frequent attenders and access to community mental health services. To include the number of mental health beds that have been taken out of the system over the last 3 years tracked against the number of breaches, with additional detail about the number of beds purchased and how many were actually used. To be presented back to PLQC in September.
All agreed that the position was unacceptable. The pressure is increasing; hence there is a need to align conversations. LCFT are still not enacting solutions that were previously agreed. K Hollis added that a Risk Summit had previously been held and significant investment was provided for 1 year to LCFT on the understanding that they evidenced that they had put in new services to help with the deteriorating position. To date, they have not demonstrated that they are moving at pace, so a new group has been commissioned to meet on a regular basis to improve this pace. She noted that quality and performance input would be needed at this meeting.
It was confirmed that this report would need to be discussed at the A&E Delivery Board for discussion and to emphasise the patient experience issues.
Members received and acknowledged this report.
18.114 LCFT CQC Inspection Report
This report was presented by K Ciraolo and provides a summary of the Care Quality Commission inspection report that was published on 23 May 2018, which rated the Trust as ‘Requires Improvement’ overall and subsequent actions taken.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
In December 2017 the Care Quality Commission (CQC) undertook a focussed inspection on the Section 136 health-based places of safety suites in Lancashire Care Foundation Trust (LCFT) and then undertook a ‘Well Led’ and focussed inspection on five core services during January and February 2018. The CQC found areas for improvement including 9 breaches of legal requirements that the Trust must put right, 23 areas that the Trust should improve, and a minor breach that did not justify regulatory action to prevent breaching a legal requirement or to improve service quality.
A Quality Risk Profile (QRP) tool exercise would be undertaken for the services delivered within the Community and Mental Health Networks and which will be led by NHS England Lancashire. A Quality Summit has been convened for 06 July 2018 and the outcome of the QRP tool exercise will be used to inform this summit along with the CQC Inspection Report findings. It is then anticipated that a Quality Board will be formed and led by NHS Improvement; this Board will focus on holding the Trust and Stakeholders to account for the improvement in services.
ACTION: A detailed update to be provided to committee in August 2018, after the Quality CQC summit on 06 July 2018 Team / D Ashby The Chair noted that there were some concerns about the case notes at the Integrated Neighbourhood Teams. J Thomas advised that the CQC inspection had only reviewed one but agreed that community case notes needs to be considered as part of a community review.
Members received and acknowledged this report.
K Lord exited the meeting
18.115 ELCCG Prescribing and Medicines Optimisation Annual Report
This report was presented by Dr L Rogan and provides a comprehensive review of the performance and outcomes delivered through the ELCCG Prescribing and Medicines Optimisation Work Programme 2017-18. The report demonstrates delivery of £5,480,900 which exceeds the proposed target of £1.93 million and a national cost pressure of £2,340,151 due to NCSO price concessions. It also provides a summary of: the CCG position with respect to cost growth compared with Lancashire CCGs and England average; the outcomes from the service transformation projects including the Appliance Prescription Service and Nutrition Prescription Service; achievement of the CCG Quality Premium on antimicrobial prescribing; the admission avoidance red alerts through ECLIPSE; outcomes from the Prescribing Incentive Scheme 2017-18; outcomes from the Care Homes Medicines Optimisation; patient engagement work; implementation of the MHRA Drug Safety Updates 2017-18; and a summary of the CCG’s compliance with NICE Technology Appraisals. Full details are available within the annual report.
It was noted that both CCGs have also undertaken some joint work as well, and are looking ahead to engage in joint working with the Trust. There was debate about the levels of activity, and the concern that there is a shift in pushing prescribing to primary care, such as around medication for neuropathic pain.
K Hollis thanked the team, noting that this report represented true Quality, Innovation, Productivity and Prevention (QIPP) saving for the organisation. J Hanson echoed this, adding that the support of primary care colleagues had helped to achieve these outcomes. The Chair thanked Dr L Rogan for her report and all those who were involved in the work.
Members acknowledged the report.
Pennine Lancashire Quality Committee 27/06/2018 Page 6 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
18.116 Pennine Lancashire Quality and Performance Report Month 01
S Bradley and A Daniels presented the key points from the Pennine Lancashire Quality and Performance Report for Month 01. Full details are available within the report.
ELHT: A&E Breaches There was underperformance against the 4 hour A & E target with performance in April 2018 at 84.91% (ELHT). The Urgent Care Team had included a detailed update in relation to actions being taken by the system to improve performance.
Ambulance Calls There is underperformance for both CCGs; BwDCCG had underperformance against Ambulance Response Programme Categories 2-4, and ELCCG had underperformance against Ambulance Response Programme Categories 1-3.
RTT Incomplete There was underperformance against RTT incomplete standard for both CCGs. There remain a number of problems within the neurology department at LTH that are affecting the performance for both CCGs.
52 week Waits In April 2018 BwD reported 2 patients with a wait over 52-weeks, and ELCCG reported 6 patients with a wait over 52-weeks. One of the patients for BwDCCG is awaiting treatment under a Specialised Commissioning contract so it has been challenged that this breach should be attributed to them.
ACTION: The Chair asked for updates on when all of the patients will be scheduled Quality to receive their treatment. Team
Cancer patients seen within 2 weeks for an urgent GP referral This target was not met for ELCCG in April 2018. There were 87 breaches, although the information was not available due to the changes to the new Cancer Waiting Times System. The number of e-referrals is increasing.
Cancer patients seen within 2 weeks for an urgent referral for breast symptoms The 2 week target was not met at BwD CCG in April 2018.
Cancer patients receiving treatment for cancer within 62 days from an NHS Cancer screening Service The target was not met by BwDCCG in April 2018. The new Cancer Waiting Times System and dataset went live on 1st April 2018, with Open Exeter switched off from 2nd May 2018. Healthcare providers will be required to submit additional data fields for July 2018 activity onwards.
Clostridium Difficile In April 2018 BwDCCG had 5 cases of C-Diff against a trajectory of 3, and ELCCG had 7 cases against a trajectory of 5.
E-Coli In April 2018 there were 33 cases of E-Coli identified in ELCCG, and 11 cases in BwDCCG.
Pennine Lancashire Quality Committee 27/06/2018 Page 7 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
LCFT: Duty of Candour Discrepancies with the data submitted by LCFT and data held on internal systems have been highlighted to the Trust. An updated position is awaited. Work is ongoing with LCFT to ensure their monthly reporting compliance is consistently reflective of all Serious Incidents affecting patients.
LCFT: IAPT Prevalence In April 2018 the target was not met by the Trust nor by ELCCG.
LCFT: IAPT Recovery In April 2018 the 50% recovery target was not met by BwDCCG
LCFT: Early Intervention Psychosis In April 2018 the target was not met by the Trust nor by ELCCG.
LCFT: ADHD Seen within 18-Weeks At Trust level, the target for 92% of service users to wait less than 18 weeks for treatment was not met in April 2018. S Martin informed members that an ADHD pathway is being developed on a shared care with primary care. The new model is proposing team of GPs take on 6- and 12- month reviews of patients once they have been stabilised on their medication. The CCG need to understand this in more detail as there is a discrepancy on the staffing figures for the model.
ACTION: S Martin to discuss the ADHD pathway with A Walker to understand the S Martin detail and how this fits with other business cases submitted by LCFT around LD and CAMHS
LCFT: Out of Area Placements At Trust level there was an average of 28.3 Out of Area Placements (OAPs) in April 2018, against a trajectory of 16, and a target of 0.
180+ Day Length of Stay Patients It has been noted that there are a number of 180+ day cases that are affecting flow through the pathway. J Thomas advised that LCFT have set up a target of 1-hour assessment for patients from ED, and wondered how this correlates to the 12-hour breach figures. There was also discussion about how the Liaison Team is changing to a different format and how this will affect performance. There was debate about the completion of Quality Impact Assessments when there are changes to service delivery or teams and how these provide assurance, include the oversight on that actual impact. It was felt that this should fit with the wider Lancashire South Cumbria work.
ACTION: S Martin and J Hanson to discuss the issues about QIA with Lancashire J Hanson South Cumbria teams / S Martin The chair thanked the team for their update.
ACTION: The next report to include an update on the 9 ‘Must Do’ items. Quality Team The Committee formerly received the report for information.
Dr U Chauhan exited the meeting.
Pennine Lancashire Quality Committee 27/06/2018 Page 8 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
18.117 Serious Incident Review Group Recommendations
L Wilkinson presented the paper to the committee.
ELCCG In April and May 2018, 21 reports were reviewed. Of these, 14 were approved for closure, 2 were returned to the provider for further information, and 5 required an internal CCG action before closure could be approved
BwDCCG In April and May 2018, 14 reports were reviewed. Of these, 7 were approved for closure, 5 were returned to the provider for further information, and 2 required an internal CCG action before closure could be approved.
During this period, a total of 11 extension requests were submitted by ELHT; 7 requests were made before the deadline. There have been 10 extension requests submitted by LCFT; 7 were received before the deadline.
ELHT submitted 11 out of 17 Rapid Reviews within the 72-hour timeframe. LCFT had 6 out of 17 Rapid Reviews within the 72-hour timeframe.
ELCCG has 40 StEIS incidents and BwDCCG has 68 incidents open at present.
L Wilkinson advised the committee that there is a revised framework being drafted which should be oublished by the end of 2018.
The Committee formerly received the report for information.
L Wilkinson exited the meeting; C Wright entered the meeting.
18.118 Pennine Lancashire CQUIN 2017/2018 and Q4 Payments
2017/2018 CQUIN Reconciliation has taken place for Q4 for ELCCG and BwDCCG hosted contracts, and the quarterly report was received. Full details are available within the report.
BMI The data discrepancy previously reported has been reviewed, and payment for the outstanding CQUIN has been approved.
ELHT Evidence pertaining to the Sepsis CQUIN indicator have now been received and reconciled. Payment has been recommended.
LCFT Evidence has been submitted by LCFT pertaining to the outstanding ‘healthy food’ indicator, which has been fully met. Payment has been recommended.
MCFT Additional information for Q2 and Q3 have been submitted relating to the indicator “Improving Physical healthcare to reduce premature mortality in people with serious mental illness”. Evidence has also been submitted for the Q4 milestones, however further clarification is needed from the Trust regarding how this addresses the reporting requirements for local and national audit. Therefore payment for the Q2 and Q3 milestones is recommended, but payment for the Q4 milestone has been withheld at this time.
Pennine Lancashire Quality Committee 27/06/2018 Page 9 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
IAPT Consortium Evidence has been submitted for the Q4 indicator, and this has been reconciled.
About Health Evidence has not been received for the Q2 and Q3 milestones for 1 indicator, the second indicator has been achieved.
Age UK Evidence has been submitted for the Q4 indicator, and this has been reconciled.
Members acknowledged the report and approved the recommendations for payment of CQUIN monies as outlined in the report
18.119 Quality Accounts
This report was presented to inform the Committee of the process implemented for publication and sign off of the 2017/18 Quality Accounts for EL and BwDCCG hosted contracts. Organisations that provide healthcare commissioned by NHS England of Clinical Commissioning Groups are required to produce and publish an annual Quality Account, which must then be uploaded to the NHS Choices website. These are an important way for local NHS services to report on quality and show improvements in the services they deliver to local communities and stakeholders.
Providers are required to share their Quality Accounts with the commissioner responsible for the largest number of patients that services have been provided to during the reporting period. The end of each Quality Account contains a statement from the provider’s main commissioner reflecting on the content of the account and the quality of services provided.
Draft Quality Accounts have been received for the main hosted providers for BwD and EL CCGs, and those where the CCG is an associate on the contract. These are: BMI, ELHT, LCFT, and MCFT.
Members acknowledged the report
18.120 Pennine Lancashire Primary Care Quality Updates
ELCCG C Wright presented the ELCCG Primary Care Annual Report.
The report detailed the progress of primary care across East Lancashire, including the development of the Quality Assurance process and Quality Assessments. The report also provided a detailed breakdown of complaints and patient experience.
The report concludes that the Primary Care Quality Team has made great progress in providing assurance to East Lancashire CCG of the quality of General Practice service provision over the past 12 months. Over the next 12 months the team plan to embed the established processes and ensure that they become core principles of the CCG’s work.
It was noted that the report shows a deterioration in the satisfaction with out of hours services; C Wright advised that the new patient satisfaction data is due to be published so this should provide further clarity. The Chair observed that it would be good to see better use of the Friends and Family test, as the CCG are behind the national position. She suggested
Pennine Lancashire Quality Committee 27/06/2018 Page 10 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
practices incorporating a standardised approach to the free text question, ‘If you could change one thing about the practice what would it be?’, supported by the Quality Framework.
ACTION: Catherine Wright to discuss the Friends and Family Test at the Quality Group
S Martin asked for it to be noted that the primary care quality service had helped commissioners and was improving performance in practices. Members were advised that the Primary Care Quality services for El and BwD CCGs will be combining to provide a Pennine Lancashire approach.
BwDCCG M Ridgway presented the BwDCCG Primary Care Report. The report provides a bi-monthly update on the Quality Assurance Monitoring, CQC Progress and Complaints for practices within Blackburn with Darwen.
ACTION: J Hanson and Dr M Ridgway to discuss whether to include the J Hanson / Primary Care Quality minutes with the agenda for information. M Ridgway
Members acknowledged the reports.
J Mulloy entered the meeting
18.121 Pennine Lancashire IPA / CHC Update
S Martin presented this report to committee to update on the progress and current risks in relation to Individual Patient Activity for the Pennine Lancashire CCGs. Full details are available within the report.
Continuing Health Care (CHC) Following discussions between East Lancashire CCG, Blackburn with Darwen CCG and Midlands and Lancashire CSU it was agreed that the organisations would work in partnership to pilot the commissioning model proposed in the Commissioning Development Framework (IPA). The inaugural meeting of the Pennine Lancashire CHC Development Group was held on 08 June 2018. The overall aim is to improve the effectiveness and efficiency of the local CHC process by integrated working with single line management structure
MLCSU have indicated that there are 205 CHC reviews outstanding for ELCCG and 65 reviews outstanding for BwD. The CCG IPA leads have received a full breakdown of the activity and impact of the additional resource funding for reviews provided to the CSU
Members expressed concern that the number of outstanding reviews remains high, as both CCGs are still underachieving against the quality premium.
Previously Unassessed Period of Care (PuPOC) The CSU is continuing to manage the process by responding to the disputes against decisions received. There have been no further disputes received this financial year. East Lancashire CCG has received a draft report following an Ombudsman investigation relating to the previously held position of CCGs across Lancashire regarding the review of retrospective eligibility for CHC. The CCG has accepted the findings and recommendations of the report, which has an impact on the seven CCGs using MLCSU for the provision of IPA services. The CSU is currently triaging the requests to identify those that are true retrospective cases and those which should have been addressed through “business as usual”.
Pennine Lancashire Quality Committee 27/06/2018 Page 11 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
Personal Health Budgets NHS England has announced the expectation that all CHC eligible patients choosing to have care delivered in a non-residential setting should have this delivered by a PHB. Work is ongoing about how this will be delivered to the CCG, and meetings are being held with J Johnston and I Fletcher.
CHC Choice and Equity Policy Further to the last report advising on the challenge on the Choice and Equity Policy by the Equality and Human Rights Commission, (EHRC), the Lancashire CCGs have agreed to review the policy in light of the comments from the Commission and the revised national framework for CHC. The CCGs have instructed Hempsons to revise the policy. With regard to the CCGs in other parts of the country that had been notified of judicial review by the EHRC, it is understood that all are now reviewing their policies. NHS England has indicated that they will be supporting local areas with this work but clarity is being sought on what this means and the impact on our local actions to date.
Transforming Care Work continues to procure local CCG commissioned beds and in implementing the revised service specification for learning disability services. There was discussion about the patients in secure settings and how to support them to move to the community. S Martin explained that the CCG has to commission a certain number of low secure and step down beds, but have not got the right number in place at present. There is also an agreement for flexible beds with LCC, but this is not working as planned either.
ACTION: Transforming care to be invited to present at a future committee. D Ashby
Court of Protection and Deprivation of Liberty Work has commenced to ensure that there is assurance that all those receiving care in a non- residential setting that could be subject to restrictions have the necessary legal framework in place. An update will be provided in due course.
LeDeR Work has commenced on reducing the number of outstanding reviews and it is hoped that the learning will be shared within the next report.
ACTION: S Martin to ascertain how many LeDeR reviews are outstanding and S Martin inform safeguarding.
The Chair thanked S Martin for her update.
Members received the report and noted the concerns raised.
18.122 Pennine Lancashire E&I Quarterly Reports
J Mulloy presented the Pennine Lancashire Equality and Inclusion Annual Report, noting that it detailed the equality work undertaken by both BwD and EL CCGs over the last12 months and the progress made against the equality pledges.
A work programme for E&D work for the year ahead has been agreed across both CCGs focusing on: Mandated equality duties Support to satisfy the public-sector equality duties through equality impact risk assessment processes
Pennine Lancashire Quality Committee 27/06/2018 Page 12 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
Regular reporting Face to face governing body training session Face to face Equality and Diversity mandatory training for both CCG’s Equality Delivery System work Procurement work where appropriate
J Mulloy warned that the WRES report may not be published on CCG websites on 01 August as the required information from HR is not due to be received until mid-July, which will not allow time to process; the report will then need to go through the governance route. She has raised this with HR as a concern.
ACTION: K Hollis to raise the concern about the availability of the WRES K Hollis information with HR
The Chair queried how recommendations made to each CCG, and whether good practice is replicated. J Mulloy confirmed that this happens where appropriate.
Members acknowledged the report and approved it for discussion at the Governing Body Meetings for EL and BwD CCGs.
J Mulloy exited the meeting.
18.123 Pennine Lancashire Safeguarding Dashboard
S Clarke presented the Pennine Lancashire Safeguarding Dashboard to members.
The report ensures the Committee is sighted on the key safeguarding priorities and is aware of the safeguarding activity that has taken place in the last 3 months.
The report also provided a detailed update on the development of a Pennine Lancashire model for safeguarding, which continues to experience difficulty in balancing the ever increasing safeguarding workload with the Pennine developmental work and wider partnership work. ELHT have served notice on the Designated Doctor provision to BwDCCG, which has enabled the team to establish Pennine Lancashire posts, which will take effect from 01 July 2018.
There are concerns around the Initial Health Assessments undertaken by ELHT, which has been escalated to Children’s Commissioners as a matter of urgency. A full review will be undertaken to ascertain the reasons for the fall in performance. The community paediatric specification has been signed off and the first set of performance data is due in July 2018. Concerns about poor performance have escalated to manager in ELHT in June 2018, and children’s commissioner will meet with him recommending that he appoint a lead to oversee and monitor this at a senior level, and to link with the CCG. However, it was noted that compliance is reliant on the Local Authority providing information to the team in a timely way, and that there are instances where children are offered an appointment but do not attend the clinic. A more in-depth audit is currently being undertaken to better understand the underperformance.
Since the report was finalised, it has been reported that the court has ruled on the procurement of the 0-19 services, stating that the LCC records of the moderation process fell short of standards so they cannot proceed with contract award. The current 0-19 service will remain until March 2019, but LCC are yet to confirm their plans after this date. This issue remains on the risk register for both CCGs.
Pennine Lancashire Quality Committee 27/06/2018 Page 13 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
J Hanson took the opportunity to thank the Safeguarding Team for their hard work, particularly in relation to a number of complex cases.
The Chair thanked the team for the detailed report.
Members acknowledged the report.
18.124 Quality Performance Meeting Draft Minutes: May 2018 BMI Lancashire East Lancashire Hospitals NHS Trust Lancashire Care NHS Foundation Trust
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes.
18.125 ELCCG Risk Management and Information Governance Group Draft Minutes: May 2018
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes.
18.126 Cancer Tactical Meeting Minutes May 2018
These were distributed prior to the meeting for information. A query was raised after the meeting.
The Chair queried a reference within the minutes to a ‘fail period’, asking what this meant and the implications. S Bradley clarified that the ‘fail period’ relates to where a target is not being met and a provider is given a period of time to allow actions to put in place for the target to be sustainably met, and underperformance is accepted for this period.
Members acknowledged the minutes.
18.127 GP Quality Group Minutes for ELCCG and BwDCCG: May 2018
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes.
18.128 National Audit Office’s Report into NHS England’s Management of the Primary Care Support Services Contract with Capita
This report was provided to members for information. It assesses whether NHS England managed the Primary Care Support England contract effectively to secure the intended benefits.
No comments were raised.
Members acknowledged the report.
Pennine Lancashire Quality Committee 27/06/2018 Page 14 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
18.129 Quality Assurance Visit: Scarisbrick Unit
This report was provided to members for information.
This was a routine quality assurance visit carried out as part of planned schedule of quality assurance visits agreed in partnership with Midland and Lancashire CSU (acting for Blackburn with Darwen CCG as lead commissioner for mental health services) in relation to concerns. The terms of reference for the visit were determined following a review of quality surveillance data and post-incident reviews related to the Scarisbrick Inpatient Unit. The purpose of the visit was to explore and seek assurance of compliance CQC fundamental standards, and to seek assurance that the actions from Serious Incident Action Plans related to the unit had been fully embedded and implemented.
No comments were raised.
Members acknowledged the report.
18.130 Pennine Lancashire HCAI Update
This report was provided to members for information. It provided the annual update for 2017/18 on Healthcare Associated Infections (HCAIs) for the CCGs within the footprint of Lancashire County Council (LCC) and Blackburn with Darwen (BwD) Council.
MRSA: In 2017/18 there were 5 cases from ELCCG, and 2 cases from BwDCCG. The team are reviewing the data to identify any lessons that can be learned across Lancashire, but due to the small number it is difficult to determine these trends.
C-Difficile In 2017/18 BwDCCG had 39 cases against a trajectory of 40, and ELCCG had 97 cases against a trajectory of 58.
E-Coli: In 2017/18 BwDCCG had 134 cases against a trajectory of 141, and ELCCG had 322 cases against a trajectory of 257.
Full details are included within the report
Members acknowledged the report.
18.131 Any Other Business:
Community Services. A query was raised regarding how community services are monitored and how this information is utilised during re-procurement. S Martin explained that there is a programme of service reviews that will delve into the detail and re-write service specifications, where necessary, with quality standards that outline what is expected. There is a focus on aligning this process across Pennine Lancashire to ensure a joint approach to commissioning, despite differing providers. It was noted that more rigorous reporting around community services would be useful, although members were cautioned that the Commissioning Business Group and Sustainability Committee should receive the performance monitoring information for both CCGs.
Pennine Lancashire Quality Committee 27/06/2018 Page 15 of 16 Minutes Approved by the Chair: 13/07/2018
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
ACTION: J Hanson and J Thomas to consider how the governance for monitoring J Hanson / community services could work. J Thomas
18.132 Items for the Risk Register
There were no additional items to be added to the risk register.
18.133 Date & Time of Next Meeting
The next meeting has been scheduled for Wednesday 25 July 2018 in Meeting Room 1, Walshaw House.
Deadline for papers is 5pm on 16 July 2018.
Pennine Lancashire Quality Committee 27/06/2018 Page 16 of 16 Minutes Approved by the Chair: 13/07/2018
CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Audit Committee Meeting held on 24th May 2018 at 1 p.m. in the Board Room, Fusion House Evolution Park, Haslingden Road, Blackburn, BB1 2FD
PRESENT: Mr Paul Hinnigan Lay Member – Governance (Chair) Dr Nigel Horsfield Lay Member Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Dr John Randall General Practitioner (GP) Executive Member
IN ATTENDANCE: Mr Roger Parr Chief Finance Officer Mrs Linda Ring Senior Finance Manager Mr John Farrar Engagement Lead, Grant Thornton UK LLP. Mr Simon Hardman Audit Manager, Grant Thornton UK LLP Mrs Pauline Milligan Governing Body Secretary (minutes)
Min No Item Action By 18.040 Chair’s Welcome
The Chair welcomed everyone to the meeting of the Clinical Commissioning Group’s (CCG’s) Audit Committee (AC).
18.041 Apologies for Absence and Confirmation of Quoracy
Apologies had been received from:
Mrs Claire Moir, Governance, Assurance and Delivery Manager Mrs Kerry Ann Wheat, Anti-Fraud Manager, Mersey Internal Audit Agency (MIAA) Mrs Lisa Warner, Senior Internal Audit Manager, MIAA Ms Louise Cobain, Engagement Lead, MIAA
The Chair explained that, as the purpose of the meeting was to agree the final annual accounts, some members of the CCG and members of MIAA were not required to attend the meeting.
The meeting was confirmed as quorate.
18.042 Declarations of Interest
The Chair invited members to declare any interests they may have in relation to items on the agenda.
No declarations of interest were made.
Declarations declared by CCG staff are listed in the CCG’s Registers of Interests. The Registers are available, either via the Secretary to the Governing Body (GB), or on the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/
The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting.
18.043 Minutes of the Meeting held on 24th April 2018
The minutes of the meeting held on 24th April 2018 were reviewed and agreed as an accurate record.
RESOLVED: That the minutes of the meeting held on 24th April 2018 were approved as an accurate record.
18.044 Matters Arising
18.044.1 Action Matrix
The Action Matrix was reviewed and it was noted that there were two actions scheduled to be completed in August.
All other actions had been completed.
18.045 2017/18 Annual Report and Financial Statements
18.045.1 Audit Findings Report 2017/18
Mr John Farrar presented the report, which detailed the observations arising from the audit that are significant to the responsibility of those changed with governance to oversee the financial reporting process.
Mr Farrar confirmed that the audit had been conducted within the audit framework set by the National Audit Office.
The auditors were required to form an opinion on whether the CCG’s accounts and financial statements for 2017/18 (including the audited parts of the Remuneration Report and Staff Report) gave a true and fair view of the financial position of the CCG and its expenditure and income for the year (page 3).
The auditors were also required to report whether the Annual Report and Annual Governance Statement (AGS) were consistent with the financial statements.
He confirmed that, subject to a small number of outstanding queries being resolved, it was anticipated that an unqualified audit opinion on the financial accounts for 2017/18 and an unqualified Value for Money (VfM) conclusion would be issued.
The auditors had not exercised any of their additional statutory powers or duties, or changed their audit approach. There were no new risks to report during the course of the audit.
Mr Farrar explained the figures contained within the materiality for the financial statements (page 4).
Mr Farrar concluded by thanking the CCG for its support during the audit and remarked that there was very little by way of adjustments to be made to the financial accounts.
The Chair, on behalf of the AC, thanked the Finance Team for their hard work in preparing the accounts and financial statements.
Page 2 of 5
Mr Simon Hardman echoed Mr Farrar’s comments in thanking the Finance Team for their support during the audit.
Mr Hardman highlighted the going concern commentary (page 5) and significant audit risks (pages 6 and 7). There were no areas of concern to bring to the attention of the AC.
He outlined the accounting policies assessments (page 8), which were rated ‘green’ and other communication requirements (page 9) and explained some of the points in the commentary.
Mr Hardman referred to the other responsibilities under the code (page 10) and reported that there were some minor amendments to be made to the auditable elements of Remuneration and Staff Report. The review of accounts consolidation schedules was to be finalised following the AC.
VfM Conclusion Mr Hardman stated that the auditors were required to satisfy themselves that the CCG had made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and report by exception where they were not satisfied (page 13).
He reminded members that the auditors had carried out an initial risk assessment in February 2018 and identified a number of significant risks. The risks were communicated to the CCG in the External Audit Plan dated April 2018. He highlighted the key findings against the significant risks (page 13). In terms of financial sustainability, he confirmed that the auditors considered that the arrangements the CCG had in place to identify and address financial risks were ‘good’. The auditors recognised that the CCG’s Quality, Innovation, Productivity and Prevention (QIPP) target for 2017/18 had been achieved and the CCG was on track to identify schemes to achieve its target in 2018/19.
Mr Hardman confirmed that there were no significant facts or matters that impacted on their independence as auditors to bring to the attention of the AC and that no non-audit related services were delivered during the year (page 14).
He explained the Statement of Changes in Taxpayers Equity statement (page 15) and it was noted that a minor amendment was being considered. Mrs Linda Ring confirmed that the amendment had now been agreed.
Mr Hardman highlighted the auditors’ final fees for the audit (page 16). He drew members’ attention to the details of the draft audit opinion (page 17), which reported that the auditors expected to provide the CCG with an unmodified audit report.
He concluded by stating that all that remained was for the Letter of Representation to be signed, and some other final minor amendments to be made, to complete the audit.
Questions and answers followed.
The Chair summarised that he was pleased to receive the audit report issuing an unqualified opinion and to note that the audit had worked well; with no major issues.
RESOLVED:
Page 3 of 5
i. that the AC agreed to delegate authority to the Chief Finance Officer to oversee any minor amendments which needed to be made to the accounts and financial statements 2017/18; ii. that the AC noted the content of the report.
Members stated that they had received significant assurance that the CCG was a well-run organisation; however, Dr Geraint Jones questioned who was responsible for monitoring the risks in relation to Integrated Care Partnership across Pennine Lancashire and Integrated Care System across Lancashire and South Cumbria. The Chair responded that it was the responsibility of the GB to ensure that it had clarity on the wider risk management processes across the system and to maintain its oversight of the CCG’s financial planning.
18.045.2 Letter of Representation
Members reviewed the standard letter, requested by all auditors, which provided the CCG’s opinion as to its financial statements giving a true and fair view in accordance with International Financial Reporting Standards and the accounting policies directed by the Secretary of State with the consent of the Treasury, as relevant to the NHS in England.
Members noted that the letter would be signed by the Clinical Chief Officer and Chief Finance Officer following approval.
Questions and answers followed.
RESOLVED: That the AC approved the Letter of Representation.
18.045.3 Annual Report and Financial Statements
The Chair introduced the Annual Report and Financial Statements 2017/18, which had been reviewed at the last meeting.
He stated that Mrs Ring had provided him with a list of the minor amendments that had been made following advice from the auditors.
The Chair invited any further comments or questions.
The Chair stated that he was happy to approve the documents and enquired if, subject to the delegated authority given to the Chief Finance Officer to oversee any further minor amendments, the AC agreed to approve the Annual Report and Financial Statements 2017/18.
RESOLVED: That the AC approved the Annual Report and Financial Statements 2017/18.
18.046 Any Other Business
Acknowledgements Mr Parr thanked Mr Farrar and Mr Hardman for their hard work and challenging approach in auditing the CCG’s annual accounts.
Mr Parr also thanked the AC for their attendance and contribution to the AC meetings.
18.047 Date and Time of Next Meeting
It was agreed that the next meeting would be scheduled for Tuesday 21st
Page 4 of 5
August 2018 at 2 p.m. Pauline ACTION: Mrs Pauline Milligan to confirm. Milligan
The Chair thanked everyone for their attendance and input and the meeting closed.
Page 5 of 5
GOVERNING BODY MEETING
REVIEW OF GOVERNING BODY REGISTER OF INTERESTS
Date of Meeting 5th September 2018 Agenda Item 18
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity X To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements 9 To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access X Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund X Access to Re-ablement and Intermediate Care X Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions X Access to high quality Urgent and Emergency Care X Scheduled Care X Quality 9 GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 3
Clinical Lead: N/A
Senior Lead Manager Mrs Claire Moir Finance Manager Mr Roger Parr Equality Impact and Risk Assessment This report is for information only completed: Is a Data Protection Impact Assessment Required? Yes No Data Protection Impact Assessment completed: Yes No Patient and Public Engagement completed: This report is for information only Financial Implications This report is for information only Risk Identified This report is for information only Report authorised by Senior Manager: Mr Iain Fletcher Y
Decision Recommendations
The Governing Body is requested to note the content of the report.
CLINICAL COMMISSIONING GROUP (CCG)
Governing Body Meeting Page 2 of 3
GOVERNING BODY MEETING
5TH SEPTEMBER 2018
REVIEW OF GOVERNING BODY REGISTER OF INTERESTS
1. Introduction
The purpose of this briefing is to provide the Governing Body with an update on its Register of Interests.
Following revised guidance from NHS England and the subsequent revision to the CCG’s Conflicts of Interest Policy, it was agreed that the CCG’s Registers of Interests would be renewed bi-annually.
2. Governing Body Register
Governing Body Members have recently been requested to review their Declaration of Interests, to ensure that the register is up to date (attached as Appendix 1). The register was presented to the CCG’s Audit Committee on 21st August 2018 and has been published on the CCG’s website in line with statutory requirements.
3. Recommendation
The Governing Body is requested to note the content of the report.
Mr Iain Fletcher Head of Corporate Business 24th August 2018
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REGISTER OF INTERESTS NHS BLACKBURN WITH DARWEN (BwD) CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY - AUGUST 2018 Name and position within, or Type of Interest Description of Interest (including for indirect interests, Dates Interest Relates Actions to be taken to mitigate risk (to relationship with, the CCG details of the relationship with the person who has the From and To be agreed with Line Manager or a interest) Senior CCG Manager) Dr Adam Black (General Financial GP Partner for Cornerstone Practice 2008 Present As per CCG Conflicts of Interest (CoI) Practitioner (GP) Executive Policy Member) Director of Cornerstone Healthcare Community Integrated Care 2009 Present As per CCG CoI Policy (CIC) I am a member of a General Practice which is a member of East 2008 Present As per CCG CoI Policy Lancashire Medical Services (ELMS) and I am an Out of Hours (OOHs) sessional GP for them. Non-Financial Professional Director of Cornerstone Healthcare Charity 2010 Present As per CCG CoI Policy
Indirect Wife is Speech and Language Therapist for 'Speak Easy' 2014 Present As per CCG CoI Policy Charity Mr Graham Burgess (Chair) Non-Financial Professional Chair of Torus Social Housing Company, Warrington and St 2014 Present As per CCG CoI Policy Helens Non-Financial Professional Chair of Rochdale Integrated Commissioning Board 2018 Present As per CCG CoI Policy
Non-Financial Professional Chair Pennine Lancashire Accountable Care Partnership 2018 Present As per CCG CoI Policy (Shadow) Professor Dominic Harrison Indirect Director of Public Health with the Local Authority 2009 Present As per CCG CoI Policy (Director of Public Health, BwD Borough Council) Partner is a Green Party County Councillor on Lancashire 2015 Present As per CCG CoI Policy County Council Visiting Professor at the University of Central Lancashire 2014 Present As per CCG CoI Policy
Mr Paul Hinnigan (Lay Member - Financial Director of Beardwood Business Services Limited 2012 Present No longer trading Governance) Director of Northlands Consultancy Services Limited 2016 Present Health Consultancy. Projects discussed with BwD CCG Chair in advance to ensure no conflict. Non-Financial Professional Lay Member for Heywood, Middleton and Rochdale CCG 2018 Present Lay Member for Governance - NHS CCG, therefore, no perceived conflict. Dr Nigel Horsfield (Lay Member) Non-Financial Professional Friends and former colleagues work at East Lancashire 1981 2010 As per CCG CoI Policy and Personal Hospitals NHS Trust (ELHT), Beardwood Hospital and Gisburne Park Hospital Miss Claire Jackson (Director of Financial Seconded from role jointly funded through the Local Authority 2017 2018 Indirect so no action Commissioning Operations) and CCG
Indirect Friendships with colleagues at Blackburn with Darwen Borough Indirect so no action Council and Trafford CCG Dr Geraint Jones (Lay Member - Non-Financial Professional Friends and former colleagues work at ELHT, Beardwood 1987 2016 As per CCG CoI Policy Secondary Care Doctor (Retired)) and Personal Hospital and Gisburne Park Hospital Dr Penny Morris (GP Executive Financial GP Partner Darwen Healthcare (DHC). Dr M Ninan (Partner at TBC Present As per CCG CoI Policy Member) DHC) is GPwSI in Cardiology. Indirect Dr Mohammed Umer (Partner at DHC) is Chair of the Local 2017 Present As per CCG CoI Policy Primary Care Federation Non-Financial Personal Medical Advisor to the W M and BW Lloyd Trust (Charity) in 2016 Present As per CCG CoI Policy Darwen. Mr Roger Parr (Deputy Chief Non-Financial Professional Father is Chair of East Lancashire Hospice and Governor at 2014 Present As per CCG CoI Policy Executive/Chief Finance Officer) ELHT Public Sector Director of East Lancashire Building Partnership 2013 Present As per CCG CoI Policy
Indirect Partner is the Director of Performance at Blackpool CCG 2017 Present As per CCG CoI Policy Dr Zaki Patel (GP Executive Financial GP Principal at Hollins Grove Surgery, Darwen 2017 Present As per CCG CoI Policy Member) Sessional work for ELHT 2017 Present As per CCG CoI Policy I am a member of a General Practice which is a member of 2016 Present As per CCG CoI Policy ELMS and I am an Out of Hours (OOHs) sessional GP for them.
Sessional work for Local Primary Care 2017 Present As per CCG CoI Policy Director of ZNM Limited 2013 Present As per CCG CoI Policy Non-Financial Professional Board Member of Tauheedul Islam Girls' High School 2015 Present As per CCG CoI Policy Dr John Randall (GP Executive Financial GP at Oakenhurst Medical Practice 1992 Present As per CCG CoI Policy Member) GP Partner, Dr Ali, within my practice receives financial TBC Present As per CCG CoI Policy remuneration for conducting Phase 3 trials for Merck; Sanofi; Novonordisk; AstraZenica. I am a member of the Local Blackburn GP Federation TBC Present As per CCG CoI Policy I am a member of a GP Practice which is a member of ELMS TBC Present As per CCG CoI Policy Indirect My wife is Executive Chief Nurse at Trafford CCG TBC Present As per CCG CoI Policy Dr Malcolm Ridgway, Clinical Financial Seconded to NHS England two days per week as a Primary 2016 2018 Exclusion from decisions that might Director for Quality and Primary Care Senior Responsible Officer benefit the CCG. Care Indirect Son in Law, James Bibby, Manager at ELMS 2009 2018 Exclusion from any discussions regarding ELMS. Daughter, Jennifer Ridgway, works as a Practice Nurse in 2014 Present Exclusion from any relevant discussion. Nelson Daughter, Rebecca Bibby, works for Pharma, a specialist in 2018 Present Exclusion from any relevant discussion. supplying comparator drugs for clinical trials. Dr Preeti Shukla (GP Executive Financial GP Partner Ewood Medical Centre 2018 Present As per CCG CoI Policy Member) Director OM AADI Limited (private company) 2018 Present As per CCG CoI Policy Local Medical Committee Member 2016 Present As per CCG CoI Policy British Medical Association General Practitioner Committee 2017 Present As per CCG CoI Policy Members GP Survival England Representative 2016 Present As per CCG CoI Policy Blog writer 2016 Present As per CCG CoI Policy Deputy Policy Lead, British Medical Association 2017 Present As per CCG CoI Policy Federation GP for the Spoke Hub 2017 Present As per CCG CoI Policy Ad hoc work (case writing) for the University of Central 2018 Present As per CCG CoI Policy Lancashire Medical School GPH Clinician - GP Health Service 2018 Present As per CCG CoI Policy I am a member of a General Practice which is a member of East 2017 Present As per CCG CoI Policy Lancashire Medical Services (ELMS) and I am an Out of Hours (OOHs) sessional GP for them. Non-Financial Professional British International Doctors Association Executive Member 2016 Present As per CCG CoI Policy Blackburn National GP British International Doctors Association Chair 2017 Present As per CCG CoI Policy Non-Financial Professional Friends and colleagues working as GPs, Consultants, Health 2011 Present As per CCG CoI Policy and Personal Care Assistants, Nurses, Allied Health Professionals at East Lancashire CCG, Blackburn with Darwen CCG, ELHT, Beardwood Hospital and other hospitals and other areas via social media contacts. Mrs Janet Thomas (Executive Non-Financial Professional Friends and former colleagues at Lancashire Care NHS 2000 2017 As per CCG CoI Policy Nurse and Associate Director of and Personal Foundation Trust and ELHT Quality and Commissioning)
GOVERNING BODY MEETING
COMMUNICATIONS AND ENGAGEMENT REPORT SEPTEMBER 2018 Date of Meeting September 5, 2018 Agenda Item 19
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor x outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity x To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access x Self-Care and Early Intervention x Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING
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Clinical Lead:
Senior Lead Manager Lucie Higham Finance Manager Roger Parr Equality Impact and Risk Assessment EIA was completed on the Communication and completed: Engagement Strategy July 2015 Patient and Public Engagement completed: Yes on going Is a Data Protection Impact Assessment No Required? Data Protection Impact Assessment No completed: Financial Implications Within Budget Risk Identified Engagement risk is reducing Report authorised by Senior Manager: Y
Decision Recommendations
The Governing Body is requested to:
1. Note the contents of the report; 2. Feedback any comments or suggestions in relation to communications and engagement activity and comment on future plans; 3. Receive a further report at its meeting in December 2018.
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CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
SEPTEMBER 5, 2018
COMMUNICATIONS AND ENGAGEMENT REPORT SEPTEMBER 2018
1 Introduction
This report provides an analysis of communications and engagement activity by the CCG over the last quarter.
2 Background
NHS Blackburn with Darwen CCG is supported in its communications and engagement activity by the Midlands and Lancashire Commissioning Support Unit, The Communication and Engagement Team operates as one team with NHS East Lancashire CCG colleagues, to realise the benefits of economies of scale and avoid unnecessary duplication. A proposal to bring the CSU staff into the CCG is proceeding. The team currently operates as a Pennine Lancs CCGs communication and engagement team with bases at Fusion House, and at Walshaw House.
3 Communication and Engagement Report September 2018
3.1 This report provides a summary of activity on communications and engagement by Blackburn with Darwen CCG between June 2018 and end of August 2018. It covers a wide range of activity, including:
• Engagement including staff and stakeholder; • Proactive and reactive media relations; • Integrated communications • Design and marketing; • Website and digital media; • Campaigns: and • Future work.
4 Overall assessment
4.1 The main focus for the Communications Team this quarter has been delivering the summer campaigns and supporting the health system during the busy periods. The highlight of this quarter was the launch of the Blackburn with Darwen Shadow Local Integrated Care Partnership Launch event in June which the team helped deliver in partnership with the Communications Team at Blackburn with Darwen Council. In addition, the team have supported the launch of Care Navigation led by the GP Federation.
5 Proactive and Reactive Media Management
5.1 The Communications Team have continued to be proactive in terms of both press releases and social media posts as well as reactive in terms of media enquiries. A comparison of the last 12 months has been compiled. Governing Body Meeting Page 3 of 8
5.2 Comparison over the last 12 months :
September - PR activity June 2018 – March 2018 – December 2017 November 17 September 2018 May 2018 – February 2018
Media enquiries received 5 10 2 3 Proactive media releases 30 17 28 39 issued
Proactive Facebook posts 140 98 1911 181
Proactive Twitter posts 295 148 214 285
5.3 Website
5.4 During the quarter, there were 12,819 page reviews; 10,481 unique page reviews and an average of 00:01:49 time spent on each page. Press releases are posted in the news section on the website and there were visits during this quarter. If an article needs further promotion, it is promoted on the home page too.
5.5 Page reviews
5.6 The most popular pages during this quarter were:
1 - Home Visits: 295 2 - Pharmacy Opening Times - 35 3 - Top accolade awarded to local GP Neil Smmith - 13 4 - Stakeholder Event & Annual General Meeting 26th September 2018 - 13 5 - Blackburrn with Darwen GP practice Care Navigators helping support patients - 11 Governing Body Meeting Page 4 oof 8
6 - Breastfeeding has benefits for both mum and baby - 10 7 - Vacancy - Chair of the Governing Body - 10 8 - About us - 9 9 – Home - 8 10 - Contact us - 8
5.7 Most popular pages over the last 12 months were:
1 - Home - 2,862 2 - Governing Body Meetings - 674 3 - Policies and procedures - 648 4 - Governing Body Meetings - 476 5 - Vacancies - Visits: 460 6 - Pharmacy Opening Times - 384 7 - Contact us - 377 8 - Publication Scheme - 364 9 - Governing Body Members - 339 10 - Cancer G.P. and 25 year old patient encourage young women to have a smear - 337
6 Integrated communications
6.1 During the last quarter, the joint Pennine Lancashire Communications Team has successfully delivered the Communications and Engagement Service for Blackburn and East Lancashire CCG as well as working with partners across the health system.
6.2 Following a request by the Seniors Leaders Group for Pennine Lancashire, a review of this function has been carried out to build on this strong foundation of partnership working across communications and engagement professionals. As a result, it is proposed to create an agency model across the partner organisations, details of which will be subject to a separate report. The proposal has been approved by the Governing Body for East Lancashire CCG, with the caveat that a memorandum of understanding is agreed between the CCGs and ELHT, and that the focus remains on avoiding duplication, “doing once” and focussing on the needs of the Together A Healthier Future transformation requirements. As such there is an appetite for a virtual, agile team working across the primary/secondary care interface, but caution about the commissioner /provider duties of each team being managed, and equity of support for each organisation.
6.3 The communication and engagement teams for all partner organisations (including both CCGs, ELHT, LCFT and local authorities) have had good, effective working relationships over the last few years; sharing workload and providing mutual support on joint communication and engagement plans such as the winter A&E delivery campaign, other marketing campaigns, joint PR and communications. This varies depending on the nature of the communication and engagement requirement, and ranges from advice, to joint working and mutual aid or support. There has been a willingness and commitment to avoid duplication, ‘do things once’ and ensure consistency and coherence of messaging to avoid confusing or complicating messages.
6.4 In other sectors, the agency model is a well-established, tried and tested model for communication and engagement support. The agency model provides the basis for our recommendations for communication and engagement support in Pennine Lancashire. A key aspect of this model is that the communication and engagement service is organisationally agnostic, operating across all organisation and functional boundaries managing communication and engagement support on a project and account basis Governing Body Meeting Page 5 of 8
7 Design and marketing
7.1 The Midlands and Lancashire Commissioning Support Unit’s Design team provide design support to the team through the CSU contract. As part of the inhousing proposal, the CCG has invested in design and technology capacity and training to ensure continuity of design support moving forward. The current design work includes a number of materials this quarter, including
• NHS70 food bags – canvas bags with NHS 70 logo for staff to fill with ffood for local charities
• GP access poster – extended accesss for GPs
• Health service design diagram – Blackburn with Darwen Shadow Local Integrated Care Partnership Launch event
• Annual Report Summary – 12 page document for the AGM
• More than you Think message for billbboard – Summer campaign for the CCG’s town centre billboards
• Local Integrated Care Partnership - Fact Sheet foor staff based on the new shadow partnership
8 Digital media
The Communications Team’s “digital first” approach has again proved to be extremely successful, particularly in the promotion of the Summer Campaign.
8.1 During the last 12 months, the CCG’s digital channels have grown significantly and have proven to be a key part of the team’s communication and engagement tools.
8.2 Facebook
8.3 Page Followers
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8.4 Twitter
8.5 Followers
8.6 You Tube
Top videos
Top videos Views Blackburn GP explains why gelatin is in the child flu nasal spray 1,255 Smear tests save lives 480 Child flu vaccine for egg allergy 269 Child flu vaccine – GP explains how it works 304 Patient stories- Living well with pain 120 Who should have the flu vaccination? 179 Blackburn GP explains important of child flu vaccination 198 Matt’s medicine cabinet 137 Toddler has nasal spray flu vaccine 262 School nurses child flu vaccination 146
9 Campaigns and marketing
9.1 A number of campaigns have been supported over the last quarter including Stroke Awareness; Ramadan; Mental Health; Deaf Awareness; Diabetes and Blood in pee campaign. As well as promoting the campaigns through the local media and on the CCG’s digital channels, promotional packs were sent to GP practices containing posters and leaflets for patients.
9.2 The communication team has supported the GP Federation in the launch of Caare Navigation, this including GP (internal) communication, patient information, and public relations in local media. A video which includes a patient case study, is being edited for further promotion.
10 Engagement, Insight and Market Research
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10.1 Engagement has been carried out in relation to a number of commissioning intentions including Audiology and community services as well as part of the Pan Lancashire Policy Harmonisation including laser eye surgery and grommets.
10.2 The team has supported the pan lancs audiology (NHS hearing aids) review and proposed procurement. This is led by the CCG and the communication and engagement team have supported this, across Lancashire. Two surveys and related reports of hearing aid users, and GPs have been produced following a communication campaign, and these will be considered by the Lancashire and South Cumbria Audiolgy Leadership Board in due course.
10.3 The communication and engagement team have also been supported the Pan Lancs review of CAMHS services. Much of this work has been focused on coproduction of the service spec with children and young people, and the process is at the stage where we are ready to feed back the findings in the context of a “You said, we did” report. The coproduction will be continuing throughout the autumn and winter months, and is shared with other CCGs and Trusts.
11 Staff Engagement
11.1 The Communications Team supported the annual CCG Away Day which was held at Samlesbury Hall in June. The results of the annual CCG staff survey 2018 and the 360 Ipsos Mori Annual CCG survey 2018 were discussed with staff and their views sought. An action plan has been put together based on the comments.
11.2 The CCG’s celebrations to mark NHS70 were hailed a huge success, both in terms of staff engagement but also two local charities benefited as well. Staff filled over 100 food bags for the homeless charity Nightsafe and the Wish Centre, a charity which supports women, men and children who are affected by domestic violence or domestic abuse. Both charities were absolutely delighted with the donations.
12 Future work
12.1 The priority for the coming quarter for the Communication Team is the planning of this year’s AGM and Stakeholder event on September 26, 2018 at Blackburn’s Central Library as well as this year Winter Communications Campaign. The stakeholder event will again be interactive and it is hoped many of the borough’s public and third sector organisations will again attend.
Meetings have already been held with key stakeholders including local councillors about how they again support this year’s winter campaign including the promotion of the flu vaccinations.
13 Recommendation
13.1 The Governing Body is requested to:
1. Note the contents of the report; 2. Feedback any comments or suggestions in relation to communications and engagement activity and comment on future plans; 3. Receive a further report at its meeting in December 2018.
Lucie Higham Communications and Engagement Account Manager August 2018 Governing Body Meeting Page 8 of 8