Virtual Governing Body

To be held on Thursday 2 September 2021

From 1.00 pm until 3.30 pm

VIRTUAL GOVERNING BODY To be held on Thursday, 2 September 2021 at 1pm A G E N D A

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

2. Declarations of Interest Verbal All For noting The CCG’s register is available via the Governance team or on the CCG website which can be accessed here.

3. Minutes of the meeting held on 1 July Enc A Dr Crichton For approval 2021

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

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

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

7. Patient Story Verbal Dr Crichton For discussion

Strategy

8. LeDeR Annual Report Enc B I Boldy For approval

9. Joint Commissioning Strategy & Enc C Dr Crichton For approval delegation to the Joint Committee Clinical Commissioning Groups

10. Healthwatch Doncaster Annual Report Enc D S Whittle For noting 2020/2021

11. Audit Committee Annual Report Enc E P Wilkin For noting

Assurance

12. Quality & Performance Report Enc F A Fitzgerald & For noting A Russell • Spotlight Report on Living Well

13. Finance Report Enc G T Wyatt For noting

14. Governing Body Assurance Framework – Enc H C Rollinson For approval Quarter 1

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Ref Item Enclosure Led By Action Required 15. Chair and Chief Officers Report Enc I Dr Crichton & J For noting Pederson Items to Note

16. ICS CEO Report – August 2021. Enc J Dr Crichton For noting

Receipt of Minutes

17. Receipt of Minutes Enc K Dr Crichton For noting

• Executive Committee – Minutes of the meeting held on 16 June and 21 July 2021. • Quality & Patient Safety Committee – Minutes of the meeting held on 6 May 2021. • Engagement & Experience Committee – Minutes of the meeting held on 3 June and 1 July 2021. • Public Primary Care Commissioning Committee – Minutes of the meeting held on 10 June 2021.

18. Any Other Business Verbal Dr Crichton For discussion

19. Date and Time of Next Meeting For noting Thursday 7 October 2021 at 1pm

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

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Minutes of the Virtual Governing Body Thursday 1 July 2021 at 1pm

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

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

In J Satterthwaite PA to Chair and Chief Officer (Minute attendance: Taker) J Telford Healthwatch Doncaster (Item 7 Patient Story) S Barnes Interim Estates Lead (Item 9 Performance Report) K Dowson Director of Digital (Item 9 Performance Report) A Molyneux Head of Medicines Management (Item 9 Performance Report)

Action 1. Apologies for Absence

Apologies were noted from:

• Dr R Suckling, Director Public Health • P Holmes, Doncaster Council Representative

2. Declarations of Interest

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

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

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

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups:

None declared.

Declarations of interest from today’s meeting:

Dr Jones and L Tully declared an interest in item 8 of the agenda, Governing Body Tenures, Dr Crichton advised that they both refrain from the discussion and decision for this item.

3. Minutes from the Previous Meeting held on 3 June 2021

The minutes of the Governing Body meeting held on 3 June 2021 and the Extraordinary Governing Body meeting on 10 June 2021 were approved as correct records.

4. Matters Arising not on the Agenda

There were no Matters Arising.

5. Notification of Any other Business

There was no notification of further business to discuss.

6. Questions from Members of the Public

There were no questions received from the Public.

7. Patient Story

The Governing Body received a video which featured Denise who had to access health services during the pandemic in support of several health conditions.

Denise utilised an online booking system to make appointments with her GP, Advance Nurse Practitioner and Pharmacist which were conducted via the telephone and found this to be very useful as it reduced the frustration of continuous calls to the surgery. On one occasion the GP needed visual access to a particular condition. Denise was sent a link on her mobile phone and asked

to upload a photograph to the link and was very surprised at how easy the process was. A hospital referral to dermatology was made.

Denise has diabetes which requires annual health checks. Although initially apprehensive, her appointment was conducted face to face where her feet, weight, blood tests and the flu vaccine were undertaken. The blood test required repeating which was done at the Keepmoat Stadium drive through and took only minutes to do. Denise felt this was a very good system and hoped that it will continue going forward.

Denise has received both her COVID-19 vaccinations and was advised by a friend to download the NHS App, which she was unaware of, as they are recorded on it along with other relevant information. Although Denise found the online services hugely beneficial and was satisfied and grateful for the services she has received over the last year, she is aware that there may be some people who do not have access to smartphones or may struggle with the technological aspects.

A Fitzgerald commented that Denise’s story is particularly topical as clinicians are aware of the increase and demand currently being experienced to access General Practice and we are exploring different models across the Primary Care Networks (PCNs) to help alleviate the issue.

S Whittle queried if all Doncaster residents have access to all their health record on the NHS App or if it related just to the COVID-19 vaccinations. Dr Crichton advised that the App can be downloaded by individuals following a verification process and contains a basic medical record. A secondary process via your registered practice enables further detailed information.

S Whittle acknowledged that telephone access to GPs may save time for patients and asked if this was the case for GPs. Dr Pieri felt that it doubled the time with a patients for GPs as some may require a further face to face appointment following. Dr Kolusu highlighted that during telephone consultations, GPs could potentially miss visual clues to a patient’s wellbeing such as body language. If his patients need a face-to-face appointment the practice has a designated COVID safe area for the consultations which is sanitised after each patient.

Dr Crichton thanked J Telford for attending the Governing Body. He commented that the patient story summary slide was very useful and recommended that they be used for each meeting going forward.

8. 2021/2022 Governing Body Tenures

L Devanney explained that there are two Governing Body tenures due to cease during 2021/22 as follows:

• Secondary Care Doctor – due to cease 30 September 2021 • Lay Member for Primary Care – due to cease 28 February 2022

Considering the changes anticipated from April 2021, having a stable and consistent Governing Body during the transition period would be a benefit to the CCG not just from a leadership perspective but also in terms of capacity and skill mix of the Governing Body. It was proposed at the Remuneration Committee meeting on 27 May 2021 that the existing contracts of the above posts be extended to 31 March 2022 in line with recent NHS England guidance.

The Governing Body was asked to approve the recommendation from Remuneration Committee to extend the two existing posts to 31 March 2022 for the:

• Secondary Care Doctor • Lay Member for Primary Care

Dr Crichton advised the Governing Body that he had attended the Remuneration Committee meeting where the proposal to extend the tenures was unanimously recommended to the Governing Body for approval.

The Governing Body approved the extension of the following posts to 31 March 2022:

• Secondary Care Doctor • Lay Member for Primary Care

9. Quality and Performance Report

A Fitzgerald presented the Quality & Performance Report for noting by the Governing Body. The format of the Report has been changed to reflect the Operating Planning Guidance and the following priorities for 2021/2022:

• Supporting the health and wellbeing of staff and taking action on recruitment and retention. • Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19. • Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services. • Expanding primary care capacity to improve access, local health outcomes and address health inequalities. • Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay. • Working collaboratively across systems to deliver on these priorities.

A Fitzgerald highlighted the following key areas:

Vaccination Programme • Almost 80% of Doncaster residents have received the first dose of their

COVID-19 vaccination and 63% the second dose. This is a great achievement. We have been looking at innovative ways of delivering the

vaccine and to date we have introduced walk-in clinics, pop up sites and administering in places of employment. Planning is now underway for the potential Phase 3 booster vaccination programme alongside the annual flu vaccination programme.

Restoration of elective and cancer care and manage the increasing demand on mental health services • Although we have noted some improvement in waiting times, it is anticipated that it will be a long time before a recovery in some services is seen. • There has been an increase in demand for mental health services. A particular focus will be on dementia diagnosis and there are concerns regarding the number of patients accessing Improving Access to Psychological Therapies (IAPT) Services. We are working with providers to address the demand.

P Wilkin highlighted that a pre-pandemic objective was to reduce the number of Out of Area bed days and queried if there had been any lessons learned. A Russell explained that there had been several issues regarding discharges as COVID-19 had created a slowing of progress. Visits to providers were delayed and virtual visits were not as simple. Demand on the service is higher with significant pressures experienced for Out of Area placements.

A Fitzgerald drew attention to the Ageing Well Delivery Plan contained within the Report and stated that it detailed gave a summary of the actions for 2020/2021.

Spotlight Report – Primary Care

Primary Care Estates

S Barnes attended the Governing Body meeting to give a presentation on Primary Care Estates and highlighted the following points:

• Doncaster is part of the South Yorkshire & Bassetlaw (SY&B) capital programme which is funded by NHS England for new build, refurbishment, and extensions. The capital programme is time driven, and the funding must be spent by 2023. • We have been working across the 5 PCNs to maximise their estates. Some are at capacity however there is some potential within buildings to reconfigure and satisfy the requirement to extend. • Business Case development for 3 new GP premises - Circa £16m & 4700m2. • Business Case development for the refurbishment and extension to 2 existing GP premises – Circa £2.5m & increase of 450m2. • Refresh of the Primary Care Estates Strategy. • Estates data gathering. • Repurposing of existing space to support staff and patient growth. • Partnership working to reduce void space.

Next Steps 2021/2022

• Business Case drafting and approvals – 5 projects. • North PCN – Bentley, Petersgate, Great North options study. • South PCN – Mexborough, Rossington, Conisbrough Group. • East PCN – Hatfield, Thorne Moor. • Central – PCN hub in WRH, Scott Practice. • 4Doncater PCN – medium term expansion into Rutland House. • Complete estates strategy refresh. • Data gathering project.

P Wilkin asked how the Doncaster Estates Strategy connects with other strategies in SY&B. S Barnes reported that we have commissioned an organisation to refresh our strategy, and this will align us to across the region with a partnership approach. We have a strong strategic estates group with the Local Authority. Improvements in connectivity across estates have been made however there is more that can be done to understand the future demand of new housing and the impact on services.

S Whittle informed the Governing Body that the Primary Care Commissioning Committee receives regular monthly estate reports with feedback from SY&B therefore the links across the area are good.

Total Triage 2021/2022

K Dowson attended the Governing Body meeting and gave a presentation on Total Triage and highlighted the following points:

• National guidance requires practices to triage patients remotely in advance of an appointment (wherever possible) so that they can be directed to the most appropriate appointment type for their needs. • Increased utilisation of digital pathways will provide safer alternatives to face-to-face consultations and will enable our member practices to offer more consultation and communications options to patients, promoting more patient choice. • We have invested in a set of core systems and digital tools to help our practices work more effectively, transform traditional pathways, and crucially improve patient experience and outcomes. • In the last year we rolled out over 500 laptops, additional webcams, screens, and headsets to support remote consultations. • As part of our response to the Pandemic we rapidly introduced AccuRx in all practices to support video consultations and two-way messaging to help protect patients and staff from the risks of infection. • We did not see an increase in utilisation for Doctorlink (online consultations). • AccuRx Plus has been funded for all practices up until March 2022.

Expanding Total Triage

• Change management, training and support was difficult to implement during the pandemic. • We have recently applied for Digital Primary Care Funding to fund a 3year programme of work which will help us to optimise and increase utilisation of our "core digital tools" used by all member practices, and to support practices/PCNs with their online presence. • We will work closely with practices, observing and shadowing each one to get a better understanding of how they work and where our tools can support them. • Our aim is to increase overall digital skills and confidence across our workforce. • We want to achieve an equitable level of confidence, utilisation of systems and tools across all 38 practices, which should result in benefits for our population and workforce.

Enabling Strategies – Challenges

• Stakeholder Availability and Capacity. • Funding. • Decision Making and Governance. • Ensuring enabling strategies are aligned (we need to address change thinking about the full supporting infrastructure our services need). • Alignment with wider ICS plans.

Dr Crichton advised that patient surveys have been undertaken by Healthwatch on how the digital appointments have been received. It is crucial we hear the patient’s voice regarding what they want and what works for them. We may revert to more face-to-face appointments as we come out of the pandemic. Dr Khan added that digital appointments do help to reduce the face-to-face consultations however it is a difficult skill for some to learn and is not part of doctors core training. It would be helpful to include this as part of the training for GPs in Doncaster. There are also some patients who have no or poor broadband connection or no smartphones.

K Dowson informed the Governing Body that we are providing training for patients to support them with technology issues at the Edlington Community Centre and to date 50 individuals have visited the centre and are now booking online appointments. We are also working with Voluntary Action Doncaster in supporting individuals with kit in their own homes.

Dr Pieri felt that the Total Triage was not currently working effectively. The signposting of patients to the most appropriate healthcare professional is causing a bottleneck of patients contacting surgeries. K Dowson stated we are working hard to support practices going forward and to keep the communication channel open.

Spotlight Report – Medicines Management

A Molyneux gave an overview of the work undertaken by the Medicines Management Team (MMT), the challenges and next steps as follows:

Highlights

• COVID-19 related support including guidelines, governance oversight, and vaccination staffing. • The MMT has provided resources across CCG departments supporting community pharmacy services commissioning, infection prevention and control, contract monitoring and significant re-working of the woundcare model. • SY&B ICS working on several workstreams; stoma and continence service, proxy ordering, nutrition provision re-evaluation.

Challenges

• The pandemic and its workload/effects on the prescribers and practices. • Lack of physical practice access. • Impact on the prescribing budget due to out of stock issues and reduced focus on prescribing choices during the pandemic. • Rollout of the Indicative Budget Scheme. This is now live across Doncaster and it is anticipated that we will see its effect over the next few months.

Next Steps

• To proceed with the 2021/2022 plan until March 2022. • To support practices in delivering the savings with the plan and provide support for additional work that could assist them. • To engage with ICS planning to shape the future of the medicines management element of the quality stream. • To develop and build on strong links between pharmacy teams at place. • To support and assure colleagues with the forthcoming changes. • Support to integrate community pharmacy into wider healthcare information sharing. • Cessation of third-party ordering. • Utilise research from the Campaign to Reduce Opioid Prescribing (CROP) to create pain management pathway. • Complete activation of new community pharmacy ear care service and minor ailment scheme. • Stoma service redesign – overcome block to contract matter. • Support Discharge Medicines Service activation. • Rollout proxy ordering to care homes. • Continue promoting self-care initiatives.

Dr Jones advised the Governing Body that the Quality & Patient Safety Committee received regular and comprehensive Medicines Management Team reports and that the Medicines Management Team Annual Report was received at today’s Committee meeting. We must acknowledge that we do not always recognise the impact the Team has on the way we use medicines, a lot of work is undertaken that does not always receive recognition.

Dr Crichton extended his thanks to the Medicines Management Team for its flexibility during the COVID-19 pandemic and for the input he has given into the safety of the COVID-19 vaccines which are quite fragile and require to be treated carefully.

Dr Crichton thanked S Barnes, K Dowson and A Molyneux for attending the Governing Body meeting.

The Governing Body noted the Quality and Performance Report.

10. Finance Report

H Tingle presented the Finance Report which set out the financial position as at the end of May 2021 and the forecast to Month 6. The CCG has a fixed allocation for the first 6 months of the financial year (known as H1) and has submitted a break-even plan. Further information is expected in the summer in relation to the second half of the year (known as H2).

Funding for the Hospital Discharge Programme (HDP) is outside the financial allocation and will be funded separately once approved by NHS England. Additional funding is also anticipated in relation to the Elective Recovery Fund (ERF) where the CCG exceeds its threshold target level of activity and spend. At Month 2, the CCG is showing an overspend of £338k against the break - even target. The overspend relates entirely to expected funding for HDP and ERF of £320k and £18k respectively.

Due to the early stage in the year the majority of other spend is in line with budget and there are no other material variances that require highlighting. All NHS contracts remain on the block arrangements and no prescribing data has yet been received for this year. Continuing Healthcare and Specialist Placement activity is currently in line with plan.

We await further clarity for the final 6 months of the year however financial planning is currently being undertaken and is expected to gather pace over the Summer. This will be shared with the Governing Body in due course.

The Governing Body noted the Finance Report.

11. Chair & Chief Officer Report

The Chair & Chief Officer Report was taken as read. J Pederson highlighted the following points:

• NHS Doncaster CCG held its Annual Assessment on 29 June 2021 and was attended by J Pederson, Dr Crichton, Sir A Cash, System Leader, ICS and A Knowles, Locality Director, South Yorkshire & Bassetlaw. The meeting focussed on the following areas:

o The response to the COVID-19 pandemic.

o How the CCG will move forward and support the transition to the Integrated Care System. o Mental Health and the reduction in Out of Area Placements. o Referral to Treatment and elective waiting times.

The approach to the 2020/21 assessment has been simplified due to the continued impact of COVID-19 and the change in priorities to respond. This approach means that CCGs will no longer be given an overall rating, as this has been replaced by a narrative assessment of CCG performance.

The outcome of the Annual Assessment will be shared with the Governing Body in due course.

• COVID-19 Vaccination Programme

Any adult over the age of 18 can now book their first vaccination appointment. Throughout June there have been additional pop-up clinics and drop-in sessions arranged to continue the vaccine uptake across Doncaster. Last weekend saw all vaccination sites running clinics throughout the weekend and this will continue this coming weekend.

Nationally, the aim is for all adults to have had their first vaccine by the 19 July 2021.

The Governing Body noted the Chair & Chief Officer Report.

12. Integrated Care System CEO Report

Dr Crichton presented the Integrated Care System CEO report and highlighted the following points:

• South Yorkshire & Bassetlaw announced as pilot for national Accelerator programme

South Yorkshire and Bassetlaw Integrated Care System has been chosen as one of the thirteen systems to receive a share of £160m in funding and extra support to implement and evaluate innovative ways to increase the number of elective operations they deliver. The plans include: o Working with clinicians to improve capacity and streamline pathways, particularly using national care pathway blueprints that highlight best practice transformation ideas for theatres, outpatients and endoscopy services. o Offering advice and guidance from clinical specialists to support primary care colleagues. o Developing plans for even more joined up work across SYB, particularly for orthopaedics, ophthalmology and paediatric surgery. o Making best use of a wide range of providers.

Learning from what works well in South Yorkshire and Bassetlaw and the other ‘elective accelerator’ sites will help form approaches for elective recovery to be used across the country.

• Community Diagnostic Hub for South Yorkshire & Bassetlaw

Community Diagnostic Hubs (CDHs) are proposed as a new service model that will contribute to the expansion of diagnostic services, separating planned and unplanned diagnostics.

The Community Diagnostic Hub guidance shared with systems in April sets out the following primary aims:

o To improve population health outcomes. o To increase diagnostic capacity, by investing in new facilities, equipment and new staff. o To improve productivity and efficiency of diagnostics by streaming acute & elective. o To contribute to reducing health inequalities. o To deliver better, personalised patient experience. o Promote primary and secondary care integration

Dr Crichton added that the Hubs will help patients access care closer to home.

The Governing Body noted the Integrated Care System CEO Report.

13. Receipt of Minutes

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

• Executive Committee – Minutes of the meetings held on 19 May 2021. • Engagement & Experience Committee – Minutes of the meeting held on 6 May 2021. • Public Primary Care Commissioning Committee – Minutes of the meeting held on 13 May 2021.

14. Any other Business

Governing Body Meeting – 5 August 2021

Dr Crichton proposed that the next Governing Body meeting on 5 August 2021 be stood down due to the Summer holidays and Members agreed with the proposal.

The next meeting will take place on 2 September 2021.

Post Meeting Note

The Governing Body meeting on 5 August 2021 was cancelled via email on 5 July 2021.

Healthwatch Doncaster Annual Report

Dr Crichton informed the Governing Body that the Healthwatch Doncaster Annual Report will be presented on 2 September 2021 for noting.

15. Date and Time of Next Meeting

Thursday 2 September 2021 from 1pm.

Meeting name Governing Body Meeting date 2 September 2021

Title of paper LeDeR Annual Report

Executive / Andrew Russell, Chief Nurse Clinical Lead(s) Ian Boldy, Head of Individual Placements & Designated Nurse Author(s) Safeguarding Adults

Status of the Report

X To approve To consider / discuss

To note

Purpose of Paper - Executive Summary

The purpose of this report is to provide the Governing Body with an update on the LeDeR work stream.

Recommendation(s) The Governing Body is asked to: • Support and endorse the report

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis The report reflects several aspects related to the quality of care, these are Quality impact inherent within the body of the report.

Equality Tick impact relevant box

An Equality Impact Analysis/Assessment is not required for this report. x

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An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of No Conflicts Interest Consultation / Engagement (internal No Consultation at the time of presentation, the report will be presented departments, once ratified at a number of stake holder events clinical, stakeholder and public/patient) Report previously None presented at Risk None analysis Corporative Objective / All Corporate Objectives Assurance Framework

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LeDeR Annual

Report

2020/2021

Ian Boldy

Head of Individual Placements

Designated Nurse Safeguarding Adults

Doncaster Clinical Commissioning Group

Index:

• Index-Page 2 • Executive Summary – Page 3 • Acknowledgments – Page 4

Part One • Introduction-Page 5 • Statement of Purpose-Page 5 • How do we achieve this challenge-Page 6 • Progress on Reviews-Page 6 • Governance-Page 6 • Public Engagement and LeDeR-Page 6 • Impact of Covid 19 on Reviews-Page 7

Part Two • Outcome of Reviews-Page 8 • Gender-Page 8 • Age Range-Page 9 • Severity of Learning Disability –Page 10 • Ethnicity-Page 10 • Place of Death –Page 11 • Cause of Death –Page 12 • Standard of Care-Page-Page 13 • Multi-Agency Review-Page 13 • Evaluation-Page 14 • Recommendations-Page 14 • Strategic Action Plan-Page 15 • Measurement Strategy-Page 15 • Achievements-Page 15 • Funding –Page 15 • Performance against National Targets-Page 15

Part Three • Wider Learning Disability Developments- Page 17 • Learning Disability Quality Cell – Page 17 • Local Strategic Developments – Page 19 • ICS Developments – 29

Part Four • Future Plans –Page 32

Executive Summary

This is the 2020/2021 Doncaster LeDeR Annual Report. The report will provide an overview of the work of the LeDeR Review program. It will also provide an overview of wider LD work and achievements that affect the Doncaster Learning Disability population. Deaths notified in 2020/2021 After a fall to 10 deaths in 2018/2019, 2019/2020 saw an increase to 19 deaths for the year reviewed, two of those were children. This year saw an increase to 35 deaths. 60% were male and 40% were female. 43% of those that were reviewed were 65 years old or older, with 26% of reported deaths falling into the age group of 50 years to 64 years. The oldest death reported was 85, the youngest was 7 years old. Dur- ing this year, no cases proceeded to full multi-agency review. The people whose deaths were notified 80 % of deaths notified held an ethnicity of White British, with 5% indicating Asian. 31% had a Mild Learning Disability, 12% had a Severe Learning Disability and 3% had a Moderate Learning Disability. Place of death of those notified 79% of deaths reported cited the hospital as the place of death, with 21% of deaths reported as the occurring in the individual’s usual residence. The causes of death of those notified Covid has had a significant impact on this group of users of health services, 31% of deaths were attributable to Covid. This is slightly higher than the national picture, where 24% of cases reported to the LeDeR programme were attributed to Covid.

When reviewing other causes of deaths against the national picture, there is little variation locally, the picture remains consistent with the national picture, with significant number of individuals dying from respiratory disease.

The Quality of Care

In 52% of cases the quality of care has yet to be assessed, the reason for this is described later. In terms of care of those reviewed, 31% of the total number reviewed were deemed to have received deemed care to be Good. A small percentage, 6% of reviews were deemed Exceptional, whilst the remaining 6% care was assessed as being Satisfac- tory. Measurement against the National Standards

All the national standards have been achieved during 2020/2021

Acknowledgements The writer would like to place on record his thanks for the support and courage dis- played by the families that have contributed to the LeDeR process, without their assistance this initiative would lack meaning. Their willingness to be part of this review system is instrumental in enabling the wider health community to have a greater understanding of their experiences, in the hope that learning will take place.

The writer would also like to express his gratitude to the professionals that have been part of this work, who have made themselves open to professional review and to those that have undertaken reviews for their commitment and courage during the most difficult and challenging times.

Part One

1. Introduction

The Learning Disabilities Mortality Review (LeDeR) programme was established in 2016 to support local areas across England to review the deaths of people with a learning disability, to learn from those deaths and to put that learning into practice. As part of the process, CCGs are expected to work with their local partners including people with a learning disability, families and carers, Local Authorities and NHS Trusts.

The LeDeR process provides a unique opportunity to improve the quality of the health and social care services provided to people with a learning disability, and to address the persistent health inequalities this group of people often face. The review process also provides a voice for the family and relatives of people with learning disabilities.

Locally the LeDeR programme looks to utilise the partnership approaches in place around Learning Disabilities across Doncaster. These partnerships are utilised in both the review process and in terms of the learning elements that come out of the review process.

LeDeR Developments during 2021

During Quarter 4 of 2020/2021 the whole LeDeR process and IT Platform that supports LeDeR went through a full evaluation. The forthcoming year will be subject to a significantly different approach. To prepare for this the IT platform on which LeDeR sat closed at the end of March. This meant that any open cases had to be temporarily suspended in terms of reviews. This has meant that a high number of cases that sat on the 2020/2021 caseload remained incomplete and have yet to be ‘released’ for review.

This has meant that the data used in this report is incomplete. Incomplete in the sense that some data prior to completion of review was extracted for this report but some was not. This means that in some of the areas explored in this report there may be full data, but in other areas, here will not.

The intention is to revisit this report later in 2021 to provide a complete version of the annual report.

1a. Statement of Purpose around LeDeR locally The aim of the LeDeR programme locally is to build on the tremendous amount of work undertaken by a number of agencies by proving the learning disability community with a voice. The review programme ensures that every child or adult that dies with a learning disability undergoes a robust review process to identify any cause for concern around their care, any areas of good practice and to identify any areas where their care could have been improved.

The spread of the information gleaned from the reports, described in the governance section of this report, illustrates the importance that this work holds.

1b. How do we achieve this challenge?

Doncaster has a number of LeDeR reviewers that can undertake reviews, but this is part of their total role rather than their sole role responsibility, in light of this, to assist the CCG in meeting its national targets and to ensure reviews are undertaken in a timely manner, the CCG has a dedicated reviewer resource to undertake reviews. This action ensures that reviews are completed to a consistently high level of quality, both in the completion of the review and in the approach adopted in their completion.

1c. Progress on Reviews

The period of this review saw 35 reported. As a result of the pandemic there were many challenges emerged that resulted in delays in completing reports, such as access to families and access to clinical notes. At the time of the report there are 11 reviews that requires starting, with a further 6 that have been submitted but require completion in terms of data.

1d. Governance

The LeDeR work stream is part of the Transforming Care work and so reporting is partially done through that route, but locally reporting sits alongside of other ‘Individual Placements’ work with reporting going through the Quality and Patient Safety Com- mittee of the CCG, which is a subgroup of the CCG’s Governing Body. Another pathway where the LeDeR work is shared is into the Learning Disability Partnership Board. As a result of this arrangement, periodic reports are presented around LeDeR findings and areas of focus.

As a result of the impact of the Covid Pandemic the involvement of the Learning Dis- ability Community in the writing of this report has been limited, however it is intended that as processes begin to ‘open up’ the report will be shared with the Learning Disa- bility Partnership Board, as well as the LeDeR Learning Group and the newly formed Learning Disability Framework that has come out of the Doncaster Covid response.

1e. Public engagement and LeDeR One of the LeDeR programme’s primary aims is to try to make sure that local learning leads to service improvements. This can only be done if bereaved family carers are approached to support them describing their experiences of care delivery and care pathways. From the outset, the involvement of families has been a core principle and value that sits at the heart of the LeDeR programme.

In order to facilitate this involvement, the reviewer arranges as many appointments as possible necessary to give adequate time and space to formulate their individual thoughts, feelings of the care delivery experienced over the final 12 months of their

loved one’s life. From these discussions the reviewer identifies the areas of good practice, experiences and areas where they think practice could be improved upon. This approach is important as many nuances around services are not captured in records.

1f. Impact of Covid 19 on Reviews

The Covid 19 Pandemic has significantly impacted this work stream, affecting in two distinct ways.

At the height of the pandemic there was a clear spike in deaths. For the period between 23rd of March to 23rd May 2020, a period of 9 weeks, a total of 13 deaths were registered, some were due to Covid 19, some not. This is startling when compared to data for the previous three years.

As indicated below there has been an almost 200% increase in deaths during the reported period.

2017-2018 18 Deaths 2018-2019 10 Deaths 2019-2020 19 Deaths 2020-2021 35 Deaths

Part Two

2. Outcome of Reviews

This section will provide details and analysis of date drawn from the LeDeR cases. There have been 35 reviews reported in the year covered by the report.

During the period of this review there were zero cases that related to children.

Throughout this review the writer will reflect the local position where appropriately against the national position, and in some situations previous years.

Gender

Gender 25

21 20

15 14

0 Male Female

The 2020 national report reflected 57% Males and 43% Females passed through the review process. The difference in data is not deemed to be significant.

Age Range

16 15 14 12 10 9 8 6 4 4 4 2 2 1 0 0 Age 4yrs - 17yrs 18yrs - 24yrs 25yrs - 49yrs 50yrs - 64yrs 65yrs + Unknown

As reflected in the data and chart above there has been a wide spread of cases in terms of ages that have been reviewed over the past year. The eldest case was 85 years of age and the youngest was 7 years old. In the last national report, the number of children made up of only 5%. The Doncaster figure is 11%

In the last annual report, the author noted a difference between the data for the over 65 group, reflecting this age group made up 47% of deaths, whilst nationally although the highest group in terms of age categorisation, the % was 37%, 10% lower. In this year this situation has changed with Doncaster falling in line with the national picture of 41% and 43% respectively.

This trend noted last year has continued with the age group between 50 and 64; nationally the report reflects 35%, whilst locally this is only 26%.

When analysing the data from a median viewpoint, the Doncaster number for females is 70 and 58.5 for males. Nationally, the median age of deaths 61 for males and 59 for females nationally. Locally, the median age of deaths is 62 for males and 63 for females. Median age across all deaths is 63, this is in line with the national picture of 61.

Median age is an effective measure of how people with Learning Disabilities compare with the general population. In the last national report, the median age of general population is 83 for males and 86 for females, thus reflecting the requirement for the Le- DeR projects.

Severity of Learning Disability

Severity of Learning Disability 20 19 18 16 14 12 11 10 8 6 4 4 2 1 0 0 0 Severity of Mild Moderate Severe Profound Not Known Learning Disability

The Doncaster data reflects, those with Mild Learning Disabilities are disproportionally represented from the data analysed. However, this should be interpreted this way with significant caution., in that more than 50% of reviews do not have a classification at the time of the report. Therefore, the author urges caution.

The latest national report records that 33% of cases are those with a Mild Learning Disability, 35% are those with Moderate Learning Disability, 25% with a Severe Learn- ing Disability and 7% with a Profound Learning Disability.

Ethnicity

30 28

5 3 2 1 1 0 White British White Not Recorded Mixed Unknown

As the above chart reflects the ethnicity of those reviewed in Doncaster is recorded as White British at 80 %, with 6% recorded as Mixed. The data reviewed does not provide ethnicity on 11%. Nationally, 8% of cases reviewed were from a black or ethnic minority. Once again it is important to reflect this data against Doncaster’s population, the 2011 census indicated that 91.8% of the population saw themselves as White British.

Place of Death

Place of Death 30 26 25

10 7

0 Usual Residence Hospital

The reviewed data shows that 79% of individuals died in hospital, this is a slight increase from the previous year where 66% died in hospital. This is possibly a reflection of an acute clinical deterioration in individual circumstances rather than planned ‘end of life’ care. The first national Leder Report of 2017/2018 reported that 62% died in hospital, whilst the 2018/2019 report reflected that 60% patients died in Hospital. A more striking comparison is that 46% of the ‘general population’ die in hospital.

This could be related to the Covid Pandemic, and so this trend will be one of the key focus’ in future.

Cause of Death

12 10 10 8 8

4 3

2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0

Cause of Death Not Known 10 Arrythmia/Cardiomyopathy 1 Aspiration Cardiac Arrest 1 Aspiration Pneumonia 1 Breast Cancer 1 Covid/Cancer 1 Covid 8 CVA 1 Empyema/Respiratory Disease 1 Frailty/Covid 1 Frailty/Chest Infection 1 Oesophageal Cancer 1 Pneumonia 3 Pneumonia/Covid 1 Pneumonia / Heart Failure 1 Sepsis Dialysis 1 Sepsis / Liver Abscess 1

When reviewing the cause of deaths within the review, clearly Covid has had a significant impact on this group of users of health services, 31% of deaths were attributable to Covid. This is slightly higher than the national picture, where 24% of cases reported to the LeDeR programme were attributed to Covid.

This remains unchanged from previous years national data where respiratory disease was attributable for 40% of deaths, with cardiac disease and sepsis being responsible for 8% and 7% respectively.

Standard of Care

Standard of Care 20 18 18 16 14

12 11 10 8 6 4 4 2 2 0 0 0 Unknown Exceptional Good Satisfactory Care Fell Short of Care Fell Short of Good Practice Good Practice (Not Detriment) (Detrimental)

As the above chart reflects there is a significant omission in this area in the data due to the issues described elsewhere in the report.

However, there is a positive analysis of those reviews with data, with no indications of care falling short of good practice, and overall standard of care identified within the reviews covered by the report sitting at either satisfactory, good or exceptional.

Nationally, the direction of care is similar to that of Doncaster, where there is an incre- mental increase in the proportion of reviews identifying providing examples of good practice up to 58% in 2020.

Multi Agency Reviews

During 2020/2021 there has been no multi-agency review undertaken.

3. Evaluation of the Data

This report has provided a detailed overview of information generated from 35 LeDeR reviews. Unfortunately, as a result of factors described within the report, there has only been limited data available for evaluation. It is intended that this will be rectified with the report being revisited later in 2021.

The data generated does give a varied picture which reflects the wide and varied Learning Disability population in place in Doncaster.

Regarding the delivery of care, the review data gives some degree of assurance that care on the whole is good. With reviews indicating either care is good or satisfactory.

There are some areas of focus that also require further work beyond the scope of LeDeR, the key one being the number of Learning Disability patients that die in hospital, Doncaster has a higher percentage than the national picture and has increased year on year, so therefore required further understanding. It is possible this could also be linked to the failure to identify deterioration in a timely manner.

4. Recommendations

As a result of the issues described around data the formulation of recommendations is somewhat challenging, but again will be revisited.

One area of focus needs to be the increase in numbers of deaths in hospital. As indicated, this could be as a result of this year’s events however it is essential to look at this through a critical eye to ensure this does not continue in inappropriate circumstances.

The annual report of 2019/2020 identified an area of concern around the lack of early recognition of deterioration, it is essential that as the full data of 2020/2021 is reviewed the relationship between the two factors above are considered in terms of their inter- relationships.

5. Strategic Action Plan

1a. Fully evaluate (when data available) the potential developing trend of increasing deaths of people with a learning disability in hospital

1b. Consider the potential impact of the previous years recommendation around failure to recognise deterioration in clinical condition of people with a learning disability.

6. Measurement Strategy

The above recommendations have come through reviews that have been undertaken during the Covid Pandemic. It is crucial to fully evaluate the years data when this is available. The measurement strategy will be developed at this time.

7. Achievements

In terms of key achievements around this agenda, there was a challenge to maintain the momentum around the reviews, because of difficulties in accessing information and in terms of being able to undertake reviews. In the year reported these have been around the on-going progress of the reviews. These continue to be undertaken in a timely and supportive manner, enabling the voice of the Learning Disability population to be heard by all the partnership organisations.

It is also important to recognise the evaluation related to the standard of care, this is overall a positive reflection of care delivered by the Doncaster care community. The reviews have drawn out aspects of care that require address and improvement; these will be moved into the different commissioning organisations.

8. Funding

The CCG has dedicated funding in place for a Senior Nurse. This position enables a consistent and timely approach to LeDeR reviews. In addition to this there are many other reviewers in non-dedicated posts. Moving forward a review will be undertaken regarding availability and on-going appropriateness of these staff, whilst looking at opportunities for others to take up this role.

9. Performance against National Targets

At a national level there are a series of performance criteria that each CCG are meas- ured against. The responsibility for LeDeR sits with the CCG Chief Nurse, who along

with the Deputy Chief Nurse organises and delivers the requirements of the programme.

1. Each CCG must be a member of a learning disabilities mortality review (LeDeR) steering group, and have a named person with lead responsibility

Responsibility sits with the CCG Chief Nurse with operational support from the Head on Individual Placements.

2. There must be a robust CCG plan in place to ensure that a LeDeR review is undertaken within six months of the notification of a death in its area

All reviews are commenced within the required timeframe and ordinarily are completed in a timely manner, although there are a small number that for reasons outside of the control of the reviewer do take some time to complete, examples of this are if cases are subject to Child Death Overview Panel scrutiny or are subject to Coroner interven- tion.

3. CCGs must have systems in place to analyse and address the issues and recommendations arising from completed LeDeR reviews

2020/2021 saw a number of developments be introduced to assist the response across health and social care to the Covid Pandemic. The local developments described around learning Disabilities made a significant impact to the care of service users, their families and care staff.

4. An annual report, detailing the findings of local LeDeR reviews and the actions taken, must be submitted to the appropriate board/committee for all statutory partners, and shared amongst other local health and social care boards as appropriate.

This report and its findings are planned to be shared with the Doncaster Safeguarding Partnership Board and the Doncaster Learning Disability Partnership Board.

Part Three

Wider Learning Disability Developments

LD Quality Cell

On the 13th of April 2020 the Learning Disability Quality Cell was established, and the group formed as a meeting for the first time. The Learning Disability Quality Cell was formed with membership from NHS Doncaster CCG, Doncaster Council and the Acute Liaison Nurse from Doncaster Royal Infirmary initially and latterly joined by Rother- ham, Doncaster & South Humber NHS Foundation Trust which would establish a full multi-disciplinary cell. The cell took a similar form and function to cells developed around wider care home work.

Once the Learning Disability Quality Cell was established a piece of work was undertaken to establish what the COVID response would look like. The initial focus of the cell was the CQC registered Learning Disability Homes.

The Cell set out a plan of having a multi-disciplinary team for each residential home in Doncaster. The response from all attendees was extremely positive and received with great intention of creating and maintaining a support network for those homes looking after individuals with a Learning Disability in Doncaster.

The MDT for each care home compromised of a named person from the following services:

• Named allocated nurse from CHC Team • Named allocated Social Worker from DMBC • Named allocated clinician / nurse from RDASH • Named contract monitoring officer from DMBC Commissioning

The MDT produced an individual plan, following discussion with that home about the issues that home faces, their capability to respond and the support required. This was a critical development in terms of keeping the individuals with a Learning Disability as protected as possible during the COVID-19 pandemic.

The Learning Disability Quality Cell also took on the role of ‘Discharge Support’, with members provided a high calibre oversight of discharges and potential discharges.

Supported Living

A decision was taken to allocate a multi-disciplinary team to the supported living homes within the borough. A COVID supported living action plan was developed jointly between NHS Doncaster CCG and Doncaster Council.

The Learning Disability Quality Cell has had an extensive membership with each individual bringing key skill to the cell which has formed a strength-based approach. As

well as having social workers, contracts monitoring officers, clinicians, the Cell has also had involvement from Performance, Insight and Change members, project management, and commissioning from NHS Doncaster CCG. Members have worked collaboratively to create an effective pro-active and reactive response at all times.

The success of the Cell has been recognised within the care home/supported living community, numerous feedbacks has been received via the Multi-Disciplinary Teams about the support that has been received both through the multi-disciplinary team and through escalation to the cell.

Here a few specifics of how the Cell supported the Doncaster Community

1. Infection Prevention & Control/Personal Protective Equipment Training

As part of the National response to COVID-19 a training programme was developed by The Royal National Orthopaedic Hospital NHS Trust and delivered by NHS Eng- land. The programme was rolled out to several super trainers within each Clinical Commissioning Group nationally and then disseminated to allocated clinicians to become trainers.

The training programme included but was not limited to Hand-washing and Personal Protective Equipment, Taking Care of Residents, and yourselves, and taking care of your environment.

Five of the clinical case managers and the clinical team leader from the Learning Dis- abilities team were successful in being certified as trainers. The Learning Disabilities Support Worker was also certified leading to her having a significant impact in terms of the number of sessions delivered, but also enabling the clinical team to focus their work on case management and multi-disciplinary teams.

The team worked flexibly to accommodate delivering the sessions in such a way which worked for the providers. This included delivering sessions outside of core working hours to ensure staff members within the providers who work nightshifts we’re accom- modated for and enabled to receive the same level of training as those working shifts within NHS Doncaster CCG’s core working hours. The team also delivered a number of sessions within the outside garden space of homes due to being unable to deliver the sessions inside the property as social distancing measure could not be adhered to.

2. FFP3 Fit Mask Testing

In addition to delivering the IPC/PPE training, two members of the Cell trained to undertake the role of fit testing FFP3 masks for those staff who worked with individual with an aerosol generated procedure.

3. COVID Swabbing/Testing

The Cell supported through referrals from partner organisation to access swabbing in their own homes, supported living and residential care. Using the members skills and experiences this support enabled individuals to move placement, access respite, due to symptoms or because of an outbreak within their placement.

The formation of the Learning Disability Cell required a commitment from all agencies to ensure Doncaster’s Learning Disability Community received a high level of care at the time of their greatest vulnerability. This was achieved through exceptional partnership working which was driven by a willingness to deliver a flexible model of care that put the service user at the centre of its emergence and decision making.

2020/2021 Local Strategic Developments

Doncaster’s All Age Learning Disability and Autism Strategy 2021-2024 was jointly developed by Doncaster Council and NHS Doncaster CCG, in partnership with statutory and non-statutory partners from across Doncaster, and people with lived experience of Learning Disability and / or Autism during 2018/2019. Since the Strategy was developed and the priorities defined, five key work-streams have been set up to develop plans and progress key activities to address the five priorities, and three key cross cutting themes. The Doncaster Learning Disability and Autism Partnership Boards respectively have provided regular monitoring and challenge of the delivery, to ensure the plans deliver what people with lived experience need, want and expect from them.

In development of the Strategy, Doncaster Council and NHS Doncaster CCG commissioned Speak Up and Inclusion North, to plan and facilitate engagement exercises to gain the views, experience and preferences people with lived experience to inform the development of the strategic plans. As part of the process, people with lived experience agreed a Vision Statement to describe the aim of the strategy and its delivery plans, with 16 underlying principles, which formed the foundation of the Strategy development.

In Doncaster, we will strive to ensure that people with learning disabilities and/or autism should:

1. Have access to a timely diagnosis in line with national guidance 2. Have a safe, happy and healthy childhood, accepted for who they are, supported to have self- worth and to develop skills and talents 3. Be encouraged to hope for the same things in life as other citizens-work, family life, relationships, own home 4. Be safe in their community and free from the risk of discrimination, hate crime and abuse 5. Should live in a family home or their own home with people they chose to live with unless there are exceptional circumstances why this can’t happen 6. Have access to a good education and learning throughout life 7. Aspire/hope to have a paid job and be supported to achieve this

8. Be supported by family carers/relatives whose own needs, rights and views have been fully considered and are supported in their caring role 9. Have equal access to good health care and be supported to live healthy lives 10. Have highly personalised support, which is built up around people’s strengths, their own networks of support and in their local community 11. Be supported to access universal and early support services, where their needs are understood, they are accepted for who they are, and reasonable adjustments are made 12. Have the information they need to access social care and health services and universal services 13. Have a planned and smooth transition from child to adult life 14. Have a fulfilling and healthy later life with the same opportunities as other older people 15. Expect health and social care to work together with others to make the best of resources, working hard to achieve fully personalised support 16. Have their views and wishes in the centre of planning and shaping support

The Vision and Principles are central to the plans developed to deliver the priorities identified within the strategy.

Taking all the information from engagement, national and local policies and initiatives as outlined above, 16 areas of work to improve services, support and life opportunities, were identified. To ensure that progress is made on the key priorities, people with lived experience were asked to prioritise the areas that will have the biggest impact. Five areas were identified: a. Diagnosis of Autism b. Education and Inclusion c. Employment d. Needs of Carers and Short Breaks e. Housing and Support

A further three areas of high importance were identified which need to be addressed by each of the work areas identified above: a. Health Inequalities b. Young people in Transitions c. Transforming Care Programme (supporting people to live their best life in the community)

Action plans are in place to support the LeDeR programme and to improve health equalities for people with learning disabilities.

Annual Health Checks

People with a learning disability have poorer physical and mental health than other people. Many of the conditions people with a learning disability live with or die from are potentially treatable. Only 37% of people with a learning disability live beyond 65. For the general population that statistic is 85%.

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

The end of year position for Doncaster annual health checks was 62% with the national target being 67% in 2020/21.

The formation of the Doncaster LD Annual Health Check task and finish group with a core improvement model was set up in October 2020 to specifically improve the uptake and quality of annual health checks for the Doncaster Learning Disability population.

Membership of this group include:

• NHS Doncaster Clinical Commissioning Group Strategy and Delivery Man- ager and Performance and Intelligence • Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) Health Action Team – Primary Care Liaison Nurse and Services Manager • RDaSH – Learning Disability Service Manager • Doncaster Council Social Care Team Leader • Primary Care Network (PCN) Learning Disability care coordinators • PCN Clinical Directors • GPs • Coproduction with people with lived experience

Showing the work area meets NHS long term plan aims for organisations to work together in partnership to ensure that patients get the right care, in the right place, at the right time, thereby improving clinical outcomes for all patients.

Areas of work within the group are:

Standardised template

GP practices were previously using contrasting adaptations from national templates meaning the annual health check appointments can be different depending on where you are registered. The standardised template aims to offer a consistent approach whilst still able to produce a personalised health action plan. This template was embedded in all GP practices across Doncaster in December 2020.

Pre appointment questionnaire

The Health Action Team Primary Liaison nurse and ChaD (Choice for All Doncaster are a committee of adults who have a Learning Disability and speak up on behalf of up to 700 peers in Doncaster) devised a pre appointment questionnaire which care coordinators use when booking appointment:

• Informs the patient of the clinical importance to attend

• Explains what the appointment covers

• Collect any relevant information prior to the appointment

• Shorten the length of the appointment

• Understands any reasonable adjustments

• Answers any other queries

• Improve non-attendance of booked appointments

Primary Care Passport Promotion

It is the responsibility of all members to promote the awareness and use of the Primary Care Passport

Following national success of the Hospital Traffic Light system, RDaSH and DCCG worked in partnership to create the Primary Health and Care Passport in July 2019.

The passport includes key information based on who the individual is, communication preferences, what medication they take and how health and care professionals know if the individual is in pain or displaying signs, they may be unwell, making it easier for health and care professionals to provide the right treatment.

The passports will help prevent common questions which are often repeated and can become confusing for the individual. This can lead to individuals not attending future appointments.

The RDaSH learning disability Health Action Team has a primary care liaison nurse. She has completed verification of the GP LD register in December this included:

• An accuracy check of the register

• An accuracy check of re-code searches

• Support correct recording of the health check

LD training to Primary Care

LD awareness and Annual health check training session took have been delivered by the Health Action teams. This includes learning and recommendations from the LeDeR programme.

GP practice data pull information

A monthly data pull has been created to share with the task and finish group to identify distribution of support and identify areas for improvement:

• number of people on each practice LD register

• number and percentage of annual health checks completed

• number and percentage of blood pressure • number and percentage BMI recorded • number and percentage waist circumference • number and percentage cholesterol • number and percentage smoking status • number and percentage diabetic checks • number and percentage diabetic retinal checks

Also, Cancer screening • number and percentage bowel screening • number and percentage breast screening • number and percentage cervical screening 25-49 age • number and percentage cervical screening 50-64 age

14+ engagement and promotion

Links with Children and Young People Developing Well group and Doncaster SEN- DIAS service in February 2021 started.

Continuing healthcare, adult and children 14+ social care teams will be adding and questioning if an annual health checks were completed as part of their routine annual reviews.

Other areas of such as the Enhanced Health in Care Homes and Clinical Quality Review Group subgroups have a standing item on their agendas to question providers if individuals in their care have attended annual health checks and to offer support if required.

Transforming Care

The Transforming Care programme aims to improve the lives of people with a learning disability, autism or both who display behaviours that challenge, including those with a mental health condition. The programme has three key aims:

• To improve quality of care for people with a learning disability and/or autism • To improve quality of life for people with a learning disability and/or autism • To enhance community capacity, thereby reducing inappropriate hospital admissions and length of stay.

Transforming care trajectory –

Over the past 4 years, the number of people from Doncaster within specialist inpatient services has reduced by 75%. More work is being done to increase this number further to enable individuals to live in the community in their own homes.

We continue to review community and inpatient services; working with other commissioning areas in the Transforming Care Partnership to clarify the type and level of need; is it fit for purpose, does it meet the level of need and does it meet the key aims.

Proactive Monitoring Support Register –

This reviews individuals at risk of inpatient care and how to positively support the person to remain in the community with wrap around services or to review the thera- peutic pathway for individuals transitioning from inpatient services to the community.

Good system to record out of area visits as we are required to complete 8 weekly visits to measure quality of services and the patient welfare and wellbeing. A very positive group involving:

• Strategic and operational commissioning from the CCG and Doncaster Coun- cil

• Care coordinators,

• CCG specialist placement case manager,

• South Yorkshire Police

• Incorporates and assesses recommendations from the Care and Treatment reviews

Crisis and Intensive Support team (CAIS)

The CCG transforming care specialist placing nurse is linked in with both Children’s and Adults proactive monitoring groups and works closely with commissioning to highlight upcoming needs to best shape resources and services.

CAIS Care coordinators have a step-up knowledge and skill in support people with LD, autism, or both. They plan alternative and additional needs such as supporting management of risk for people who present the most complex challenges.

Care and (education) Treatment Reviews

People who are at risk of admission are offered a community care and treatment review to see whether they are safe, in the right place, and to understand future plans. Recommendations from community C(E)TRs involve support from specialist health teams, local authority respite care, voluntary agencies, short breaks, self- advocate, and carer organisations providing support. By understanding people’s needs and recognising early signs that might lead to a crisis it means that extra support can be put in place quickly, so the person doesn’t end up going into hospital unnecessarily.

Forensic Outreach Liaison Service (FOLS) –

• Now in place, nurse practitioners have been assigned to areas within the TCP. Phase one completed to link in with individuals identified for discharge into community provision to review safe transition.

Phase 2 mobilising to assign practitioners to individuals and provision in the community to support in a proactive way to reduce the requirement for inpatient services.

Enhanced Community Framework

The framework has been developed by NHS and local government commissioners working together. It is designed specifically for individuals aged 16 or over with a learning disability and/or autism, who are living at home, in the community or are in hospital – and whose needs cannot be adequately met by existing care and support services.

Doncaster is using the framework with 2 providers working on 2 separate projects to build specific person-centred accommodations and care needs.

Monthly mobilisation meetings occurring which identify and solve barriers leading to better pathways and discharge planning.

ECHO

The Project ECHO (Extension for Community Healthcare Outcomes) methodology provides a scalable tele-mentoring platform designed to improve health outcomes and develop communities of practice that supports service delivery, sharing of knowledge and support from professionals and carers within health and social care

settings to help improve the confidence and skills of the workforce. The training modules have been coproduced with key partners and the sessions will be facilitated by both professionals with specific areas of expertise and also by people with lived experience.

The key stakeholders that the training will be targeted at will be: • Day care Services and Community Services • Residential Care Homes/Nursing Care Homes • Supported Living Services • Domiciliary Care

The South Yorkshire and Bassetlaw Integrated Care System are committed to improving health inequalities and want to support care staff that provide care and support to people with learning disabilities and people with autism across a range of care settings. The training programme will cover the following areas and will be delivered over a 12-month period to allow people to join all the sessions when convenient. Modules to be delivered are on: • Constipation • Epilepsy and Seizure control • Dysphagia/Posture • Sepsis awareness

SAMI RESTORE 2

Allocation of 420 candidates assigned to each of the CQC adult registered homes and supported living homes.

RESTORE2™ stands for: Recognise early soft signs, take observations, Respond, Escalate. The tool has been designed to help care and nursing professionals to: • Recognise when a resident may be deteriorating or at risk of physical deterioration • Act appropriately according to the resident’s care plan to protect and manage the resident • Obtain a complete set of physical observations to inform escalation and conversations with health professionals • Speak with the most appropriate health professional in a timely way to get the right support • Provide a concise escalation history to health professionals to support their professional decision making The British Geriatrics Society (BGS) released a new guide, COVID-19: Managing the COVID-19 pandemic in care homes, offering key recommendations to help all care home staff and the NHS staff who work with you to support residents through the epidemic.

One of these recommendations advises staff in care homes in the practice of taking vital signs to use the RESTORE2™ tool to recognise deterioration in residents, measure vital signs and communicate concerns to healthcare professionals. As a recognised tool, RESTORE 2™ is a useful resource at this time as it can help care professionals spot deterioration from COVID-19 related illness or recognise non-COVID-19 related deterioration and act to decrease avoidable hospital admissions.

SAMI ensures key documentation is available that is held at source having involved the cared for person and offers reassurance to the clinician that the details have been gathered in a structured and accurate way.

The key outcomes that underpin SAMI are: • Recognise early signs of illness and record appropriate physiological observations • Improve carer knowledge, understanding and decision-making skills when deal- ing with individuals who present with an urgent condition • Understand when to report the findings to appropriate clinical services and when an emergency call is required • Improve the quality of life of patients by helping them to remain in their home • Prevent unnecessary ED attendances and hospital admission • Contribute towards a reduction in avoidable 999 ambulance transportations • Support the receiving clinician to make a better and more informed decision on the correct care pathway • Improve engagement and relationships between carers and the primary and secondary care professionals • Ultimately it will help prevent an avoidable death It will also improve the parity of the social care workforce by providing them with accredited training and making them feel more valued within the system. Attached is some of the evaluation feedback from carers.

Enhanced Health in Care Homes Framework

People living in care homes should expect the same level of support as if they were living in their own home. This can only be achieved through collaborative working between health, social care, Voluntary, Community, and Social Enterprise (VCSE) sector and care home partners. The Enhanced Health in Care Homes (EHCH) model moves away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff. Such care can only be achieved through a whole system, integrated, collaborative approach. The EHCH framework lays out a clear vision for working with care homes to provide joined up working, via a range of in reach services. 27

https://www.england.nhs.uk/wp-content/uploads/2020/03/the-framework-for- enhanced-health-in-care-homes-v2-0.pdf

The framework sets out evidence-based interventions which together combine to significantly improve the quality of care for residential and nursing home residents.

“Almost 30,000 adults with learning disability live in residential social care. People with learning disability have higher rates of physical and mental health problems and they also die at a much younger age than the general population. The COVID pandemic has highlighted the vulnerability of this group and the even higher death rates not just from COVID but from other health conditions. The Enhanced Health in Care Homes service provides a significant opportunity to address these inequalities and to provide the support and facilitation for timely and appropriately adjusted healthcare.” Dr Roger Banks, National Clinical Director for Learning Disability and Autism, NHS England and Improvement)

Rolling MDTs with the care homes have been formed. Membership includes GP representation, residential home representation, Continuing Healthcare, Social Care, RDaSH Learning Disability nurse care coordinator, contract manager.

The MDTs reduce the need for referrals by having the right representation from each agency making accessing services quicker. It reduces duplication of work by removing silos of working through a formed collaborative group. Improves early identification of health needs and improves pathway planning where access to services is required.

Feedback received by Continuing Health Care nurse:

• Providers have confirmed this has been helpful and a forum where they can raise any additional concerns / issues and to pose any queries to ensure they ‘are getting things right’ • I have received many comments around how beneficial the MDT meetings have been and how much the homes are appreciative of such • We have been able to achieve more proactive responses for individuals in terms of reasonable adjustments and timely referrals being made • Wider MDT members feel such have improved partnership working and enabled better communication for professionals to facilitate their roles in particular contract monitoring of the homes • The homes have commented on the support and dedication that has been received by Doncaster and how this is non-existent and not echoed by other areas • These meetings have been successful in achieving timely outcomes for residents co coordination of Annual health checks and flu vaccinations • MDT / members of the care home have gathered intelligence around a person’s history and need to promote screening in particular breast screening

• All MDT members are familiar with the home, environment and individual re- siding in the service to offer wrap around support • Not only has this forum enabled and yielded improvements for an individual’s health and wellbeing we are provided with further intelligence around any environmental concerns, staffing or contractual issues which then can be referred accordingly • The managers of the home are so grateful for the support and this has improved communication immensely, the providers are now contacting and keeping us informed to stay abreast of individuals needs this is not just for the individuals we have case management / funding responsibilities for but other individuals within the home so we can sign post them to relevant services or look at health funding where this may be required / warranted • From a case management perspective, I feel this has saved time liaising with MDT individual and enabled us to work collaboratively together sharing our expertise and knowledge

2020/2021 ICS Developments

Improving Health Inequalities for People with Learning Disabilities and Autism across SY&B ICS

Addressing health inequalities faced by people with learning disabilities and autism is a key priority for the SY&B ICS. We have an established Health Inequalities Steering Group which currently meets 6 weekly that specifically looks at a collaborative approach, sharing best practice to improve our pathways, provision and more importantly raise awareness

There are a number of projects across the ICS where we are working to address the health inequalities that our learning disability and autism population are still facing. The latest LeDeR report identifies that people are still dying much earlier than the general population with a learning disability (22 years younger for males and 27 years younger for females).

The LeDeR ECHO Project

Utilising the ECHO platform, we are rolling out a series of ECHO modules to LD and Autism care homes, supported living settings and domiciliary care which will increase the knowledge, competency, and confidence of staff. Focussing on the key findings and recommendations from the LeDeR reports including the following which will be phase 1 of the projects:

• Constipation • Epilepsy and Seizure Control • Dysphagia/Posture • Sepsis Awareness

These sessions will also be available to GP practices, other Clinicians and family carers later in 21/22.

ECHO training – Self Advocates from Speakup have attended ECHO training and are now supporting the rollout of the above modules presenting the case studies.

Flyer v7.pdf

SAMI/RESTORE 2 Mini Tool Project

To compliment the above project, we are also rolling out SAMI Restore 2 Mini Tool training which is an accredited training programme. The programme offers education and training for care support staff within care settings, supported living, care homes and domiciliary care. Carers are taught to recognise measure and report changes to an individual’s health status at an early stage, thus preventing deterioration in that person's health and wellbeing and avoiding preventable deaths in line with the LeDeR Programme. The aim of the programme is to identify early signs of illness, prevent unnecessary hospital admissions/attendances at A&E, reduce stress for the cared for person, increase confidence of carers, improve communications with primary care and urgent care services. We will also be providing calibrated equipment including Oximeters, Blood Pressure Machines, Thermometers and Clinical Watches. This work will also link in with the national Oximeter Pilot.

SAMI - Final FLYER FOR LD V5.pdf

Big Health Days

Speakup facilitated two big health days prior to the lock down. Over 200 people with learning disabilities, autism or both attended (the first day was for children and young people and the second day was for adults). As well as working closely with our health action teams - we partnered with SENSE and South Yorkshire Sport so that people had the opportunity to take part in sport and physical activity. Everyone had the opportunity to take part in 5 workshops on, Cancer Screening, Sexual Health and Dysphagia along with two workshops on physical activity. Everyone really enjoyed the days and when lockdown is ended, we would like to run more of these events.

Other projects

• Speakup Self advocates have co-produced an online accessible newsletter, “Spreading the News”. This gives easy read information about Covid-19, Lockdown and keeping safe. There have been 19 editions of the newsletter; it has been distributed through the Speakup website and shared through all communication and engagement leads across health and social care as well as VCR’s and parent carer forums. There are 3 further co-produced easy reads, “Kick Out Those Lockdown Blues”, offering some ideas on coping with Lockdown.

• Speakup and their advocates have carried out Zoom sessions in January 21 to spread awareness on the “early signs and symptoms of cancer” and the “Covid-19 Grab and Go sheet” these sessions will be for people with learning disabilities, family carers and supporters along with any provider services who would like to know more. A special edition of the ‘Spreading the News’ re Cancer Awareness covering 5 key areas has also been co-produced:

POSTER Covid 19 Grab and Go sheet an Be Cancer Aware.pdf The newsletter has been well received and other Integrated Care Systems are asking to use this.

• Linking in with local and ICS flu groups to try and increase the uptake of flu vaccinations. Speakup put together a flu ‘Spreading the News’ edition in easy read which will include all PHE guidance and links to those services to provide support regarding desensitisation.

Stopping Flu final Oct 20.pdf

• Health Check work - Prior to Christmas Speakup contacted 27 homes in Roth- erham (responses from 21) to find out if people had, a hospital passport, Covid-19 grab and go sheet, had attended their annual health check and had been offered a flu jab. Speakup were then asked to do the same for Doncas- ter and Sheffield and to include information about the ECHO training; an online form to capture the information was created. Since the 31 March Speakup have contacted 311 homes. Speakup also contacted care homes in Barnsley & Bassetlaw to share information about the ECHO training. Findings from the online form will be shared at the SY&B Transforming Care Health In- equalities Steering Group Meeting.

• GP Training – Speakup have delivered one training session in Doncaster and one in Sheffield, three other dates are booked for Sheffield and one for Roth- erham. Speakup have also been training medical students in Sheffield and have run two training sessions this year to 80 students. Speakup advocates also ran a session with Sheffield University to health and social care workers to talk about the TCP work and have since been contacted by a dentist who is wanting to create a quality-of-life scale around oral health.

• NHSE masterclass - Experts by experience at Speakup helped to run a masterclass for Coping with Covid: Supporting People with Learning Disabilities, Autism or both.

Part Four

10. Future Plans

The Covid 19 Pandemic has had a significant impact on the LeDeR review process; this resulted in a backlog of cases to be reviewed. It is planned that this will be brought back into line by the end of quarter 2 of 2020/2021. Once this position has been achieved the writer intends to look to identify any opportunities arising out of the ‘Covid reset’.

As part of the Doncaster Covid response a specific Learning Disability cell was developed, this included senior staff from key agencies, who came together to provide support to care facilities and individuals throughout this period. It is intended this cell has remained functional longer term. As a result of this development, discussion will be undertaken to understand how this group can be utilised from a LeDeR viewpoint.

Proposal to CCG Governing Bodies

Supplement the JC CCG Manual to expand the Scope of the Joint Committee Delegation and put in place additional arrangements for the transition to ICBs 2021/22 (SCHEDULE 3)

NHS Doncaster CCG Governing Body Meeting Public Session 2 September 2021 Author(s) Rob McGough - Hill Dickinson

Sponsor SYB AOs and Joint Committee CCGs

Is your report for Approval / Consideration / Noting

Approval

Background

NHS Operational Planning Guidance for 2021/22 requires systems to start formally planning for the establishment of the statutory integrated care systems during Q1 of 2021, including setting out plans to operate in shadow form in Q4 of 2021/22. In summary this will involve the establishment of a statutory Integrated Care Board (ICB) and an Integrated Care Partnership (ICP) which together make the Integrated Care Systems (ICSs) of the future. Both statutory functions of current CCGs and some of NHS England will transfer to the ICB, along with existing non-statutory functions of ICSs, including strategic planning, transformation and oversight. The ICB is working towards operating in full shadow form from December 2021. The five CCGs and ICS wish to put in place arrangements to ensure a smooth transition to the ICB in April 2022. It has been decided that the most practical way of doing this is for the Joint Committee of CCGs (“the Joint Committee”) to co-ordinate the taking of preparatory steps for the transition to the ICS on behalf of the CCGs and for the ICS to have visibility of that work. The boundaries of the ICS mean that NHS Bassetlaw will be moving from the ICS into Nottinghamshire and a neighbouring integrated care system on 1st April 2022. NHS Bassetlaw will continue to have an interest in many of the transitional issues within the remit of the Joint Committee. However, it is recognised that there may also be areas in which NHS Bassetlaw does not have a direct interest, and that NHS Bassetlaw may want to be less involved in discussions on such issues. The transitional operating arrangements take account of this.

Summary of key points This proposed Schedule (3) sets out that the Joint Committee of the five CCGs is adapted for the transition to the South Yorkshire and Bassetlaw Integrated Care System by:

• Expanding the scope of its delegation to include transition work such as the carrying out of due diligence, development of corporate policies, development of the constitution for the new ICB and liaising with NHS England regarding the constitution;

• Inviting members of the ICB to its meetings, so that they have a full understanding of the preparatory work being done by the Joint Committee;

• Establishing a sub-committee to carry out this preparatory work; and

• Having a working arrangement with Bassetlaw CCG that the CCG may choose not to participate in parts of the meeting that are not directly relevant to Bassetlaw, following the move of Bassetlaw from South Yorkshire & Bassetlaw ICS to Nottinghamshire & Nottingham ICS on 1st April 2022.

• No changes are made to the Joint Committee’s Terms of Reference. In particular, Bassetlaw CCG will continue to be a member of the Joint Committee and attendance of a representative from Bassetlaw CCG will still be required in order for meetings of the Joint Committee to be quorate. If a member from Bassetlaw CCG is in attendance at a Joint Committee meeting and decides not to actively participate in discussions on a particular topic, that will not mean that the meeting is inquorate.

• This paper has been supported by Barnsley CCG, Bassetlaw CCG, Doncaster CCG, Rotherham CCG, Sheffield CCG and Derbyshire CCG as a variation to the Manual and Delegation. If there is any difference between the provisions of this Schedule 3 and the remainder of the Manual or the Delegation, then the terms of this Paper will take precedence.

• As set out above, nothing in this Schedule 3 amends the Joint Committee Terms of Reference (ToR attached for reference).

Recommendations

This paper seeks agreement from the CCG members of the Joint Committee to this approach and agreement for the Schedule (3) enclosed to be added to the JC CCG Manual Agreement / TOR (attached for reference) and specifically approval of the following: 1. Proposed amendment to the delegation of the Joint committee for the transition work but the Joint committee TOR (enclosed for reference) are unchanged

2. Establishment of the Joint Committee sub-committee – the Change and Transition Board - to take forward the transition work between September and end March 2022

Joint Committee Transition 2021/22 Proposal to add as SCHEDULE 3 to Joint Committee of CCGs Manual / Terms of Reference

Background 1 NHS Operational Planning Guidance for 2021/22 requires systems to start formally planning for the establishment of the statutory integrated care systems during Q1 of 2021, including setting out plans to operate in shadow form in Q4 of 2021/22. In summary this will involve the establishment of a statutory Integrated Care Board (ICB) and an Integrated Care Partnership (ICP) which together make the Integrated Care Systems (ICSs) of the future. Both statutory functions of current CCGs and some of NHS England will transfer to the ICB, along with existing non-statutory functions of ICSs, including strategic planning, transformation and oversight. The ICB is working towards operating in full shadow form from December 2021.

2 The five CCGs and ICS wish to put in place arrangements to ensure a smooth transition to the ICB in April 2022. It has been decided that the most practical way of doing this is for the Joint Committee of CCGs (“the Joint Committee”) to co-ordinate the taking of preparatory steps for the transition to the ICS on behalf of the CCGs and for the ICS to have visibility of that work.

3 The boundaries of the ICS mean that NHS Bassetlaw will be moving from the ICS into Nottinghamshire and a neighbouring integrated care system from the 1st April 2022. NHS Bassetlaw will continue to have an interest in many of the transitional issues within the remit of the Joint Committee. However, it is recognised that there may also be areas in which NHS Bassetlaw does not have a direct interest, and that NHS Bassetlaw may want to be less involved in discussions on such issues. The transitional operating arrangements take account of this.

4 It is anticipated that these arrangements will be in place between September 2021 and 1st April 2022, when CCGs will be dissolved, and ICSs formally established under legislation.

5 In this paper capitalised terms have the same meaning as in the Manual, unless otherwise defined. References to the ICB, ICP and ICS include those organisations operating in shadow form, prior to their legal establishment under the Health & Care Bill.

Transitional arrangements 6 The Joint Committee is adapted for the transition to the South Yorkshire Integrated Care System (“ICS”) by:

a. Expanding the scope of its delegation to include transition work such as the carrying out of due diligence, development of corporate policies, development of the constitution for the new ICB and liaising with NHS England regarding the constitution;

b. Inviting members of the ICB to its meetings, so that they have a full understanding of the preparatory work being done by the Joint Committee;

c. Establishing a sub-committee to carry out this preparatory work; and

d. Having a working arrangement with Bassetlaw CCG that the CCG may choose not to participate in parts of the meeting that are not directly relevant to Bassetlaw, following the move of Bassetlaw from South Yorkshire & Bassetlaw ICS to Nottinghamshire & Nottingham ICS on 1st April 2022.

7 No changes are made to the Joint Committee’s Terms of Reference. In particular, Bassetlaw CCG will continue to be a core member of the Joint Committee and attendance of a representative from Bassetlaw CCG will still be required in order for meetings of the Joint Committee to be quorate. If a member from Bassetlaw CCG is in attendance at a Joint Committee meeting and decides not to actively participate in discussions on a particular topic, that will not mean that the meeting is inquorate.

8 This paper has been supported by Barnsley CCG, Bassetlaw CCG, Doncaster CCG, Rotherham CCG, Sheffield CCG and Derbyshire CCG as a variation to the Manual and Delegation. If there is any difference between the provisions of this Schedule 3 and the remainder of the Manual or the Delegation, then the terms of this Paper will take precedence. As set out above, nothing in this Schedule 3 amends the Joint Committee Terms of Reference.

Expanding the Delegation 9 The Delegation is expanded by adding the following paragraph to the end of section B:

The delegated functions also relate to the preparation for the transition of commissioning responsibilities from CCGs and NHS England to Integrated Care Systems following the introduction of new legislation. The CCGs delegate these functions (regarding the preparation for the transition of commissioning responsibilities) to the Joint Committee, to enable consistent and effective decision-making. Such preparation for future commissioning to be carried out by Integrated Care Boards (ICBs) may include (but is not limited to):

• The development of draft corporate policies for consideration/ adoption by the ICB once it is formally established e.g. in the areas of HR, conflicts of interest, finance.

• Developing the ICB constitution and liaising as appropriate with NHS England to gain approval for the constitution; this may include overseeing support work carried out by the ICB, such as producing drafts of the constitution and co-ordinating engagement.

• Producing/ providing input into the transition schemes that will manage the move from CCGs to ICSs and liaising as appropriate with NHS England.

• Being the point of contact for any queries from the ICB while it operates in shadow form, including for the provision of information needed to support the ICB’s work.

The development of any ICB plans (such as the Forward Plan and the Capital Plan) will be carried out by the ICB operating in shadow form.

Developing the ICB constitution 10 Under the Health & Care Bill 2021 as currently drafted the CCGs are responsible for the consultation on and submission for approval of the ICB constitution. Under the updated delegation (see section above) this responsibility has been delegated to the Joint Committee.

11 The ICB has offered support to the Joint Committee regarding the constitution, including through preparation of a draft constitution for consideration by the Joint Committee and the co-ordination of any engagement exercise.

12 The Joint Committee may request and obtain assistance from the ICB regarding its responsibilities related to the constitution, in particular regarding any engagement exercise. This may include the ICB carrying out/ co-ordinating activities to support the Joint Committee. The Joint Committee shall be responsible for overseeing any such activity by the ICB and taking any final decisions regarding the CCGs’ responsibilities relating to the ICB constitution.

Meeting arrangements for the Joint Committee during the transition period 13 The following arrangements will be put in place to ensure effective working between the Joint Committee and the ICB during the transition period.

Attendance 14 Under its terms of reference (paragraph 5.4) the Joint Committee can invite non-voting members to join the Joint Committee. Non-voting members are invited to all Joint Committee meetings but do not count towards the quorum. The Joint Committee invites the following post holders to join the Joint Committee as non-voting members:

• ICB Chair Designate

• Two individuals nominated by the ICB Chair Designate (the ICB Chair Designate may update these nominations from time to time through informing the Joint Committee Chair of the change)

15 It will be for these invitees to decide whether or not to attend the meeting, informed by the meeting agenda. If the Joint Committee particularly wants a representative from the ICB to attend, this should be highlighted to the ICB Point of Contact at the time that the agenda is circulated.

16 Each ICB non-voting member may nominate a deputy to attend in their place. Such nominations should be made at least three working days in advance of the meeting where possible and should be made by contacting the Joint Committee Point of Contact.

17 The Joint Committee may invite further post holders to join the Joint Committee. If the Joint Committee wishes further ICB officers to join, the Joint Committee Point of Contact should make a request to the ICB Point of Contact. If the ICB wishes further ICB officers to join, the ICB Point of Contact should make a request to the Joint Committee Point of Contact. The Joint Committee can then decide whether those individuals should be added as non-voting members and whether or

not they are able to appoint a deputy if they are unable to attend. To keep meetings manageable, it is envisaged that the total number of non-voting members from the ICB will not exceed four.

18 The Joint Committee can also invite additional experts to attend its meetings on an ad hoc basis. If the Joint Committee wishes an expert from the ICB to attend, then they should make this request to the ICB Point of Contact. If the ICB wishes an ad hoc expert to attend then the ICB Point of Contact should make a request to the Joint Committee Point of Contact at least five working days prior to the meeting.

Communications

19 To ensure clear lines of communication both the ICB and the Joint Committee will have a dedicated Point of Contact. The Chair of the Joint Committee will nominate the Joint Committee point of contact and the Chair Designate of the ICB will nominate the ICB point of contact. Nominations may be updated from time to time. At the time of writing the points of contact are:

Joint Committee Point of Contact – Lisa Kell, Director of Commissioning at the ICS, [email protected] ICB Point of Contact – Will Cleary-Gray, Chief Operating Officer at the ICS, [email protected]

20 Communications regarding the administration of Joint Committee meetings should go through these points of contact.

Meeting administration 21 Administration of the meeting shall continue to be the responsibility of the Joint Committee. It will therefore be the responsibility of the Joint Committee to ensure that:

• Meeting invitations are sent out to the appropriate people (including non-voting members from the ICB) • Meeting agendas and papers are circulated in advance • Minutes of the meeting are taken. • Minutes of the meeting are circulated

22 If the ICB wants a matter to be added to the Joint Committee meeting agenda then the ICB Point of Contact should notify the Joint Committee Point of Contact at least 5 working days before the meeting and provide any relevant papers within the timescales requested by the Joint Committee Point of Contact. The Joint Committee will then consider whether to include the item in accordance with its Terms of Reference.

Meeting papers

23 The agenda and minutes for each meeting will clearly set out:

23.1 The voting members from the Joint Committee who are attending

23.2 The non-voting members from the ICB who are attending

23.3 Any other non-voting members

23.4 Anyone attending as an ad hoc expert

23.5 Who is leading on each agenda item

24 Technically, the minutes will be approved by voting members of the Joint Committee attending the following meeting. However, the voting members will take account of the views of non-voting members in attendance at the relevant meeting before approving the minutes.

Establishing sub-committees

25 The Joint Committee establishes a sub-committee (the Change and Transition Board) to assist it with transition work.

26 The sub-committee will prepare proposals and carry out preparatory work for approval/ adoption by the Joint Committee. The sub-committee will not itself make decisions.

27 The Change and Transition Board sub-committee will operate in accordance with its terms of reference, set out below.

Terms of Reference

Group or Change and Transition Board sub-committee, a sub-committee of the meeting Joint Committee of CCGs (“Joint Committee”) To assist the Joint Committee with the preparation for the transition of Roles and commissioning responsibilities from the CCG and NHS England to the responsibilities ICS.

The Joint Committee will ask the sub-committee to complete particular tasks on a case by case basis.

The sub-committee will make proposals to the Joint Committee. It will then be for the Joint Committee to discuss and adopt these as appropriate. The sub-committee cannot make any decisions on behalf of the Joint Committee.

Membership Voting members One individual nominated by Barnsley CCG One individual nominated by Bassetlaw CCG One individual nominated by Doncaster CCG One individual nominated by Rotherham CCG One individual nominated by Sheffield CCG A CCG Director of Finance from one of the core member CCGs nominated by the Chair of the Joint Committee Each of these members may nominate a deputy to attend in their place. Each CCG may update their nominations from time to time through informing the sub-committee Chair of the change.

Observers Four individuals nominated by the ICB Chair Designate (the ICB Chair Designate may update these nominations from time to time through informing the sub-committee Chair of the change). It is anticipated that the initial nominees will be the ICS Lead, the ICS Deputy Lead, the ICS Chief Operating Officer and the ICS Director of HR. The Joint Committee Point of Contact, as described in Schedule 3 of the Manual. Each of these observers may nominate a deputy to attend in their place.

The voting members may invite such other observers to join the sub- committee provided the total number of observers does not exceed 7.

The term “Members” refers to both voting members and observers of the sub-committee.

Other attendees

The voting members may invite other individuals with subject matter expertise to join its meetings on an ad hoc basis to inform discussions

Note that the membership of the sub-committee may flex (through the CCGs and ICB updating their nominations) according to the subject matter of the sub-committee’s work.

Sub-committee The Point of Contact for the voting members shall be the Joint points of Committee Point of Contact; the Point of Contact for the observers is contact the ICB Point of Contact both Points of Contact as described in Schedule 3 of the Manual.

Chair The sub-committee will be chaired jointly by two joint Chairs: (1) The Chair of the Joint Committee of CCGs; and (2) The ICB Chair Designate will select one of his nominees to be the other joint chair. It is anticipated that the ICS Lead will be the first such appointment. References to “Chair” in these terms of reference are to the two joint Chairs acting together.

Quorum The sub-committee is considered quorate if there is at least one representative from Barnsley CCG, Bassetlaw CCG, Doncaster CCG, Rotherham CCG and Sheffield CCG present save that a meeting may be quorate without a representative from Bassetlaw CCG if Bassetlaw CCG has indicated that they do not want to participate in the relevant agenda item. If a meeting is not quorate it may continue but any work or decisions will need to be adopted by a subsequent quorate meeting before being referred to the Joint Committee. Meeting schedule Meetings The sub-committee will determine its schedule of meetings at its first meeting and may amend that schedule from time to time.

The Chair may determine that the sub-committee needs to meet on an urgent basis, in which case the notice period shall be as specified by the

Chair acting reasonably. Urgent meetings may be held virtually, using any of the means specified above.

Participation by video-link/ phone

The Chair may agree that Members may participate in meetings by

means of telephone, video or computer link or other live and uninterrupted conferencing facilities provided every Member participating is able to be heard by every other Member. Participation in a meeting in this manner shall constitute presence in person at such meeting.

Meetings in private

Given that the sub-committee will not be making any decisions on behalf of the Joint Committee, it will meet in private.

Decision- Ideally, decisions made by the sub-committee should have the support making of all voting members, save that the support of Bassetlaw CCG is not needed if it has stated that it does not have an interest in the matter.

If this is not possible then decisions may be made by the majority of voting members present and voting. If the sub-committee refers a matter to the Joint Committee that does not have consensus support as outlined above, this should be made clear and reasons for the lack of consensus given. The Joint Committee shall also be informed of any concerns raised by observers.

Conduct of If a Member wishes to add an item to the agenda they must notify the business Joint Committee Point of Contact. Requests for agenda items will be passed to the sub-committee Chair who will decide the content and order of the agenda. Circulation of the meeting agenda and papers via email will take place at least five working days prior to the meeting where possible. The sub-committee will have administrative support from the ICS Project Management Office to: - Collate items for the agenda - Circulate the agenda and any papers - take and circulate action points from meetings - maintain a record of actions and action owners The rules on conflicts of interest that apply to the Joint Committee shall Conflicts of also apply to the sub-committee. interest

Observers will comply with their organisation’s rules on conflicts of interest.

Members will be transparent about any interest their organisation has in matters being discussed by the sub-committee. References to organisation include the ICB and Integrated Care Partnership operating in shadow form.

Accountability The sub-committee is accountable to the Joint Committee. Action and reporting points from sub-committee meetings will be sent to Board Members within 10 working days of each meeting.

Members are also accountable to their host organisation.

Review It is not anticipated that these terms of reference will be reviewed as it is expected that CCGs will be dissolved in April 2022. However, the Joint Committee may review these Terms of Reference as it considers appropriate.

Manual Agreement and Terms Of Reference

Joint Committee of Clinical Commissioning Groups

South Yorkshire and Bassetlaw

2019/20

Final Version

July 2019

Start Date: 24 July 2019

Review date: 1st December 2019 Manual/Agreement for JC CCGss

Chapter Content Detail Page

1. Introduction and Overview Short Introduction setting out:-  Background to creating Joint Commissioning of Clinical Commissioning Groups (JC CCGss).  Context for decision making and purpose.  Overview of role in local health system.  Purpose of this agreement/manual.

2. Commissioning intentions Set out:- and statutory duties  Regional/Local commissioning intentions.  Application of existing arrangements.  Complying with the Statutory Duties of CCGs (should include those relating to procurement and competition as well).  Governance, including provision of assurance to members, for JC CCGss.

3. Delegation Delegation pursuant to section 14Z3:-  State purpose of delegation, what it means and the CCGs who have made it.  Set out minute and resolution [separately drafted] of delegation.  Explain terms of delegation in context of joint commissioning approach.

4. Terms of reference of joint Provisions setting out:- committee : setting out  Role the role and operation of the committee  Delegated decisions [defined list as

set out in terms]  Reserved decisions [All other than defined list]  Meetings and frequency

2 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

 Agenda and Minutes  Voting  Electronic meetings  Resolutions [form]  Quorum  Ability to create sub-committees and further delegate (as set out in terms)

5. Additional terms Matters to be addressed:- supplementing the terms  Guiding Principles for JC CCGss. of reference  Definitions and interpretation [especially delegated decisions and reserved decisions] and how to deal with disputes on definitions.  Approach to Conflicts of Interest.  Liability and indemnities.  Disputes and process to be followed to resolve. [This section may also go on to consider ability for members to revoke the delegation.  Information Sharing and General Data Protection Regulation (GDPR)  Approach to Freedom of Information Requests (FOIA) requests.  Compliance with procurement and competition law obligations (to extent not dealt with in statutory duties section)  List of any other relevant protocols  Clarification and/or additional commercial terms  Process to make variations to Delegation, ToR and/or agreement/manual  Explanation of how ratification works and process to apply.  JC CCGss reporting obligations to members and form of such reports.  Set out how finance for the programme will be dealt with, including issues such as pooled 3 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

funding.  Process and form for issuing Notices by JC CCGss.  What happens if a member leaves the JC CCGss  Supporting the JC CCGss and how the Programme Management Office (PMO) will operate.  Implementing change through NHS Standard Contract and variations to it.  Workforce and Staffing considerations within decision making.

6. Appendices • JC CCGss Terms of Reference (ToR), • statutory duties checklist and all protocols which the JC CCGss need to follow. • Clinical engagement and assurance process • Communications and Engagement assessment and assurance process

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Chapter 1 - Introduction and Overview

1. Background

1.1 The purpose of the Handbook/Agreement is to set out in practical terms how the local health system will work together in both commissioning and providing health services to the public, as well as how it will interact with the delivery of social care. 1.2 The local health commissioners have created a joint committee, through which they can both consider and undertake system wide commissioning decisions.

1.3 The CCG members of the joint committee (‘the JC CCGs) are:  NHS Barnsley Clinical Commissioning Group;  NHS Bassetlaw Clinical Commissioning Group;  NHS Doncaster Clinical Commissioning Group;  NHS Rotherham Clinical Commissioning Group;  NHS Sheffield Clinical Commissioning Group;  NHS England Specialised Commissioning; and Associate* Member CCG  NHS Derby and Derbyshire Clinical Commissioning Group;

*Associate CCG is a partner CCG outside of the SYB footprint with commissioned patient flows into SYB for acute provider secondary and tertiary care services. Derby and Derbyshire CCG is also a member of the SYB and North Derbyshire Cancer Alliance. Our Associate CCG is involved in the commissioning arrangements, decisions and voting managed through the JC CCGs where their patients are affected by any proposed change as appropriate. Associate CCGs are non-voting members of the JC CCGs where they do not have a patient interest in a proposed change overseen by the JC CCGs.

1.4 In terms of the legal basis on which the CCGs have agreed to jointly exercise a group of their functions through delegating them to the JC CCGs, this has been done using their powers under section 14Z3 of the NHS Act 2006 (as amended) (‘the Act’), which provides:

“(1) Any two or more clinical commissioning groups may make arrangements under this section. (2) The arrangements may provide for— (a) one of the clinical commissioning groups to exercise any of the commissioning functions of another on its behalf, or (b) all the clinical commissioning groups to exercise any of their commissioning functions jointly. (2A) Where any functions are, by virtue of subsection (2)(b), exercisable jointly by two or more clinical commissioning groups, they may be exercised by a joint committee of the groups…. 5 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

(7) In this section, “commissioning functions” means the functions of clinical commissioning groups in arranging for the provision of services as part of the health service (including the function of making a request to the Board for the purposes of section 14Z9).”

1.5 The JC CCGs exercises both commissioning functions and those related to commissioning, according to those set out in each CCGs delegation to it. The actual Delegations from each CCG are set out in Appendix 1 and the Terms of Reference are in Appendix 2. This should enable and support a more integrated system approach to support the SYB Integrated Care System (ICS).

2. Purpose of the JC CCGs

2.1 The JC CCGs has the primary purpose of enabling the CCG members to work effectively together, to collaborate and take joint decisions in the areas of work that they agree, by exercising the Joint Functions. 2.2 A guiding principle for any changes to commissioning and/or joint decision making through the JC CCGs must be that it demonstrates added value, including improvement in outcomes and population health, standardisation of care, financial efficiency, better use of resources including scarce workforce and avoids unnecessary duplication. Unintended significant risks for a CCG, place or ICS should be avoided. 2.3 The Joint Functions are those set out in the Delegation, appended in Appendix 1 (Delegation) and summarised. below. 2.4 In agreement with CCG Governing Bodies the purpose of the JC CCGs may expand to support implementation of the ICS strategic plan in addition to the delivery of the JC CCGs priorities. 2.5 The role of the JC CCGs, as set out in Clause 3.1 of the Terms of Reference is: 2.5.1 Development of collective strategy and commissioning intentions; 2.5.2 Development of co-commissioning arrangements with NHS England; 2.5.3 Joint contracting with Foundation Trusts and other service providers; 2.5.4 System transformation, including the development and adoption of service redesign and best clinical practice across the area – which may include the continuation or establishment of clinical networks in addition to those nationally established; 2.5.5 Representation and contribution to Alliances and Networks including clinical networks nationally prescribed; 2.5.6 Work with NHS England and Improvement on the outcome and implication of national or regional service reviews; 2.5.7 Work with the NHS England on system management and resilience; 2.5.8 Collaboration and sharing best practice on Quality Innovation Productivity and Prevention (QIPP) initiatives; and Cost Improvement Plans (CIP) 2.5.9 Mutual support and aid in organisational development.

2.6 Generally, the JC CCGs will work across the system to develop a strategic approach to commissioning sustainable, efficient services that are patient centred and focussed on 6 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

improving population health outcomes. Further, it will enable the development of integrated working with social care and wider community and voluntary sector partners so that the patients receive a more seamless service.

3. Role in local health and care system

3.1 As indicated above, the JC CCGs will support the development of a clear system strategic plan for the SYB ICS. In bringing commissioning leaders together, it will support strategic planning and provide an interface with both providers of health services and social care. The work which it can do with places and local authorities on creating better integrated health and social care services will support meeting the sustainability, quality and financial challenges in the coming years. 3.2 In terms of looking at strategic issues across the ICS footprint the JC CCGs will feed in to the work on such as:

 Leadership and governance and the best ways to set up joint working, taking account of the ability of providers and commissioners to set up shared governance structures. Some key issues to work through are conflicts and procurement, as well as good governance using the Handbook approach and assurance.  Working out how best to play in your ongoing integrated care programmes and vanguards, especially in looking to implement change to benefit patients.  Engagement and consultation strategies, both overall and when changes are needed to improve services.  Productivity strategies, especially around joint and integrated working proposals.

4. Status of this Manual and Interpretation

4.1 This Manual sets out the arrangements that apply in relation to the exercise of the Joint Functions of the JC CCGs. If there is any conflict between the provisions of this Manual and the provisions of the Terms of Reference, the provisions of the Terms of Reference will prevail. This Manual is to be interpreted in accordance with Schedule 1 (Definitions and Interpretation).

5. Term

5.1 The Manual has effect from the date of the Terms of Reference and will remain in force unless terminated in accordance with Clause (Termination of the Manual). 5.2 Individual Member CCG(s) may terminate their membership of the JC CCGs and so no longer be obliged to work in accordance with this Manual under Clause (Leaving the Joint Committee).

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Chapter 2- Commissioning Intentions and Statutory Duties

6. System / local commissioning intentions

6.1 Commissioning intentions relating to Hyper Acute Stroke services and Children’s Surgery and Anaesthesia and the 2019/20 JCCCG priorities requiring delegated authority set out below:

2019/20 JCCCG Priorities requiring Requested delegation to the JC CCGs to: delegated authority

System Contracting  develop and agree a financial threshold of contract value against contract baseline for  999 system lead contractor (YAS) for the lead contractor to negotiate on behalf of 4 SYB CCGs each CCG during 19/20 contract negotiations.  111 system lead contractor (YAS) for 5 SYB CCGs

Outpatients  identify and agree the specialities in scope of the OP review  Review of outpatient follow ups across SYB by specialty, develop clinical protocols to standardise  develop and sign off clinical protocols practice and reduce unwarranted developed with SYB clinical engagement variation * from both commissioners and providers and patients/ public as necessary  Review of outpatient first  implement clinical protocols in Providers appointments (as above) * standard NHS contracts 2019/20

Commissioning Outcomes  identify and agree the clinical priorities in the policy  Commissioning for Outcomes – new stage 2  sign off 19/20 policy ensuring public consultation /engagement has taken place  implementation of protocols and included formally in standard NHS contracts 2019/20

IVF  develop IVF options appraisal and financial modelling for consideration by CCG  Explore options for a SYB approach Governing Bodies to the number of IVF cycles

Cancer  implement standard cancer pathways in NHS provider contracts and across the 5  Standard implementation of national SYB places cancer pathways across SYB tom improve outcomes and equity of access*

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Medicines and Prescribing  Identify opportunities for medicines standardisation  Medicines optimisation – standardisation of policies across  develop and sign off policies developed with SYB SYB clinical engagement from clinicians, patients / public as necessary

Hospital Services Programme  The conclusions on next steps on transformation and reconfiguration and  Governing Bodies agreeing next implementation of these steps on the work programme of the Hospital Services Programme,

* Consistent with Long Term Plan Requirements

6.2 A clinical engagement and assurance process has been developed by the Joint Committee Sub Group to provide assurance to the JC CCGs and Governing Bodies that the work to take forward and deliver the JC CCGs 2019/20 priorities is clinically led (appendix 4). 6.3 A communications and engagement Assessment Process for Section 14Z2 Duty for Public Involvement has also been agreed to provide assurance and support the work of the JC CCGs priorities (appendix 5).

7. Any existing arrangements 7.1 Commissioning intentions relating to Hyper Acute Stroke services and Children’s Surgery and Anaesthesia agreed by the JCCCG in 2017.

8. Complying with the Statutory Duties of CCGs 8.1 The JC CCGs will need to be clear that is exercising functions it meets the statutory obligations of the CCGs which are its members. A failure to do so could lead to challenge to decisions made and an inability to assure the CCG Governing Bodies that their delegated functions are being properly exercised. Such an inability would impact on a CCG’s ability to assure NHS England and Improvement that it was operating in accordance with the CCG Improvement and Assessment Framework. 8.2 The statutory duties which need to be taken into account are summarised in the Checklist in Appendix 3. 8.3 Further, each CCG should note that under s.14Z3(6) of the Act “any delegation of functions to a joint committee of CCGs do not affect the liability of a clinical commissioning group for the exercise of any of its functions.” 8.4 The result of this is that:

a) the Member CCGs need to ensure that the JC CCGs is complying with the CCGs’ statutory duties, as the Member CCGs continue to be responsible if there are any failings in decision making; and

b) the Member CCGs need to ensure that an appropriate reporting mechanism from the JC CCGs to them is in place. This will allow the Member CCGs to maintain effective oversight of the JC CCGs processes and decision making. 8.5 In effect, the JC CCGs will stand in the place of the multiple CCGs who are its members for decision making, but those individual CCGs will continue to have liability for those

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decisions. It is therefore essential that the JC CCGs understand the statutory framework within which it will make decisions.

9. Governance

9.1 It is important that CCGs maintain effective oversight of the activities of the JC CCGs. • The JC CCGs will make a quarterly written report to the Member CCG governing bodies. This will cover, as a minimum summary of key decisions. • The JC CCGs will review aims, objectives, strategy and progress and will publish quarterly reports on progress made. • As to conducting business the JC CCGs will operate in accordance with the Terms of Reference approved by each CCG member when delegating functions to it. It shall also adopt the Standing Financial Order (SFO) and Standing Instructions (Sis) of Sheffield CCG in respect to the operation of committees, with all CCG members assuring themselves that will enable their own constitution, SFIs and SOs to be met. • Regular reporting will take place with all member CCGs to include formal decisions and minutes. • Decisions and minutes will be made public and will be posted onto the SYB ICS website. • Reports will be prepared by the SYB ICS secretariat. • Reports from any JC CCGs sub-committee will be shared with CCGs by agreement or request of the JC CCGs as appropriate.

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Chapter 3 – Delegation

10. Purpose of delegation

10.1 The Member CCGs have agreed to delegate functions to the JC CCGs in order to enable the Member CCGs to work effectively together, to collaborate and to take joint decisions in those areas of work delegated. 10.2 The Member CCGs also consider that the delegation of functions will help the CCGs more easily collaborate and take joint decisions with NHS England in respect of those services which are directly commissioned by NHS England for example specialised services. 10.3 This will also link in to the work that each ICS needs to undertake to support the delivery of the NHS Long Term Plan within the South Yorkshire and Bassetlaw ICS Strategic Plan. 10.4 The JC CCGs forms a critical element of the interim governance arrangements agreed by the SYB ICS executive and the mechanism by which future collective commissioning decisions can be made.

11. The delegation

11.1 The delegation of functions from each CCG to the JC CCGs is set out in the delegation document at Appendix A (Delegation). A summary of what that means is:- Under s.14Z3 of the NHS Act 2006 each CCG delegates a range of its commissioning functions to a joint committee, in particular to allow the joint committee to take decisions on current and future transformation programmes which involve all, or a sub-set, of the CCGs. 11.2 The delegated functions are referred to in this Manual as the “Joint Functions”. 11.3 As is noted above, the JC CCGs needs to also comply with statutory duties which the CCGs have. As a result, the Delegation also delegates the requirement to comply with statutory requirements relevant to the delegated functions.

12. Terms of delegation in context of joint commissioning

12.1 The JC CCGs will work with NHS England on ensuring commissioning is joined up and collaborative across such as primary and specialist care under existing agreements.

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Chapter 4 - Terms of reference of joint committee

13. Terms of Reference of the JC CCGs

13.1 The CCGs have established the JC CCGs in accordance with the Terms of Reference, see Appendix 2. The JC CCGs and each member will act at all times in accordance with the Terms of Reference and that means the decisions of the JC CCGs will be binding on the Member CCGs. 13.2 The JC CCGs may at any time agree to make a decision or decisions through a common process with a CCG that is not a member of the JC CCGs. The common process would include the non-member CCG being in the same room as the JC CCGs, with the same papers and making a decision at the same time as the JC CCGs but as a separate CCG. 13.3 In determining those matters on which they want to share decision making, the CCGs have also agreed a number of areas in which they are not planning to make joint decisions. The following are functions which have not been delegated to the JC CCGs:

14. Reserved Functions 14.1 All functions are reserved for statutory organisations that are not specifically stated in the scheme of delegation. 14.2 It will be important for the JC CCGs to be cognisant of the above Reserved Functions and to engage with member CCGs if any of those arise in the context of the functions which the JC CCGs are to exercise.

14.3 Exercise of the Joint Functions The JC CCGs must exercise the Joint Functions in accordance with:  the Terms of Reference;  the terms of this Manual;  all applicable law, see framework in Appendix 3;  all applicable Guidance issued by health system regulators; and  good Practice.

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Chapter 5- Additional terms supplementing the Terms of Reference

15. Key Objectives and Guiding Principles for JC CCGs

15.1The JC CCGs shall work towards achieving the Key Objectives of the JC CCGs and all members of the JC CCGs shall act in good faith to support achievement of the Key Objectives.

15.2The Key Objectives of the JC CCGs are: 15.2.1To achieve better patient experience, better outcomes and more efficient service delivery through the Member CCGs collaborating in the commissioning of services, by: 15.2.1.1 working together on contractual and service issues with providers several or all of the Member CCGs use, due to patient flows; 15.2.1.2 sharing clinical expertise, best practice and management resource in service redesign, enabling more focussed commissioning capacity and leadership; 15.2.1.3 working together on patient and public participation in commissioning health and care, taking into account updated guidance. 15.2.1.4 leading transformation change where working together is necessary to ovate change; 15.2.1.5 achieving economies of scale through shared representation and input to clinical networks, specialised commissioning and primary care commissioning (where CCGs will wish to influence primary and tertiary commissioned pathways, and specialised and primary care commissioners will wish to influence secondary care and enhanced care pathways); 15.2.1.6 coordinate work with NHS England, particularly on specialised and primary care, where this improves experience for patients, giving consistency along pathway interfaces and avoiding duplication; 15.2.1.7 resolving cross boundary issues, where the action of one Member CCG could have an impact on a neighbour Member CCG; 15.2.1.8 providing leadership to the health system in the area covered by the Member CCGs; and 15.2.1.9 ensuring equity of access to services collaboratively commissioned; and 15.2.1.10 To support ongoing effective working of the Member CCGs.

15.3 The JC CCGs shall adopt and follow the JC CCGs Guiding Principles and all members of the JC CCGs shall act in good faith to follow the Guiding Principles.

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15.4 The Guiding Principles of the JC CCGs are set out in the Terms of Reference and are:  To collaborate and co-operate. Do it once rather than repeating or duplicating actions and increasing cost across the CCGs. Establish and adhere to the governance structure set out in the Terms of Reference and in this Manual, to ensure that activities are delivered and actions taken as required;  To be accountable. Take on, manage and account to each other for performance of the respective roles and responsibilities set out in the Terms of Reference and in this Manual;  To be open. Communicate openly about major concerns, issues or opportunities relating to the functions delegated to the JC CCGs, as set out in Appendix 1 (Delegation);  To learn, develop and seek to achieve full potential. Share information, experience, materials and skills to learn from each other and develop effective working practices, work collaboratively to identify solutions, eliminate duplication of effort, mitigate risk and reduce cost whilst ensuring quality is maintained or improved across all the Member CCGs;  To adopt a positive outlook. Behave in a positive, proactive manner;  To adhere to statutory requirements and best practice. Comply with applicable laws and standards including EU procurement rules, data protection and freedom of information legislation.  To act in a timely manner. Recognise the time-critical nature of the functions delegated to the JC CCGs as set out in Appendix 1 (Delegation), and respond accordingly to requests for support;  To manage stakeholders effectively;  To deploy appropriate resources. Ensure sufficient and appropriately qualified resources are available and authorised to fulfil the responsibilities set out in the Terms of Reference and in this Manual; and  To act in good faith to support achievement of the Key Objectives and compliance with these Principles.  The JC CCGs has a commitment to ensuring that in pursuing its Key Objectives it does not increase inequalities or worsen health outcomes for any local populations.

 Where one of the partners voted in a different way to others on any issue the committee would take the time to discuss and understand the reasons why.

16. Sub committees of the JC CCGs

16.1 The JC CCGs shall be able to appoint sub-committees, which shall include:

16.1.1Joint Committee Sub Group

17. Finances/ Pooled Funding

17.1 The Member CCGs may, for the purposes of exercising the Joint Functions under this Manual, establish and maintain a pooled fund in accordance with section 14Z3 of the 14 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

NHS Act 2006. Specifically, member CCGs may want to look at how to support the implementation of the decisions they make from service reconfiguration processes through to enabling strategic system change across the region. Pooling funds for use across the region for the overall benefit of all patients would ensure that best use of limited resources is achieved. It will also mean that implementation of decisions is less likely to stall due to financial challenges in that a pooled fund provides greater regional support options than CCGs seeking to implement change individually.

In some instances, consideration can also be given to getting better value for money by consolidating purchasing/commissioning power in a pooled fund.

18. Secretariat

18.1 SYB ICS will provide the secretariat to the JC CCGs 18.2 JC CCGs associated ICS staffing resource are hosted by Sheffield CCG

19. Staffing 19.1 See 18 above

20. Conflicts of Interest.

20.1 The Member CCGs must comply with their statutory duties set out in Chapter A2 of the NHS Act 2006, including those relating to the management of conflicts of interest as set out in section 14O of the Act.

20.2 Each member of the JC CCGs must abide by NHS England’s guidance Managing conflicts of interest – statutory guidance for CCGs as updated from time to time (https://www.england.nhs.uk/commissioning/pc-co-comms/coi/) and all relevant Guidance and policies of their appointing body in relation to conflicts of interest.

20.3 In addition, the JC CCGs shall operate a register of interests and has a Conflicts of Interest Policy. Members of the JC CCGs shall comply with the JC CCGs’s conflicts of interest policy and shall disclose any potential conflict; where there is any doubt or where there is a divergence between the terms of the conflicts of interest policy of a member’s appointing CCG and that of the JC CCGs, the member should always err on the side of disclosure of any potential conflict.

20.4 Where any member of the JC CCGs has an actual or potential conflict of interest in relation to any matter under consideration by the JC CCGs, that member must not participate in meetings (or parts of meetings) in which the relevant matter is discussed, or make a recommendation in relation to the relevant matter. The relevant appointing body may send a suitable deputy to take the place of the conflicted member in relation to that matter.

20.5 Any breaches of the JC CCGs conflicts of interest policy or NHS England guidance on managing conflicts of interest shall be reported to the Member CCGs promptly and in any event within 5 business days of the breach having come to light.

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21. General Data Protection Regulation (GDPR) 2018

21.1The Member CCGs shall all comply with GDPR requirements. 21.2 The GDPR introduces a principle of ‘accountability’. This requires that CCGs and organisations must be able to demonstrate compliance. The key obligations to support this include: • the recording of all data processing activities with their lawful justification and data retention periods • routinely conducting and reviewing data protection impact assessments where processing is likely to pose a high risk to individuals’ rights and freedoms • assessing the need for data protection impact assessment at an early stage, and incorporating data protection measures by default in the design and operation of information systems and processes • ensuring demonstrable compliance with enhanced requirements for transparency and fair processing, including notification of rights • ensuring that data subjects’ rights are respected (the provision of copies of records free of charge, rights to rectification, erasure, to restrict processing, data portability, to object, and to prevent automated decision making) • notification of personal data security breaches to the Information Commissioner • the appointment of a suitably qualified and experienced Data Protection Officer.

21.3 The Member CCGs agree that, in relation to information sharing and the processing of information for the purposes of the Joint Functions, they must comply with:

21.3.1 all relevant Information Law requirements including the common law duty of confidence and other legal obligations in relation to information sharing including those set out in the NHS Act 2006 and the Human Rights Act 1998; 21.3.2 Good Practice; and 21.3.3 relevant Guidance (including guidance given by the Information Commissioner).

22. IT inter-operability

22.1The Member CCGs will aim to develop inter-operable IT systems (where necessary for the exercise of the Joint Functions) in line with national Information Governance (IG) rules to enable data to be transferred between systems securely, easily and efficiently.

23. Confidentiality

23.1 Where information is shared with the JC CCGs of a confidential or commercially sensitive nature information will be treated under the confidential policy of the host CCG.

24. Freedom of Information

24.1 Each Member CCG acknowledges that the other Member CCGs are a public authority for the purposes of the Freedom of Information Act 2000 (“FOIA”) and the Environmental Information Regulations 2004 (“EIR”). 24.2 Each Member CCG may be statutorily required to disclose information about the Agreement and the information shared or generated by the Member CCGs pursuant to this Agreement and the Terms of Reference, in response to a specific request under FOIA or EIR, in which case: 16 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

24.2.1 each Member CCG shall provide the others with all reasonable assistance and co-operation to enable them to comply with their obligations under FOIA or EIR; 24.2.2 each Member CCG shall consult the others regarding the possible application of exemptions in relation to the information requested, giving them at least 5 working days within which to provide comments. Such consultation shall be effected by contacting [the CCG Representative named in Column 2 of Schedule 2 (Member CCGs)]; and 24.2.3 each Member CCG acknowledges that the final decision as to the form or content of the response to any request is a matter for the Member CCG to whom the request is addressed.

25. Procurement 25.1 Commissioners are required to ensure that their decisions to procure services, which relates to many commissioning decisions , comply with the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. Key questions are set out under each heading below to assist you when considering whether you are meeting these requirements. Commissioners are also required to comply with EU/UK general procurement law but this is not covered in the list below. The real procurement objective is to - ‘To secure the needs of patients and improve quality and efficiency of services’ Therefore, part of considering how robust your decision is in terms of meeting procurement obligations is to look at: • What have you done to assess patient need and do you have evidence to support your findings? • How are you assessing the quality of services and the performance of the current providers? How have you assessed whether the service is offering value for money? • Have you reviewed the current service specification to ensure it is working well and whether there is scope for further improvement? In particular, it would be helpful to have a schedule of all existing contracts and relationships, including performance monitoring on contracts. • What steps have you taken to assess equitable access to services by all patient groups? 25.2 In achieving the main objective, the regulations contain three general requirements, which are: 25.2.1 To act transparently and proportionately and in a non-discriminatory way. • What steps have you taken to make providers and stakeholders aware of your plans? Have you provided reasons to support your decisions? • Are you publishing details in a timely manner and have you kept records of decision making, e.g. board minutes and briefing papers? • Do providers understand the selection criteria you are using and are they able to express an interest in providing the services? Can you show that you have not favoured one provider over the other? • Is your approach proportionate to the nature of the services in relation to the value, complexity and clinical risk associated with the provision of the services in question? 17 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

25.2.2 To contract with providers who are most capable of meeting the objectives and provide best value for money • How have you identified existing and potential providers and objectively evaluated their relative ability to deliver the service specification, improve quality and meet the needs of patients? • Are you satisfied providers are capable and robust enough to deliver a safe and efficient service and provide the best value for money in doing so? 25.2.3 Consider ways of improving services through integration, competition and patient choice • What evidence do you have to show the steps you taken to determine whether it might be better for patients if the services are integrated with other health care services? • Have you asked providers, patients, and other stakeholders for their views? • Does your specification or performance monitoring process incentivise delivery of care in a more integrated manner? • Have you considered whether competition or choice would better incentivise providers to improve quality and efficiency? Do you have evidence to support your findings? 25.3 Advertisements and expressions of interest To ensure providers are able to express an interest in in providing any services which includes the requirement to publish opportunities and awards on a website • How have you gathered evidence about the existing and potential providers on the market? • Have you published your intentions to the market by way of commissioning intentions or publication on a website? 25.4 Award of a new contract without a competition A new contract may be awarded without publishing a contract notice where the commissioner is satisfied that the services in question are capable of being provided only by that provider, e.g. A&E services in a particular area or where it is not viable for providers to provide one service without also providing another service. • What steps have you taken and what evidence are you relying on to satisfy yourself that there is only one capable provider? 25.5 Conflict of Interests Commissioners are prohibited from awarding a contract where conflicts, or potential conflicts, between the interests of Commissioners in commissioning services and the interests involved in providing the services affect, or appear to affect, the integrity of the award of the contract. • Have you recorded how you have managed any conflict or potential conflict? This will be an issue over which the ICS needs to be sensitive given the collaborative working between commissioners and providers. Further information and guidance is available in section 20 above. 25.6 Anti-competitive behaviour Not to engage in anti-competitive behaviour unless to do so would be in the interests of people who use NHS services

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• Are you acting in an anticompetitive manner – for instance have you prevented new providers from entering the market or caused a provider to exit the market? • If so, is it objectively justifiable as being in the interests of users and stakeholders? What evidence do you have to support this? 26 Competition Issues 26.1 Requirement to Notify the Competition and Markets Authority (CMA) The obligation to notify the CMA sits with the provider and guidance is set out below on when that duty bites. It should also be noted that if a provider has given any undertakings to the CMA or its predecessor, the Competition Commission, then they may prohibit a statutory transaction and should be checked. A brief overview of the merger regime is set out below: 26.2 Merger control rules The merger control regime may apply to NHS service reconfigurations where two or more services are merged and the transaction meets the jurisdictional tests. 26.3 Jurisdictional Tests The CMA has jurisdiction to examine a merger where: 26.3.1 Two or more enterprises cease to be distinct (change of control) 26.3.2 and either • the UK turnover of the acquired enterprise exceeds £70 million; or • the enterprises which cease to be distinct together supply or acquire at least 25% of all those particular services of that kind supplied in the UK or in a substantial part of it. The merger must also result in an increment to the share of supply, i.e. the merging providers must supply or acquire the same category of services. [ Enterprise: NHS foundation trusts and NHS trusts controlling hospital, ambulance services, mental health service, community services or individual services or specialities may be enterprises for the purpose of merger control. Change in control: Two enterprises (or services) cease to be distinct if they are brought under common ownership or control. There must be a change in the level of control over the activities of one or more enterprises (or services) for merger control to apply.] 26.4 Competition test The CMA assesses qualifying mergers to decide whether they are likely to lead to a substantial lessening of competition (‘SLC’). An SLC occurs when competition is substantially less after the merger. 26.5 SLC assessment The CMA will require detailed information about the reconfiguration. This will include: • service overlaps; • GP referral data / catchment area analysis; and • Hospital share of GP practice referrals. 26.6 CMA merger assessment timetable The process is divided into two stages: • Phase I: an initial 40 working day investigation; and

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• Phase II: a possible 24 weeks in-depth investigation, which can be extended if the CMA considers it necessary.

27 Liability and indemnities. 27.1 In accordance with section 14Z3 of the NHS Act 2006, the Member CCGs retain liability in relation to the exercise of the Joint Functions.

28 Breach of this Manual and Remedies 28.1 Any breach of this manual will be raised by the Chair and identified senior officer. Disputes will be dealt with under 29 below.

29 Dispute Resolution 29.1 Where any dispute arises within the JC CCGs in connection with this Manual, the relevant Member CCGs must use their best endeavours to resolve that dispute on an informal basis within the JC CCGs. 29.2 Where any dispute is not resolved under clause on an informal basis, any CCG Representative (as set out in Column 2 of Schedule 2 (Member CCGs) may convene a special meeting of the JC CCGs to attempt to resolve the dispute. 29.3 If any dispute is not resolved under clause , it will be referred by the [Chair] of the JC CCGs to the Accountable Officers of the relevant Member CCGs, who will co-operate in good faith to resolve the dispute within ten (10) days of the referral. 29.4 Where any dispute is not resolved under clauses , or , any CCG Representative may refer the matter for mediation arranged by an independent third party to be appointed by [the Chair of the JC CCGs] [CEDR], and any agreement reached through mediation must be set out in writing and signed by and the relevant Member CCGs.

30 Leaving the JC CCGs

30.1 Should this joint decision making arrangement prove to be unsatisfactory, the governing body of any of the Member CCGs can decide to withdraw from the arrangement, but has to give a minimum of six months’ notice to partners, with consideration by the JC CCGs of the impact of a leaving partner - a maximum of 12 months’ notice could apply.

30.2 The Member CCG who wishes to withdraw from the JC CCGs will work together with the other Member CCGs to ensure that there are suitable alternative arrangements in place in relation to the exercise of the Joint Functions.

30.3 After leaving the JC CCGs, that CCG shall no longer be a Member CCG but shall remain bound by Clauses 23 (confidentiality)

31 Termination of the Manual

31.1 This Manual shall no longer apply if the JC CCGs is terminated.

31.2 Such termination shall be effective if all Member CCGs agree in writing that the JC CCGs shall end and withdraw the delegation of their functions to the JC CCGs.

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32 Notices

32.1 Any notices given under this Manual must be in writing, must be marked for the [CCG Representative noted in Column 2 to Schedule 2 (Member CCGs”)].

32.2 Notices sent: 32.2.1 by hand will be effective upon delivery; 32.2.2 by post will be effective upon the earlier of actual receipt or five (5) working days after mailing; or 32.2.3 by email will be effective when sent (subject to no automated response being received).

33 Variations

33.1 Any variation to the Delegation, Terms of Reference or this Manual will only be effective if it is made in writing and signed by each of the Member CCGs.

33.2 All agreed variations to the Delegation, Terms of Reference or this Manual must be appended as a Schedule to this Manual.

34 Counterparts

This Manual may be executed in any number of counterparts, each of which when executed and delivered shall constitute an original of this Manual, but all the counterparts shall together constitute the same agreement.

35 Applicable Law

This Manual shall be interpreted in accordance with the laws of England and Wales and each party to this Manual submits to the exclusive jurisdiction of the courts of England and Wales.

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Schedule 1 Definitions and Interpretation

In this Manual, the following words and phrases will bear the following meanings:

Manual means this agreement between the Member CCGs comprising the body of the Manual and its Schedules;

Data Controller shall have the same meaning as set out in the GDPR;

Delegation means the delegation of functions set out in Appendix 1 to this Manual;

Good Practice means using standards, practices, methods and procedures conforming to the law, reflecting up-to-date published evidence and exercising that degree of skill and care, diligence, prudence and foresight which would reasonably and ordinarily be expected from a skilled, efficient and experienced commissioner;

GDPR means the General Data Protection Regulation 2018;

Guidance means any applicable health and social care guidance, guidelines, direction or determination, framework, standard or requirement issued by NHS England or any other regulatory or supervisory body, including the Information Commissioner, to the extent that the same are published and publicly available;

Information Law The, GDPR, DPA, the EU Data Protection Directive 95/46/EC; regulations and guidance made under section 13S and section 251 of the NHS Act; guidance made or given under sections 263 and 265 of the Health and Social Care Act 2012; the Freedom of Information Act 2000; the common law duty of confidentiality; the Human Rights Act 1998 and all other applicable laws and regulations relating to processing of Personal Data and privacy including General Data Protection Regulation requirements;

JC CCGs means the joint committee of the Member CCGs established on the terms set out in the Terms of Reference;

Joint Functions means the functions jointly exercised by the Member CCGs through the decisions of the JC CCGs in accordance with the Terms of Reference and as set out in detail in clause [add] of the Delegation;

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Law means:

(i) any applicable statute or proclamation or any delegated or subordinate legislation or regulation;

(ii) any enforceable EU right within the meaning of section 2(1) European Communities Act 1972; or

(iii) any applicable judgment of a relevant court of law which is a binding precedent in England and Wales,

in each case in force in England and Wales;

Member CCG means the CCGs which are part of the JC CCGs and are set out in the Terms of Reference and Column 1 of Schedule 2 (Member CCGs) to this Manual.

NHS Act 2006 means the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012 or other legislation from time to time);

NHS England means the National Health Service Commissioning Board established by section 1H of the NHS Act, also known as NHS England;

Non-member CCG means a CCG which is not a member of the JC CCGs

Non-Personal Data means data which is not Personal Data;

Personal Data shall have the same meaning as set out in the DPA and shall include references to Sensitive Personal Data where appropriate;

Sensitive Personal Data shall have the same meaning as in the DPA; and

Terms of Reference means the terms of reference for the JC CCGs agreed between the CCG(s).

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Schedule 2 Member CCGs

Column 1

Clinical Commissioning Groups

NHS Barnsley Clinical Commissioning Group;

NHS Bassetlaw Clinical Commissioning Group;

NHS Doncaster Clinical Commissioning Group;

NHS Rotherham Clinical Commissioning Group;

NHS Sheffield Clinical Commissioning Group;

NHS England Specialised Commissioning

And associate CCG:

NHS Derby and Derbyshire Clinical Commissioning Group;

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Appendix 1 Delegation by CCGs to JC CCGs

A. The CCG functions at B will be delegated to the JC CCGs by the member CCGs in accordance with their statutory powers under s.14Z3 of the NHS Act 2006 (as amended) (“the NHS Act”). Section 14Z3 allows CCGs to make arrangements in respect of the exercise of their commissioning functions and includes the ability for two or more CCGs to create a Joint Committee to exercise functions.

B. The delegated functions relate to the health services provided to the member CCGs by all providers they commission services from in the exercise of their functions. The CCGs delegate their commissioning functions so far as such functions are required for the Joint Committee to carry out its role, as set out in the Terms of Reference (appendix 2). The CCGs delegate the functions to enable the Joint Committee to take decisions around future transformation projects, specifically and limited to transformation and redesign of Hyper Acute Stroke services and Children’s Surgery and Anaesthesia services and the specific delegation requirements for JC CCGs set out in the agreed 2019/20 JCCCG priorities which are summarised below:

2019/20 SYB System Commissioning Requested delegation to the JC CCGs to: Priorities requiring delegated authority

System Contracting  develop and agree a financial threshold of  999 system lead contractor (YAS) for contract value against contract baseline for 4 SYB CCGs the lead contractor to negotiate on behalf of each CCG during 19/20 contract negotiations.

 111 system lead contractor (YAS) for 5 SYB CCGs

Outpatients  identify and agree the specialities in scope of  Review of outpatient follow ups the OP review across SYB by specialty, develop clinical protocols to standardise practice and reduce unwarranted  develop and sign off clinical protocols variation * developed with SYB clinical engagement from both commissioners and providers and patients/ public as necessary  Review of outpatient first appointments (as above) *  implement clinical protocols in Providers standard NHS contracts 2019/20

Commissioning Outcomes  identify and agree the clinical priorities in the  Commissioning for Outcomes – new policy stage 2

 sign off 19/20 policy ensuring public

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consultation /engagement has taken place

 implementation of protocols and included formally in standard NHS contracts 2019/20

IVF  develop IVF options appraisal and financial  Explore options for a SYB approach modelling for consideration by CCG Governing to the number of IVF cycles Bodies

Cancer  implement standard cancer pathways in NHS  Standard implementation of national provider contracts and across the 5 SYB cancer pathways across SYB tom places improve outcomes and equity of access*

Medicines and Prescribing  Identify opportunities for medicines  Medicines optimisation – standardisation standardisation of policies across SYB  develop and sign off policies developed with SYB clinical engagement from clinicians, patients / public as necessary

Hospital Services Programme  The conclusions on next steps on transformation and reconfiguration and  Governing Bodies to agree next steps implementation of these on the work programme of the Hospital Services Programme,

C. Each member CCG shall also delegate the following functions to the JC CCGs so that it can achieve the purpose set out in (B) above: 1. Acting with a view to securing continuous improvement to the quality of commissioned services. This will include outcomes for patients with regard to clinical effectiveness, safety and patient experience to contribute to improved patient outcomes across the NHS Outcomes Framework 2. Promoting innovation, seeking out and adopting best practice, by supporting research and adopting and diffusing transformative, innovative ideas, products, services and clinical practice within its commissioned services, which add value in relation to quality and productivity. 3. The requirement to comply with various statutory obligations, including making arrangements for public involvement and consultation throughout the process and taking into account updated guidance on patient and public participation in commissioning health and care. That includes any determination on the viability of models of care pre-consultation and during formal consultation processes, as set out in s.13Q, s.14Z2 and s.242 of the NHS Act. 4. The requirement to ensure process and decisions comply with the four key tests for service change introduced by the Secretary of State for Health, which are: . Support from GP commissioners; . Strengthened public and patient engagement; . Clarity on the clinical evidence base; and 26 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

. Consistency with current and prospective patient choice.

5. The requirement to comply with the statutory duty under s.149 of the Equality Act 2010 i.e. the public sector equality duty. 6. The requirement to have regard to the other statutory obligations set out in the new sections 13 and 14 of the NHS Act. The following are relevant but this is not an exhaustive list: ss.13C and 14P - Duty to promote the NHS Constitution ss.13D and 14Q - Duty to exercise functions effectively, efficiently and economically ss.13E and 14R – Duty as to improvement in quality of services ss.13G and 14T - Duty as to reducing inequalities ss.13H and 14U – Duty to promote involvement of each patient ss.13I and 14V - Duty as to patient choice ss.13J and 14W – Duty to obtain appropriate advice ss.13K and 14X – Duty to promote innovation ss.13L and 14Y – Duty in respect of research ss.13M and 14Z - Duty as to promoting education and training ss.13N and 14Z1- Duty as to promoting integration ss.13Q and 14Z2 - Public involvement and consultation by NHS England/CCGs s.13O - Duty to have regard to impact in certain areas s.13P - Duty as respects variations in provision of health services s.14O – Registers of Interests and management of conflicts of interest s.14S – Duty in relation to quality of primary medical services

7. The JC CCGs must also have regard to the financial duties imposed on CCGs under the NHS Act and as set out in:  s.223G – Means of meeting expenditure of CCGs out of public funds  s.223H – Financial duties of CCGs: expenditure  s.223I - Financial duties of CCGs: use of resources  s.223J - Financial duties of CCGs: additional controls of resource use 8. Further, the JC CCGs must have regard to the Information Standards as set out in ss.250, 251, 251A, 251B and 251C of the Health & Social Care Act 2012 (as amended). 9. The expectation is that CCGs will ensure that clear governance arrangements are put in place so that they can assure themselves that the exercise by the JC CCGss of their functions is compliant with statute. 10. The JC CCGs will meet the requirement for CCGs to comply with the obligation to consult the relevant local authorities under s.244 of the NHS Act and the associated Regulations. 11. To continue to work in partnership with key partners e.g. the local authority and other commissioners and providers to take forward plans so that pathways of care are seamless and integrated within and across organisations. 12. The JC CCGs will be delegated the capacity to propose, consult on and agree future service configurations that will shape the medium and long terms financial plans of the constituent organisations. The JC CCGs will have no contract negotiation powers meaning that it will not be the body for formal annual contract negotiation between commissioners and providers. These processes will continue to be the responsibility of Clinical Commissioning Groups (and NHS England) under national guidance, tariffs and contracts during the pre-consultation and consultation periods.

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Appendix 2 JC CCGs Terms of Reference

1. Introduction

.1 The NHS Act 2006 (as amended) (‘the NHS Act’), was amended through the introduction of a Legislative Reform Order (“LRO”) to allow CCGs to form joint committees. This means that two or more CCGs exercising commissioning functions jointly may form a joint committee as a result of the LRO amendment to s.14Z3 (CCGs working together) of the NHS Act.

1.2 Joint committees are a statutory mechanism which gives CCGs an additional option for undertaking collective strategic decision making and can include NHS England, who may also make decisions collaboratively with CCGs.

1.3 Individual CCGs and NHS England will still always remain accountable for meeting their statutory duties. The aim of creating a joint committee is to encourage the development of strong collaborative and integrated relationships and decision-making between partners.

1.4 The Joint Committee of Clinical Commissioning Groups (‘JC CCGs’) is a joint committee of:

(1) NHS Barnsley Clinical Commissioning Group;

(2) NHS Bassetlaw Clinical Commissioning Group;

(3) NHS Doncaster Clinical Commissioning Group;

(4) NHS Rotherham Clinical Commissioning Group;

(5) NHS Sheffield Clinical Commissioning Group;

(6) NHS England Specialised Commissioning; Non voting

And *Associate CCG members:

(6) NHS Derby and Derbyshire Clinical Commissioning Group;

*Associate CCG is a partner CCG outside of the SYB footprint with commissioned patient flows into SYB for acute provider secondary and tertiary care services. Derby and Derbyshire CCG is also a member of the SYB and North Derbyshire Cancer Alliance. Our Associate CCG is involved in the commissioning arrangements and decisions managed through the JC CCGs where their patients are affected by any proposed change as appropriate. Associate CCGs are non-voting members of the JC CCGs where they do not have a patient interest in a proposed change overseen by the JC CCGs. The involvement of the associate CCG in the JC CCGs work (where voting rights would be appropriate for that specific priority) is clarified on the list of JC CCGs work priorities.

It has the primary purpose of enabling the CCG members to work effectively together, to collaborate and take joint decisions in the areas of work that they agree.

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1.5 In addition the JC CCGs will meet collaboratively with NHS England to make integrated decisions in respect of those services which are directly commissioned by NHS England.

1.6 Guiding principles:

 Collaborate and co-operate. Do it once rather than repeating or duplicating actions and increasing cost across the CCGs. Establish and adhere to the governance structure set out in these Terms of Reference and in the JC CCGs Manual (as updated from time to time), to ensure that activities are delivered and actions taken as required;  Be accountable. Take on, manage and account to each other for performance of the respective roles and responsibilities set out in these Terms of Reference and in the JC CCGs Manual (as updated from time to time);  Be open. Communicate openly about major concerns, issues or opportunities relating to the functions delegated to the JC CCGs, as set out in Schedule 1; ensuring our collective decisions are based on the best available evidence, that these are fully articulated, heard, and understood.  Learn, develop and seek to achieve full potential. Share information, experience, materials and skills to learn from each other and develop effective working practices, work collaboratively to identify solutions, eliminate duplication of effort, mitigate risk and reduce cost whilst ensuring quality is maintained or improved across all the CCGs;  Adopt a positive outlook. Behave in a positive, proactive manner;  Adhere to statutory requirements and best practice. Comply with applicable laws and standards including EU procurement rules, data protection and freedom of information legislation.  Act in a timely manner. Recognise the time-critical nature of the functions delegated to the JC CCGs as set out in Schedule 1, and respond accordingly to requests for support;  Manage stakeholders effectively;  Deploy appropriate resources. Ensure sufficient and appropriately qualified resources are available and authorised to fulfil the responsibilities set out in these Terms of Reference and in the JC CCGs Manual Agreement (as updated from time to time);  Act in good faith to support achievement of the Key Objectives as set out in the JC CCGs Manual and compliance with these Principles.  The JC CCGs has a commitment to ensuring that in pursuing its Key Objectives it does not increase inequalities or worsen health outcomes for any local populations.  From time to time programmes boards may be established to oversee individual programmes of work. Where these are established under the direction of the JC CCGs these will be accountable to the JC CCGs.  Where one of the partners voted in a different way to others on any issue the committee would take the time to discuss and understand the reasons why.

2. Statutory Framework

2.1 The NHS Act which has been amended by LRO 2014/2436, provides at s.14Z3 that where two or more clinical commissioning groups are exercising their commissioning functions jointly, those functions may be exercised by a joint committee of the groups.

2.2 The CCGs named in paragraph 1.5 above have delegated the functions set out in Schedule 1 to the JC CCGs.

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3. Role of the JC CCGs

3.1 The role of the JC CCGs shall be:

• Development of collective strategy and commissioning intentions; • Development of co-commissioning arrangements with NHS England; • Joint contracting with Foundation Trusts and other service providers; • System transformation, including the development and adoption of service redesign and best clinical practice across the area – which may include the continuation or establishment of clinical networks in addition to those nationally established; • Representation and contribution to Alliances and Networks including clinical networks nationally prescribed; • Work with NHS England and Improvement on the outcome and implication of national or regional service reviews; • Work with the NHS England Area on system management and resilience; • Collaboration and sharing best practice on Quality Innovation Productivity and Prevention initiatives; and • Mutual support and aid in organisational development.

3.2 At all times, the JC CCGs, through undertaking decision making functions of each of the member CCGs, will act in accordance with the terms of their constitutions. No decision outcome shall impede any organisation in the fulfilment of its statutory duties.

4. Geographical coverage

4.1 The JC CCGs will comprise those CCGs listed above in paragraph 1.5, NHSE/I specialised commissioning covering the South Yorkshire and Bassetlaw, Derby and Derbyshire areas (associate members).

5. Membership

5.1 Membership of the committee will combine both Voting and Non-voting members and will comprise of: -

5.2 Voting members:

• Two decision makers from each of the five SYB member CCGs: the Clinical Chair and Accountable Officer. Each CCG has one vote.

5.3 Non-voting attendees:

• Two Lay Members • One Director of Finance chosen from the member CCGs. • A Healthwatch representative nominated by the local Healthwatch groups • SYB ICS Chief Executive or deputy • SYB ICS Director of Commissioning • SYB ICS Communications and Engagement lead • NHSE Specialised Commissioning lead • Associate CCG member (where no or minimal patient interest in proposed changes, see para 1.4)

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5.4 The JC CCGs may invite additional non-voting members to join the JC CCGs to enable it to carry out its duties

5.5 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the JC CCGs. All deputies should be fully briefed and the secretariat informed of any agreement to deputise so that quorumum can be maintained.

5.6 No person can act in more than one role on the JC CCGs, meaning that each deputy needs to be an additional person from outside the JC CCGs membership.

5.7 The SYB ICS will act as secretariat to the JC CCGs to ensure the day to day work of the JC CCGs is proceeding satisfactorily. The membership will meet the requirements of the constitutions of the CCGs named above at paragraph 1.4.

5.8 The JC CCGs will be Chaired by a respective CCG Clinical Chair and vice clinical Chair. For 2019/20 the chair is Doncaster CCG Clinical Chair, Deputy Chair is Rotherham CCG Clinical chair. The tenure of the role is 12 months.

6. Meetings

6.1 The JC CCGs shall adopt the standing orders of NHS Sheffield Clinical Commissioning Group insofar as they relate to the:

a) notice of meetings;

b) handling of meetings;

c) agendas;

d) circulation of papers; and

e) conflicts of interest.

7. Voting

7.1 The JC CCGs will aim to make decisions by consensus wherever possible. Where this is not achieved, a voting method will be used. The JC CCGs has five CCG members and 1 vote for each CCG. The voting power of each individual present will be weighted so that each party (CCG) possesses 20% of total voting power.

7.2 It is proposed that recommendations can only be approved if there is approval by more than 80%.

8. Quorum

8.1 At least one full voting member from each CCG must be present for the meeting to be quorate. The Healthwatch representative must also be present.

9. Frequency of meetings

9.1 Frequency of meetings will usually be monthly, but the Chair has the power to call meetings of the JC CCGs as and when they are required.

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9.2 Meetings may be held by telephone or video conference, JC CCGs members can participate and included as quorum in a face to face meeting, by telephone or by video link.

10 Meetings of the JC CCGs

10.1 Meetings of the JC CCGs shall be held in public unless the JC CCGs considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. Therefore, the JC CCGs may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

10.2 The Chair shall set the agenda and arrange papers to be circulated 5 working days prior to the JC CCGs meeting

10.3 Members of the JC CCGs have a collective responsibility for the operation of the JC CCGs. They will participate in discussion, review evidence and provide objective expert input to the best of the knowledge and ability, and endeavour to reach a collective view.

10.4 The JC CCGs may call additional experts to attend meetings on an ad hoc basis to inform discussions.

10.5 Each JCCCG member must abide by all policies in relation to conflicts of interests. Where any JC CCGs member has an actual or potential conflict of interest in relation to any matter under consideration at any meeting , the Chair (in their discretion) shall decide, having regard to the nature of the potential or actual conflict of interest, whether or not that member of the JC CCGs can participate / vote in the meeting or part of the meeting where the item is discussed

10.6 The JC CCGs has the power to establish sub groups and working groups and any such groups will be accountable directly to the JC CCGss.

10.7 Members of the JC CCGs shall respect confidentiality requirements as set out in the Standing Orders referred to above unless separate confidentiality requirements are set out for the JC CCGs, in which event these shall be observed.

10.8 The right of attendance at meetings by members of the public as referred to in paragraph 10.1 does not give the right to such members of the public to ask questions or participate in that meeting, unless invited to do so by the Chair.

10.9 Members of the public or press may not record proceedings in any manner whatsoever, other than in writing, or make any oral report of the proceedings as they take place, without the prior written agreement of the Chair.

10.10 Questions must be submitted in writing to the JC CCGs secretariat by noon on the Monday before the meeting.

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10.11 Answers to submitted questions relating to the agenda received in advance of the meeting will be published on the JCCCG section of the South Yorkshire and Bassetlaw Integrated Care System website prior to the meeting. Up to 15 minutes will be set aside at the beginning of the meeting in public for questions and/or statements to be made by members of the public. The chair reserves the right to not answer questions or statements that are not deemed appropriate to the JC CCGs agenda.

10.12 Confidential items will be considered in a closed private meeting of the JC CCGs.

10.13 The Chair may exclude any member of the public from a meeting of the JC CCGs if they are interfering with or preventing the proper or reasonable conduct of that meeting.

11. Secretariat provisions

The secretariat to the JC CCGs will:

a) Take and circulate the minutes, conflicts, matters arising action notes and decisions of the JC CCGs meeting to all members; and

b) Present the minutes, conflicts, matters arising, action notes and decisions to the governing bodies of the CCGs set out in paragraph 1.4 above.

12. Reporting to CCGs

The JC CCGs will make a quarterly written report to the CCG member governing bodies and the SYB ICS and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made.

13. Decisions

13.1 The JC CCGs will make decisions within the bounds of the scope of the functions delegated.

13.2 The decisions of the JC CCGs shall be binding on all member CCGs.

13.3 All decisions undertaken by the JC CCGs will be published by the Clinical Commissioning Groups set out in paragraph 1.4 above.

13.4 The JC CCGs agrees to make decisions by a common process for decision making with a non-member CCG. This process will apply where a non-member CCG has delegated the functions within the scope of the JC CCGs to an individual or member or employee of the non-member CCG.

15. Attendance

14.1 Voting members of the JC CCGs shall attend a minimum of at least 75% of meetings during the financial year.

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15. Review of Terms of Reference

These terms of reference will be formally reviewed in 6 months by Clinical Commissioning Groups set out in paragraph 1.4 and may be amended by mutual agreement between the CCGs at any time to reflect changes in circumstances as they may arise.

15. Withdrawal from the JC CCGs

15.1 Should this joint commissioning arrangement prove to be unsatisfactory, the governing body of any of the member CCGs can decide to withdraw from the arrangement, but has to give a minimum six months’ notice to partners, with consideration by the JC CCGs of the impact of a leaving partner - a maximum of 12 months notice could apply.

16. List of Members from each CCG and non-voting members

Column 1 Column 2

Organisation or nomination Representatives

Voting members

NHS Barnsley Clinical Commissioning Group; The Clinical Chair, The Accountable Officer

NHS Bassetlaw Clinical Commissioning Group; The Clinical Chair, The Accountable Officer

NHS Doncaster Clinical Commissioning Group; The Clinical Chair, The Accountable Officer

NHS Rotherham Clinical Commissioning Group; The Clinical Chair, The Accountable Officer

NHS Sheffield Clinical Commissioning Group; The Clinical Chair, The Accountable Officer

Non-voting members

JC CCGs Lay Members Lay members X2

Nominated Director of Finance NHS Sheffield CCG Director of Finance

Healthwatch Doncaster Nominated Healthwatch member

South Yorkshire and Bassetlaw ICS ICS Chief Executive or Deputy ICS Director of Commissioning ICS Communications & Engagement Lead

NHS England Specialised Commissioning

Associate CCG member NHS Derby and Derbyshire CCG

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Appendix 3

Checklist of Statutory Duties and Protocols

Public Law Issues (including for service change) 1. Case For Change The starting point is to have established a clear Case for Change that both commissioners and providers agree is clinically and financially sound. 2. Engagement with Public and Patients You must comply with various statutory obligations to engage with and consult the public and patients throughout the process. That includes any determination on the viability of models of care pre-consultation and during formal consultation processes. – see s.13Q, s.14Z2 and s.242 of the NHS Act 2006 (as amended) (‘the Act’) and statutory guidance for CCGs and NHS England (May 2017). 3. Four Key Tests It is important throughout the reconfiguration process to have in mind the four key tests introduced by the last Secretary of State for Health, which are: (i) strong public and patient engagement; (ii) consistency with current and prospective need for patient choice; (iii) a clear clinical evidence base; and (iv) support for proposals from clinical commissioners. Decision makers will need to show compliance when making a final decision on service change. 4. Equality All NHS statutory bodies must also ensure compliance with their duty under s.149 of the Equality Act 2010 that is their public sector equality duty. 5. Statutory obligations Commissioners must also have regard to the other statutory obligations set out in the new sections 13 and 14 of the Act. In looking at CCG duties the following, amongst others, are relevant: • 14P – Duty to promote NHS Constitution • 14Q – Duty as to effectiveness, efficiency etc • 14R – Duty as to improvement in quality of services • 14T – Duty as to reducing inequalities

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• 14V – Duty as to patient choice • 14X - Duty to promote innovation • 14Z1 – Duty as to promoting integration • 14Z2 – Public involvement and consultation by CCGs (see above) 6. Government Consultation Principles Updated 2018 All consulting NHS bodies should consider and comply with government principles on Consultation on what needs to be done to undertake a lawful public consultation exercise. 7. Principles for consultation (2018) • Consultations should be clear and concise Use plain English and avoid acronyms. Be clear what questions you are asking and limit the number of questions to those that are necessary. Make them easy to understand and easy to answer. Avoid lengthy documents when possible and consider merging those on related topics. • Consultations should have a purpose Do not consult for the sake of it. Ask departmental lawyers whether you have a legal duty to consult. Take consultation responses into account when taking policy forward. Consult about policies or implementation plans when the development of the policies or plans is at a formative stage. Do not ask questions about issues on which you already have a final view. • Consultations should be informative Give enough information to ensure that those consulted understand the issues and can give informed responses. Include validated impact assessments of the costs and benefits of the options being considered when possible; this might be required where proposals have an impact on business or the voluntary sector. • Consultations are only part of a process of engagement Consider whether informal iterative consultation is appropriate, using new digital tools and open, collaborative approaches. Consultation is not just about formal documents and responses. It is an on-going process. • Consultations should last for a proportionate amount of time Judge the length of the consultation on the basis of legal advice and taking into account the nature and impact of the proposal. Consulting for too long will unnecessarily delay policy development. Consulting too quickly will not give enough time for consideration and will reduce the quality of responses. • Consultations should be targeted Consider the full range of people, business and voluntary bodies affected by the policy, and whether representative groups exist. Consider targeting specific groups if appropriate. Ensure they are aware of the consultation and can access it. Consider how to tailor consultation to the needs and preferences of particular groups, such as older people, younger people or people with disabilities that may not respond to traditional consultation methods. • Consultations should take account of the groups being consulted Consult stakeholders in a way that suits them. Charities may need more time to respond than businesses, for example. When the consultation spans all or part of a holiday period, consider how this may affect consultation and take appropriate mitigating action, such as prior discussion with key interested parties or extension of the consultation deadline beyond the holiday period. 36 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

• Consultations should be agreed before publication Seek collective agreement before publishing a written consultation, particularly when consulting on new policy proposals. Consultations should be published on gov.uk. • Consultation should facilitate scrutiny Publish any response on the same page on gov.uk as the original consultation, and ensure it is clear when the government has responded to the consultation. Explain the responses that have been received from consultees and how these have informed the policy. State how many responses have been received. • Government responses to consultations should be published in a timely fashion Publish responses within 12 weeks of the consultation or provide an explanation why this is not possible. Where consultation concerns a statutory instrument publish responses before or at the same time as the instrument is laid, except in very exceptional circumstances (and even then publish responses as soon as possible). Allow appropriate time between closing the consultation and implementing policy or legislation. • Consultation exercises should not generally be launched during local or national election periods. If exceptional circumstances make a consultation absolutely essential (for example, for safeguarding public health), departments should seek advice from the Propriety and Ethics team in the Cabinet Office. This document does not have legal force and is subject to statutory and other legal requirements. 8. Governance As to decision making it is important that clear governance arrangements are put in place that are compliant with statute. 9. Local authorities Equally you must comply with your obligation to consult the relevant local authorities under s.244 of the Act and the associated Regulations. 10. Clear plan As to consulting you need to have a clear plan in place which ensures that you give the public sufficient information for them to provide informed responses. 11. Analysis and report Once the public consultation is complete, you must be able to collate and analyse responses for the decision makers to consider, often in the form of a consolidated report. Equally, you need a clear analysis of compliance with your obligations under the public sector equality duty. 12. Compliance with statutory obligations and four Key Tests Commissioners will also want to ensure that decisions comply with their other statutory obligations and the four Key Tests, as set out above. 13. IRP Consideration should be given to those issues which the IRP have indicated in annual reviews cause the most concern to the public an patients. (See separate note for a list of the issues). Procurement Issues

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Commissioners are required to ensure that their decisions to procure services comply with the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. Key questions are set out under each heading below to assist you when considering whether you are meeting these requirements. Commissioners are also required to comply with EU/UK general procurement law but this is not covered in the list below. 1. Procurement objective ‘To secure the needs of patients and improve quality and efficiency of services’. • What have you done to assess patient need and do you have evidence to support your findings? • How are you assessing the quality of services and the performance of the current providers? How have you assessed whether the service is offering value for money? • Have you reviewed the current service specification to ensure it is working well and whether there is scope for further improvement? In particular, it would be helpful to have a schedule of all existing contracts and relationships, including performance monitoring on contracts. • What steps have you taken to assess equitable access to services by all patient groups? 2. Three general requirements I. To act transparently and proportionately and in a non-discriminatory way. • What steps have you taken to make providers and stakeholders aware of your plans? Have you provided reasons to support your decisions? • Are you publishing details in a timely manner and have you kept records of decision making, e.g. board minutes and briefing papers? • Do providers understand the selection criteria you are using and are they able to express an interest in providing the services? Can you show that you have not favoured one provider over the other? • Is your approach proportionate to the nature of the services in relation to the value, complexity and clinical risk associated with the provision of the services in question? II. To contract with providers who are most capable of meeting the objectives and provide best value for money • How have you identified existing and potential providers and objectively evaluated their relative ability to deliver the service specification, improve quality and meet the needs of patients? • Are you satisfied providers are capable and robust enough to deliver a safe and efficient service and provide the best value for money in doing so? III. Consider ways of improving services through integration, competition and patient choice • What evidence do you have to show the steps you taken to determine whether it might be better for patients if the services are integrated with other health care services? • Have you asked providers, patients, and other stakeholders for their views? • Does your specification or performance monitoring process incentivise delivery of care in a more integrated manner? • Have you considered whether competition or choice would better incentivise providers to improve quality and efficiency? Do you have evidence to support your findings?

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3. Advertisements and expressions of interest To ensure providers are able to express an interest in in providing any services which includes the requirement to publish opportunities and awards on a website • How have you gathered evidence about the existing and potential providers on the market? • Have you published your intentions to the market by way of commissioning intentions or publication on a website?

4. Award of a new contract without a competition A new contract may be awarded without publishing a contract notice where the commissioner is satisfied that the services in question are capable of being provided only by that provider, e.g. A&E services in a particular area or where it is not viable for providers to provide one service without also providing another service. • What steps have you taken and what evidence are you relying on to satisfy yourself that there is only one capable provider? 5. Conflict of Interests Commissioners are prohibited from awarding a contract where conflicts, or potential conflicts, between the interests of Commissioners in commissioning services and the interests involved in providing the services affect, or appear to affect, the integrity of the award of the contract. • Have you recorded how you have managed any conflict or potential conflict? 6. Anti-competitive behaviour Not to engage in anti-competitive behaviour unless to do so would be in the interests of people who use NHS services • Are you acting in an anticompetitive manner – for instance have you prevented new providers from entering the market or caused a provider to exit the market? • If so, is it objectively justifiable as being in the interests of users and stakeholders? What evidence do you have to support this?

Competition Issues 1. Requirement to Notify to the Competition and Markets Authority (CMA) Any undertakings given to the CMA or its predecessor, the Competition Commission, may prohibit a statutory transaction and should be checked. They may not apply to a merger by reconfiguration but the merger regime set out below will still apply. 2. Merger control rules The merger control regime may apply to NHS service reconfigurations where two or more services are merged and the transaction meets the jurisdictional tests. 3. Jurisdictional Tests The CMA has jurisdiction to examine a merger where: 1. two or more enterprises cease to be distinct (change of control) 2. and either • the UK turnover of the acquired enterprise exceeds £70 million; or 39 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

• the enterprises which cease to be distinct together supply or acquire at least 25% of all those particular services of that kind supplied in the UK or in a substantial part of it. The merger must also result in an increment to the share of supply, i.e. the merging providers must supply or acquire the same category of services. [ Enterprise: NHS foundation trusts and NHS trusts controlling hospital, ambulance services, mental health service, community services or individual services or specialities may be enterprises for the purpose of merger control. Change in control: Two enterprises (or services) cease to be distinct if they are brought under common ownership or control. There must be a change in the level of control over the activities of one or more enterprises (or services) for merger control to apply.]

4. Competition test The CMA assesses qualifying mergers to decide whether they are likely to lead to a substantial lessening of competition (‘SLC’). An SLC occurs when competition is substantially less after the merger. 5. SLC assessment The CMA will require detailed information about the reconfiguration. This will include: • service overlaps; • GP referral data / catchment area analysis; and • Hospital share of GP practice referrals. 6. CMA merger assessment timetable The process is divided into two stages: • Phase I: an initial 40 working day investigation; and • Phase II: a possible 24 weeks in-depth investigation, which can be extended if the CMA considers it necessary.

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Appendix 4 South Yorkshire and Bassetlaw JC CCGs Clinical Engagement and Assurance Process

The SY&B system commissioning priorities for 2019/20 have been developed by the JC CCGs, members of SYB CCG Governing Bodies and Directors of Commissioning. Individual CCGs will be responsible for leading specific priorities of work to be adopted across the ICS in order to standardise access, improve outcomes and quality of care for patients across SY&B. It is important that JC CCGs priorities are clinically developed using best practice and evidence based and are locally clinically led to ensure an agreed SYB consensus to pathways, policies and protocols. Assurance will be sought through the JC CCGs that all SYB priorities being developed are underpinned by a robust locally managed process in each place for clinicians to engage, influence, develop and agree the work and is supported by CCG memberships. Wider involvement of clinicians and professionals from across the system including; primary and community care, secondary care, tertiary care, mental health, cancer and specialised services will be engaged in the relevant work priorities as appropriate to inform the clinical consensus. The lead CCG will ensure that wider SYB clinical engagement has been undertaken as required. Each CCG currently has a forum to ensure this clinical assurance takes place locally through their place:

 Doncaster CCG – Clinical Reference Group  Barnsley – Clinical Forum  Sheffield CCG – Clinical Reference Group  Rotherham CCG – Clinical Referral Management Committee  Bassetlaw CCG – Service Delivery Committee

These respective groups all have the remit to ensure clinical debate and assurance is undertaken at place enabling a clinical consensus in each place for SYB system commissioning priorities throughout the work that cover the following requirements:

 Patient centred and quality driven decision making  Local ownership and implementation of recommendations 41 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets Manual/Agreement for JC CCGss

 Consistency of guidelines and clinical pathways across the ICS  Timely decision making to ensure implementation within agreed timeframes

SYB Clinical Engagement and Assurance Process: Lead CCG liaises with individual places to ensure clinical reference and agreement takes place during development of work:

Lead CCG Each Place If Individual Place Adoption of final develops work ensures work is cannot agree – guidelines and establish Virtual policy within using Place clinical Clinical considered and ICS Clinical individual CCGs Assurance feedbacks to lead Reference Group*

*A virtual ICS Clinical Reference Group would be created to debate and reconcile clinical opinion and confirm final clinical sign off in each place. This group would be clinically tailored to the priority subject matter and have authority of clinical decision making from the ICS and place.

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Appendix 5 South Yorkshire and Bassetlaw ICS Assessment Process for Section 14Z2 Duty for Public Involvement

DEVELOP 14Z2

Project lead and Communications & Engagement Team

ICS Workstream lead to

amend and approve

ICS Commissioning Director and Communications and Engagement Director to amend and approve

Citizens’ Panel and SYB wide Lay Members* review and offer advice and support

Appropriate ICS Workstream JCCCG Steering Board to amend for approval (in the areas and approve where they have delegated authority for integrated decision making)

43 Final JC CCGs Manual Agreement and TOR July 24th 2019/20 - duplicated bullets JHOSC For comment, and advice on if Quarterly ICS significant service change Communications &

Engagement Update Paper *subject to agreement of of to members lay agreement *subject

Meeting name Governing Body Meeting date 2 September 2021

Title of paper Healthwatch Doncaster Annual Report 2020-21

Executive / Anthony Fitzgerald – Director of Strategy and Delivery Clinical Lead(s) Andrew Goodall – Chief Operating Officer – Healthwatch Author(s) Doncaster

Status of the Report

To approve To consider / discuss

To note X

Purpose of Paper - Executive Summary Healthwatch Doncaster are the independent champion for people using local health and social care services. We listen to what people like about services and what could be improved. We share their views with those with the power to make change happen. People can also speak to us to find information about health and social care services available locally.

Our sole purpose is to help make care better for people.

Healthwatch Doncaster produce an Annual Report every year that details the work of the team and the outcomes that have been achieved.

Healthwatch Doncaster delivers its core programme of work around three pillars:

Engage – engaging local people in conversations about health and care services in Doncaster

Inform – local people inform us about changes and improvements they would like to see

Influence – we use the stories and experiences of local people to influence changes and improvements to the quality of local services

Healthwatch Doncaster

• spoke to over 3500 people about their experiences of health and care locally. We have published 8 reports on a range of topics including Cancer, Urgent and Emergency Care and Digital appointments in Primary and Secondary Care

• developed new services in response to the Covid-19 pandemic – this enabled the team and the organisation to maintain its focus on engagement and support for

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local people and communities – the Daily Dose programme of videos and information enabled Healthwatch Doncaster to reach over 90,000 through social media and keep them informed and engaged

• continued to support its network of groups and for a through digital meetings so that people were given support and opportunity to have their voices heard and their experiences listened to

• supported 31 volunteers to deliver over 550 hours of valued and valuable time on projects and programmes

• supported the Health Ambassadors, the PPG Network, the Keeping Safe Forum and Choice for All Doncaster to get involved and have their say about local services and changes to health and care services.

Future plans and projects

Healthwatch Doncaster has identified its top three priorities for 2021-22

1. Restart community engagement and listen to local people about their experiences of accessing services

2. Mental Health –listen to people’s experience of mental health support in Doncaster

3. Access to Dental Care –review and investigate the provision of local Dental services for local people

Healthwatch Doncaster’s next steps to achieve the identified priorities are: • Transforming the way that we work –Healthwatch Doncaster will be more agile and community-based

• Maintaining digital engagement alongside face-to-face engagement

• Continue to focus on listening to people from communities whose voices are seldom heard

The Healthwatch Doncaster Annual Report 2020-21 can be downloaded here: https://www.healthwatchdoncaster.org.uk/report/2021-07-01/healthwatch-doncaster- then-and-now-annual-report-2020-21

Recommendation(s) NHS Doncaster CCG’s Governing Body is asked to:

• Note the contents of the report

• Recognise the development and achievements of Healthwatch Doncaster as a key local partner

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Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis The Healthwatch Doncaster Annual Report 2020-21 is for information and Quality impact noting

The Healthwatch Doncaster Annual Report 2020-21 is for information and noting Tick relevant box

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

Sustainability The Healthwatch Doncaster Annual Report 2020-21 is for information and impact noting Financial NONE implications Legal NONE implications Management of Conflicts of NONE Interest Consultation / Engagement (internal The Healthwatch Doncaster Annual Report 2020-21 is for information and departments, noting clinical, stakeholder and public/patient) Report previously NONE presented at Risk The Healthwatch Doncaster Annual Report 2020-21 is for information and analysis noting Corporative Objective / NONE Assurance Framework

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Engage, Inform, Influence

Then and now

Healthwatch Doncaster Annual Report 2020-21 Then and now | Healthwatch Doncaster | Annual Report 2020-21 2 Contents

Message from our Chief Operating Officer 3 About us 4 Highlights from our year 5 Signposting and information 6 Theme one: Urgent and Emergency Care: Then and now 7 Theme two: Accessing you local surgery: Then and now 9 Theme three: Missed Appointments: Then and now 11 Theme four: Engagement and Involvement: Then and now 13 Responding to COVID-19 15 Experiences of Cancer pathways during a pandemic 18 Volunteers 19 Reaching Out – a volunteer-led project 21 People’s Voices 22 Enter and View 23 Choice for All Doncaster 24 Health Ambassadors and Patient Participation Group Network 25 Keeping Safe Forum 26 Finances 27 Next steps 28 Statutory statements 30 Then and now | Healthwatch Doncaster | Annual Report 2020-21 3

Message from our Chief Operating Officer

2020-21 – A year to remember for so many different reasons

This year Healthwatch Doncaster experienced, along with the rest of the world, a year like no other. One minute we were chatting in the office about the news from China and Italy about a virus and the next minute we were putting our emergency planning processes in to place and working from home!

The staff team and the Board members all pulled together to ensure that we were able to continue to provide a local, independent voice for people and communities in Doncaster. Without their hard work and dedication then we would have struggled to bail out the boat that we were in with everyone else.

In our time of adversity, the team came together with creativity and innovation to drive us forward to develop new ways of engagement and involvement to ensure that local voices were heard and listened to.

“Talking to people from our room, using a new platform known as Zoom. Passing on information, keeping people up to date, for sharing with others, not forgetting your mate.” Engagement and impact Healthwatch Doncaster recognised the value of reaching out to local people throughout the pandemic – we wanted to continue to hear their voices and share new information with them. We developed the Daily Dose of Healthwatch Doncaster programme early on in the pandemic which quickly gained momentum. We received funding from the local Covid grants to enable us to buy Zoom licences and soon we were broadcasting on Zoom and Facebook Live enabling us to engage with lots of different people. The team developed more and more content – videos, quizzes, cooking, relaxation, music – that we were able to share. Healthwatch Doncaster have embedded this engagement approach into our core work and it will continue after the pandemic.

Listening to local people The team did not shy away from difficult topics and I am really proud to say that we developed and delivered a qualitative report about people’s experience of accessing cancer services throughout the pandemic. The recommendations from this project have been shared at the local Cancer Programme Board and we are working together to put them into action and make some changes.

Moving forward Healthwatch Doncaster will continue to work closely with people and communities so that their stories and experiences can improve the quality of health and care services. We recently heard from over 4000 local people about their experiences of the Covid-19 vaccination process – this has enabled us to share reports and information to influence the development of vaccine clinics across Doncaster. Andrew Goodall Then and now | Healthwatch Doncaster | Annual Report 2020-21 4 About us Here to make health and care better We are the independent champion for people who use health and social care services in Doncaster. We’re here to find out what matters to people and help make sure your views shape the support you need, by sharing these views with those who have the power to make change happen. Helping you to find the information you need We help people find the information they need about services in their area. This has been vital during the pandemic with the ever-changing environment and restrictions limiting people’s access to health and social care services.

Our goals

Supporting you to Providing a high Ensuring your views 1 have your say 2 quality service 3 help improve health & care We want more people to get We want everyone who We want more services to the information they need to shares an experience or use your views to shape the take control of their health seeks advice from us to get a health and care support you and care, make informed high quality service and to need today and in the future. decisions and shape the understand the difference services that support them. their views make.

“Local Healthwatch have done fantastic work throughout the country during the COVID-19 pandemic, but there is more work ahead to ensure that everyone’s views are heard. COVID-19 has highlighted inequalities and to tackle these unfair health differences we will need those in power to listen, to hear the experiences of those facing inequality and understand the steps that could improve people’s lives.” Sir Robert Francis QC, Chair of Healthwatch England Then and now | Healthwatch Doncaster | Annual Report 2020-21 5 Highlights from our year Find out about our resources and how we have engaged and supported people in 2020-21.

Reaching out We heard from 3567 people this year about their experiences of health and social care. We provided advice and information through Zoom and Facebook and reached 91,196 people this year.

Responding to the pandemic We developed 2 new services (in addition to maintaining support for all of our existing groups and networks) this year to support and engage with our local communities in the pandemic.

We engaged with 3567 people this year in our projects and surveys – their voices helped make changes and improvements throughout the pandemic

Making a difference to care We published 8 reports about the improvements people would like to see to health and social care services. 100% of our reports have been shared locally and we are actively reviewing progress on the recommendations that we made.

Health and care that works for you 31 volunteers helped us to carry out our work. In total, they contributed 577 hours of valued and valuable time. We employ 8 staff 62% of whom are full time equivalent, which is the same as the previous year. We received £189,693 in funding for the local Healthwatch contract from our local authority in 2020-21 – this is 12% less than the previous year. Then and now | Healthwatch Doncaster | Annual Report 2020-21 6 Signposting and information This year we helped 338 people get the advice and information they need by:

• Providing advice and information articles on our website • Answering people’s queries about services through a variety of different ways • Directing people to our social media channels to access information about services that can help and support local people

How did people contact Healthwatch Doncaster?

4% 7%

24%

65%

Telephone Email Website Social Media Then and now | Healthwatch Doncaster | Annual Report 2020-21 7

Theme one: Then and now Urgent and Emergency Care

Then: Urgent and Emergency Care

In 2019 Healthwatch Doncaster volunteers undertook a project to explore patient experience of accessing Urgent and Emergency Care Services over a 24-hour period. This piece of work earned the volunteers a Highly Commended Award from Healthwatch England in the 2020 Healthwatch Awards.

The findings from the report identified that patients were satisfied with the services that they received from Urgent and Emergency Care providers.

The volunteers were, however, able to make some recommendations to improve the patient experience. These were around waiting facilities at the Emergency Department and the triage process for the Same Day Health Centre. Then and now | Healthwatch Doncaster | Annual Report 2020-21 8

Now: How did COVID-19 change things?

In September 2020 in the midst of the COVID-19 pandemic, Healthwatch Doncaster and its volunteers carried out a follow up to our original project. Due to restrictions it was not possible to attend the services that we had visited during the previous study, so the volunteers had to think about things in a different way. We worked with the volunteers and developed a means of gathering people’s experiences over the phone. This was done with the co-operation of the Urgent and Emergency Care services who gained signed consent from patients to share their telephone number with Healthwatch Doncaster.

Our volunteers were able to talk to 74 people who had attended Urgent and Emergency Care services in a 24-hour period. People were able to share their experiences of:

• The Urgent Treatment Centres at Mexborough Montagu Hospital and Doncaster Royal Infirmary

• The Same Day Health Centre based at Cavendish Court, Doncaster

• The Emergency Department at Doncaster Royal Infirmary

As in the previous study, people who attended Urgent and Emergency Care services were satisfied with the service they had received. However, as to be expected in the circumstances, we received feedback on the measures in place due to COVID-19 and people reported feeling more comfortable in some departments than others. This was due to the actions of other people waiting to be seen who did not use the hand sanitiser provided or who chose not to wear a face covering.

“I should be more bold and tell people that I don't understand what they are saying but this is hard for me.”

“Make better explanations please.”

The report made a recommendation to allow and enable, at the clinicians’ discretion, someone to accompany the patient into a specific department or ward if their capacity was impaired, for example someone living with Dementia. This recommendation was well received by the providers.

At a recent visit to the Emergency Department, in order to access the service themselves, a member of the Healthwatch Doncaster Engagement team saw an excellent example of this being put into practice for someone who was living with Dementia. This reinforces the fact that the work of Healthwatch Doncaster has a positive impact service delivery and that outcomes and recommendations from reports are put into action.

You can read the report by clicking this link -> www.healthwatchdoncaster.org.uk/report/2020-08-29/24- hours-urgent-and-emergency-care-follow-2020

Share your views with us If you have a query about a health and social care service, or need help with where you can go to access further support, get in touch. Don’t struggle alone. Healthwatch Doncaster is here for you.

www.healthwatchdoncaster.org.uk 01302 965450 [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 9

Theme two: Then and now Accessing your local surgery

Then: Accessing your local surgery

Healthwatch Doncaster had anecdotal evidence that accessing GP surgeries was an issue for local people. A survey was developed and launched in Autumn 2019 to understand the reality and perceptions of accessing GP surgeries in Doncaster.

We gathered views from nearly 1600 local people through the survey and face-to-face engagement at over 45 community venues across Doncaster. We were able to ensure that a representative cross-section of the community completed the survey, including people of working age whose voices are not often heard when talking about access to GP services.

Key information from this project identified that 45% of local people were happy with the service received and of the other 55%, 73% had difficulty getting through to their practice on the telephone and 42% wanted to see a specific GP or Nurse.

50% used their GP Practice to access repeat prescriptions and many were not aware of alternative provision at the Same Day Health Centre or appointments at alternative GP practices at the weekend as part of the Extended Access to Primary Care service. Then and now | Healthwatch Doncaster | Annual Report 2020-21 10

Now: How did COVID-19 change things?

Access to GP services have been profoundly impacted on by the Covid-19 pandemic and anecdotally people’s shared experiences and/or perceptions have clearly evidenced this.

Without doubt the Covid-19 pandemic gave impetus to the recommendations from Healthwatch Doncaster’s original report from 2019. Changes to previous systems had to be implemented with a sense of urgency to meet people’s health needs. Digital services became vital in the approach to meet this need. Local people had to adapt quickly to generating prescriptions online and receiving digital appointments as an alternative to face to face.

“I preferred not travelling to the practice, talking to the GP on the phone was just as informative”

“For an elderly patient who is confused at the best of times - technology which they don’t understand is difficult”

Healthwatch Doncaster continued to engage with local people throughout the pandemic to establish their views on access to GP Services both formally and informally.

An online survey was completed by 320 people and the findings from this were provided to colleagues in Primary Care Doncaster and NHS Doncaster CCG.

75% of people who had a telephone or video appointment told us that there were no problems and that everything was great

“If we have to use a video call it would be helpful to know how to use it”

“This sort of service is perfect for me and I hope that I can use in the future”

Healthwatch Doncaster were able to evidence that there is a place for digital appointments and that they are appropriate for a number of people whilst for many the need to see a clinician face to face is imperative.

The continued engagement Healthwatch Doncaster has achieved throughout the Covid-19 pandemic has been crucial in assisting stakeholders to gather intelligence about the experiences and perceptions of local people who access GP services.

Our recommendations have been shared with Commissioners and Providers and received positively. There is recognition that they will help to influence and shape future service provision in Doncaster.

To find out more click here >>> Read our report from 2020

Tell us about your experiences here www.healthwatchdoncaster.org.uk/share-your-views Then and now | Healthwatch Doncaster | Annual Report 2020-21 11

Theme three: Then and now Missed Appointments

Then: Missed Appointments

In 2018 Healthwatch Doncaster worked closely with Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust to understand why some people did not attend their booked appointments in the hospital.

We talked to a lot of people in the Outpatients department, in local groups and in communities across Doncaster. We spent a lot of time talking to people face to face and talking them through a paper survey to gather their views and opinions.

The data and information from the survey was analysed and presented in a report along with a series of recommendations to:

1. Improve and enhance communication between the hospital and patients 2. Improve the experience of patients, staff and the wider public by better use of digital technology including text message updates 3. Ensure best use of resources by minimising waste 4. Increase knowledge around the services and programmes available to patients Then and now | Healthwatch Doncaster | Annual Report 2020-21 12

Now: How did COVID-19 change things?

The Covid-19 pandemic precipitated a rapid shift, across all sections of society, to digital and video solutions to enable us all to continue to communicate. This happened in our social lives, in our work lives and in our lives as patients and recipients of care and support.

Whilst many of us recall Zoom quizzes and get-togethers with friends and family, there were many people who needed to see and speak to clinicians and health professionals about their on-going care and support.

Healthcare providers responded rapidly to this new way of working and were able to offer both video and telephone consultations as part of a new offer of digital healthcare support.

Healthwatch Doncaster recognised that this rapid shift to digital appointments was in line with the recommendations that we made in our 2019 Missed Appointments report. We worked closely with colleagues at Doncaster and Bassetlaw Teaching Hospital and developed a survey about patients’ experiences of accessing outpatients and therapy appointments via digital technology including both telephone and video channels.

275 people shared their views and experiences of using digital solutions to access their appointments and the reports were shared with Committees and Board as well as Departmental meetings.

I felt no pressure and was given plenty of time to explain why I had been referred

It would be better to see someone to show the areas concerned – it is very difficult for me to describe something

The tele-consultations are good, but moving towards resuming face to face visits would be better. Moving on from Covid-19 perhaps a mixture of both virtual and face to face contacts would lead to a more efficient service without compromising patient care, the professional’s assessment and the range of interventions offered.

Our engagement work identified that patients who have used this service are satisfied with the quality of the service and they would, generally, like it to carry on. The digital video appointments are meeting patient’s needs but some people still want face to face appointments. A mixed approach to digital/non-digital appointments based on clinical need would be the ideal way forward.

www.healthwatchdoncaster.org.uk 01302 965450 [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 13

Theme four: Then and now Engagement and Involvement

Then: Engagement and Involvement

Prior to the pandemic, we were a people-facing organisation engaging with local communities to hear their views and opinions on current issues that matter them the most. We would hear about a variety of experiences from patients, young people and representations from communities who were seldom heard. Our original engagement model worked well, fantastic examples include our work on Urgent and Emergency Care and the Long Term Plan project. We enabled local people the opportunity to speak up about their experiences of a range of services and their thoughts about how they could be improved in the future.

Healthwatch Doncaster were recognised, alongside colleagues from local Healthwatch in South Yorkshire and Bassetlaw, for the work done to listen and hear from seldom heard communities as part of the work we delivered on the NHS Long Term Plan.

We have delivered other engagement sessions around involving the people of Doncaster in the commissioning cycle, facilitating face to face engagement in the development of NHS Digital services and hearing the voice of young people through our ‘Young Healthwatch Champions’ programme. This meant we were engaging with people, informing them about local health and social care services and influencing stakeholder’s decisions when delivering services at a local level. Then and now | Healthwatch Doncaster | Annual Report 2020-21 14

Now: How did COVID-19 change things?

The Covid-19 pandemic and the guidance around social mixing and virus transmission changed the way in which we engaged with local people in Doncaster. We knew our core ethos of Engage, Inform and Influence would remain at the very heart of our organisation and engagement would continue during the pandemic.

This led us to an exciting opportunity where we were able to develop a new model for engagement in a Covid-19 secure way. We achieved this by using digital tools like Zoom and social media to develop a new model of engagement. We called it the ‘Daily Dose of Healthwatch Doncaster’.

Our Daily Dose sessions allow us to share information about local health and social care services with people and professionals. The sessions are delivered across the working week and feature insightful videos of our team chatting to different people about how their services can help and support local people.

We use Facebook Live to deliver short broadcasts each day which enables people to engage with us by commenting on the videos, messaging us directly to share their own experience or interacting with links to contact the service showcased that day.

We use Zoom to record interviews and conversations with lots of different people and then broadcast them through Facebook Live and our social media channels.

“I have really enjoyed being a part of the Daily Dose sessions on Zoom and Facebook Live. It has given us another connection with people in our communities. Zoom is not just for the pandemic – we will continue to use it as we move onwards out of the pandemic.”

Healthwatch Doncaster have continued to host monthly meetings with our volunteers, Health Ambassadors, Keeping Safe Forum and Patient Participation Group Network. Everyone has embraced this new approach to engagement and moving forward we will engage with our groups using both digital and face-to-face channels.

The Covid-19 pandemic has strengthened our approach to engagement. The challenges that we faced have created new opportunities for us to engage, inform and influence. Together, we can make a difference.

. Then and now | Healthwatch Doncaster | Annual Report 2020-21 15

Responding to COVID-19

Healthwatch Doncaster plays an important role in helping people to get the information they need, especially through the pandemic. The insight we collect is shared with both Healthwatch England and local partners to ensure services are operating as best as possible during the pandemic. This year we helped over 91,000 people by: • Providing up to date advice on the COVID-19 response locally

• Curating a Daily Covid-19 music playlist that was shared across our groups and networks in Doncaster

• Delivering Daily Dose information sessions on Zoom and Facebook Live each day of the working week

• Linking people to reliable up-to-date information

• Supporting the vaccine roll-out

• Supporting the community volunteer response and working closely with Voluntary Action Doncaster

• Helping people to access the services they need Then and now | Healthwatch Doncaster | Annual Report 2020-21 16 What’s YOUR story? The intention of our engagement, Starts with You We really want to hear YOUR view Health and Social Care services providing support and care Affected by Lockdown, tell us about it, Please share

Feeling unwell, to the doctor you’d normally go In lockdown the answer was probably no What did you do to get advice and support? Tell us your story and what you thought

A prescription to order, medicines for each day On line, by an app, was that an easier way? A visit to the pharmacy, did YOU join that queue? Self- care for the family. How was it for you?

Accidents, major illness, who did you see? Did you go to A and E? If A and E was where you went Tel us about the time there you spent

Many appointments done on the phone Because you couldn’t leave your home A must to keep people safe and well Your view of the service, we want you to tell

You needed a dentist for your toothache Or perhaps a bone you did break During a pandemic, it had to happen NOW! Tell us what you did, solving this problem, HOW!

We are sure many calls for support were made Broken glasses or maybe a lost hearing aid? How did services respond to your plight? To restore your hearing or help your sight

Tell us also about Social Care Making efforts to ensure they were there Support in your home or another place Surrounded by people with a mask on their face

Other views must complete the list Of services received or possibly missed Healthwatch Doncaster we are there To hear your stories of Health and Social Care Then and now | Healthwatch Doncaster | Annual Report 2020-21 17

Top four areas that people have contacted us about:

Signposting to Voiceability Doncaster for advocacy support – 7% Dentistry and GP services – 17%

COVID-19 support and info – 52% Local groups and networks – 7% Providing accurate COVID-19 support and information Early on in the pandemic, we worked closely with We were able to highlight that people wanted clear all the Communications and Engagement Teams as and accurate local information. Our role became part of Team Doncaster. much more focused on providing people with clear, consistent and concise advice and information through our website and our daily Zoom and Facebook Live sessions.

In just three months, our digital advice and information had been accessed by over 18,000 people.

We received questions about access to GPs and Dentists as well as general questions about the Covid-19 pandemic and local groups and networks.

People also wanted to know where to get support around advocacy so we were able to signpost them to Voiceability Doncaster.

Contact us to get the information you need If you have a query about a health and social care service, or need help with where you can go to access further support, get in touch. Don’t struggle alone. Healthwatch Doncaster is here for you.

www.healthwatchdoncaster.org.uk

01302 965450

[email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 18 What did people tell us about their experiences of cancer services in Doncaster? In the summer of 2020, Healthwatch Doncaster Recommendation 5 – Person centred completed an engagement project which approach to wig provision involved gathering the views of local people in relation to their cancer journeys. Recommendation 6 – Weekend provision at the Jasmine Suite The purpose of this project was to hear about people’s experiences of cancer services in their “I received my cancer diagnosis alone due own words. to the pandemic and found the lack of family and friends support was very Healthwatch Doncaster were keen to gather unsettling and upsetting” extensive narrative to understand: “I have not seen anyone at the hospital 1. How patients’ journeys were affected by the face to face but I have had 3-4 telephone Covid-19 pandemic calls from the ENT team who suggested that I contact them should I have any 2. Patients’ experience with consultations concerns” delivered digitally or via phone “I was very happy with my GP, he 3. What went well in patients’ opinions? referred me immediately to Doncaster Royal Infirmary following identification of 4. What did not go well in patients’ opinions? a lump in my breast” Healthwatch Doncaster have made a number of “During the pandemic I was ill and recommendations that focus on person centred received a phone consultation, I would care and person centred planning. have preferred a face-to-face The following recommendations were made: appointment and it would have helped my GP understand how ill I was” Recommendation 1: Enhancing communication, involving patients and use of Care Plans

Recommendation 2 – Continued offer of digital consultations

Recommendation 3 – More effective planning for End of Life Care and robust discharge plans and use of Respect forms

Recommendation 4 – Offer of emotional and financial support throughout the patient’s journey at pivotal points evidenced within the Care Plan Then and now | Healthwatch Doncaster | Annual Report 2020-21 19

Volunteers – “Alone we can do so little; together we can do so much.” – Helen Keller

At Healthwatch Doncaster we are supported by 31 volunteers to help us find out what people think is working and what improvements people would like to make to services. This past year has been a challenging one all round and the impact of the Covid- 19 Pandemic on our volunteering programme has been no exception. Despite the challenges our volunteers have still contributed an amazing 577 hours of their time to support our mission to engage and involve local people and influence an improvement in the quality of health and care services in Doncaster. Our volunteers: • Helped people have their say from home, carrying out surveys over the telephone and online.

• Reviewed documentation and information from the local Hospital to ensure that it was easy to understand and fit for purpose

• Learned new skills around digital meetings and attending regular Zoom meetings

• Developed a presentation for the Healthwatch Doncaster Board sharing and celebrating the work of all the volunteers Then and now | Healthwatch Doncaster | Annual Report 2020-21 20

Engagement volunteer - Sue “I really enjoy getting out and about talking to people because it is important to have conversations with people about their experiences of health and social care. An initial response that a service is poor can actually turn out that it’s only one thing they have an issue with and the rest of the service is good. I’ve really missed being able to do this over the last year. I took part in the Urgent and Emergency Care project where we spoke to people on the phone who accessed the services. It was very rewarding.”

Board member - Janet “Covid-19 has significantly altered the way we all have been able to live and function. Being a member of Healthwatch Doncaster’s Board, the Volunteer Group and leading on our Enter and View programme has enabled me to contribute to Healthwatch Doncaster’s aims around sign-posting and communicating with the local people. This will support them to raise issues safely and hopefully sensitively, using the telephone and social media channels. I want to support Healthwatch Doncaster to create a safer and healthier local community.”

Reaching Out - Georgina “I have been making regular calls to 3 individuals during the Pandemic to help to combat loneliness and isolation. Making the calls has given me a great sense of achievement knowing I have made a difference to someone’s day. The people I talk to are always pleased to hear from me and I enjoy it - I love to chat!

I have been able to signpost some of the people I speak with to services that are able to help them improve their situation or deal with a particular issue.”

Volunteer with us Are you feeling inspired? We are always on the lookout for new volunteers. If you are interested in volunteering, please get in touch with us: www.healthwatchdoncaster.org.uk/get-involved 01302 965450 [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 21

Reaching Out – a telephone support service developed with and delivered by volunteers

Our Reaching Out Project was developed in What is the best thing about receiving response to the first Covid-19 lockdown. It Reaching Out calls? was put in place to reduce social isolation by matching our volunteers with local people who “J being a lovely person to talk to. It's were shielding. nice to speak to someone beside your family that you can open up to and J Healthwatch Doncaster volunteers were doesn't push the conversation” matched with people referred into the service and they made supportive, conversational “Nice to speak to someone about how telephone calls and, where appropriate, you're feeling as I am used to company offered signposting and information about and due to Covid-19, I have been stuck local services. at home”

The project extended beyond the first “Having another human being to talk to. lockdown and carried on throughout the It feels like hell having no company” pandemic. It drew to a close in May 2021 as the country followed the roadmap out of lockdown and out of the pandemic. What did our volunteers tell us about Reaching Out?

“A sense of satisfaction at being able to make a difference to someone’s day through a phone call. “

“Felt an improvement in own wellbeing during lockdown due to taking part in this project”

Want to volunteer with Healthwatch Doncaster? If you want to join our enthusiastic volunteer team, then contact us today! Website: www.healthwatchdoncaster.org.uk/get-involved Telephone: 01302 965450 Email: [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 22

People’s Voices – supporting people to share their experiences at NHS Doncaster CCG’s Governing Body

Healthwatch Doncaster continued to facilitate Care Home experience in Covid-19 – patient stories for NHS Doncaster CCG’s feedback from a Care Home Manager, a Governing Body throughout the pandemic. resident and a relative Circumstances produced a temporary gap but things recommenced swiftly and people’s Experiences of CAMHS from a 14 year stories have since been delivered via videos old through Zoom in the public Governing Body A patient journey through Urgent and meetings. Emergency Care into inpatient services We used creative approaches to facilitate Mental Health support in schools known people to share their experiences. People locally as “With me in Mind”- Feedback were happy to share their experiences and we from a young person and her mother were encouraged that many participants were willing to have a recorded conversation with Experience of a face to face GP Healthwatch Doncaster on Zoom. The videos appointment were presented at the Governing Body meeting and live streamed through You Tube We have enabled people to share their stories to the public. so that members of the Governing Body can hear about the lived experiences during the pandemic. The stories have created discussion and achieved learning to influence the development and improvement of services in all of the three Life Stages.

Healthwatch Doncaster are regularly commended by NHS Doncaster CCG in achieving the important feedback from local people and are grateful to all those who contributed over the last year.

We continued to focus on Life Stages: Starting If you would like to share your story about Well, Living Well and Ageing Well and the any aspect of health or care services in stories we heard and presented included: Doncaster then contact the Healthwatch Doncaster Engagement Team: Accessing a digital GP appointment [email protected] Maternity services - giving birth prior to Covid-19. 01302 965450 Then and now | Healthwatch Doncaster | Annual Report 2020-21 23

Enter and View – This year, due to the COVID-19 pandemic, we did not make use of our statutory Enter and View powers. Consequently, no recommendations or other actions resulted from this area of activity.

Due to the Covid-19 pandemic it has not been possible to carry out any Enter and View visits during the past year. We have, however, been working on a number of other activities related to Enter and View throughout the year. We aim to be able to return to conducting Enter and View visits when it is safe and practical to do so.

The Healthwatch Doncaster Enter and View In a separate piece of work, a care home Planning Group, made up of volunteers with resident’s story was captured via a series of one staff member, have been meeting via conversations recorded on Zoom. The Zoom throughout the pandemic. The group conversations with the care home resident, have devised a strategy to engage with local their family and the care home manager were care homes to build a picture of what impact shared at NHS Doncaster CCG’s Governing the pandemic has had on their residents and Body. This enabled Governing Body staff. member’s to gain an insight into the impact of the Covid-19 restrictions on care home The approach that has been developed residents and their families. The video and involves engaging with the local care homes update was well received. to co-produce a method of capturing experiences that has least impact on the As part of Healthwatch Doncaster’s home and residents. The Enter and View commitment to Enter and View and Planning Group have ensured that the conversations in care homes, our Volunteer approach is sensitive to the needs of the Co-ordinator and Engagement Officer has people who live in the care homes. been working with a team from Healthwatch England and the Healthwatch Newham. This has culminated in the development and delivery of a series of workshops on Virtual Visits. The workshops were delivered nationally to staff and members from across the Healthwatch network. Virtual visits cannot be classed as Enter and View but can provide an alternative to carrying our a formal visit.

In addition to this our Volunteer Co-ordinator and Engagement Officer delivered Enter and View training via MS Teams to staff from local Healthwatch teams from across the country. Then and now | Healthwatch Doncaster | Annual Report 2020-21 24

Choice for All Doncaster – ChAD – a committee of adults with learning disabilities

Over the past year the Peer Support Worker Attending Inclusion North’s Yorkshire and Humber for ChAD has continued to keep in touch with LEDER project steering group meeting the committee members by both phone and Zoom. Developing the Foreword for the All Age Learning Disability and Autism Strategy ChAD members have been supported with ongoing concerns and anxieties about Covid- NHS Independent Voices Pilot 19. They have continued to raise issues and Scheme concerns around keeping safe and Two members of ChAD are involved in this safeguarding on behalf of the people they project that involves developing measures represent. against abusive situations that occurred at Throughout the pandemic ChAD have held Winterbourne View and Whorlton Hall. two 1-hour meetings on Zoom every week. It involved speaking with patients, who have a One of the weekly meeting is used to discuss Learning Disability and Mental Health issues, projects and matters important to ChAD and in a Medium Secure hospital to ensure that the LD community The other meeting is a they are safe and involved in their future more relaxed fun session to help with discharge plans. The project was very intense member’s emotional health and well-being. and proved to be very successful. It will make ChAD members have been involved in such a difference to people’s lives and their producing short videos and information to recovery. raise awareness in the Learning Disability Easy Read information community of the importance of getting Covid-19 and flu vaccinations. ChAD members have produced two 20-page Easy Read local information booklets that have been Other work that ChAD members have distributed to over 850 adults who have a Learning been involved includes: Disability in Doncaster.

Easy Read Terms of Reference for Doncaster’s There has been lots of positive feedback about the Learning Disability Partnership Board booklets from the people whom ChAD represent.

Input in RDaSH’s Easy Read Charter poster

Want to find out more about Choice for All Doncaster? Contact them today!

Website: www.chadindoncaster.com Telephone: 07834 686858 Email: [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 25

Health Ambassadors The Patient Participation Group Network

The Health Ambassadors group supports The Patient Participation Group Network is a people and communities whose voices are monthly forum that brings together seldom heard to speak up and out on issues representatives from a number of local that are important to them. We work closely Practice Patient Participation Groups (PPGs). with NHS Doncaster CCG, Doncaster Council The aim of the Network is to share good and Doncaster and Bassetlaw Teaching practice, provide feedback on developments Hospitals to ensure that people’s voices are and changes to Primary Care and to identify heard and that areas for improvement are themes or areas for improvement. identified. As with many groups and networks, the focus The Health Ambassadors have maintained of the PPG Network was on the response to their input and involvement throughout the the Covid-19 pandemic. The Network Covid-19 pandemic. It has been interesting to members were keen to maintain their monthly hear how our diverse communities dealt with meetings and we were able to support them the changes and developments. The local all to access the meetings via Zoom. Asylum Seeker and Refugee community made us aware that safer accommodation had been Discussions at meetings centred heavily on offered to individuals who have no fixed the provision of and access to information for abode, while the more skilled members of the patients about local Practice changes as a community were making face masks for result of Covid-19. people who attend the Doncaster Members of the Network identified that there Conversation Club. In addition to this, school was help and support that they could offer in aged children were offered digital resources relation to the provision of information by such as laptops to access education during reviewing each local Practice website. A lockdown. There have been some struggles in project report identified a series of terms of accessing dental care and recommendations that have been shared with understanding Government guidance but the GP Federation and the Local Medical there is support available from the Doncaster Committee. There are on-going discussions to Conversation Club. monitor and review the impact of the recommendations.

Want to find out more about Healthwatch Ambassadors and the Patient Participation Group?

Website: https://www.healthwatchdoncaster.org.uk/get-involved Telephone: 01302 965450 Email: [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 26

Keeping Safe Forum

In the early part of the Covid-19 pandemic, The Keeping Safe Forum was formally the Keeping Safe Forum meetings were relaunched in January 2021 and takes place postponed until we were able to engage monthly on Zoom. The key themes that which people in a digital forum. Members of the been explored within the Forum are: Keeping Safe Forum were kept informed and engaged through phonecalls, emails and • Safeguarding is everybody’s business newsletter updates. delivered by NSPCC

The Annual Community Keeping Safe Event • Suicide prevention and bereavement was delivered digitally this year in line with support delivered by Open Minds & Government guidance and lockdown Changing Lives restrictions. The week consisted of a series of • Brain Disease Awareness – Huntington’s safeguarding workshops and awareness Disease: A carer’s perspective. sessions delivered in collaboration with local partners including St Leger Homes, The Avalon Group, Family Hubs and Hive South Yorkshire.

The week long event culminated in a panel that came together via Zoom that was delivered via Facebook Live. The panel discuss the importance of ensuring that ‘Safeguarding is everybody’s business’. The panel featured the newly appointed Chair of the Safeguarding Board – John Goldup, Chair of the Keeping Safe Sub group – Andrew Goodall, Learning and Development Manager – Shabnum Amin, Keeping Safe Forum Facilitator – Natalie Bowler-Smith and Samuel Finn British Youth Councillor.

Want to get involved in the Keeping Safe Forum?

Website: www.healthwatchdoncaster.org.uk/get-involved Telephone: 01302 965450 Email: [email protected] Then and now | Healthwatch Doncaster | Annual Report 2020-21 27 Finances

To help us carry out our work we receive funding from our local authority under the Health and Social Care Act 2012. We also receive additional funding from our local Clinical Commissioning Group (CCG) to deliver work around PPGs and Health Ambassadors.

We have also received additional funding to deliver support and leadership to the development of a model of representation for the local Voluntary, Community and Faith Sector in Doncaster and, as part of the national response to the Covid-19 pandemic, Healthwatch Doncaster received a grant from the UK Government.

Income 7.2% Funding from Local Authority 4.3%

8.5% Funding from CCG Total income £237,393 Additional funding COVID-19 grant 80% Additional funding VCF project and admin

Expenditure Staff costs 15%

Premises costs 9% Total expenditure Running costs £230,538

76% Then and now | Healthwatch Doncaster | Annual Report 2020-21 28 Next steps

Top three priorities for 2021-22 1. Restart community engagement and listen to local people about their experiences of accessing services

2. Mental Health – listen to people’s experience of mental health support in Doncaster

3. Access to Dental Care – review and investigate the provision of local Dental services for local people

Next steps • Transforming the way that we work – Healthwatch Doncaster will be more agile and community-based

• Maintaining digital engagement alongside face-to-face engagement

• Continue to focus on listening to people from communities whose voices are seldom heard

“We are committed to hearing from and listening to people whose voices are seldom heard so that we can highlight and tackle unfair health differences. Continuing to support and develop our strong relationships with partners across health and social care in Doncaster will enable us to achieve this” Then and now | Healthwatch Doncaster | Annual Report 2020-21 29 Thank you

This year has been a year like no other. Without the support of our Board members, staff, volunteers, local people and partners then we would not have been able to continue to listen to and share the experiences of people throughout the Covid-19 pandemic.

More than ever there is a need to be kind to one another, to work in partnership and to be creative and innovative in the work that we do. We can build on what we have all learned over the last 12 months and we will continue to listen to the voices and experiences of people and communities as we restart and re-engage in all the exciting activities that make us an active, thriving and committed partnership of people, places and positivity. Then and now | Healthwatch Doncaster | Annual Report 2020-21 30

Statutory statements

About us Doncaster Healthwatch CIC, 3 Cavendish Court, Doncaster DN1 2DJ

Healthwatch Doncaster uses the Healthwatch Trademark when undertaking our statutory activities as covered by the licence agreement. The way we work Involvement of volunteers and lay people in our governance and decision-making.

The Healthwatch Doncaster Board consists of 7 members who work on a voluntary basis to provide direction, oversight and scrutiny to our activities. Our Board ensures that decisions about priority areas of work reflect the concerns and interests of our diverse local community. Through 2020/21 the board met 10 times and made decisions on matters such as the renegotiation of the local contract for Healthwatch services including a budget efficiency saving and agreeing the new strategic business plan incorporating a commitment to digital engagement.

We ensure wider public involvement in deciding our work priorities. We listen to the views and experiences of local people that have been shared with the Engagement Team and through the Feedback Centre. The key aspects and themes of these experiences are used to shape future priorities. For example Healthwatch Doncaster has heard a number of experiences linked to local cancer services which enabled us to develop a focussed, qualitative piece of work on Cancer pathways in Doncaster.

Healthwatch Doncaster supports and facilitates a number of public forums and meetings. Our plans and project ideas are discussed in these meetings and engagement from local groups and organisations sought so that we can engage as many people as possible in the project work. Then and now | Healthwatch Doncaster | Annual Report 2020-21 31

Methods and systems used across the year’s work to obtain people’s views and experience. Healthwatch Doncaster use a wide range of approaches to ensure that as many people as possible have the opportunity to provide us with insight about their experience of health and care services. During 2020-21 we have been available by phone, by email, provided a webform on our website, provided a feedback centre, attended virtual meetings of community groups and forums, provided our own virtual activities and engaged with the public through social media.

We are committed to taking additional steps to ensure we obtain the views of people from diverse backgrounds who are often not heard by health and care decision makers. This year we have done this by, for example, listening to the views and experiences of Asylum Seekers and Refugees. Reports of people’s experiences are shared at Engagement and Experience Committees in both the local Clinical Commissioning Group and the local Teaching Hospital Foundation Trust.

We ensure that this annual report is made available to as many members of the public and partner organisations as possible. It is published on our website, on social media and through newsletters. 2020-21 priorities

Project / activity area Changes made to services Experiences of local people have influenced both Covid-19 pandemic – information, advice, the local testing programme and the vaccination signposting and support for local people programme. We continue to share reports and experiences. Recommendations made to Cancer Programme Experience of Cancer pathways during Covid-19 Board and shared with Commissioners and Providers. Reports and recommendations used by both Missed Appointments/Digital Appointments Primary and Secondary Care to support restart of services and improving access. Video interview and story shared at CCG Care homes – impact of Covid-19 Governing Body. Synopsis report of experience of resident and family written and shared. Local engagement has taken place digitally online and on the phone. Engagement and involvement Re-imagining engagement and involvement has been really successful with learning embedded for future work.

Responses to recommendations and requests We have not had any providers who did not respond to requests for information or recommendations.

This year, due to the COVID-19 pandemic, we did not make use of our Enter and View powers. Consequently, no recommendations or other actions resulted from this area of activity.

There were no issues or recommendations escalated by Healthwatch Doncaster to Healthwatch England’s Committee and so there were no resulting special reviews or investigations. Health and Wellbeing Board Healthwatch Doncaster is represented on the Doncaster Health and Wellbeing Board by Steve Shore, Chair of Healthwatch Doncaster. During 2020/21 our representative has effectively carried our this role by attending digital Health and Wellbeing Board meetings and contributing to the on-going discussions around health inequalities, the impact of the COVID-19 pandemic and recovery after the pandemic. Healthwatch Doncaster 3 Cavendish Court South Parage Doncaster DN1 2DJ www.healthwatchdoncaster.org.uk t: 01302 965450 e: [email protected]

@HWDoncaster Facebook.com/HWDoncaster /HealthwatchDoncaster Meeting name Governing Body Meeting date 02 September 2021

Title of paper Audit Committee Annual Report 2020/21

Executive / Paul Wilkin, Lay Member for Audit & Governance Clinical Lead(s) Author(s) Cheryl Rollinson, Head of Corporate Governance

Status of the Report

To approve To consider / discuss

To note X

Purpose of Paper - Executive Summary

The purpose of this report is to present the final Audit Committee Annual Report for 2020/21.

The report details the activities undertaken during the financial year and provides assurance that the Committee are operating within its remit and Terms of Reference.

Recommendation(s) Governing Body are asked to note the report.

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Quality impact Nil Tick relevant box

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

Legal Nil implications Management of Conflicts of Nil Interest Consultation / Engagement (internal Audit Committee departments, clinical, stakeholder and public/patient) Report previously None presented at Risk Nil analysis Corporative Objective / CO1 (1.1) Assurance Framework

Annual Audit Committee Chair Report to the Governing Body 2020-21

1. Introduction

This report sets out the key activities undertaken by the Audit Committee in the past year in order to discharge its duties under its approved terms of reference.

The report is submitted to the Governing Body to provide assurance that the Committee is operating effectively and in accordance with its terms of reference. This report covers the financial period from April 2020 to March 2021.

2. Membership, Meetings and Attendance during 2020-21

During the period covered in the report the Committee met on five occasions. The table below details the membership of the Committee as at 2 March 2020.

Member Title Attendance Paul Wilkin Lay Member 100% Sarah Whittle Lay Member 80% Marney Khan Locality Lead 100% Emyr Jones Secondary Care Doctor 100%

The following officers of the CCG were also in regular attendance:

• The Chief Finance Officer • The Head of Corporate Governance • The Deputy Chief Finance Officer • The Associate Director of Human Resources and Corporate Services.

Representatives from Internal Audit, External Audit and Counter Fraud services were also in attendance at each meeting.

Due to the Covid-19 pandemic, the Committee have had to adapt to meet operational requirements. Meetings have taken place virtually via Microsoft Teams, Members have indicated that these arrangements have worked well and have been effective, allowing the Audit Committee to continue its work without hindrance. The adapted way of working has not had any detrimental effect on operational requirements.

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3 The Audit Committee and its Work During 2020-21

3.1 Integrated Governance, Risk Management and Internal Control

The Committee critically reviewed the maintenance of an effective system of integrated governance, risk management and internal control. In particular the Committee completed the following:

• Review of the Annual Governance Statement and the assurance provided by the Head of Internal Audit opinion • Regular reviews of the CCG risk register supported by an Internal Audit report on Governance and Risk Management. • Quarterly reviews of the adequacy of the Board Assurance Framework including an annual deep dive with the lead Executives present. • Regular reports from the local counter fraud service. • Review of the CCG’s register of interest including an internal audit report • Regular updates in relation to financial issues. • Review and approval of key policies in line with the Committee’s terms of reference.

3.2 The Work of External Audit

External Audit services for 2020-21 were provided by KPMG. During the year the Committee reviewed the work and findings of the External Auditors and considered the implications and management responses to their work. This was achieved by:

• Discussion with External Auditors of their local evaluation of audit risks. • Review of the External Audit reports, including the report to those charged with governance and the annual audit letter. • Review of the periodic policy updates and developments that were provided by the External Auditors. These provided a basis for relevant enquiry to gain assurance that the CCG was aware of such developments and that the appropriate action was being taken where necessary.

3.3 The Work of Internal Audit and Counter Fraud

Internal Audit and counter fraud services for the CCG are provided by 360 Assurance. The CCG received the draft Internal Audit Plan for 2021-22 at the 11 March 2021 Audit Committee. The plan took into account discussions between Internal Auditors, the Audit Committee Chair and Executive Management. It also incorporated best practice and nationally mandated requirements.

In relation to counter fraud, the Committee satisfied itself that the CCG had adequate arrangements in place for countering fraud. The Counter Fraud Plan 2021/22 was agreed in line with the overall audit plan. 360 Assurance provided regular updates in relation to the progress of the plan and any other counter fraud issues.

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During the year the following audits were undertaken:

Audit Title Status Assurance Level Date Reported to Provided Audit Committee Head of Internal Audit Opinion Complete N/A 10 December 2020 Stage 1

Head of Internal Audit Opinion Complete N/A 11 March 2021 Stage 2

Conflicts of Interest Issued Significant 11 March 2021

Integrity of the General Issued Significant 27 May 2021 Ledger, Financial Reporting and Key Financial Systems

Delegated Primary Issued Substantial 13 May 2021 Medical Care Functions

Data Security Standards Issued Substantial 8 July 2021 & Protection Toolkit

HR Shared Services Issued Significant 11 March 2021 Review

The Audit Committee regularly reviewed delivery of Internal Audit recommendations against agreed timescales. These are currently at 100% delivery.

4 The Audit Committee Annual Self- Assessment

At the meeting in March 2021, the Audit Committee discussed the summary report following the annual self- assessment. The results were positive with no recommendations identified.

5 Actions and Plans for 2020-21

The Internal Audit and Counter Fraud Plan 2021-22 was approved by the Audit Committee at its meeting on 11 March 2021.

The Internal Audit Plan has been developed to meet the CCG’s assurance requirements, which reflects the CCG’s strategic objectives and priorities, is compliant with the Public Sector Internal Audit Standards, and provides for an annual Head of Internal Audit Opinion.

The Counter Fraud Plan has been developed through consideration of the CCG’s local fraud, bribery and corruption risks.

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5.1 Internal Audit Plan 2021-22

The overall requirements of the plan will ensure appropriate coverage to meet the requirements of the Public Sector Internal Audit Standards, facilitates the Audit Committee in discharging its responsibilities in relation to governance, risk management and control; and supports achievement of strategic objectives.

The following areas detail the key areas of focus of the internal auditors; a) Governance and Risk Management: • Head of Internal Audit Opinion • Conflicts of Interest b) Financial Management: • Integrity of the General Ledger, Financial Reporting and Key Financial Systems • Delegated Primary Care Functions c) Information Management & Technology • Data Security Standards d) Quality • Liberty Protection Safeguards: Implementation of the Mental Capacity (Amendment) Act 2019 - client wide project e) Management, Follow Up and Contingency

5.2 Counter Fraud Plan 2021-22

The 2021-22 plan has been developed through consideration of the organisation’s identified fraud, bribery and corruption risks and the requirements of Government Functional Standard 013: Counter Fraud (‘the Functional Standard’), implemented within the NHS for the first time from April 2021.

The Functional Standard removes the previous strategic areas of Strategic Governance, Inform and Involve, Prevent and Deter and Hold to Account and sets out a range of specific component requirements. There are a total of 12 components and the annual SRT has been replaced by the Counter Fraud Functional Standard Return (CFFSR).

The key activities are split across 12 components as follows:

1- Accountable individual 2- Counter fraud, bribery, and corruption strategy 3- Fraud, bribery, and corruption risk assessment 4- Policy and response plan 5- Annual action plan 6- Outcome-based metrics 7- Reporting routes for staff, contractors and members of the public 8- Report identified loss 9- Access to trained investigators 10- Undertake detection activity 11- Access to and completion of training

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12- Policies and registers for gifts and hospitality and COI

. 6 Looking Towards 2021/22

With the February 2021 publication of the government's white paper, 'Integration and innovation: working together to improve health and social care for all', the South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) is set to evolve into a statutory body by April 2022. NHS Doncaster CCG, along with all other CCGs in England, will be abolished and the functions and staff from the five CCGs in SYB will transfer into the new SYB ICS NHS body.

There will still remain a strong Doncaster place-based commissioning presence and NHS Doncaster CCG continues to work in collaboration with the other SYB health and social care organisations to ensure that we take advantage of these system changes to further integrate care and improve the health outcomes for our local populations.

Moving into 2021/22, the Audit Committee have agreed to have a standing agenda item to discuss any issues or concerns around the ICS transition arrangements. Escalations from the Committee will continue via the Chairs report to Confidential Governing Body

7 Recommendation to Governing Body

The Governing Body is asked to note the contents of the report and take assurance that the Audit Committee is carrying out its purpose in line with its agreed terms of reference.

Author: Paul Wilkin, Lay Member & Chair of Audit Committee Date: 13 May 2021 Finalised: 08 July 2021

Page 5 of 5 Meeting name Governing Body Meeting date 2 September Title of paper Quality & Performance Report

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

Status of the Report

To approve To consider / discuss

To note x

Purpose of Paper - Executive Summary This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (DCCG) Governing Body which due to reporting restrictions or information potentially identifiable to a patient level have not been included within the main report. This report reflects 2020/21 performance and includes a focus on 2021/22’s Starting Well Delivery Plan.

Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Further details on the reporting ceased which have been agreed with DCCG’s main providers can be found here: https://www.england.nhs.uk/coronavirus/publication/reducing-burden-and-releasing- capacity-at-nhs-providers-and-commissioners-to-manage-the-covid-19-pandemic/.

NHS Operating Planning and Contracting guidance has been released with the CCG and partner organisations working to implement recovery standards and set trajectories. This includes work around the 2021/22 Operating Framework: NHS England » NHS Operational Planning and Contracting Guidance

Please note all data is validated and quality checked internally within DCCG and with Providers as necessary. Where there is a data quality concern on any of the data or metrics presented in the following report, this will be stated in the narrative accompanying the data. Measures which also form part of the NHS Oversight Framework have been identified as (OF) within this report.

The overall response will impact a number of measures, and the ability of providers to report information, in the coming which will be detailed in future reports.

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

Restoration of elective and cancer care and manage the increasing demand on mental health services

• Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance improved to 73.6% during July but remains below the 92% target (Page 6). The total waiting list size now exceeds the target. • 52 week waits – There were 773 DCCG patients waiting over 52 weeks for treatment at the end of July, a reduction of 37. (Page 10). • Patients waiting less than 6 weeks for a diagnostic test – Performance in July failed to meet the 99% target at 53.5% (Page 12) • Cancer 2 week waits – Performance during Quarter 1 failed to meet the 93% target at 79.1% (Page 18). • New measure: Cancer 28 days faster diagnosis standard – Performance during Quarter 1 was 70.9% (Page 19) • Cancer 31 day waits – Performance during Quarter 1 failed to meet the 96% target at 94.9% (Page 20). • Cancer 62 day waits – Performance during Quarter 1 failed to meet the 85% target at 75.1% (Page 22).

Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay

• Yorkshire Ambulance Service – No measures were met during July 2021 (Page 27). • Accident and Emergency – Performance deteriorated in July 2021 to 72.7% and remains below the 95% target (Page 28).

Other Commissioned Services Improving Access to Psychological Therapies (IAPT) – 2009 people entered into treatment during Quarter 1 (target 1750) (Page 21)

Delivery Plan Reporting Full summary Starting Well June 2021 position (Page 30)

Supporting Measures (Page 38)

Recommendation(s) The Governing Body is asked to:

Note the Quality and Performance Report Report Exempt from Public Disclosure If yes, detail grounds for exemption: Yes No x

Impact analysis Quality impact Positive quality impact from a consistent focus on quality outcomes. 2

Specific quality impact as identified in the report.

Tick relevant box

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

Sustainability Nil impact Financial Nil implications Legal Nil Implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.

Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) N/A Report

previously

presented at

Risk Risks are captured in the Executive Summary. Analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework

Section1: Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19

1.1 Vaccination

The roll-out of the vaccination continues, with vaccines now being administered to at risk children aged 12-15yr and 16-17 yr (in line with recent Joint Committee Vaccination and Immunisation guidance).

Up to and including 24th August 217263 1st doses and 196954 2nd doses have been administered to Doncaster registered patients. 81.55% of the Doncaster registered population aged 16 and over have received a 1st dose and 73.93% have received both doses.

Impact of Vaccination Programme

Planning as now commenced on Phase 3 of the programme to deliver booster vaccinations to those identified as eligible under the interim JCVI guidance as below (final guidance expected early September).

Stage 1 • adults aged 16 years and over who are immunosuppressed; • those living in residential care homes for older adults; • all adults aged 70 years or over; • adults aged 16 years and over who are considered clinically extremely vulnerable; • frontline health and social care workers.

Stage 2 • all adults aged 50 years and over • adults aged 16 –49 years who are in an influenza or COVID-19 at-risk group. • adult household contacts of immunosuppressed individuals

5 All five Doncaster PCNs have signed up to Phase 3 of the programme and are awaiting sign off from NHSE to move forward to Phase 3. Five Community Pharmacies have also been put forward to be designated sites for Phase 3 and are currently undergoing assurance and compliance checks with NHSE.

1.2 Long Covid

A dedicated Post COVID Assessment clinic is established within Doncaster and further guidance has been received from NHS England to support people with ongoing symptomatic Covid-19 and with post-covid-19 syndrome strengthening diagnostics, treatment and rehabilitation. Work is now underway to ensure robust reporting is available and to model demand for those people who can be supported through primary care or care in a community setting and those who will potentially need a specialist assessment and treatment. A South Yorkshire and Bassetlaw Integrated Care System service is being established for Children and Young People. Section 2: Restoration of elective and cancer care and manage the increasing demand on mental health services

The 2021-22 Planning guidance requires Systems and their constituent Places to building on learning during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services.

2.1 Referral To Treatment (RTT) Performance

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks July- Commissioner Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 June-21 July-21 20 Doncaster CCG 52.9% 57.6% 64.1% 67.9% 68.9% 67.0% 65.0% 64.1% 68.4% 70.1% 73.1% 74.3% 73.6%

Rightcare Peer Group 46.5% 55.4% 64.9% 70.9% 73.1% 72.5% 63.8% 70.3% 55.9% 57.8% 60.0% 60.4% Doncaster and Bassetlaw Teaching 49.2% 54.0% 60.7% 64.9% 66.1% 64.6% 62.5% 61.8% 65.7% 67.4% 70.8% 71.6% 70.8% Hospitals Foundation Trust (DBTHFT) England 48.2% 54.8% 61.6% 66.3% 68.7% 68.3% 66.7% 64.9% 64.7% 65.1% 67.8% 69.0%

Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

6 Performance for Doncaster Clinical Commissioning Group (DCCG) patients at all Trusts was 73.6% in July 2021, below the 92% target. Performance was below control limits suggesting performance is under expected levels for the service.

The chart above shows that RTT performance has worsened over the last 2 years with 3 clear stages of continual deterioration. Latest performance is below the normal range of the service, affected adversely during the Covid-19 pandemic. The RTT Treatment function groups have been recategorized to make it easier to identify the specialty area, and there are now 21 specialties, of which DCCG failed to meet the 92% standard for DCCG for 17:

• Cardiology service (86.2%) • Ear, Nose & Throat (58.9%) • Elderly Medicine (83.0%) • Gastroenterology (89.7%) • General Internal Medicine (77.7%) • General Surgery (67.0%) • Gynaecology (82.9%)

7 • Neurology (84.7%) • Neurosurgery (67.1%) • Ophthalmology (75.0%) • Other - Other services (85.8%) • Other – Paramedic (78.0%) • Other – Surgical (82.0%) • Plastic Surgery (79.0%) • Respiratory Medicine (90.2%) • Trauma and Orthopaedics (T&O) (64.1%) • Urology (50.3%)

Benchmarking data from June 2021 (latest benchmark) shows DCCG performance was below the England average in 3 specialties, Urology, ENT and Elderly medicine. England was 69.0% against DCCG which was 74.3%.

The waiting list shape for Doncaster CCG patients at any provider is shown below. The CCG monitors the waiting list weekly and is in regular contact with DBTHFT for the most up to date position on patients waiting over 40 weeks, to try to reduce long waiters, including those who may breach 52 weeks.

Doncaster CCG patients on incomplete RTT pathways on 31st July 2021 2500

2000

1500

1000

500

0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 100 102 104 Weeks waiting

8 DBTHFT’s July 2021 position improved to 70.8% (provisional position). Eighteen specialties failed to meet the 92% standard:

• Breast Surgery (85.8%) • Ear, Nose & Throat (56.4%) • General Medicine (78.4%) • General Surgery (66.0%) • Geriatric Medicine (82.9%) • Gynaecology (84.9%) • Medical Ophthalmology (87.8%) • Ophthalmology (71.5%) • Oral Surgery (64.4%) • Orthodontics (85.7%) • Pain Management (90.8%) • Podiatry (84.0%) • Respiratory Medicine (90.6%) • Rheumatology (91.9%) • Trauma and Orthopaedics (60.1%) • Upper Gastrointestinal (39.2%) • Urology (50.6%) • Vascular surgery (82.7%)

The main issues impacting DBTHFT are the reduced non-urgent elective activity due to a reduced operating timetable, the challenge to maximise theatre capacity due to staffing and an increase in patient cancellations internally and with private sector providers. The Trust are continuing to source additional lists at Park Hill for T&O and maximising opportunities with Barlborough and Trent Cliff. Additional lists are also being sourced on all possible sites. The Integrated Care System is considering of alternative incentive schemes for Trust staff groups.

2.2: Waiting List Size

The focus of the operational planning guidance for 2021/22 is tackling the long waiting patients. Previously the focus has been to ensure that the number of patients on incomplete pathways is maintained below or at the waiting list size at the end of January 2020 by March 2021. The number of DCCG patients on incomplete RTT pathways increased in July 2021 by 1055 patients to 29979. This exceeds the

9 waiting list target (22206) by 7773 patients. The Trust have recommissioned Source Group (previously called North of England Commissioning Support) to undertake further data quality work on the Patient Tracking List (PTL) and validate all patients on this list.

2.3 52 Week Breaches

52 Week Waits –Incomplete Pathways

Provider July-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jun-21

Doncaster CCG 104 184 235 281 426 664 1083 1501 1562 1287 954 810 773

DBTHFT 157 278 345 393 631 986 1635 2272 2399 1943 1433 1210 1100

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

The number of breaches has increased since April 2020 primarily due to Covid-19 with Trusts expected to report breaches upto and including 104 weeks from April 2021. For July DCCG are reported to have 773 over 52 week breaches (a reduction of 37 from the previous month).

In July 2021 DBTHFT reported 1100 breaches due to Covid 19 delays, down from 1210 at the end of June 2021. Regional benchmarking indicates that DBTHFT have 2.7% of the PTL waiting over 52 weeks, and a falling trend, which is benchmarked as “green” in the range across the region.

The graph below shows the number and length of waits as at 16th August 2021 at DBTHFT data from weekly PTL data from DBTHFT

10 Number of patients on RTT pathway who have waited over 52 weeks at DBTHFT as of 16th August 2021 120

100

0 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 96 101 108 119

The table below gives the breakdown of the total breaches for DCCG in July by specialty:

General General Other - Other - Plastic Respiratory Other - Cardiology ENT Gynaecology Neurosurgical Ophthalmology Other T&O Urology Internal Total Surgery Paediatric Surgical Surgery medicine Medical Medicine DBTHFT 0 73 41 3 0 110 5 0 7 0 0 369 50 4 1 663 Other providers 3 1 8 6 2 5 1 32 7 6 3 25 7 4 0 110 Total 3 74 49 9 2 115 6 32 14 6 3 394 57 8 1 773 2.4 Diagnostics Patients waiting less than 6 weeks for a Diagnostic test

Commissioner Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 July-21

Doncaster CCG 49.6% 54.7% 58.4% 58.5% 61.8% 60.6% 57.2% 66.3% 67.5% 61.0% 58.6% 55.6% 53.5%

Rightcare Peer Group 61.9% 65.6% 71.7% 76.2% 77.2% 75.3% 74.0% 80.5% 83.5% 83.4% 84.3% 85.2%

DBTHFT 50.0% 54.4% 58.4% 58.8% 61.8% 60.4% 56.1% 66.3% 67.2% 60.6% 57.6% 54.3% 52.5%

England 60.4% 61.9% 66.9% 70.8% 72.5% 70.8% 66.7% 71.5% 75.7% 76.0% 77.7% 77.7%

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

11 Patients waiting less than 6 weeks for a diagnostic test 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jul-21 Jul-20 Jul-19 Jul-18 Jul-17 Oct-20 Apr-21 Oct-19 Apr-20 Oct-18 Apr-19 Oct-17 Apr-18 Apr-17 Jun-21 Jan-21 Jun-20 Jan-20 Jun-19 Jan-19 Jun-18 Jan-18 Jun-17 Mar-21 Mar-20 Feb-21 Mar-19 Feb-20 Mar-18 Feb-19 Feb-18 Nov-20 Dec-20 Nov-19 Dec-19 Aug-20 Sep-20 Nov-18 Dec-18 Aug-19 Sep-19 Nov-17 Dec-17 Aug-18 Sep-18 Aug-17 Sep-17 May-21 May-20 May-19 May-18 May-17 % waiting under 18 weeks Avg LCL Target

Performance for DCCG in July 2021 deteriorated to 53.5% of patients waiting less than 6 weeks for a test (5939 breaches) below the 99% target. Performance is below the statistical process control limits on the chart above which indicates performance is outside the normal variation expected for the service. Since March 2020 performance has been severely impacted by the Covid-19 pandemic.

The table below shows the diagnostic modalities that were impacted by Covid-19. Due to the National and Local response to the pandemic from March 2020 most of the Trust’s routine activity ceased limiting their ability to see patients already in the system and those referred in within the 6- week timeframe.

The issues affecting performance are an increase in 2ww referrals, urgent and routine referrals for MRI plus an increase in 2ww and urgent referrals, with a decrease in routine referrals for CT scans.

A decrease in general Ultrasound referrals, with a reduction in 2ww, urgent and routine referrals was seen. There has been a slight increase for Vascular Ultrasound for 2ww and routine referrals remaining the same, but a significant reduction in urgent scans. An increase in planned and unplanned plain film referrals

12 Reduced capacity in Non Obstetric Ultrasound waiting rooms due to Covid 19 Infection Control requirements

The service continues to proactively look for ways to optimise capacity and scheduling to help release more capacity with 2ww and urgent patients being booked into additional sessions to prevent breaches. There will be a recruitment of an additional MSK radiologist to increase capacity. DBTHFT’s July 2021 position worsened from the previous month to 52.5% against the standard of 99%. This is a reduction from last month and continues to be below the national and peer benchmark. There is a specific focus on recovering the Radiology position. Full details of individual testing pathways are shown in the table below.

Exam Type <6W >=6W Total Performance Longest Waits

MRI 1670 2007 3677 45.42% 38

CT 1935 551 2486 77.84% 37

Non-Obs Ultrasound 4009 5074 9083 44.14% 47

DEXA 447 290 737 60.65% 47

Audiology 331 189 520 63.65% 76

Echo 319 7 326 97.85% 7

Nerve Conduction 139 212 351 39.60% 22

Sleep Study 10 1 11 90.91% 7

Urodynamic 36 54 90 40.00% 70

Colonoscopy 202 118 320 63.13% 34

Flexible Sigmoidoscopy 82 64 146 56.16% 28

Cystoscopy 390 39 429 90.91% 80

Gastroscopy 331 349 680 48.68% 30

Total 9901 8955 18856 52.51%

2.5 Cancer Measures

DBTHFT are participating in the testing phase of the Clinically led Review of Standards (CRS) for cancer as 1 of 13 sites nationally. As part of the testing there will be a change in reporting with 2 week wait for Breast Symptomatic reporting no longer available for the Trust to be benchmarked. An additional Faster Diagnosis Standard will be trialed during this period and is defined as a ‘Maximum four weeks (28 days) from receipt of urgent General Medical Practitioner, General Dental Practitioner or Optometrist referral for suspected cancer, breast symptomatic referral or urgent screening referral, to the point at which the patient is told they have cancer, or cancer is definitely excluded’.

Work has been completed across Intelligence Teams within the Integrated Care System to ensure that the impact of Covid-19 can robustly be monitored in relation to cancer treatment. From April 2020 onwards Trusts have been requested to assign Covid-19 related 2 week wait breaches to ‘Other Reason’ which will include, anyone diagnosed with Covid-19, isolating due to symptoms or family reasons and capacity attributed directly to Covid-19. For all other measures ‘Other reasons’ relate to all miscellaneous reasons.

15 2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

Q2 Oct- Nov- Dec- Q3 Jan- Feb- Mar- Q4 Apr- May- Jun- Q1 Commissioner 20/21 20 20 20 20/21 21 21 21 20/21 21 21 21 21/22

Doncaster CCG 88.5% 91.5% 79.6% 80.7% 83.8% 70.6% 77.1% 76.5% 73.8% 71.0% 81.1% 85.0% 79.1%

Rightcare Peer Group 94.1% 94.6% 93.8% 95.6% 94.7% 93.5% 97.0% 97.6% 96.2% 95.5% 96.4% 95.5% 95.85

Cancer Alliance 93.7% 95.5% 90.4% 90.4% 92.0% 83.9% 90.1% 89.8% 88.1% 81.7% 84.3% 86.2% 84.1%

England 88.0% 87.9% 87.0% 87.54 87.5% 83.4% 90.3% 91.2% 88.6% 85.4% 87.5% 84.9% 85.9%

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

2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 100% 95% 90% 85% 80% 75% 70% 65% Jul-20 Jul-19 Jul-18 Apr-21 Apr-20 Oct-20 Apr-19 Oct-19 Apr-18 Oct-18 Jun-21 Jun-20 Jan-21 Jun-19 Jan-20 Jun-18 Jan-19 Mar-21 Mar-20 Feb-21 Mar-19 Feb-20 Feb-19 Nov-20 Dec-20 Aug-20 Sep-20 Nov-19 Dec-19 Aug-19 Sep-19 Nov-18 Dec-18 Aug-18 Sep-18 May-21 May-20 May-19 May-18 % of cancer referrals seen within 2 weeks Avg LCL Target

16 Performance in June 2021 was 85.0% which is below the target of 93%. There were a total of 165 breaches in June, of which 89 were due to outpatient capacity inadequate, 49 were 'patient choice', 19 were admin delay, 6 were clinic cancellation and 2 which were associated to Covid-19.The breaches were spread across the following 8 tumour groups; Upper GI (9), Skin (12), Urology, (18), Breast (107), Lung (8), Gynaecology (5), Head and Neck (4) and Lower GI (2). Four tumour groups performed below the 93% target, and these were Breast (45.4%), Lung (76.5%), Upper GI (90.8%) and Urology (82.7%). The longest an individual had to wait to be first seen was 41 days from referral and this was due to patient choice in their outpatient appointment. In June 2021, there were a total of 1099 people seen.

In Q1 2021/22 performance of 79.1% is below the 93% target. Breast (31.1%), Children (92.3%), Head and Neck (92.2%), Lung (80.3%), Upper GI (87.5%) and Urology (87.6%) were the tumour groups to perform below the 93% standard. There were a total of 3140 people seen in Q1.

On 30th June 2021 DBTHFT reopened choose and book, to enable direct booking from GPs for 2ww and routine breast patients.

Maximum four weeks (28 days) from receipt of urgent General Practice (General Medical Practitioner, General Dental Practitioner or Optometrist) referral for suspected cancer, breast symptomatic referral or urgent screening referral, to point at which patient is told they have cancer, or cancer is excluded. Commissioner Q2- Oct- Dec Q3 Jan- Mar- May- Jun- Q1 Nov-20 Feb-21 Q4-21 Apr-21 20/21 20 20 20/21 21 21 21 21 21/22 Doncaster CCG 76.8% 74.0% 73.0% 70.9% 86.9% 47.7% 58.6% 67.8% 53.0% 67.4% 71.3% 74.5% 70.9%

The standard operating contract for the 2021/22 financial year indicated that the 28 Day Faster Diagnosis Standard (FDS) performance target will be held at 75%. However, after discussions with local services, it has been agreed to maintain the local target of 80%. During the Covid-19 pandemic the national pilot period for 28 Day FDS has been paused but Trusts are still required to report against performance.

Doncaster CCG achieved 74.5% against the 75% national target and 80% local target. 1013 patients were notified of the outcome for diagnosis with 259 being more than 28 days. When breaking down the patients into cohorts, those that received confirmation of diagnosis (44 patients) 67.7% were notified within 28 days. For those that had cancer ruled out (708 patients) 75.2% of patients were notified within 28 days.

Q1 performance was 70.9%, with the two main specialties contributing to this dip in performance being Lower GI (359 breaches) and Skin (123 breaches). For Lower GI it is the continued histopathology delays due to staffing levels and continued need to outsource to Sheffield.

17 For Skin it is the surge in referral numbers which exceed the 2019/20 figures. An additional Dermatology locum consultant will be picking up some of this additional work.

31-day wait from diagnosis to first definitive treatment for all cancers Q2 Q3 Q4 Q1 Commissioner Oct-20 Nov-20 Dec-20 Jan 21 Feb 21 Mar 21 Apr 21 May 21 Jun 21 20/21 20/21 20/21 21/22 Doncaster CCG 97.3% 97.6% 95.6% 97.9% 97.0% 96.5% 97.6% 96.2% 97.0% 92.9% 97.7% 95.0% 94.9%

Rightcare Peer Group 95.5% 97.2% 95.9% 96.9% 96.7% 95.7% 95.6% 96.1% 96.2% 95.9% 96.6% 96.6% 96.3%

Cancer Alliance 95.6% 96.8% 96.0% 97.1% 96.6% 96.4% 96.7% 96.0% 95.8% 94.0% 95.5% 94.9% 94.8%

DBTHFT 98.0% 100% 96.7% 99.3% 98.7% 97.4% 97.6% 98.4% 97.8% 90.8% 99.2% 95.6% 94.9%

England 94.7% 95.7% 95.2% 96.0% 95.6% 94.0% 94.7% 94.7% 94.5% 94.2% 95.1% 94.6% 94.6%

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

31-day wait from diagnosis to first definitive treatment for all cancers 100%

98%

96%

94%

92%

90% Jul-20 Jul-19 Jul-18 Apr-21 Apr-20 Oct-20 Apr-19 Oct-19 Oct-18 Apr-18 Jun-21 Jun-20 Jan-21 Jun-19 Jan-20 Jan-19 Jun-18 Mar-21 Mar-20 Feb-21 Mar-19 Feb-20 Feb-19 Nov-20 Dec-20 Aug-20 Sep-20 Nov-19 Dec-19 Aug-19 Sep-19 Nov-18 Dec-18 Aug-18 Sep-18 May-21 May-20 May-19 May-18

% of people referred with cancer treated within 31 days Avg LCL Target

18 There were 8 breaches in June 2021, resulting in a performance of 95.0% against the 96% target. The breaches were spread across the following 6 tumour groups, Lower GI, Gynae, Lung, Skin and Urology all with 1 breach, with Breast having 3 breaches. The breaches were as a result of Treatment delayed for medical reasons (3), Elective capacity inadequate (2) and ‘Other reason’ (3). The longest an individual had to wait for first treatment of Surgery was 86 days at DBTH, due to Treatment being delayed for medical reasons in the Breast tumour group.

Q1 performance of 94.9% is below the target of 96%.

62-day wait from urgent GP referral to first definitive treatment for cancer (OF) Q2- Q3 May- Q1 Commissioner Oct-20 Nov-20 Dec-20 Jan-21 Feb21 Mar-21 Q4-21 Apr-21 Jun-21 20/21 20/21 21 21/22 Doncaster CCG 77.8% 63.4% 71.9% 79.2% 71.7% 66.7% 66.0% 71.7% 62.8% 75.0% 63.8% 83.5% 75.1%

Rightcare Peer Group 76.6% 76.8% 75.6% 72.2% 74.8% 69.5% 69.0% 74.9% 66.8% 73.1% 74.3% 77.6% 75.0%

Cancer Alliance 71.1% 66.8% 68.6% 68.8% 68.0% 61.9% 66.0% 71.4% 71.5% 71.7% 68.2% 73.1% 71.1%

DBTHFT 79.9% 66.7% 79.2% 81.4% 78.1% 76.3% 71.1% 69.2% 71.2% 76.8% 75.4% 83.1% 78.6% Sheffield Teaching Hospitals Foundation 64.4% 55.8% 61% 59.6% 59.3% 52.66% 62.5% 69.6% 62.1% 60.8% 55.3% 65.2% 60.8% Trust (STHFT) England 76.9% 74.5% 75.6% 75.2% 75.1% 71.2% 69.8% 73.9% 71.8% 75.4% 72.9% 73.3% 73.9%

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

Doncaster CCG performed at 83.5% against the 85% target in June 2021 with 13 breaches noted. The breaches were within the Breast (4), Lower GI (3), Lung (2), Gynae (1), Head and Neck (1), Urology (1) and haematological (1) tumour groups with the following breach reasons; Elective capacity inadequate (1), Inconclusive diagnostic result (1), Complex diagnostic issues (5) Other reasons (4), patient DNA a diagnostic appointment (1) and treatment delayed for medical reasons (1). There were 3 104+ day breaches at 114, 125 and 129 days. The 129 days was in the breast tumour group and due to 'Treatment delayed for medical reasons'. The Q1 performance of 75.1% is below the target performance of 85%. with only skin achieving with a performance of 93.9%.

2.6 Mental Health

2.6.1 Improving Access to Psychological Therapies (IAPT) – Cumulative percentage of people entering treatment as a proportion of people with anxiety or depression

During Quarter 1 1900 people entered treatment with RDASH against a trajectory of 1750.

The Service continues to offer additional telephone and digital interventions and a meeting has been scheduled with the CCG to discuss recovery in 2021/22.

Both the IAPT recovery rate and the waits within 6 weeks for treatment were met in June 2021.

21 Additional activity has been commissioned since May 2021 from IESO Digital Health. Up until June there were a total of 864 referrals received with 109 people having treatment by the end of the period. This means a total of 2009 people entered into treatment during Quarter 1.

2.6.2 Serious Mental Health (SMI) Physical Health checks (annual rolling figure)

As at the end of Quarter 1 2021/22 40.6% (an improvement from 29.6% from the previous quarter) (930 people) of people on a GP register with SMI had a completed physical health check and remains above the England average of 27.1%. A new pathway across Primary Care and RDaSH is due to begin in Quarter 3 2020/21 which will allow increased capacity and sharing of data which will ensure robust and accurate performance reporting. There has been an issue of recording onto some GP systems from RDaSH staff and this will be raised through contracting meetings to ensure that this is resolved.

2.6.3 Mental Health – The number of inappropriate Out of Area Placement bed days for adults (rolling 3 month data)

The trajectory submitted to NHS E aims to reduce inappropriate beds days to 270 days by the end of May 2021 has been achieved with 175 days (over a rolling 3-month period) despite an increase of 75 days from the previous timeframe (estimate of 5 patients). Due to

22 Covid-19 there has been a nationwide slowing of transfers of patients as it has proved difficult to discharge patients due to reduced community services. RDASH’s Chief Operating Officer now has weekly meetings with key personnel.

2.6.4 Dementia – the percentage of patients estimated to have Dementia within Doncaster who have received a diagnosis

Dementia diagnoses

Commissioner Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21

Doncaster CCG 65.2% 64.9% 65.5% 65.6% 64.6% 64.1% 61.1% 63.4% 63.7% 63.2% 63.6% 64.0% 64.3%

England 63.2% 63.1% 63.0% 62.9% 62.7% 62.4% 61.4% 61.1% 61.6% 61.7% 61.8% 66.7% 66.7%

Standard 66% 66% 66% 66% 66% 66% 66% 66% 66% 66% 66% 66% 66%

The percentage of people estimated to have dementia in Doncaster who have received a diagnosis increased in July 2021. This pathway includes both DBTHFT and RDASH with diagnostic testing and consultant services required. Covid-19 has impacted the ability to provide computerised tomography (CT) scans and face to face assessments which means diagnoses have slowed since April 2020.

Resumption of scanning has resumed with the pathway altered to RDASH staff visiting patients in home settings to reduce risk.

A meeting between DBTHFT and RDASH staff has been arranged to discuss this pathway and how to effectively prioritise patients to provide positive outcomes despite capacity being impacted by Covid-19.

RDASH have been requested to share their patient lists with the Doncaster GP Practices to ensure that registers are accurate.

Section 3: Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay

3.1 Yorkshire Ambulance Service (YAS)

Nov 20 Dec 20 Jan 21 Feb 21 Mar 21 Apr 21 May 21 Jun 21 July 21 Category 1 (Life threatening injuries and illness) target of 00:08:13 00:08:03 00:08:00 00:07:08 00:07:20 00:07:33 00:07:55 00:08:30 00:09:16 average time less than 7min Category 1 target 90% of times 00:14:07 00:13:54 00:13:43 00:12:11 00:12:34 00:12:52 00:13:25 00:14:24 00:15:53 less than 15 min Category 2 (Emergency) target of average time less than 18 00:24:35 00:24:03 00:24:30 00:21:24 00:21:18 00:21:14 00:25:21 00:30:03 00:37:20 min Category 2 target 90% of times 00:52:07 00:50:47 00:52:00 00:44:50 00:44:26 00:44:20 00:53:43 01:04:34 01:21:10 less than 40 min Category 3 (Urgent) target 90% 02:35:10 02:34:30 02:34:57 02:19:58 02:24:57 02:12:46 03:00:26 03:37:29 04:52:24 of times below 2 hours Category 4 (Less urgent) target 90% of times below 3 hours 03:23:35 03:45:36 04:08:47 04:02:12 04:09:13 04:07:49 05:21:16 05:36:12 07:26:48 Category 5 (Lowest acuity) target 90th centile Target TBC 01:13:06 01:19:53 01:50:42 01:23:54 01:13:33 01:35:55 02:32:05 02:48:37 03:08:47

All measures failed to meet target during July 2021 with a deterioration in performance in each.

Representatives from YAS continue to attend meetings around joint pathways in Doncaster to ensure that any issues can be addressed and continue to work closely with DBTHFT. Challenges with extensive queueing across all hospitals including Doncaster Royal Infirmary

24 were reported. YAS staff members were based within A&E at the start of December to help reduce handover times and this has worked well. In addition, lateral testing for Covid-19 was rolled out for asymptomatic staff during the month.

YAS representatives attend the Daily Partners escalation calls which include all partners in Doncaster. Staffing has been impacted as a result of staff sickness and isolation.

3.2 A&E attendance to admission, transfer or discharge (OF)

A&E attendances under 4 hours from arrival to admission, transfer or discharge Apr-21 May-21 Jun-21 July-21 Provider Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 DBTHFT (all attendances, based 91.9% 88.8% 82.6% 76.0% 76.9% 79.0% 80.7% 80.4% 84.3% 83.0% 80.3% 78.1% 72.7% on daily reported figures)

DBTHFT (Type 1 attendances) 90.0% 85.7% 78.1% 70.8% 71.8% 74.9% 76.7% 75.7% 80.1% 78.1% 74.7% 71.4% 65.9%

England (all attendances) 92.1% 89.3% 87.3% 84.4% 83.8% 80.3% 78.5% 77.4% 86.1% 85.4% 83.7% 81.3% 77.7%

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

Performance fell during July to 72.7% and remained under target. Performance also remains below statistically anticipated levels within the service. Latest performance is 5% below the England average.

Covid-19 has continued to impact on both EDs with Departments split into 2 areas to manage 2 simultaneous pathways responding to Covid-19 symptoms and non-Covid-19 symptoms which has caused periods of pressure at times during the month. Attendances to A&E continue to rise and there were 25% more attendances in June 2021 than in June 2019.

Some issues were encountered through Covid-19 specific pathways where some discharges were delayed while awaiting test results to ensure safe discharges. Waits for doctors and beds made up the majority of delays in month with the latter also leading to a higher number of delays for handovers from paramedics. Any handover delays are reviewed across the Trust and Yorkshire Ambulance Service to ensure delays are reduced and mitigated as appropriate.

Weekly escalation discussions are in place between the Trust and the Yorkshire Ambulance Service to address ‘batching’ concerns in a wider ‘System Forum’. Both sites are seeing an increase in both inappropriate and escalated acuity attendances with patient feedback indicating inability to access face to face primary care consultations. Ongoing discussions with the CCG continue to address concerns.

26 Ongoing work continues with the Teams to build and embed relationships and foster more effective patient pathways both within the Division and in the wider Trust. This is a long-term project.

3.3 Physical Health – Community Reseponse

June performance achieved the target of 50% at 91.6%.

3.4 The number of Annual Health checks carried out for person aged 14 plus on GP Learning Disability Resisters

As at Quarter 4 (latest quarterly information) 431 (up from 309 in Q3) people with Learning Disabilities had received their annual health check. During the quarter GPs and other health care professionals had taken opportunities to complete checks through other appointments available as there was an impact by Covid-19.

27 Section 4: Other Quality Elements

Safeguarding

Safeguarding Adult Reviews

There has been one new Safeguarding Adult Review commissioned by the Doncaster Safeguarding Adults Board during this reporting period. DCCG has secured Primary Care records and developed a chronology for the individual for review. This review will continue through process with updates being provided when required.

The Safeguarding Adults Review Panel are currently in the process of considering one further incident for review. The CCG has secured the Primary Care records for the individual and will contribute accordingly moving forward.

Rapid Reviews

There have been no new Rapid Reviews commissioned during this reporting period.

There has been one case presented to the Child Death Overview Panel during this reporting period. The initial findings meeting has taken place and it has been agreed that this case will be referred for a Rapid Review. Following review of the case at the Rapid Review it was agreed that this incident did not meet the Rapid Review criteria. This case will now be progressing to Case Review Group for further discussion.

It should be noted that the above incident has been logged on the STIES system as a Serious Incident.

Doncaster CCG continues to support the Rapid Reviews that remain on going within the partnership.

Lessons Learnt Reviews

There have been no new Lessons Learnt Reviews commissioned by the Doncaster Safeguarding Adults Board during this reporting period.

28 The two previously reported Adult Lessons Learnt Reviews remain in process with Doncaster CCG contributing accordingly. It should be noted that in relation to the Adult D review the report has now been approved by the Board and the author has been requested to move forward with the action plan.

Domestic Homicide Reviews

There have been no new Domestic Homicide Reviews commissioned during this reporting period.

The three previously reported reviews continue to progress within the partnership with Doncaster CCG contributing accordingly. It should be noted that all chronologies and Individual Management Review Reports have been submitted for these reviews from the Primary Care perspective.

29 Meeting name Governing Body Meeting date 2nd September 2021 Title of paper Starting Well Life Stage Report

Emma Price, Head of Strategy & Delivery Executive / Angela Harrington, Interim Head of Strategic Commissioning & Clinical Lead(s) Transformation

Performance and Intelligence Team Author(s)

Status of the Report

To approve To consider / discuss

To note x

Purpose of Paper - Executive Summary This report sets out the key quality and performance updates to be noted by the Executive Committee from the quarterly updates provided by DCCG and Doncaster Council staff in relation to the 2021/22 Starting Well Life Stage Strategic Delivery Plan.

Recommendation(s) The Governing Body is asked to:

Note the key quality performance areas for attention.

Report Exempt from Public Disclosure

If yes, detail grounds for exemption: Yes No x

Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report.

Tick relevant box Equality impact An Equality Impact Analysis/Assessment is not required x for this report.

An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate 30

Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.

An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Nil impact Financial Nil implications Legal Nil implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.

Consultation / Engagement (internal N/A departments,

clinical,

stakeholder and public/patient) Report previously N/A presented at Risk Risks are captured in the Executive Summary. analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework

Section 1: Starting Well Delivery Plan 2020/21

1:1 Actions

Completion Action Due Date Update (%) Introduction of a Recovery 31/03/2022 30% The Anna Freud element of training provision was completed and delivered to Curriculum and the schools in April and May 2021. Further training is being scheduled for the start of development of an the new school year. The SEMH and education strategy continues to meet Emotional, health and fortnightly and is developing an action plan of provision across Doncaster. wellbeing and trauma SEMH Proactive Monitoring and Support Group (PM&S) continue to meet weekly informed support system. to review young people presenting at A&E with Mental health behaviour and To include the Social and ensure appropriate services are involved. Emotional Mental Health (SEMH) and Education SEMH PM&S and Mental Health in Schools both feed into the reinstated strategy. Children and Young People Mental Health Strategic Group. Mental Health Service Mapping for children young people and families is complete and ready to feedback. We have consulted with Adults Commissioning, Public Health, CAMHS, School Nursing, Doncaster CCG, Voluntary and Community sector and internal departments to ensure that that we have the most accurate position and this will feed into the Mental Health Strategy Group

On 8 November 2020, the government announced that the holiday activities and food programme will be expanded across the whole of England in 2021. The programme has provided healthy food and enriching activities to disadvantaged children since 2018.

The programme will cover the Easter, summer and Christmas holidays in 2021.

Commissioning have supported the mobilisation of the Department for Education funded Holiday Activity and Food programme with all successful providers going through enhanced compliance process and on track to receive upfront payments to support delivery, particularly for smaller organisations.

School holidays can be particular pressure points for some families because of increased costs (such as food and childcare) and reduced incomes.

Free holiday clubs are a response to this issue and evidence suggests that they can have a positive impact on children and young people and that they work best when they:

provide consistent and easily accessible enrichment activities cover more than just breakfast or lunch involve children (and parents) in food preparation

This holiday provision is for children who receive benefits-related free school meals.

Local authorities are asked to ensure that the offer of free holiday club provision is available for all children eligible for and in receipt of free school meals in their area. This does not mean they are all required to attend as the provision is voluntary.

The free holiday club places must be targeted at children who are eligible for and receiving benefits-related free school meals.

Reduce the Waiting times 31/03/2022 50% The post diagnostic support offer has been agreed in principle and will be fully for Neuro developmental specified during July and August of 2021. Further underspend capacity has been pathways, developing an added to both the Autistic Spectrum Disorder and Attention Deficit Hyperactivity all age approach to Disorder pathways to continue to reduce the waits within the respective services. provision looking at post diagnostic support for The referral pathways and quality of referrals is currently being reviewed. Families

Implement Future 31/03/2022 25% The Oaklands renovation work is on track and consultation has commenced with Placement Strategy Service Users, Staff, Families, Local Residents and Ward members.

We continue to work to identify suitable properties with 2 potential houses in the pipeline. Support the delivery of the 31/10/2021 70% Investment has been made over and above the agreed Long Term Plan NHS Long Term Plan investment for 2021/22. An Implementation plan for the revision of both services including MH investment in has now begun.

33 both Eating Disorders and Perinatal services in 21/22.

Support Transforming 31/10/2021 75% Transforming Care Partnership PM&S continues to meet monthly and more Care agenda, including frequently as required. Terms of reference, membership and remit have recently recruitment and been reviewed. Of the 2 ICS Keyworker roles, 1 has commenced employment development of the and shortlisting has been completed, with a view to the second being in post by Integrated Care System the end of the summer. (ICS) keyworker roles.

Commission appropriate, 31/03/2022 40% We continue to commission appropriate, quality and sufficient provision for quality education provision children and young people with SEND as required. for all Special Educational Needs and Disability Work on SEMH sufficiency is underway. (SEND) children based on identified need and local Local authority continues to support Nexus with ongoing development of Bader sufficiency. School.

Big Picture – KS3 alternative provision becoming embedded within the system. KS4 have their first students in on 7/7/21. We continue to develop both models with the providers. Develop new service 31/12/21 40% Forum to progress Specification development is well established with excellent specification with a focus engagement from both parties. A range of information which will form the basis of on out of hospital care for the Service Specification has been gathered and focus areas requiring further Children's Community collaborative working identified. Nursing and Children's Collaborative working extends to Commissioners in neighbouring CCGs to Therapies consider the arrangements for out of area provision and discussions with Local Authority Commissioners to enable improved coordination and consistency across organisations. Clarity around support into Specialist Schools will require further exploration to ensure equity. Recommissioning of 5-19 31/03/2022 40% Preparations for the tender are moving forward. A successful provider healthy child programme engagement event was held in February with useful feedback from potential providers which will be fed into the development of the delivery model. Development of the service specification for the integrated 5-19 service is underway. The proposal for the integrated model was formally agreed by Cabinet

in June and we can now proceed with the open tender. Work is also progressing with engagement with children and young people to develop the service specification and support the tender process. We have set up a steering group of young people from XP school and are planning to approach other young person groups to feed into the development of the service model.

Embed and evaluate the 30/09/21 40% The evaluation of the 1001 days integrated pathway pilot is well underway. To impact of the first year of date, early data from both families involved in the pilot and professionals working the pilot to develop an within the Early Days team has been collated to being to demonstrate potential integrated offer for parents impact of the pathway and where improvement might be made. General and families for the first feedback from families is that they value the service and are finding input from 1001 days the professional useful and timely. Feedback from professionals working in the team is mixed with challenges highlighted as well as benefits of integrated working and focus around 1001 days. The evaluation will continue with plans to survey more families moving though the pilot and to conduct in-depth interviews with both families and professionals involved in the pilot. A comparison survey will be put out to non-pilot families in Doncaster to assess if the integrate pathway is offering any additional value over the current system.

Vulnerable 31/03/22 A change in lead to this action has taken place meaning that an update has not Adolescents - been possible at time of writing. establishment of the delivery model and outcomes to evaluate the effectiveness of the pilot

Work together across 31/03/22 10% A refreshed approach has been agreed with the Health and Wellbeing Board for partners to identify areas how Team Doncaster partners will undertake needs assessments. This includes of priority to provide plans to capture experiential qualitative data alongside more traditional commissioning/service quantitative data which will allow a broader and deeper understanding of need redesign opportunities to and inequalities for strategic commissioning purposes. increase patient and resident outcomes Early Help -To develop and 31/03/22 A change in lead to this action has taken place meaning that an update has not embed co-ordinated been possible at time of writing. support and evidence-

35 based interventions, through a practice framework across agencies Implementation of the 31/03/22 25% The action plan has been developed with four priorities: Young Carers action plan 1.Increase the identification of young carers 2.Raise awareness to young people themselves as being in a caring role 3.Transition for young adult carers 4.Gain the voice of Young carers

An animation has been created by young carers to promote the benefit and need for a Young Carers Champion in all schools. Training is available for professionals to raise awareness of the role and responsibility of the Young Carers Champion.

During Carers week a social media campaign supported the identification and raising awareness of the work young carers undertake.

All Age Market Position 31/03/22 25% An initial draft of the market position statement has been completed, however Statement - Initial scoping due for a request for more high level oversight and involvement, the current of the market to develop, version (for Children's, focusing on Short Breaks) has been put on hold and shape, and improve a consequently will require an update. variety services across all age cohorts working A review of the Short Breaks service and the Dynamic Purchasing System is closely with a range of key underway and feedback from the MPS will be used to inform changes to delivery, stakeholders but will also be updated from the findings from Short Breaks Market Engagement and consultation with Service users.

Market Development lead officer is providing ongoing support to all providers on the Short Breaks Dynamic Purchasing System, plus the Alternative Provision,1 to 1 Tutors and Transport frameworks. Focus is currently on the Department for Education Holidays And Food Programme, to ensure sufficient quality activities for eligible Children and Young People, which involves support with Expect Youth and internal departments. (Participation and engagement, Museum, Trust, Adult Commissioning) Transport (taxi providers).

Service revisions to be implemented in both Perinatal services and ED services during 21/22 to ensure NICE and LTP compliancy

Key Performance Indicators

Ensure that all Schools are utilising the reformed toolkit for SEMH and engaging with MHST and locality teams

65% In house foster provision by mixed economy of overnight short breaks provision by March 2022. Currently figures stand at 57% In House and 43% IFA

Reduce the number of Out Of Authority Education Placements by 20% by the end of the year

Total number at the end of the quarter is 104, with no new placements in April, May and June.

Increase the number of young carers identified and who have the opportunity of an appropriate assessment

The numbers of young carers identified and assessed appropriately has increased to 280 (quarter 4 2020-2021). This is an increase from 263 the needs of young carers have increased during the on-going pandemic so it would be expected that more young carers would have been identified by partners.

Ensure that at least 90% of Children receive a diagnosis decision within 18 weeks of referral for ADHD

100% 80% 60% 40% 20% 0% Apr-20 May-20 Jun-20 Jul-20

Ensure that at least 90% of Children receive a diagnosis decision within 18 weeks of referral for ADHD Target

This pathway has been further impacted by Covid-19 and not likely to meet the 90% target during 2020/21. A meeting with DCCG Commissioning, Quality and Performance teams with RDASH representatives has been arranged to identify a way forward with an appropriate recovery trajectory.

Appendix A: Additional measures

Supporting Measures

June-20 July-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Cancer – 2WW 88.9% 100% 100% 80.6% 59.6% 18.2% 3.6% 28.6% 18.4% 14.3% 11.0% 20.3% 21.6% breast symptomatic Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

Cancer – 31 day 100% 96.3% 92.9% 90.0% 95.0% 94.4% 94.4% 95.5% 94.7% 100% 93.8% 91.7% 89.5% subsequent surgery Cancer – 31 day subsequent 78.3% 85.5% 89.3% 91.9% 91.7% 97.1% 100% 100% 96.3% 97.9% 96.6% 94.7% 97.4% radiotherapy

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% Cancer – 31 day subsequent drug 97.8% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% regimen Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% Cancer – 62 day 50.0% 0% 100% 88.9% 88.9% 100% 100% 58.3% 50.0% 66.7% 38.5% 71.4% 37.5% screening service Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Cancer – 62 day 60.0% 71.4% 60.0% 90% 92.3% 68.2% 87.9% 86.7% 78.6% 66.7% 78.3% 93.3% 71.4% consultant upgrade Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% Q1 Q2 Q3 Q4 Q1 21/22 2020/21 2020/21 2020/21 20/21 Bowel screening coverage, aged 60– 62.7% 64.6% 64.9% 65.6% 74, screened in last 30 months Target (Above 61.1% 63.2% 64.7% 65.4% national average) Breast screening coverage, females aged 50–70, 72.8% 70.6% 69.3% 67.2% screened in last 36 month Target (Above 72.3% 72.3% 70.0% 70.4% national average) Cervical screening coverage, females aged 25-64, 75.3% 75.% 74.7% 74.6% attending screening within target period Target (Above 72.3% 72.2% 72.0% 70.4% national average) Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-21 Feb-21 Mar-21 Apr-22

GP appointments 125822 124200 140297

Target 119666 121062 129226 142933 126067 153816 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Proportion of people who survive cancer for at least 1 year after diagnosis 63.5% 64.3% 64.7% 65.7% 66.4% 67.1% 67.7% 68.8% 69.5% 70.1% 70.8% 71.2%

Target (England) 65.6% 66.4% 67.1% 67.8% 68.5% 69.2% 70% 70.7% 71.3% 72% 72.7% 73.3% 2015 2016 2016 2017 2017 2017 2017 2018 2018 2015 Q3 2016 Q2 2016 Q3 2018 Q3 Q4 Q1 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Proportion of cancers diagnosed at stages 1 or 2 against stages 1-4 53.2% 45.8% 49.1% 48.3% 46.5% 45.4% 46.7% 52.6% 51.9% 54.4% 45.4% 53.7% 57.5%

Target (England Average)

51.6% 52.2% 52.5% 52.7% 51.5% 52.5% 52.3% 52.1% 51.5% 51.7% 51.8% 55.1% 53.9%

Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-21 Feb-21 Mar-21

30-minute ambulance breaches Target Antimicrobial resistance: appropriate prescribing of 1.02% 1.01% 0.99% 0.98% 0.97% 0.95% 0.93% 0.90% 0.86% 0.83% antibiotics in primary care

Target <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965 <0.965

Antimicrobial resistance: appropriate prescribing of broad- 5.82% 5.95% 6.05% 6.08% 6.15% 6.29% 6.48% 6.78% 7.03% 7.24% spectrum antibiotics in primary care

Target <10% <10% <10% <10% <10% <10% <10% <10% <10% <10% <10% <10% <10%

Sept-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Flu Number of people season N/A N/A N/A N/A N/A receiving flu runs vaccination sept-Feb May-20 Jun-20 July-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Proportion of patients directly 56.60% 60.80% 77.78% 52.38% 62.86% 49.40% 47.10% 49.20% 54.90% 38.50% 57.70% 47.9% 51.9% admitted to a stroke unit < 4 hours Target 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%

Meeting name Governing Body Meeting date 2 September 2021

Title of paper Finance Report July 2021 (Month 4)

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

Status of the Report

To approve To consider / discuss

To note X

Purpose of Paper - Executive Summary

This report sets out the financial position as at the end of July 2021 and the forecast to Month 6.

The CCG has been given allocations for the first 6 months of the year only (known as H1) and further information is expected in the early Autumn in relation to the second half of the year (known as H2).

The report also outlines:

• The risks that the CCG is currently facing • The CCG’s Financial Summary (Appendix 1) • The CCG’s summary of allocations (Appendix 2)

Recommendation(s)

The Governing Body is asked to:

• Receive the report and note any risks and issues as highlighted in the report.

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Page 1 of 5

Impact analysis Quality impact N/A

Tick relevant box

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

Sustainability NIL impact The CCG is showing an underspend of £151k relating to anticipated Financial funding for the Hospital Discharge £50k and £204k clawback on the implications Elective Recovery Schemes. Legal NIL implications Management of Conflicts of N/A Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) Report previously None presented at Risks of £2.1m were included in the original plan and these mainly related to QIPP achievement and growth levels above planned levels. The CCG Risk currently holds a contingency and there are central transformation funds analysis to offset these risks should they materialise. Other risks are outlined in the report. Corporative Objective / CO1 - maintain spend within allocations overall. Assurance Framework

Page 2 of 5

NHS DONCASTER CCG

2021/22 FINANCE REPORT MONTH 4 – JULY 2021

1. Introduction

This report provides the financial position for NHS Doncaster CCG for 2021/22 as at the end of July 2021 (Month 4) and includes a forecast to Month 6 only.

The CCG has a fixed allocation for the first 6 months of the financial year (known as H1) and has submitted a break - even plan.

Funding for the Hospital Discharge Programme (HDP) is outside the financial allocation and will be funded separately once approved by NHS England. There is a fixed allocation for the ICS and current forecasts show that this will be exceeded. A new process has been introduced for ICSs to submit a case for additional funding.

Additional funding is also anticipated in relation to the Elective Recovery Fund (ERF) where the CCG exceeds its threshold target level of activity and spend. The threshold for payment is changing from the original guidance from Q2 and this may reduce the funding for the CCG.

Some Service Development Funds (SDF) are being held nationally together with the additional funding for Additional Roles Reimbursement Scheme (ARRS) above the baseline. This funding can be drawn down as required through the year.

2. Current Position

At Month 4, the CCG is showing an underspend of £151k against the break - even target. The underspend relates to £50k expected funding for HDP and a potential clawback of ERF funding of £204k. The ERF funding for April & May has now been allocated to the CCG (calculated by NHSE using centrally submitted activity data from providers). The CCG has received £504k but this is significantly higher than the CCG’s calculated position of £18k using contract information submitted by providers to the CCG. The position has been queried with NHSE and in order to be prudent, it has been assumed that this will be clawed back.

There is also a slight overspend against ARRS but this has been offset in the overall position. It is not yet clear how centrally held funding for ARRS can be accessed and further guidance is expected in month 5.

The overall forecast position is an overspend of £258k (£462k HDP and £-204k ERF)

The forecast position has been updated in Month 4 to reflect a more accurate position. Key variances include a forecast underspend against prescribing of £0.5m, underspends against primary care of £0.4m relating to enhanced services and release of accruals for QOF achievement from 20/21, an underspend on

Page 3 of 5

independent sector acute activity £0.6m and overspends on individual placements and CHC £2.5m.

The volume of Out of Area Placements is increasing and causing significant pressures. Discussions have been held with RDASH around how this can be managed with a proposal to block book beds with the Independent Sector rather than spot purchasing. This has not yet been agreed as further work is required, a proposal will be taken to Exec Committee once it has been worked up in more detail.

Spend on Covid related costs is now limited to HDP (funded centrally) and additional spend on Patient Transport Services which is now funded from the CCG’s financial envelope.

A full summary of the position is outlined in Appendix 1 together with a summary of the CCG’s allocations in Appendix 2.

3. QIPP

Included in the plan for Month 1- 6 is an expectation of delivering QIPP of £3.2m across numerous budget lines including CHC, prescribing and running costs. The CCG is limited in its ability to deliver QIPP due to the nature of the financial regime and block contracts with NHS providers.

A draft plan was discussed at QIPP Board in June which showed a shortfall against the overall target. Attached at Appendix 3 is the current position based on the draft plan. Approximately £0.5m has been delivered so far relating to prescribing and running costs with a forecast of £0.75m. This is therefore a forecast under delivery of £2.5m.

4. Risks

When completing the plans for Month 1-6, £2.1m of risks were identified regarding the ability to deliver a balanced position. These were mainly related to achievement of the £3.2m QIPP targets and actual growth levels being above plan. These are now materialising in the position, but the CCG is utilising its contingency and slippage on other planned spend to balance the position. However, should these continue into H2 then the CCG may not be able to manage them.

Information and guidance around H2 has not yet been published and this will not be released until mid September. Agreement has not yet been reached with the Treasury on the totality of funding for H2. Early information suggests that there will be a minimum of 3% efficiency required for H2 (called “Waste Reduction”).

The transition from H1 to H2 is also not clear and whether any shortfall/surplus from H1 can be utilised in H2, this may be a risk for the CCG.

The final risk to highlight is around the HDP funding. The ICS has a fixed envelope and based on current forecasts this will likely be exceeded, mainly due to high levels of spend by Sheffield CCG. A new process is being implemented where ICS’s can put a case for additional funding above the envelope, CCGs are putting a case

Page 4 of 5 forward to NHSE based on the Month 4 position and will await a response. If it is not agreed, then all CCG’s may need to manage some of the overspend in their position.

5. Other Statutory Targets

The CCG is still required to meet its statutory duties in relation to BPPC and cash management and a summary of the current position is as below.

Duty Target Achievement Achieved Cash 1.25% 3.77% N

BPPC - NHS Invoices (No.) paid in 30 days 95% 97.62% Y BPPC - NHS Invoice (£) paid in 30 days 95% 100.00% Y BPPC - Non NHS Invoices (No.) paid in 30 days 95% 96.18% Y BPPC - Non NHS Invoice (£) paid in 30 days 95% 98.47% Y

In July the CCG did not receive the usual invoices to pay CHP the GP rent and void payments and therefore had £1.2m excess cash. These have now been received and the cash cleared in early August.

6. Recommendation

Governing Body are asked to note the current position as at the end of July 2021 (Month 4) and to note the current level of risks.

Page 5 of 5

NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 1

SUMMARY FINANCIAL POSITION MONTH 4 2020/21

Month 4 Total Forecast to Month 6 Budget Actual Variance Budget Actual Variance £'000 £'000 £'000 £'000 £'000 £'000 Revenue Resource Limit (in year) 205,531 205,531 0 313,952 313,952 0

Acute services - NHS (Block) 98,663 98,662 1 148,768 148,768 0 Acute services - Independent/commercial sector (outside of Nationally procured) 2,525 2,087 -438 3,787 3,201 -586 Acute services - Other non-NHS 2,714 2,714 0 4,071 4,071 0 Acute Services - Other Net Expenditure 131 -3 -134 2,530 2,197 -333 Acute Services 104,032 103,459 -571 159,156 158,237 -919

MH Services - NHS (Block) 15,129 15,117 -12 23,089 23,089 0 MH Services - Independent / Commercial Sector (outside of Nationally procured) 9,378 10,538 1,161 13,756 15,796 2,040 MH Services - Other non-NHS 111 76 -36 172 176 4 MH Services - Other net expenditure -553 -443 110 37 -115 -151 Mental Health Services 24,065 25,289 1,224 37,054 38,946 1,892

Community Health Services (ISFE) 19,085 18,977 -108 28,618 28,678 60

Continuing Care Services (ISFE) 12,908 13,004 96 19,274 19,790 516

Prescribing 20,444 20,127 -317 30,666 30,166 -500 Community Base Services 1,508 1,234 -274 2,459 2,104 -355 Out of Hours 0 0 0 0 0 0 £1.50 per head PCN Development Investment 163 163 0 244 244 0 GP IT Costs 327 363 35 491 491 0 PC - Other 357 330 -28 536 536 0 Primary Care Services (ISFE) 22,800 22,216 -584 34,396 33,541 -855

General Practice - GMS 10,803 10,679 -125 15,867 15,761 -106 General Practice - PMS 1,779 1,815 36 2,668 2,668 0 Other List-Based Services (APMS incl.) 658 759 100 987 916 -72 Premises cost reimbursements 2,249 2,154 -95 3,373 3,267 -106 Primary Care NHS property Services Costs - GP 0 0 0 0 0 0 Other Premises costs 32 24 -8 48 48 0 Enhanced services 445 478 33 668 628 -40 QOF 1,680 1,595 -85 2,521 2,381 -140 Other - GP services 38 148 110 57 30 -27 Primary Care Co-Commissioning (ISFE) 17,685 17,651 -34 26,190 25,700 -490

Other Programme Services (ISFE) 3,209 3,203 -6 6,212 6,258 46

Total Commissioning Services 203,785 203,798 16 310,900 311,150 250

Running Costs (ISFE) 1,746 1,582 -164 3,052 3,060 8

Total CCG Net Expenditure 205,531 205,380 -149 313,952 314,210 258

In Year Underspend/(Deficit) 0 151 151 0 -258 -258

Hospital Discharge Funding expected 50 50 462 462 Elective Recovery Fund expected -204 -204 -204 -204

Revised variance 0 -3 -3 0 0 0 NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 2

SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 4 JULY 2021

Recurrent Non Recurrent Total £000's £000's £000's Baseline Allocation -244,338 0 -244,338 Running Cost Allowance -3,052 0 -3,052 Co-Commissioning -24,651 0 -24,651 Top Up/Covid/Growth 0 -33,551 -33,551 Total Resources Available at Plan Stage -272,041 -33,551 -305,592

Adjustments to the Resource Limit:

Month 01 April No adjustments 0 0 0 0 0 0

Month 02 May Primary Care: GP IT Infrastructure and Resilience (revenue) -18 -18 Primary Care: Improving Access -493 -493 Mental Health: SDF: CYP community and crisis -188 -188 Mental Health: SDF: 18-25 young adults (18-25) -56 -56 Mental Health: SDF: MHST 18/10009 Trailblazers (MHST18/10009) -358 -358 Mental Health: SDF: Adult Mental Health Community (AMH Community) -276 -276 Mental Health: SR: Children & Young People's Eating Disorders -34 (CYPED) -34 Mental Health: SR: CYP community and crisis -126 -126 Mental Health: SR: Adult Mental Health Community (AMH Community) -163 -163 Mental Health: SR: Adult Mental Health Crisis (AMH Crisis) -37 -37 Mental Health: SR: Improving Access to Psychological Therapies - -90 adult and older adult (IAPT) -90 Mental Health: SR: 18-25 young adults (18-25) -37 -37 Mental Health: SR: Memory assessment services and recovery of the -48 dementia diagnosis rate (Memory/Dementia) -48 Mental Health: SR: Discharge -244 -244 Mental Health: SR: Physical health outreach and remote delivery of -34 checks (PH Checks) -34 Cancer: Targeted Lung Health Checks -1767 -1,767 LD & Autism: Community investment/reduce admissions -258 -258 LD & Autism: CeTR review -18 -18 LD & Autism: Learning Disabilities Mortality Review Programme -21 (LeDeR) -21 Maternity: LTP - SBL Pre-term Birth -29 -29 Primary Care: Improving Access -493 -493

0 -4,785 -4,785

Month 03 June Covid vaccinations for CCG Inequalities -21 -21 Keyworkers [email protected] -229 -229 2.5 4 Week Wait Sites (4WW) [email protected] -395 -395 Autism Diagnostic Waiting Times (CYP) [email protected] -35 -35 Clinical Champions ICS [email protected] -13 -13 Community Respite Care (CYP) [email protected] -30 -30 0 -723 -723 Month 04 July Primary Care: GP IT Infrastructure and Resilience -18 -18 Covid vaccinations for CCG Inequalities 21 21 Diabetes Programme Transformation Fund H1 -41 -41 Primary Care Covid Support/Expansion Fund (£120m) -676 -676 Online consultation software systems (local) -22 -22 Ageing Well - additional community services -803 -803 Post Covid Assessment Clinic Funding 21/22 -135 -135 LMS Continuity of Carer & Equity -21 -21 LMS Enhanced Continuity of Carer -8 -8 Autism Diagnostic Pathway CYP -71 -71 Autism Diagnostic Pathway Adult -26 -26 PEoLC Match Funding -13 -13 ERF Payment (April and 90% May) -504 -504 Hospital Discharge Programme (April - June) -535 -535 0 -2,852 -2,852

Revised Resources available as at Month 4 July 2021 -272,041 -41,911 -313,952 NHS DONCASTER CLINICAL COMMISSIONING GROUP

QIPP POSITION - MONTH 4

YTD Forecast to Month 6 Target Achieved Variance Target Achieved Variance CHC 200 0 -200 300 0 -300 Individual Placements 133 0 -133 200 0 -200 Prescribing 644 317 -327 966 500 -466 PICU bed 97 0 -97 146 0 -146 Running Costs 167 164 -3 250 250 0 Unidentified 907 -907 1,361 -1,361 Total 2,148 481 -1,667 3,223 750 -2,473 Meeting name Governing Body Meeting date 2 September 2021

Governing Body Assurance Framework 2021/22 – Quarter 1 Title of paper

Executive / Clinical Lisa Devanney, Director of HR and Corporate Services Lead(s) Author(s) Cheryl Rollinson, Head of Corporate Governance

Status of the Report

To approve X To consider / discuss

To note

Purpose of Paper - Executive Summary

1. Introduction

• The report presents the current position of the Governing Body Board Assurance Framework (BAF) as at the end of Quarter 1 2021/22.

2. Board Assurance Framework

• The BAF can be viewed in Appendix 1.

• Additions are highlighted blue and removals are highlighted red. Key changes to note:

o There have been no changes in the risk scores for any risks associated with Corporate Objectives 1, 2, 3 & 4

• The Strategy and OD Forum discussed the Assurance Framework for 2021/22 and confirmed that the existing risks and corporate objectives were relevant for the year.

• The Audit Committee approved the proposed new Corporate Objective and associated risk as follows:

o Corporate Objective 5 - Managing the organisation through the close down of CCG's and transitioning to new NHS ICS Body

5.1 Risk Description: There is a risk to the CCG's capacity and resources in meeting its statutory obligations and maintaining effective Doncaster Place partnership working. Risk Cause: This is due to the anticipated ICS transformation changes during 2021/22.

Page 1 of 3

Risk Consequence: Resources being diverted to set up new ICS governance / financial arrangements whilst maintaining statutory CCG requirements. Impact on staff morale, including Board level, during organisational change which could lead to vacancies and lower resource. Impact on retaining place-based partnership working and existing relationships. Future funding allocations and flows maybe affected during the transition whilst maintaining focus on 2021/22 deliverables.

Risk Score: 3x3 = 9 (High)

3. Deep Dives

• A deep dive into Corporate Objective 3 was undertaken at Audit Committee in July 2021.

4. Quarter 2 Updates

• Senior Risk Owners are scheduled to review and update risks during August to reflect the Quarter 2 position.

• The Quarter 2 position will be presented to the Audit Committee scheduled 9 September 2021.

Recommendation(s)

The Governing Body is asked to:

- Review the updated Assurance Framework - As recommended by Audit Committee, confirm that the Assurance Framework is an accurate position of the CCG’s principle risks as at the end of Quarter 1 and that Governing Body are assured that appropriate actions are taking place to mitigate potential impacts and consequences - As recommended by Audit Committee, approve the new Corporate Objective and Risk 5.1

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Page 2 of 3

Impact analysis Quality impact N/A

Tick relevant box

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

Sustainability impact Nil Financial Nil implications Legal Nil implications Management of None identified Conflicts of Interest Consultation / Engagement (internal Engagement with Senior Risk Owners or nominated deputies. departments, clinical, stakeholder & public/patient) Report previously Audit Committee 08.07.21 presented at Risk Captured throughout the Assurance Framework analysis Assurance All Assurance Framework risks Framework

Page 3 of 3

NHS Doncaster CCG Governing Body Assurance Framework

Corporate Objectives (COs)

CO 1 Ensure an effective, well led, and well governed organisation and its statutory obligations are met.

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

CO 3 Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change.

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

CO 5 Managing the organisation through the close down of CCG's and transitioning to new NHS ICS Body

Consequences / Impact

Insignificant Minor Moderate Major Catastrophic Likelihood of 1 2 3 4 5 occurrence Rare 1 2 3 4 5 1 Unlikely 2 4 6 8 10 2 Possible 3 6 9 12 15 3 Likely 4 8 12 16 20 4 Almost Certain 5 10 15 20 25 5

1-3 Low The risk appetite under which risks can be tolerated is a score of 12 4-6 Medium or below. 8-12 High 15-20 Very High Risks scored at or in excess of a score of 13 must be escalated to 25 Extreme the Governing Body.

Page 1 of 14 Governing Body Board Assurance Framework 2021-22

Risk Consequent / Impact Assessment Risk Rating Corporate Oversight Assurance High Level Risk Description Owner Objective Catastrophic Major Moderate Minor Insignificant Year-End 2021-22 (Committee) (Committee) 25 20 16 15 12 10 9 8 6 5 4 3 2 1 2020-21 Q1 Q2 Q3 Q4 Organisational Change - The CCG may not have the right C I workforce capacity and capability to meet its organisational T Director of HR and CO1 (1.1) 9 9 Executive Governing Body objectives and to meet its statutory obligations. Corporate Services

Quality Impact - There is a risk to maintaining quality, services I and outcomes through local transformation. C CO2 (2.1) 10 10 Chief Nurse Executive Governing Body T Quality Impact - The quality of care delivered to patients and the achievement of associated quality and performance targets I Director of Strategy CO2 (2.2) could be adversely affected if we fail to commission effective, 12 12 Executive Governing Body resilient and sustainable services. C T and Delivery

Primary Care: The quality of care delivered to patients and the I achievement of associated quality and performance targets Director of Strategy CO2 (2.3) 12 12 Executive Governing Body could be adversely affected by the failure to engage and and Delivery involve primary care. C T The Provider Workforce lacking the capacity of sufficiently I C T skilled staff, which could be detrimental to patient care. Director of HR and CO2 (2.4) 9 9 Executive Governing Body Corporate Services

Transformation - Expenditure is in excess of income and QIPP C / transformation plans fail to bridge the gap resulting in the I CO3 (3.1) 8 8 Chief Officer Executive Governing Body CCG not meetings its statutory financial and quality duties. T

Efficiencies - The quality and efficiency savings within the C Delivery Plans are not achieved, therefore alternative I CO3 (3.2) commissioning arrangements including the decommissioning of 8 8 Chief Officer Executive Governing Body services may be required. T Control Total and System Affordability - Inability to commission I efficiently, effectively and to achieve value for money if the C CO3 (3.3) 9 9 Chief Officer Audit Governing Body control total is impacted is not achieved. T Control Total - As further delegation of statutory duties and financial decision-making develops (with the Doncaster I C Chief Finance CO3 (3.4) Council in ‘Place’ and with other CCGs in the SYB ICS) the 9 9 Audit Governing Body Officer CCG may agree to decisions which are considered to be in the greater good. T Joint Working: The dual areas of focus may stretch the local system leadership as resource is aligned both locally and I C T Director of Strategy CO4 (4.1) across a wider collaborative footprint, this complexity could 9 9 Executive Governing Body potentially impact upon our capacity to commission services. and Delivery

Engagement & Prevention: Doncaster Place does not achieve the move towards tackling inequalities and move towards I C T Director of Strategy CO4 (4.2) greater self-care prevention and patient empowerment. 8 8 Executive Governing Body and Delivery

ICS Transition: There is a risk to the CCG's capacity and N/A - New resources in meeting its statutory obligations and maintaining Director of HR and CO5 (5.1) I C T for 9 Executive Governing Body effective Doncaster Place partnership working. Corporate Services 2021/22

1-3 Low I Initial The risk appetite under which risks can be tolerated is a score 4-6 Medium C Current of 12 or below. 8-12 High T Target 15-20 Very High Risks scored at or in excess of a score of 13 must be 25 Extreme escalated to the Governing Body. Gaps in Gaps in control Internal and External assurance and Reference Risks Current Controls Positive Assurance and timescale for Actions to be taken Progress Against Actions Assurances timescales for remedial action

remedial action

Director and Director

Responsible

Current Risk Rating Risk Current

Operational Lead Initial Rating Risk Lead Committee/ Where can we gain Action Board for evidence that the Areas where we End Date What evidence Areas where we do delegation of What controls/systems do we controls / systems are not What could Happen and shows we are not have adequate Actions Date IdentifiedDate have in place that are we are placing receiving

Should the Risk Rating Risk Target reasonably controls /systems Detail the Actions CO1 - 1.1 Lead operating at this level and reliance on are evidence that Update on Actions, is the plan on track

Materialise, What is the managing our risks in place or existing Taken

Total Total Likely Likely assist in the delivery of aims effective internally / controls / Impact and our objectives controls /systems and manage / mitigate risks. externally? systems are are being delivered are not effective

Date and Name of effective Impact /Impact Consequence Impact /Impact Consequence Committee or Board

Strategic Objective 1 -Ensure an effective, well led, and well governed organisation and its statutory obligations are met. Outcomes i) Established • Organisational Development (OD) External Assurances: • Executive Committee Awaiting finalisation of • The CCG will need to 21.06.2021 - Senior Risk Owner Meeting. TCG now Governance Strategy. The People and OD • Annual and quarterly minutes (also reported to the Workforce consider the outcome, moved to fortnightly. Stock stake exercise complete, and Strategy was presented and agreed reviews with NHS Governing Body) planning for once available, of workforce lead gave a presentation to Doncaster management of Risk Description: The CCG at the October Strategy and OD England • Quality of Leadership Doncaster Place, Integrating Care - Next Partnership Board and sought clarity on which health the local may not have the right Forum, following staff and staff side • Annual and quarterly Assessment results stock take exercise is Steps Guidance that sets outcome whole system partnerships should focus on in the commissioning workforce capacity and engagement. reviews with Integrated • Internal Audit on scheduled for out the options for ICS's first instance, the recommendation was to focus on obesity. strategy and capability to meet its • Business Continuity Plans at team Care System Workforce Planning 06.04.21 to review and how the next steps will The overall workforce strategy and workforce plan has wider organisational objectives and level • Staff Survey (nationally (January 2019) - progress and impact on Commissioning been deferred to April 2022 to take account of new NHS collaborative to meet its statutory • Executive Committee - administered) 2019 significant assurance workforce metrics functions. organisational structures. Challenges with local CCG commissioning obligations. responsibility for deploying action plan pending. • Head of internal audit captured so far • Increasing staff recruitment are being observed, a new process has been commitments. organisational resource • SYB Governance opinion - significant • Outcome of the ICS engagement regarding agreed for any recruitment from 1 July across SYB CCG's, • Constitution, Standing Orders, Leads Meeting assurance 2018-19. Integrating Care - transition to the ICS and ICS Programme Management Board. CCG are starting to ii) Improvement Governance Meeting Structure, • Staff Survey 2020, • Annual and quarterly Next Steps Guidance additional support consider return to premises proposals in anticipation of the Assessment Risk Management, Information over 95% would reviews with NHS mechanisms being Governments next step in easing restrictions. Risk score Framework Governance, Health & Safety, recommend DCCG as a England. pursued for posts Board remains the same. (NHSE) Emergency Preparedness and place to work indicating • Annual and quarterly level and above submission. Risk Cause: A lack of Mandatory & Statutory training a high degree of job reviews with Integrated • Plans regarding returning 29.03.2021 - Senior Risk Owner Meeting workforce and OD strategy to • Organisational Development / satisfaction Care System. to premises (when As part of the ICS transition arrangements an employment iii) Delivery of support the current and future Learning & Development budget • Place-Based possible to do so) are guarantee has been provided for below Board Level People and direction of the CCG. • Personal Development Reviews Internal Assurances: Workforce Lead has being developed and will employees which offers staff a level of security. The CCG Organisational Corporate Governance (PDRs)/Talent Management Policy • Colleague been appointed and be presented to a future have held staff briefs and team timeouts to discuss the Development structure failing to meet • Organisational Development Engagement Group have commenced in Executive Committee transition arrangements, currently awaiting the HR Strategy statutory obligations. network established, membership (CEG) & Staff Briefs - post and are picking up framework which will be issued in May 2021. Score includes senior HR/OD involving staff in workforce strategy work reduced from 3x4 to 3x3 due to not seeing any impact of iv) Assured by professionals within Team readiness for the future for whole system the new variant and nationally the alert level has reduced Internal Audit Doncaster, accountable to DGT • Executive Committee partnership from level 4 to level 3. The tactical management group on Governance Portfolio Group minutes (Workforce chaired by Public Health has reduced from twice a week to and Risk • Workforce is a standing agenda related reporting) once a week. A stock take exercise is scheduled for Management. item on the Executive Committee • Management training 06.04.21 to review progress and workforce metrics • Doncaster Place Based workforce being delivered in-house captured so far for the Doncaster Place workforce planning. and Education committee • Appropriate established participation in regional 06.01.2021 - Senior Risk Owner Meeting Director of • Delivery Plans to meet strategic talent boards Score increased from 2x2 to 3x4 due to the new variant of HR and 3 3 life stages: Starting, Living and the covid virus, roll out of the vaccination programme that Apr-19 4 2 8 9 4 • Audit Committee deep None Identified Mar-22 Executive Corporate Ageing Well, detailing actions and dives of the BAF requires CCG resource and wave 3 which is preventing Serivces outcomes reported to Governing • Risk assessment for recovery work taking place. The CCG will need to consider Body. buildings have been the outcome, once available, of Integrating Care - Next • Quarterly reviews with Integrated completed to facilitate Steps Guidance that sets out the options for ICS's and how Care System. safe return due to Covid- the next steps will impact on Commissioning functions. A • Commissioned whole systems 19 deep dive of this risk was undertaken at Audit Committee partnerships to undertake a piece of • Majority of staff have held 10 December 2020. workforce planning at Place-based had an individual leading to the development of a assessment to facilitate 27.10.2020 - Senior Risk Owner Meeting. Doncaster Place Workforce safe return to work due The Place-Based Workforce Lead has now been appointed Strategy. to Covid-19 and will commence in post January 2021. The Whole • Currently recruiting Place-based • Staff survey results for Systems Partnership work has recommenced, a follow up Workforce Lead 2020 received and meeting was held Thursday 22 October, the Whole • Refreshed Management overall are positive Systems Partnership are collating data around Local Organisational Change Policy which •CCG received Authority health staff which will be combined with NHS is now consistent across all SYB outstanding for fourth Workforce data with stakeholder engagement commencing CCG's and agreed with staff side, year for 2019/20 in January 2021 when the Place-Based Workforce Lead is approved by GB •CCG have rolled out the in post, recognising existing capacity in the system is being Risk Consequence: Not • Majority of CCG staff now have new Agile working policy directed to managing the pandemic. No changes to risk achieving both our local Safemove to access servers score. commissioning strategy and remotely our wider collaborative • Microsoft Teams has been 22.07.2020 Senior Risk Owner Meeting. commissioning commitments. implemented for virtual meetings Action remains ongoing with a revised end date. The Reputational and structural risk • New ICS recruitment process from recruitment of Workforce Lead was postponed by RDaSH, if we are not seen to be 1 July 2021 a revised banding structure has been agreed and this is forward thinking and now back out to advert. The expectation is to complete transformational within the recruitment in August 2020. The Whole Systems Integrated Care System. Partnership was on hold due to Covid-19, following a Poor annual review from NHS meeting held 21.07.20 this will now recommence with work E / I in relation to the across the ICS footprint. Improvement Assessment Framework. Gaps in Gaps in assurance control and and Reference Risks Current Controls Internal and External Assurances Positive Assurance timescale for Actions to be taken Progress Against Actions timescales remedial for remedial action

action

Initial Risk Rating Risk Initial

Current Risk Rating Risk Current and Operational and Lead

Responsible Director Director Responsible Lead Action Committee / Areas where End Board for we do not Date delegation of Areas where have adequate Actions

What could Identified Date Where can we gain evidence that the we are not controls Happen and Rating Risk Target What controls/systems do we have in place that are controls / systems we are placing What evidence shows we are reasonably receiving /systems in Detail the Actions

CO2 - 2.1 Lead Should the Risk operating at this level and assist in the delivery of aims and reliance on are effective internally / managing our risks and our objectives evidence Update on Actions, is the plan on track Total Total

Total place or Taken Likely Materialise, What Likely manage / mitigate risks. externally? are being delivered that controls existing is the Impact Date and Name of Committee or Board / systems controls are effective

/systems are

ImpactConsequence / ImpactConsequence / not effective

Strategic Objective 2: Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population. Outcomes • Quality Surveillance Group across South Yorkshire & Bassetlaw (SYB) External Assurances: • Reporting of information to Q&PSC minutes • Emerging • Emerging • Development and 25.06.2021 Senior Risk Owner Review area • NHS England (NHSE) Quarterly Review • Care Quality Commission website Governance Governance understanding of required no changes to risk, however have received additional Risk Description: • Safeguarding Boards for Children and Adults meetings; benchmarking data • All Provider and Partnership minutes structure for new structure for clinical governance and guidance in relation to the emerging ICS model and Quality Impact - • Quality Accounts from our main providers - reviewed by Quality Team • CQC website • Routine surveillance reporting to NHSE models of new models of quality assurance system form and design between now and the 1st There is a risk to • Care Homes/Provider Risk Meetings • Safeguarding Board minutes • NHSE QSG working. working. framework for joint areas of April 2022. Emerging ICS leadership model will maintaining quality, • Joint Commissioning Management Board (JCMB) meetings plus sub • JCMB minutes • CRG minutes • Outcome of the • Clinical working. evolve the quality assurance and risk management services and structure of Doncaster Integrated Care Partnership (DICP) and • Prescribing Sub Group & APC minutes ICS Integrating governance • Develop joint structures within the new statutory body. outcomes through Doncaster Integrated Care Operational Group (DICOG) - system wide • Quality Accounts published in public domain Care - Next across commissioning relationship local transformation. with agreed devolution for joint commissioning • CRG minutes Steps Guidance providers with Providers with new 31.03.2021 Senior Risk Owner Review • Safer Stronger Partnership Board (SSPB) membership and sub model of care No significant changes identified during Quarter 4, groups. Internal Assurances: • Influence providers to but more understanding and clarity is anticipated in • Provider and other Partnership Governance meetings. • Quality & Safety Directorate structure develop clinical governance regards to the ICS model following the publication of • Quality & Patient Safety Committee (Q&PSC) with agreed Terms of • CRG minutes structures Integrated Care - Next Steps Guidance. Score Reference • CQRG - (Quality schedules, KPIs and • The CCG will need to reviewed and no changes required. • Quality & Performance Reports monthly to Governing Body information schedule). consider the outcome, once Risk Cause: • National oversight and benchmarking of key quality performance • Patient level assurance for individual available, of Integrating 08.01.2021 Senior Risk Owner Review. Deterioration in the targets placements. Care - Next Steps Deep dive of risk undertaken at Audit Committee held quality of patient care • Contractual provider quality monitoring reports including CCG oversight • Provider and other partnership governance Guidance that sets out the 10.12.20, score reviewed and remains relevant. The and safety. of the quality impact of provider Cost Improvement Programmes meeting minutes and report. options for ICS's and how Covid19 Governance Structure for Wave 3 of the • Incident Management Group (IMG) oversees Serious Incident • CHC performance and quality. the next steps will impact Pandemic and the escalation framework continues. Reporting • Quarterly and annual report on complaints on Commissioning The CCG will need to consider the outcome, once i) Achieve safe • Prescribing Sub Group; Area Prescribing Committee (APC) through Q&PSC functions. available, of Integrating Care - Next Steps Guidance effective care Chief • Quality & Safety Team - capacity and capability assurance • Reporting of information to Q&PSC minutes Executive that sets out the options for ICS's and how the next Apr-19 5 4 20 5 2 10 10 Mar-22 and a positive Nurse • Primary Care Commissioning Committee (PCCC) • Governing Body minutes Committee steps will impact on Commissioning functions. experience. • Contract provider governance structure and contractual arrangement • IMG minutes • Primary Care Data Information SubGroup • QSG minutes 04.11.2020 Senior Risk Owner Review. • Chief Officer Safeguarding Oversight Board (SOB) • CQRG minutes Risk score still relevant, Quality & Patient Safety • LeDeR Process. • Quality and performance report to Governing Committee has continued . The Covid19 • Continuing Health Care (CHC) capacity and capability. Body Governance Structure has been reviewed and • Complaints and enquiries process. • Patient experience and engagement process updated in anticipation of managing Wave 2 and • Quality risk profile tool and process • Each QIPP plan has a quality and safety additional winter pressures. An escalation framework • Clinical Quality Review Group (CQRG) minutes impact assessment has also been agreed across the system. Any new • Patient experience and engagement process • LeDeR Learning Group system specific high risks in relation to Covid19 and Risk Consequence: • Chief Nurse is a member of the Quality Improvement Productivity • Minutes from the Covid 19 Governance quality are discussed at the Health & Care Group and Patient harm, Programme Board (QIPP) Structure Meetings i.e Health & Care Group escalated. experience and • Chair of the Q&PSC is Chair of the Clinical Reference Group (CRG) reduced outcomes. • Medicines Management Group (MMG) • Temporary Internal Governance Arrangements and Controls During Covid Pandemic wave 1 i.e Healthcell • The Covid 19 Governance Structure has been reviewed and updated for Wave 2 Gaps in Gaps in control assurance and Reference Risks Current Controls Internal and External Assurances Positive Assurance and timescale for Actions to be taken Progress Against Actions timescales for Rating remedial action

remedial action

Current Risk Risk Current

Director and and Director

Responsible Responsible Operational Lead Operational Initial Risk Rating Risk Initial Lead Action Committee / End Board for Where can we gain evidence that Areas where we do Areas where we Date delegation What controls/systems do we What could Happen the controls / systems we are not have adequate are not receiving of Actions Date Identified Date have in place that are operating at What evidence shows we are

and Should the Risk Rating Risk Target placing reliance on are effective controls /systems evidence that

CO2 - 2.2 Lead this level and assist in the reasonably managing our risks and Detail the Actions Taken Update on Actions, is the plan on track Total Total

Materialise, What is Total internally / externally? in place or existing controls / Likely Likely delivery of aims and manage / our objectives are being delivered the Impact Date and Name of Committee or controls /systems systems are mitigate risks.

Board are not effective effective

ImpactConsequence / ImpactConsequence /

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

Outcomes i) Achieve actions • Relevant delivery groups (eg. Planned External Assurances: • Delivery Plans (Strategic Delivery Plan for • Dedicated Mental None • Mental Health Board has been 30.06.2021 - Senior Risk Owner Meeting. Operational plan signed off by and outcomes Care Board) . • NHS England approval of winter plan each Life Stage) received by Governing Health Board has agreed in principle, interim model in NHS England. Risk of Covid impact upon delivery has reduced in line with within Joint • Contracts with providers for CCG annual planning submission. Body October 2019 (minutes). been agreed in place successful vaccination programme. Doncaster have signed up as part of Commissioning Risk Description: management and monitoring of the • Quality and Performance monthly reports principle, but is not yet • Work to be agreed around the ICS Accelerator Programme for elective waiting time recover. Risk Health and Social Quality Impact - The delivery of services. Internal Assurances: to Executive Committee and Governing in place. outpatient transformation remains the same, no changes to risk score. Care Strategy quality of care delivered • Quality & Performance monitoring • Governing Body focus on Life Stage Body. • Place Plan - gaps in programme and the capacity to to patients and the reporting to Governing Body. (rolling cycle each month) October 2019 • Regular contract meetings with main capacity with strategic support 20.04.2021 - Senior Risk Owner Meeting. Deep Dive undertaken at Audit achievement of • Patient Experience reported to (minutes). providers. change across • System partner operational group Committee March 2021. The Operating Framework for 2021/22 has been ii) Achieve actions associated quality and Engagement and Experience • Minutes of relevant Delivery Groups to • Regular system-wide reporting from partnership - sign off (SPOG) to meet in July published, the CCG is currently working with Doncaster Place partners and outcomes performance targets Committee. Executive Committee. whole system. of capacity to support and the ICS to develop system plans based on priorities in the guidance. within Place Plan could be adversely • Place Plan refresh. • Signed contracts and minutes of Contract • Positive friends and family test reports. Place Plan. 2021/22 life stage plans were signed off by Governing Body in April 2021. affected if we fail to • Whole system winter plan developed Board Meetings. • CQRG minutes to Quality and Patient The escalation framework still in place and risks continue to be managed commission effective, and implemented. • Quality & Performance Reports monthly Safety Committee. by the Health and Care Group. Nationally, the NHS response to Covid19 resilient and sustainable • Temporary Internal Governance at Governing Body and Executive • Mental Health reported through has reduced to Level 3. The biggest risk going onto 2021/22 is the services. Arrangements and Controls During Committee (minutes). governance structures and frameworks. recovery of waiting time positions particularly in relation to elective care. Covid Pandemic i.e. Healthcell • Contract Board, Finance Performance • Governing Body have been kept informed Risk score remains the same. • The Covid 19 Governance Structure and Information Group and Clinical Quality with Covid Pandemic Arrangements has been reviewed and updated for Review Group Meeting (CQRG) minutes • System escalation framework has been 18.01.2021 - Senior Risk Owner Meeting. NHS England response level Wave 2 with main providers. signed off and is implemented. as been increased to Level 5 due to Covid pandemic. The CCG and • System Escalation Framework • Life stage reports are taken to Joint provider services have had to prioritise capacity to meet Covid response implemented from November 2020 Commissioning and Operational Group and implementation of the vaccination programme, this has led to the Risk Cause: • Daily assurance meetings commenced (JCOG) on a monthly basis and issues system planning accordingly for Winter and prioritised services to manage System capacity cannot with NHS England from Qtr 3 (2020) escalated to JCMB, as appropriate. Wave 3 demand. System escalation framework still in place and risks / respond to demand. • Place Plan reporting monthly at threats continue to be managed through Health & Care Cell. A Deep Doncaster Integrated Care Operational Dive was undertaken at Governing Body on the 3rd December around Group (DICOG) and quarterly Doncaster Ageing Well delivery plans. Integrated Care Partnership board • Minutes of QIPP Programme Board 06.11.20 Senior Risk Owner Meeting. The CCG have submitted all • 2019/20 Year end update on delivery planning assumptions and trajectories to NHS England for the remainder Director of plans presented to March Governing Body of 2020/21, as guided by the NHS England phase 3 letter. Reprioritised Strategy Executive Apr-19 4 3 12 4 3 12 6 • Minutes from the Covid 19 Governance Mar-22 delivery plans were presented and agreed at Septembers Governing and Structure Meetings i.e Health & Care Committee Body. A system escalation framework has been developed and agreed to Delivery. Group support management of Winter pressures / Covid. Daily assurance • Governing Body Minutes from September meetings with NHS England have been scheduled. A deep dive into 2020 demonstrate discussion and approval cancer and urgent care was presented to November Governing Body. of reprioritised delivery plans Due to moving into Wave 2 of the pandemic and winter pressures • System Escalation Framework presented combined with system capacity to manage demand and maintain quality, Risk Consequence: to November 2020 Governing Body the impact score has been increased from 3 to 4. • Deterioration in the quality of patient care 23.07.2020 Senior Risk Owner Meeting. Whilst there has been some and safety. acceleration in certain areas, the majority of delivery plans have been • Patient harm and paused due to the pandemic and national guidance during phases 1 and 2 potential death. of the pandemic The CCG have maintained Quality Assurance meetings • Reduction in with providers and processes have been implemented to ensure providers constitutional have undertaken clinical prioritisation i.e. waiting times. Performance performance targets. targets are not being met due to guidance around the response to the • Increase in patient flow pandemic but work is taking place with providers around recovery plans. across the system. The current financial regime related to the pandemic limits the CCG's • inability to financially ability to achieve QIPP in 2020/21. Activity and finance planning is being balance health and reviewed with NHS England and the CCG are reprioritising delivery plans social care system. which will be presented to September Governing Body for approval. In terms of actions, interim Mental Health Board arrangements are in place and new models to support the Joint Commissioning Strategy and Place Plan have been complete. Recruitment for the two strategic change posts are now complete. No change to risk score. Gaps in control Gaps in assurance Internal and External Positive Reference Risks Current Controls and timescale for and timescales for Actions to be taken Progress Against Actions

Lead Assurances Assurance Rating

Rating remedial action remedial action

Initial Risk

Operational

CurrentRisk

Directorand Responsible Lead Committee/ Action Board for End Where can we gain What evidence Areas where we delegation of evidence that the controls shows we are do not have Areas where we Date What could Happen Actions What controls/systems do we have in place that / systems we are placing reasonably adequate controls are not receiving and Should the Risk DateIdentified

CO2 - 2.3 Lead TargetRisk Rating are operating at this level and assist in the delivery reliance on are effective managing our /systems in place evidence that Detail the Actions Taken Update on Actions, is the plan on track

Materialise, What is

Total Total Likely Likely of aims and manage / mitigate risks. internally / externally? risks and our or existing controls / systems the Impact Date and Name of objectives are controls /systems are effective

Committee or Board being delivered are not effective

Impact/ Consequence Impact/ Consequence

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

Outcomes i) Achieve against • Primary Care Strategy and Delivery Plan. External Assurances: • Minutes of Primary • Some individual None. Implementation of estates 22.06.21 - Associate Director of Primary Care Review - The Doncaster the Primary Care • Primary Care Commissioning Committee oversight. • CQC Visits to Practices. Care Commissioning practice issues with strategy is ongoing, a refresh will workforce priorities have been agreed and a workshop is planned for the Strategy and Annual • Local implementation of GP investment through long term • Delegation Agreement from Committee. sustainability and be undertaken during 2021/22 to 23rd June with a focus on obesity. CCG Delivery Plans were approved Workplan plan 2019/20. NHS England to CCG. • Delegation business models. reflect PCN requirements at Governing Body in April and the Primary Care Delivery Plan was • Delegation from NHS England for commissioning primary • Positive feedback from NHS Agreement from NHS • Timeliness of • Primary Care Commissioning approved by Primary Care Committee in May. A deep dive on Primary ii) Achieve GP IT Risk Description: medical care services - supports better integration of primary England primary care team England to CCG. practice engagement receives updated Estate Action Care digital and estates is planned for July Governing Body. Substantial Operating Primary Care: If we fail medical care commissioning with the wider CCG and ICS. • Practice Intelligence with the CCG Plan monthly. assurance was received for 360 Assurance Audit. The Stagegate 5 Framework to commission commissioning strategy. • Healthwatch - Primary Care Reporting. • More development • The CCG will need to consider review has been completed this quarter, ratings are to be confirmed. effective, resilient and • Quarterly reporting from Primary Care Commissioning Access Survey. • Positive feedback needed of the outcome, once available, of The target for completing adult Covid vaccinations is 19 July 2021, sustainable primary Committee to Governing Body. * NHSE outcomes from the from NHS England triangulation of Integrating Care - Next Steps Doncaster have a high uptake but there is an expectation to return to pre- medical care services, • National oversight and benchmarking of key quality quarterly stage gate reviews primary care team primary care data Guidance that sets out the covid activity levels in terms of appointments and delivery. The biggest the quality of care performance targets. * 2020/21 360 Assurance audit and ICS. and sustainability options for ICS's and how the challenge is managing patient expectations and demand, CCG are delivered to patients • Quality Performance Reporting on Primary Care to Quality issued with substantial • Primary Care within individual next steps will impact on supporting via a communications campaign and have discussed and the achievement of & Patient Safety Committee. assurance Commissioning practices. Commissioning functions. recovery planning, a joint meeting with the Trust is planned for early associated quality and • Quarterly contract meetings with Primary Care Doncaster * An ICS Primary Collaborative Issues Log • Development of the • 2021/22 Delivery Plans to be July. Health and wellbeing of Primary Care staff is a priority. An ICS performance targets Federation . is being established with • Annual 360 relationship of the developed and to be approved at Primary Care Collaborative was agreed by HEG in June and is in the could be adversely • Primary Care Matrix and Associated quality visits to Doncaster representation Assurance audits on PCNs. April Governing Body process of being established, Risk score remains the same. affected, and the full practice. commissioning, • Programme • Outcome of Stagegate 5 review vision contained within • Director of Strategy and Delivery visits to every practice Internal Assurances: governance and Business Case to be considered once available 23.03.21 - Associate Director of Primary Care Review the Place Plan could within 12 months. • Delivery Plan received by procurement. approved by ICS but • PCCC to consider the role of Data is being gathered to support the WSP programme via all Doncaster potentially be adversely • Use of NHS England GP resilience monies. Governing Body April 2020 • Neighbourhood multiple comments the Primary Care Cell and how its partners, work will progress to inform workforce planning and a strategy. affected. • Use of local Doncaster CCG non-recurrent resilience (minutes). profiles and GP have been received fits into the CCG governance Delivery Plans for 2021/22 have been discussed at S&OD Forum in money. • Minutes of Primary Care Matrix. from the Department structure going forward. March and will be presented to April Governing Body for approval. The • Primary Care Workforce Strategy and workplan Commissioning Committee. • Detailed guidance of Health which need 360 Assurance Internal Audit has been completed, awaiting final report implementation. • Practice Intelligence on contract to be worked through for comment and approval. Qtr 4 Stage Gate review completed, rated • Primary Care Estates Strategy and workplan Reporting. framework for primary and may impact on as amber for all projects and actions for progressing have been implementation. • Primary Care Commissioning medical care delivery identified. A Primary Care in focus session was held at March • Regular strategic meetings with Local Medical Committee & quality Issues Log (PCQ) published 6 February Governing Body. Pressure is building in Primary Care around offering and Primary Care Doncaster. • Primary Care Matrix and 2020. vaccines to all eligible cohorts and ensuring adequate access to primary • Locality Meetings with GP Locality Lead, Manager and Variation in Practice • New contractual care, CCG are supporting primary care with calling patients to follow up representation from practices. • Roadshows framework for on vaccination delivery. Score reviewed and remains the same as • Agreement and formation of five primary care networks • Newly formed Information community pharmacy mitigations have been identified to support practices in maintaining Risk Cause: across Doncaster Sub Group to the Delivery published October service and delivery. • Primary Care services • Monthly meetings with Primary Care Network Clinical Group. 2019. are unsustainable. Directors. • 2019/20 practice visits by • Programme 08.01.21 - Associate Director of Primary Care Review • Primary Care Strategy • New GP Contract Framework and national letters regarding Director Business Case for The estates business case has been approved by all 5x CCG's and is is not delivered. contractual implications due to Covid, including recovery • 2019/20 Year end update on estates signed off in now with the ICS HEG Group for ratification. PCN clinical directors and • GP IT Operating • Temporary Internal Governance Arrangements and delivery plans presented to Nov 2020 CCG meetings are taking place monthly and estates will be discussed Framework is not Controls During Covid Pandemic i.e Primary Care Cell March Governing Body • PCCC received and as part of that forum. Daily sitrep reports are now being received from delivered • The Covid 19 Governance Structure has been reviewed • Action taken by CCG approved the estates practices which identifies any pressures that requires CCG support. and updated for Wave 2 regarding any adverse practice plan in Nov 2020 360 Assurance are scheduled to undertake the next mandatory audit on Director of * Quarterly assurance report to NHSE around the CQC ratings primary care contract management during Qtr4. The next quarterly NHS Strategy & Apr-19 4 3 12 3 4 12 6 development of our PCNs • Use of the Primary Care Mar-22 Executive Committee England stage gate review is scheduled for Qtr 4. The Primary Care Delivery • Primary Care Quality and Performance Framework which Matrix Tool delivery plan will be presented to March Governing Body. Score was approved by PCCC in November 2020 • Minutes from the Covid 19 reviewed and remains the same due to additional pressures with * Daily reporting on workload and capacity is being received Governance Structure delivering vaccination programme, managing workforce absence which which will be incentivised through the GP Additional Care Meetings i.e Health & Care potentially could be impacted by Covid and maintaining business as Fund (GPSCF) from 1 July 2021 Group usual services. • Decision made by Primary Care Healthcell during Covid19 03.11.20 - Associate Director of Primary Care Review. Projects are are presented to Primary Care progressing around estates development and use of capital, monthly Commissioning Committee report presented to PCCC and the programme business case will be presented in November for PCCC approval. Limited engagement around Primary Care due to other priorities with managing the pandemic, Primary Care Manager is maintaining engagement directly with practices. Primary Care Cell continues to operate on a weekly basis to consider and implement national guidance and make local decisions, a Primary Care escalation framework has been agreed. Windows 10 and Office 365 upgrades are taking place. The PCN's are on with recruiting additional roles required. A meeting has been held with Healthwatch to review and implement the results from the Healthwatch Survey around Risk Consequence: online access during Covid pandemic. Score remains the same. • Adverse quality and experience for patients 28.07.20 - Associate Director of Primary Care Review - An interim within primary care. estates manager is now in post and workshops were held in February • There would be 2020 around Communications & Engagement and the Nurse Awards. significant demand Director practice visits were completed for 2019/20, these visits upon other services highlighted issues around finance, IT, medicines management and within Doncaster e.g. access processes which have been followed up. The CCG are Acute services. reprioritising delivery plans following the pandemic. The GP IT operating framework was released and the CCG Practice Agreement was updated and had these were all signed and returned by the 31st March. The score has been increased from 3x3 to 3x4 to reflect a possible second wave of the pandemic and the stepping back up of services as part of recovery both of which will impact on Primary Care capacity to deliver. Gaps in control Gaps in assurance and Internal and External Reference Risks Current Controls Positive Assurance and timescale for timescales for Actions to be taken Progress Against Actions Assurances

Rating remedial action remedial action

Director and Director RiskCurrent

Responsible OperationalLead Initial Risk Rating Initial Lead Action Committee / End Board for Where can we gain evidence Areas where we do What could Date delegation of that the controls / systems we What evidence shows not have adequate Happen and What controls/systems do we have in place Areas where we are Actions DateIdentified are placing reliance on are we are reasonably controls /systems

Should the Risk TargetRisk Rating that are operating at this level and assist in not receiving evidence CO2 - 2.4 Lead effective internally / managing our risks and in place or Detail the Actions Taken Update on Actions, is the plan on track

Materialise, the delivery of aims and manage / mitigate that controls / systems

Total Total Likely Likely externally? our objectives are being existing controls What is the risks. are effective Date and Name of Committee delivered /systems are not Impact

or Board effective

Impact / ConsequenceImpact / ConsequenceImpact /

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

Outcomes i) Provider • Refreshed Doncaster Place Plan - a vision of an External Assurances: • All statutory organisations • Education & training • Development of a consistent 21.06.2021 - Senior Risk Owner Meeting. Stock stake exercise Assurance Risk Description: Accountable Care System with providers working in • All statutory organisations have have supported the vision in programmes which meet health and social care complete, workforce lead gave a presentation to Doncaster through The Provider partnership together. supported the vision in the Place the Place plan the needs of the future competency framework, training Partnership Board and sought clarity on which health outcome whole Contract Board Workforce lacking • Team Doncaster - working together to improve the plan. • Strategic Workforce and health and social care delivered by DBTHFT. system partnerships should focus on in the first instance, the the capacity of economic climate in Doncaster, attract and retain • Minutes of Team Doncaster - Education Committee workforce. • Education and training recommendation was to focus on obesity. Strategic Workforce sufficiently skilled new workforces, and train our own staff from within Chief Officer & Chair • Place based workforce lead programme in progress to support Education Committee (SWEC) scheduled for 25.06.21, main focus of staff, which could Doncaster. representation. funded recurrently. the health and social care meeting with be to review the Doncaster Workforce vision and be detrimental to • Better Work and Jobs Network formulated • Minutes of Joint Commissioning • Vaccination programme workforce. priorities . No changes to provider staff absence and Covid19 patient care. (inaugural meeting February 2020). Management Board. underway and front facing • Potential development of a vaccination uptake, no issues raised so far. Risk score remains the ii) Positive • Joint Commissioning Partnership with Doncaster • ICS Place Based Workforce Lead healthcare workers are being University Campus in Doncaster same. Quality and Council - including the Better Care Fund. in place. vaccinated for health and care. Performance • Doncaster Place Director of Digital appointed with • Strategic Workforce and • Development of skills 29.03.21 - Senior Risk Owner reports responsibility for implementation of the Doncaster Education Committee (SWEC) passport to enable Score reduced from 4x4 to 3x3 due to feedback from provider Place Digital Strategy. linked to schools, colleges and movement of staff between organisations around reduction in staff absence and high uptake of • Integrated care record to support Digital Strategy. universities to promote career NHS organisations and an Covid19 vaccination. Education and Training actions will be • Partnership engagement with Health Education pathways. agreed MOU reconsidered once system is in recovery and stable. Awaiting England and Doncaster College on provider • Doncaster Growing Together • Place-Based Workforce finalisation of the Workforce planning for Doncaster Place, a stock workforce needs. Strategy detailing learning, working, Lead has been appointed take exercise is scheduled for 06.04.21 to review progress and • Integrated Care Partnership receives reports on living and caring. and have commenced in workforce metrics captured so far provider workforce. • Daily ops meeting held by the post and are picking up • Provider organisations have shared workforce risk Trust to review capacity workforce strategy work for 06.01.21 - Senior Risk Owner assessments with the CCG and have plans in place • Daily regional touch point whole system partnership Score increased from 3x3 to 4x4 due to wave 3 which has seen an to mitigate these risks. meetings with Directors of increase in infection rates which may result in greater demand • NHS Interim People Plan Commissioning to understand coupled with likelihood of increased staff absence. The Covid19 • Commissioned whole systems partnerships to system wide pressures Governance Structure for Wave 3 of the Pandemic and the undertake a piece of workforce planning at Place- • Health & Care Group (formally the escalation framework continues. A deep dive of this risk was based leading to the development of a Doncaster Healthcell( meets at least weekly for undertaken at Audit Committee held 10 December 2020. Risk Cause: Place Workforce Strategy. escalation of issues and to, where Workforce • Currently recruiting Place-based Workforce Lead possible, enact any mutual 27.10.2020 - Senior Risk Owner Meeting. • Temporary Internal Governance Arrangements aid/support between organisations. Risk narrative reworded from "The Provider Workforce being Director of Strategies of the and Controls During Covid Pandemic This group may escalate to Team insufficiently skilled, which could be detrimental to patient care" to HR and Providers fail to Executive Apr-19 5 4 20 3 3 9 8 • The Covid 19 Governance Structure has been Doncaster Gold where appropriate Mar-22 reflect capacity challenges of skilled workers. The NHS People Plan Corporate recruit and retain Committee reviewed and updated for Wave 2 has now been published and each local organisation has developed a Services appropriate skills sets and capacity Internal Assurances: local versions. An ICS Strategic Workforce Lead has been appointed to meet the • Minutes of Doncaster to work across workforce planning, a workforce strategy has been requirements. Interoperability Group - assurance produced in relation to the phase 3 planning guidance. The Place- on IT. Based Workforce Lead has now been appointed and will commence • Chief Officer engagement within in post January 2021. SWEC not been meeting due to capacity and Team Doncaster. competing priorities in regards to the pandemic. The Covid19 • Executive Committee minutes governance structure has been reviewed and updated. Daily ops (workforce related reporting). meeting held by the Trust to review capacity and daily regional touch • Established the Healthcell during point meetings take place with Directors of Commissioning to Covid-19 with representatives from understand system wide pressures. The Health & Care Group providers, responsible for escalating (formally the Healthcell ( meets at least weekly for escalation of risks including workforce issues and to, where possible, enact any mutual aid/support between • Minutes from the Covid 19 organisations. This group may escalate to Team Doncaster Gold Governance Structure Meetings i.e where appropriate. No change to risk score. Health & Care Group 22.07.2020 - Senior Risk Owner Meeting Actions achieved: Provider organisations to provide a response to NHS E / I on the Interim People Plan and development of nurse apprenticeships. An ICS Strategic workforce lead has been appointed as support for the whole system which will result in an ICS Risk Workforce Plan. The recruitment of Workforce Lead was postponed Consequence: Not by RDaSH, a revised banding structure has been agreed and this is achieving both the now back out to advert. The expectation is to complete recruitment in local August 2020. Revised end date identified for remaining actions. commissioning strategy and the wider collaborative commissioning commitments. Gaps in assurance Gaps in control and Reference Risks Current Controls Internal and External Assurances Positive Assurance and timescales for Actions to be taken Progress Against Actions

Lead timescale for remedial action Rating

Rating remedial action

Initial Risk

Operational

CurrentRisk Directorand Responsible Lead Committee/ Action Board for End Date delegation of What could Where can we gain evidence that the Areas where we are What evidence shows we are Areas where we do not have Actions

Happen and DateIdentified What controls/systems do we have in place that are controls / systems we are placing not receiving reasonably managing our adequate controls /systems Detail the Actions CO3 - 3.1 Lead Should the Risk TargetRisk Rating operating at this level and assist in the delivery of reliance on are effective internally / evidence that Update on Actions, is the plan on track

risks and our objectives are in place or existing controls Taken

Total Total Likely Materialise, What Likely aims and manage / mitigate risks. externally? controls / systems being delivered /systems are not effective

is the Impact Date and Name of Committee or Board are effective

Impact/ Consequence Impact/ Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change Outcomes i) Achievement • South Yorkshire & Bassetlaw (SYB) Sustainability & External Assurances: • Monthly reporting to Governing • Outcome of the ICS Integrating None • Transforming Care 24/06/2021 - Meeting with CFO - plans are now developed and against the joint Transformation Plan (STP). • Collaborative Partnership Board minutes Body on CCG Delivery Plan Care - Next Steps Guidance Partnership - entering a submitted for first 6 months of 2021/22 (H1). The plans ae still based on commissioning • Collaborative Partnership Board for the SYB STP - Chief • NHS E operating plan submission progress. risk share with other the national financial regime therefore the allocations are nationally health and social Officer representation. • NHS E IAF Reports • NHS England Improvement & CCGs. determined and continue to include directed block contracts resulting in care strategy • Doncaster Place Plan. • Right Care tracker document Assessment Framework Reports • Joint commissioning and minimal flexibility of funding. The submitted final plan includes a QIPP and operational • CCG Commissioning & Contracting Intentions. • Health & Wellbeing Board minutes - Chair & • NHS England review process pooling of resources with requirement of 3.1 million and limited investments (other than spending delivery plans • Joint Commissioning Strategy with the Local Authority and Chief Officer representation • Governing Body reporting of LA and CCG - review funding) due to the financial regime, therefore work is underway Risk Description review of Delivery Plans for the three stages (Starting, Living, • NHS E Annual review process. refreshed plan and deep dives on commissioning for service to ensure savings plans are fully developed and realisable. All savings Transformation: Ageing Well). • Doncaster System Place review - quarterly. delivery plan at each Governing and pooled-budgets is plans are robustly monitored through the QIPP board and some Expenditure is in • Operational planning templates 2019-20 submitted to NHS • Team Doncaster minutes. Body meeting being progressed with mitigation has been identified in case of slippage. Therefore at this stage excess of income England (NHS E) alongside a planning narrative setting out • Established ICS System Efficiency Board • Governing body approved Joint Children's Continuing this risk is being managed. and QIPP / plans to deliver agreed activity reductions, standards and minutes. Commissioning Strategy for Healthcare. To be transformation plans targets and financial affordability. • Integrated Care Partnership group refreshed Health and Social Care March reconsidered in 2021/22 01.04.2021 - Meeting with CFO. Transformation for 2020/21 has been fail to bridge the gap • NHS Long Term Plan (LTP) (5 years) and Technical November 2018, agrees the overall strategy of 2019 • CCG to review outcome limited due to the nature of the financial environment in response to the resulting in the CCG Guidance review and submission of operating plan to NHSE, the LA, CCGs, NHS Provider and other local • QIPP Efficiency Savings report of projects supporting high national pandemic however the CCG's 2020/21 financial duties have not meetings its ii) Delivery of currently being developed. Implementation framework issued providers, Chief Executive led. and minutes cost individual placements been achieved, clearly as the year has drawn to a close all the statutory financial Place Plan with 27 June 2019. • ICS System wide Finance meetings • Financial reports demonstrate once available, this project uncertainties in terms of the financial regimes have been clarified. We and quality duties. partners • Commissioning for Value Decision Making Framework. the control total is being met. has commenced. are now in receipt of the 2021/22 financial and operational guidance and • NHS E Improvement & Assessment Framework (IAF) - a Internal Assurances: • System wide costing exercise • The CCG will need to currently working through the requirements and how this may impact on continuous risk-based process, with meetings as required, • QIPP)Programme Board minutes. undertaken. consider the outcome, the CCG. Score reviewed and amended from 3x3 to 4x2 to meet the informed by performance indicators and a wide range of other • Governing Body reporting of refreshed plan • Patient validation work once available, of target score for 2020/21. sources of insight, leading to a formal assessment against the and deep dives on delivery plan at each undertaken by DBTHFT, Integrating Care - Next 4 domains of assurance at the year end. Governing Body meeting. commissioned by the CCG. Steps Guidance that sets 15.01.2021 - Meeting with CFO. The financial position has improved • Internal assessment of national potential Right Care and Get • Commissioning legal agreement between • Achievement of 2019/20 out the options for ICS's since the last update which is due to prescribing and Service It Right First Time opportunities and tracking of progress Local Authority and CCG (1 April 2020). statutory financial requirements and how the next steps Development Funding (SDF). The improvement around prescribing is against these. • Joint Commissioning Strategy for Health and will impact on primarily due to the settling of the volatility of expenditure each month, • Integrated Care System (ICS) has a System Efficiency Board Social Care with the Local Authority to be Commissioning functions. we had a prudent forecast in the early months of the financial year due iii) Achieve Risk Cause to review right care opportunities, Get It Right First Time, approved by Governing Body on 31 March • Monitoring efficiency to uncertainty, in addition we are not anticipating a significant impact control total, Financial spend in working with external consultancy and CCG representation. 2019. plans via the QIPP board from the EU Exit as initially predicted. SDF Funding has been received efficiencies and delivery of services • Health & Wellbeing Board - local collaborative work to • Monthly reporting to Governing Body on CCG by the CCG however this is already included in provider baselines and is system will be higher than improve health outcomes and address health inequalities; Delivery Plan progress. therefore double funding. These two elements have resulted in a affordability. our contract plans. Health & Wellbeing Board challenge of CCG plans. • Governing Body approval of CCG favourable variance against plan. We continue to work with managers The service would • Quality, Innovation, Productivity and Prevention (QIPP) Commissioning & Contracting Intentions – to develop and push forward efficiency savings however these will not not be delivered in Delivery Plan. March 2019 be delivered until 2021/22 and the financial pressure of QIPP delivery an integrated care • Quality, Innovation, Productivity and Prevention (QIPP) • Governing Body support of Joint Health and due to the improved forecast has decreased. A joint project is being setting. Programme Board. Social Care Commissioning and delivery plans - undertaken with RDaSH on out of area placements and a further project Chief Apr-19 4 4 16 4 2 8 8 • Joint Transformational Board with Doncaster system partners March 2019. Mar-22 Governing Body is underway with external support to look at high cost individual Officer including Bassetlaw CCG, looking at joint efficiency • Governing Body support of the Integrated placements. Risk score reduced from 4x4 to 3x3. opportunities, part of the remit is to look at joint activity and Care System - April 2018 waiting list planning and redesign of service transformation. • CCG and DBH Transformation Board 16.11.2020 . Following the notification of the Allocations and the • Governance and Finance Sustainability Self-Assessment. minutes. financial framework, a revised financial plan has been developed. There • Commissioning legal agreement between Local Authority is significant risk built into this plan which looks at efficiency savings and CCG (1 April 2018) and has been extended to March across both CHC and prescribing. A number of schemes have been 2020. developed to support the delivery of these savings and were signed off • Memorandum of Understanding - Accountability Care Plan at the Executive Committee on 21.10.2020. Mobilisation plans are now (ACP) Agreement. underway and delivery will be monitored closely each month. In addition • Partnership working with Team Doncaster. we have agreed with the ICS that the CCG have an underlying £1.8m of • Daily CCG Covid meetings which incudes finance unmitigated risk in our plan, the ICS are developing risk share • Sub-Group under RDaSH Board to progress out of area arrangements across the system in the event of any Organisation not placements project achieving its control total. In 2021 the CCG will have limited ability to • CFO and Chief Nurse are joint SRO's for overseeing high invest in transformation schemes. Risk score increased to 4x4 due to Risk Consequence cost individual placements project which will report to uncertainty. The CCG would not Executive Committee meet its statutory 30.07.2020 - Meeting with CFO. The CCG met its statutory duties and financial required efficiencies as at 31 March 2020. From 1 April, the CCG's requirement. financial plan has been suspended due to the response to the Covid The CCG would not pandemic. Allocations were provided for the first four months, meet the integration confirmation is awaited on allocations for the remainder of 2020/21. of care systems Nationally, the financial framework is being reviewed which we anticipate agenda. will clarify future arrangements and system wide working, the principle of a system wide approach to financial stability remains. the CCG are currently refreshing delivery plans and developing reprioritisation plans. The deep dive into CHC spend was suspended due to the pandemic and will be reconsidered at a future date once in recovery. Actions remain the same but the consequence score has been increased to reflect the unknown expectations of the revised planning arrangements expected imminently. Gaps in Gaps in control and assurance and Reference Risks Current Controls Internal and External Assurances Positive Assurance Actions to be taken Progress Against Actions

timescale for remedial action timescales for

Rating Rating

Initial Risk remedial action

Operational

Current Risk Current Director and Director and

Responsible Lead Action Committee/ End Board for Where can we gain evidence that Areas where we What could Date delegation of What controls/systems do we have in the controls / systems we are What evidence shows we are Areas where we do not have are not receiving Happen and Actions Date IdentifiedDate place that are operating at this level and placing reliance on are effective reasonably managing our risks adequate controls /systems evidence that

CO3 - 3.2 Lead Should the Risk Target Risk Rating Detail the Actions Taken Update on Actions, is the plan on track

assist in the delivery of aims and manage internally / externally? and our objectives are being in place or existing controls controls /

Total Total Likely Materialise, What Likely / mitigate risks. Date and Name of Committee or delivered /systems are not effective systems are is the Impact

Board effective

Impact / Consequence Impact / Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change Outcomes i) Achievement • Financial Strategy refreshed further after the External Assurances: • Joint Commissioning Strategy for • A single System Control total has Prescribing Internal • Commissioning for Value 24/06/2021 - plans are now developed and submitted for against the publication of the five year allocations 2019 - 24. • Collaborative Partnership Board Health and Social Care (Local been agreed in the 12 Audit to take place Framework limiting to NICE first 6 months of 2021/22 (H1). The plans ae still based joint • Commissioning for Value Decision Making minutes. Authority and CCG). organisation across the ICS 2020/21. (previous guidance. Developing on the national financial regime therefore the allocations commissioning Framework • NHS England financial plan • NHS England Improvement & footprint, there will be a was 2014/15). guidelines for outpatient are nationally determined and continue to include health and • Standards of Business Conduct & Conflicts of submission. Assessment Framework Reports. requirement if one organisation activity. directed block contracts resulting in minimal flexibility of social care Interest Policy - including business case and • NHS England Improvement & • NHS England Review process. within that footprint fails to deliver, • delivery plan deep dive funding. The submitted final plan includes a QIPP strategy and procurement requirements Assessment Framework Reports. • Governing Body reporting of that an action plan will be discussion is taking place at requirement of 3.1 million and limited investments (other operational • ICS has a System Efficiency Board to review • NHS England Review process. refreshed plan and deep dives on developed. There will be an each Governing Body which than spending review funding) due to the financial delivery plans right care opportunities, Get It Right First Time, delivery plan at each Governing Body impact on other organisations incorporates QIPP monitoring regime, therefore work is underway to ensure savings Risk Description: • Integrated Care Partnership group working with external consultancy and CCG meeting. should one organisation fail. • The CCG will need to plans are fully developed and realisable. All savings Efficiencies: The refreshed November 2018, agrees the representation. Four business cases being • Update of prescribing spend to • Primary Care prescribing costs consider the outcome, once plans are robustly monitored through the QIPP board quality and overall strategy of the LA, CCGs, NHS assessed. Executive Committee. still higher than peers. available, of Integrating Care - and some mitigation has been identified in case of efficiency savings Provider and other local providers, Chief • Monitoring of Prescribing is presented on a • QIPP programme board required a • Outcome of the ICS Integrating Next Steps Guidance that sets slippage. Therefore at this stage this risk is being within the Delivery Executive led. quarterly basis to the Executive Committee. monthly performance report. Each Care - Next Steps Guidance out the options for ICS's and managed. Plans are not • ICS System wide Finance meetings • South Yorkshire & Bassetlaw Integrated Care lead for each scheme provides an how the next steps will impact achieved, therefore ii) Delivery of System update to the meeting. on Commissioning functions. 01.04.2021 - Meeting with CFO. Efficiency plans for alternative Place Plan with • Collaborative Partnership Board for the South • Deloitte report - NHS commissioned • The CCG is currently 2020/21 have been limited due to the nature of the commissioning Internal Assurances: partners Yorkshire & Bassetlaw ICS - Chief Officer against delivering our QIPP schemes. developing the 2021/22 financial environment in response to the national arrangements • Joint Commissioning Strategy for representation • ICS System Efficiency Board looking financial plan pandemic however the CCGs 2020/21 financial duties including the Health and Social Care approved by • Doncaster Place Plan at joint opportunities. • Monitoring efficiency plans via have been achieved, clearly as the year has drawn to a decommissioning of Governing Body in March 2019 and • CCG Commissioning & Contracting Intentions • Doncaster System Wide the QIPP board close all the uncertainties in terms of the financial services may be delivery plans. iii) Achieve • Joint Commissioning Strategy for Health and Transformation Board. regimes have been clarified. We are now in receipt of required. • Right Care tracker document is used to control total, Social Care with the Local Authority, including target areas in order to prepare efficiency • Achievement of 2019/20 statutory the 2021/22 financial and operational guidance and efficiencies refresh and review of Delivery Plans for the three plans. financial requirements currently working through the requirements and how this and system stages (Starting, Living Aging Well) approved • Prescribing Reports to Prescribing Sub • 92% QIPP delivery ambition for may impact on a future QIPP programmes. The process affordability. March 2019 by the Governing Body. Group (minutes), monitoring to Executive 19/20 achieved for recruiting a joint outpatient transformation post • Operational planning templates 2019-20 Committee. across Doncaster Place has commenced. Score submitted to NHS England alongside a planning • Governing Body support of the reviewed and amended from 3x3 to 4x2 to meet the narrative setting out plans to deliver agreed Integrated Care System - April 2018 target score for 2020/21. activity reductions, standards and targets and • Quality, Innovation, Productivity and financial affordability. Prevention (QIPP) Programme Board 15.01.2021 - Meeting with CFO. The CCG are still • NHS Long Term Plan (5 years) and Technical minutes. holding QIPP Board meetings and managers are Guidance review and submission of operating • Commissioning for Value. working on QIPP schemes but the current financial plan to NHSE. Implementation framework • Governing Body support of Doncaster regime limits delivery. Score reduced from 4x4 to 3x3 at issued 27 June 2019. Place Plan. this point in time due to the arrangements established for • NHS England Improvement & Assessment • Governing Body approval of CCG 2020/21 however once a revised financial plan is Risk Cause: The Chief Framework - a continuous risk-based process, Commissioning & Contracting Intentions available for 2021/22 the risk will be reconsidered as the CCG won't4E6:T51Q6E6:S51E6:V51E6:T51 achieve 4 16+Q6+E6:S514 2 8 8 Mar-22 Governing Body Officer with meetings as required, informed by – March 2019. impact and consequences will increase. Following the delivery against the performance indicators and a wide range of other • Monthly reporting to Governing Body on EU Exit, prescribing costs will be monitored but not identified schemes. sources of insight, leading to a formal CCG Delivery Plan progress. anticipating any impact at this stage. If prescribing costs assessment against the 4 domains of assurance increase, financial at the year end. 16.11.2020 . Following the notification of the Allocations balance may be • Procurement Strategy and the Contract and the financial framework, a revised financial plan has impacted. Management Plan, reporting to Audit, Executive been developed. There is significant risk built into this Committee and Governing Body. plan which looks at efficiency savings across both CHC • Deep Dive with CCG Leads on Delivery Plans and prescribing. A number of schemes have been to Governing Body. developed to support the delivery of these savings and • Quality, Innovation, Productivity and Prevention were signed off at the Executive Committee on (QIPP) Delivery Plan 21.10.2020. Mobilisation plans are now underway and • Quality, Innovation, Productivity and Prevention delivery will be monitored closely each month. In (QIPP) Programme Board addition we have agreed with the ICS that the CCG have • Joint Transformational Board with DBH and an underlying £1.8m of unmitigated risk in our plan, the Bassetlaw looking at joint efficiency opportunities, ICS are developing risk share arrangements across the part of the remit is to look at joint activity and system in the event of any Organisation not achieving its waiting list planning and redesign. control total. In 2021 the CCG will have limited ability to • Services Delivery Plan refresh for 2019-20 - invest in transformation schemes. Risk score increased joint agreement with local acute foundation trust to 4x4 due to uncertainty. Risk Consequence: to undertake joint activity and waiting list planning Breach of break- • Governance and Finance Self-Assessment 30.07.2020 - Meeting with CFO. The CCG achieved its even statutory • Daily CCG Covid meetings which incudes 92% QIPP ambition by 31 March 2020. A reprioritisation responsibility. finance plan is being prepared and delivery plans are being Increase QIPP to refreshed. Nationally, the financial framework is being deliver more reviewed which we anticipate will clarify future savings. arrangements. Actions remain ongoing and no change Decommission to risk score. services. Gaps in control and Gaps in assurance

Reference Risks Current Controls Internal and External Assurances Positive Assurance timescale for and timescales for Actions to be taken Progress Against Actions

Lead Rating

Rating remedial action remedial action

Initial Risk

Operational

Current Risk Director and

Responsible Lead Action Committee/ End Board for Areas where we do Where can we gain evidence that the Areas where we are Date delegation of What could Happen and What controls/systems do we have in place What evidence shows we are not have adequate controls / systems we are placing not receiving Actions Should the Risk Date Identified that are operating at this level and assist in reasonably managing our controls /systems in Detail the Actions Update on Actions, is the plan on CO3 - 3.3 Lead

Target Risk Rating reliance on are effective internally / evidence that

Materialise, What is the the delivery of aims and manage / mitigate risks and our objectives are place or existing Taken track

Total Total Likely Likely externally? controls / systems Impact risks. being delivered controls /systems Date and Name of Committee or Board are effective

are not effective

Impact / Consequence Impact / Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change Outcomes i) Achievement • South Yorkshire & Bassetlaw Integrated Care External Assurances: • NHS England yearly Review • Outcome of the ICS A single System Control • Contracts continue to be 24/06/2021 - plans are now developed and against the joint System. • Collaborative Partnership Board minutes. process. Integrating Care - Next total has been agreed in nationally determined for submitted for first 6 months of 2021/22 commissioning • Collaborative Partnership Board for the South • NHS England operational plan submission. • ICS quarterly assurance Steps Guidance the 12 organisation the first two quarters of (H1). The plans ae still based on the health and Yorkshire & Bassetlaw ICS - Chief Officer • Working Together Partnership Board minutes - meetings. across the ICS footprint, 2021/22, based on block national financial regime therefore the social care representation. received by Governing Body. • Updated version of the South there will be a contracts with an element allocations are nationally determined and Risk Description: Control strategy and • Doncaster Place Plan. • NHS England Review process. Yorkshire & Bassetlaw ICS MoU. requirement if one of aligned incentives continue to include directed block contracts operational total and System Affordability: • CCG Commissioning & Contracting Intentions. • Updated South Yorkshire & Bassetlaw ICS • Commissioning legal agreement organisation within that attached. The CCG are resulting in minimal flexibility of funding. The delivery plans Inability to commission • Joint Commissioning Strategy for Health and MoU. between Local Authority and CCG footprint fails to deliver, working with providers submitted final plan includes a QIPP efficiently, effectively and to Social Care has been developed with the Local • Internal Audit Plan and Counter Fraud Work - 31 March 2020. that an action plan will be now guidance is requirement of 3.1 million and limited achieve value for money if the Authority, including refresh and review of Delivery plan 2019-20. • Governing Body approval of developed. There will be published to enact investments (other than spending review control total is not achieved. Plans for the three stages (Starting, Living Aging • Integrated Internal Audit and Counter Fraud Strategy - March 2019. an impact on other arrangements funding) due to the financial regime, As further delegation of Well). Work plan being prepared for 2019/20. • Joint Commissioning Strategy for organisations should one • Consideration of revised therefore work is underway to ensure statutory duties and financial • Operational planning templates 2019-20 • Head of Internal Audit Opinion; 2018/19 Health and Social Care (Local organisation fail. financial framework and savings plans are fully developed and decision-making develops submitted to NHS England alongside a planning Budgetary Control & Key Financial Systems Authority and CCG). allocations realisable. All savings plans are robustly (with the DMBC in ‘Place’ and narrative setting out plans to deliver agreed activity Internal Audit Report - full assurance. • Integrated Internal Audit and • Consideration of revised monitored through the QIPP board and ii) Delivery of with other CCGs in the reductions, standards and targets and financial • Annual Audit Letter; ISA260 Report to those Counter Fraud Work plan contract some mitigation has been identified in case Place Plan with SYandB ICS) the CCG will be affordability. charged with Governance 2018-19. 2019/20. • The CCG will need to of slippage. Therefore at this stage this risk partners adopting decisions that are • NHS Long Term Plan (5 years) and Technical • Published as Outstanding Rating for the CCG • Head of Internal Audit Opinion; consider the outcome, is being managed. for the greater good of Place Guidance review and submission of operating plan (external assessment) where finance is a 1819DCCG09R, Budgetary once available, of or the ICS, resulting in a risk to NHSE. Implementation framework published 27 significant element. Control & Key Financial Systems Integrating Care - Next 01.04.2021 - Meeting with CFO. The CCG's of deviating from the Joint June 2019. • Established ICS System Efficiency Board. Internal Audit Report - significant Steps Guidance that sets 2020/21 financial duties have been Commissioning Strategy and • Commissioning for Value Decision Making assurance. out the options for ICS's achieved, clearly as the year has drawn to a iii) Achieve • Doncaster System Wide Transformation / or financial plan. Framework. • Annual Audit Letter, ISA260 and how the next steps close all the uncertainties in terms of the control total, Board. • Working Together Partnership Board - Report to those charged with will impact on financial regimes have been clarified. We efficiencies and • ICS System wide Finance meetings collaborative decision making on Hyper Acute Governance 2018-19. Commissioning functions. are now in receipt of the 2021/22 financial system Stroke Unit services and Children's Surgery & • Achievement of 2019/20 • Monitoring efficiency and operational guidance and currently affordability. Anaesthesia and Hospital Services Review. Internal Assurances: statutory financial requirements plans via the QIPP board working through the requirements and how • Place Plan State of Readiness Report and • Governing Body approval of Strategy - March • National planning guidance has this may impact on the CCG and the recommended next steps. 2019. been received in Qtr 3 2020 system. No changes to risk score. • Quality, Innovation, Productivity and Prevention • Joint Commissioning Strategy for Health and (QIPP) Delivery Plan. Social Care (Local Authority and CCG). Risk Cause: Statutory duties • Quality, Innovation, Productivity and Prevention • Quality, Innovation, Productivity and 15.01.2021 Meeting with CFO. Over the last not being undertaken. (QIPP) Programme Board. Prevention (QIPP) Programme Board minutes. few weeks further information has become • South Yorkshire & Bassetlaw ICS Memorandum of • Governing Body approval of CCG available around funding settlements, this is Understanding (MoU). Commissioning & Contracting Intentions – both at CCG and system level and with the • Commissioning legal agreement between Local March 2019. information we know this reduces the Authority and CCG (1 April 2019) 31 March 2020. • Governing Body support of Doncaster Place financial risk however there are still some • Governance and Finance Sustainability Self- Plan. uncertainties around forecast for example Chief Assessment. • Governing Body support of the Integrated prescribing and potential adjustments in Officer / Audit Committee Financial Strategy being refreshed further after the Care System. relation to the Month 9 allocations. The risk Chief Apr-19 4 4 16 3 3 9 9 Mar-22 and Governing publication of the five year allocations 2019 - 24. • Integrated Care Partnership group refreshed will be kept under regular review and Finance Body • Finance Report to Governing Body on a monthly November 2018, agrees the overall strategy of updates continue to be provided to Officer basis. the LA, CCGs, NHS Provider and other local Governing Body. The risk will be • Standing Financial Instructions, Standing Orders, providers, Chief Executive led. reconsidered for 2021/22 when national & Scheme of Delegation. guidance is available. Risk score reduced • Finance, Performance & Information Group (FPIG) from 4x4 to 3x3 meetings with Providers. • Internal Audits. 16.11.2020 . Following the notification of • External Audit. the Allocations and the financial framework, • Non-ISFE returns to NHS England (put in full) and a revised financial plan has been provides a summary of our risk and mitigation. developed. In addition we have agreed • Daily CCG Covid meetings which incudes finance with the ICS that the CCG have an underlying £1.8m of unmitigated risk in our Risk Consequence: The plan, the ICS are developing risk share CCG would be in breach of arrangements across the system in the the statutory duties to event of any Organisation not achieving its commission efficient, effective control total. Risk score increased to 4x4 and value for money health due to uncertainty. care services. • This would lead to 30.07.2020 - Meeting with CFO. The increasingly limited financial control total for 2020/21 is unknown. From resource which may require 1 April, allocations were provided for the the CCG to undertake greater first four months, confirmation is awaited on prioritisation to meet the allocations for the remainder of 2020/21. needs of the population. Nationally, the financial framework is being reviewed which we anticipate will clarify future arrangements. A revised financial plan will be required , in addition the national contract framework will be amended which may support the CCG's intention to develop aligned incentive contract with providers. Actions remain ongoing and no change to risk score. Gaps in control Gaps in assurance and timescale Actions to be Reference Risks Current Controls Internal and External Assurances Positive Assurance and timescales for Progress Against Actions

Lead for remedial taken Rating Rating remedial action

Initial Risk Initial action

Operational

Current RiskCurrent

Director and Director Responsible Lead Committee/ Action Areas where we Board for End do not have delegation of Where can we gain evidence that the adequate Areas where we are Date What controls/systems do we have in place What evidence shows we are Actions

What could Happen and Should DateIdentified controls / systems we are placing controls not receiving Detail the that are operating at this level and assist in reasonably managing our CO3 - 3.4 Lead the Risk Materialise, What is TargetRisk Rating reliance on are effective internally / /systems in evidence that Actions Update on Actions, is the plan on track

the delivery of aims and manage / mitigate risks and our objectives are

Total Total Likely the Impact Likely externally? place or existing controls / systems Taken risks. being delivered Date and Name of Committee or Board controls are effective

/systems are not Impact / ConsequenceImpact / Impact / ConsequenceImpact / effective

Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change

Outcomes i) Achievement • Financial Strategy refreshed after the publication of External Assurances: • Governing Body approval of Joint Uncertainty of the A single System • Continue to 24/06/2021 - plans are now developed and against the the five year allocations 2019 - 24. • Internal Audit Plan and Counter Fraud Commissioning Strategy for Health impact on the CCG Control total has been develop aligned submitted for first 6 months of 2021/22 (H1). The joint • Commissioning for Value Decision Making Workplan 2019-20. and Social Care - March 2019. if the single system agreed in the 12 incentive plans ae still based on the national financial regime commissioning Framework • Head of Internal Audit Opinion; 1819 • Joint Commissioning Strategy for control total that organisation across contracts with therefore the allocations are nationally determined health and • Finance Report to Governing Body on a monthly Budgetary Control & Key Financial Systems Health and Social Care (Local has been agreed in the ICS footprint, there providers which and continue to include directed block contracts social care basis Internal Audit Report - significant assurance. Authority and CCG) the 12 organisation will be a requirement if will aim to resulting in minimal flexibility of funding. The strategy and • Standing Financial Instructions, Standing Orders, & • Annual Audit Letter 2018-19; ISA260 Report • Head of Internal Audit Opinion; across the ICS one organisation reduce volatility submitted final plan includes a QIPP requirement of operational Scheme of Delegation to those charged with Governance. 1819-DCCG-09-R – Budgetary footprint is not within that footprint across the 3.1 million and limited investments (other than delivery plans • Finance, Performance & Information Group (FPIG) • Published as Outstanding Rating for the Control & Key Financial Systems achieved. fails to deliver, that an system. spending review funding) due to the financial meetings with Providers CCG (external assessment). Internal Audit Report - full • Outcome of the action plan will be regime, therefore work is underway to ensure • Internal Audits • Collaborative Partnership Board minutes. assurance ICS Integrating developed. There will • The CCG will savings plans are fully developed and realisable. All Risk Description: Control total: If • External Audit • NHS England financial plan submission. • Annual Audit Letter 2018-19; Care - Next Steps be an impact on other need to consider savings plans are robustly monitored through the we do not meet our CCG statutory • South Yorkshire & Bassetlaw ICS Plan • NHS England Review process. ISA260 Report to those charged Guidance organisations should the outcome, QIPP board and some mitigation has been identified control total due to the impact of • Doncaster Place Plan • Updated South Yorkshire & Bassetlaw ICS with Governance one organisation fail. once available, in case of slippage. Therefore at this stage this risk external controls on CCG allocations • Delivery Plans in place to deliver the Joint Plan MoU - 2018. • NHS England yearly review of Integrating is being managed. and/or the impact of unpredicted in- Commissioning Strategy for Health and Social Care • ICS System Efficiency Board minutes. process - Improvement Assessment Care - Next year cost pressures, then we will be • Joint Commissioning Strategy for Health and Social • Integrated Care Partnership group refreshed Framework Steps Guidance 01.04.2021 - Meeting with CFO. The CCG's unable to commission efficiently, Care with the Local Authority, including refresh and November 2018, agrees the overall strategy of • Updated version of the South that sets out the 2020/21 financial duties have been achieved, ii) Delivery of effectively and to achieve value for review of Delivery Plans for the three stages (Starting, the LA, CCGs, NHS Provider and other local Yorkshire & Bassetlaw ICS Plan options for ICS's clearly as the year has drawn to a close all the Place Plan money. Living Ageing Well). providers, Chief Executive led. MoU -2018 and how the uncertainties in terms of the financial regimes have with partners This will lead to increasingly limited • Operational planning templates 2019-20 submitted • ICS System wide Finance meetings • Integrated Care Partnership group next steps will been clarified. We are now in receipt of the financial resource which may require to NHS England alongside a planning narrative refreshed November 2018, agrees impact on 2021/22 financial and operational guidance and the CCG to undertake greater setting out plans to deliver agreed activity, standards the overall strategy of the LA, Commissioning currently working through the requirements and how iii) Achieve prioritisation to meet the needs of the and targets and financial affordability. Internal Assurances; CCGs, NHS Provider and other functions. this may impact on the CCG and the system. No control total, population. • NHS Long Term Plan (5 years) and Technical • Joint Commissioning Strategy for Health and local providers, Chief Executive led. • Monitoring changes to risk score. efficiencies Guidance review and submission of operating plan to Social Care approved by Governing Body in • Commissioning legal agreement efficiency plans and system NHSE. March 2019 and delivery plans. between Local Authority and CCG - via the QIPP 15.01.2021 Meeting with CFO. The CCG are affordability. • Partnership working across Team Doncaster. • Governing Body support of the Integrated 31 March 2020. board meeting their control total for 2020/21 and the Chief • Working Together Partnership Board Care System. • Internal Audit Plan and Counter financial position has improved. The risk will be Finance Apr-19 4 4 16 3 3 9 9 Mar-22 Audit Committee • Quality, Innovation, Productivity and Prevention • Quality, Innovation, Productivity and Fraud Workplan 2019-20. reconsidered for 2021/22 when national guidance is Officer levels (QIPP) Delivery Plan Prevention (QIPP) Programme Board minutes. • Integrated Internal and Counter available. Risk score reduced from 4x4 to 3x3 • Quality, Innovation, Productivity and Prevention • Governing Body approval of Commissioning Fraud Plan 2019/20 (QIPP) Programme Board for Value Framework. • Procurement Strategy and the 16.11.2020 . Following the notification of the • ICS System Efficiency Board • Governing Body approval of CCG Contract Management Plan, Allocations and the financial framework, a revised • Doncaster System Wide Transformation Board with Commissioning & Contracting Intentions – reporting to Audit, Executive financial plan has been developed. In addition we Doncaster system partners including Bassetlaw CCG March 2019. Committee and Governing Body. have agreed with the ICS that the CCG have an looking at joint efficiency opportunities, part of the • Governing Body support of Doncaster Place • QIPP monitoring report to underlying £1.8m of unmitigated risk in our plan, the remit is to look at joint activity and waiting list planning Plan. Executive Committee. ICS are developing risk share arrangements across and transformation service redesign. • Non-ISFE returns to NHS England (put in • Monthly financial report to the system in the event of any Organisation not Risk Cause: • South Yorkshire & Bassetlaw ICS Plan full) and provides a summary of our risk and Governing Body. achieving its control total. Risk score increased to Statutory duties not being Memorandum of Understanding (MoU) mitigation. • Achievement of 2019/20 statutory 4x4 due to uncertainty. undertaken. • Commissioning legal agreement between Local • CCG and DBH Transformation Board financial requirements Authority and CCG - 31 March 2020. minutes. 30.07.2020 - Meeting with CFO. The CCG met all • Governance and Finance Sustainability Self- its statutory requirements for 2019/20. The control Assessment total for 2020/21 is unknown. From 1 April, • Monthly one-to-one’s with Accountable Officer / allocations were provided for the first four months, Chief Finance Officers to discuss financial position. confirmation is awaited on allocations for the Risk Consequence: • The CCG • Joint meetings at Place level with Chief Finance remainder of 2020/21. Nationally, the financial would be in breach of the statutory Officers / Chief Executive Officers across RDaSH / framework is being reviewed which we anticipate duties to commission efficient, DBHTFT and CCG. will clarify future arrangements. Actions remain effective and value for money health • South Yorkshire & Bassetlaw Directors of Finance - ongoing and no change to risk score. care services. Finance and Assurance Meeting. • This would lead to increasingly • Daily CCG Covid meetings which incudes finance limited financial resource which may require the CCG to undertake greater prioritisation to meet the needs of the population. Gaps in Gaps in control Internal and External assurance and Reference Risks Current Controls Positive Assurance and timescale for Actions to be taken Progress Against Actions Assurances timescales for Rating remedial action

remedial action

Current Risk Risk Current

Director and and Director

Responsible Responsible Operational Lead Operational Initial Risk Rating Risk Initial Lead Action Committee/ Areas where we End Board for Where can we gain evidence do not have Areas where we Date delegation of that the controls / systems What could Happen and What controls/systems do we have in What evidence shows we adequate are not receiving Actions

Date Identified Date we are placing reliance on Should the Risk place that are operating at this level are reasonably managing controls /systems evidence that

CO4 - 4.1 Lead Rating Risk Target are effective internally / Detail the Actions Taken Update on Actions, is the plan on track Total Total

Materialise, What is the Total and assist in the delivery of aims and our risks and our objectives in place or controls / Likely Likely externally? Impact manage / mitigate risks. are being delivered existing controls systems are Date and Name of /systems are not effective Committee or Board

effective

ImpactConsequence / ImpactConsequence /

Strategic Objective 4: Work collaboratively with partners to improve health, care and reduce inequalities in well governed and accountable partnerships.

Outcomes i) Improvement in • Governing Body approval for the level of External Assurances: • BCF Reports to JCMB. • Outcome of the ICS None • Creation of Doncaster mini-commissioning 30.06.2021 - Meeting with Director of Strategy and Delivery. ICS quality as part of delegation to Joint Committees. • JCMB approved terms of • JCMB, JCOG, JCCC, Team Integrating Care - teams across life stages of commissioning is Design framework published. System partners are working through the ICS delivery • South Yorkshire & Bassetlaw (SYB) Health reference. Doncaster minutes. Next Steps Guidance ongoing. the model and implications of place and ICS with the Integrated Care objectives. Executive Group - Collaborative Partnership • Signed Section 75 agreement. • Health and Wellbeing Board • Joint BI / SPU integration plan, ongoing. Board. Developing place maturity matrix and action plan for moving Board for the SYB Integrated Care System • Collaborative Partnership Board reporting. • Joint Partnership Board level domains to 'Thriving'. Risk remains the same, score remains the (ICS) Chief Officer and Chair representation. minutes. • Governing Body reporting communications to be approved by CCG once same. Risk Description: Joint • Doncaster Integrated Care Partnership Board • JCCCG / Working Together • Non recurrent funding agreed to finalised working focus: We have (Doncaster Place Plan) - represented on Partnership Board minutes - support complex lives and • Continue to work with Doncaster Place 20.04.2021 - Meeting with Director of Strategy and Delivery. Deep dual areas of partnership collaborative partnership by Chair & Chief received by Governing Body. vulnerable adults programmes Partners around the System Leadership Dive undertaken at Audit Committee March 2021. Workshops commissioning focus - our Officer and Director of Strategy and Delivery. • Team Doncaster minutes and • Bi-monthly Place newsletter for Maturity Matrix continue within the Place Board continue and Doncaster Place local focus on Doncaster as • Partnership working across Team Doncaster attendance. staff and public launched • System partner operational group (SPOG) to partners are currently undertaking a system leadership maturity ii) Achieve Patient a place delivering the representation. November 2020 meet in July. matrix both to inform where the partnership needs to develop and to and Public ambition described in the • Section 75 agreement with Doncaster Internal Assurances: give assurance to SYB ICS on levels of autonomy. The Partnership Involvement NHSE Doncaster Place Plan, and Council (Better Care Fund). • Governing Body minutes. Board have agreed a Doncaster place agreement and the areas of requirements our collaborative • Commissioning agreement with Doncaster • Governing Body support of ICS opportunities for 2021/22, this will be reviewed at the beginning of commissioning Council and Joint Commissioning Management Plan. quarter 3 in line with requirements of the Operating Framework. This commitments within South Board (JCMB). • Governing Body support of work is being undertaken in conjunction with the ICS commissioning Yorkshire & Bassetlaw ICS • Regular updates to staff at Staff Briefing. Commissioning Agreement - development and the establishment of statutory ICS's. Risk score This complexity could • Memorandum of Understanding (MOU) for March 2018. Extended to April remains the same. potentially impact upon our Continuing Health hosting arrangements by 2020. capacity to commission NHS Doncaster CCG. • Staff Brief presentations. 18.01.2021 - Meeting with Director of Strategy and Delivery. The services. • Standards of Business Conduct & Conflicts • Governing Body assurance CCG have recommissioned Hill Dickenson for a further 6 months of of Interest Policy 2018 - including business focus upon Life Stages reports work with place partnership, Place Board have agreed a letter of iii) Achieve actions case and procurement requirements. (actions and outcomes).z response to the NHS Guidance around future arrangements of and outcomes • Chief Officer representation on Joint • Minutes from the Covid 19 ICS's, which will be submitted Qtr 4. Following the ICS Governance contained in the Committee of Clinical Commissioning Groups Governance Structure Meetings Review, the CCG will have membership on all relevant steering Joint (JCCCG) and ICS Programme Board. i.e Health & Care Group boards for further ICS development. Agreement has been obtained Commissioning • Individual representation on ICS • Governing Body Minutes from to extend the commissioning agreement with the Local Authority for Health and Social workstreams. September 2020 demonstrate further 12 months. Further work is underway to associate funding Care Strategy Chief Executive Apr-19 3 4 12 2 3 9 6 • Chief Finance Officer, Director of Strategy discussion and approval of Mar-22 with integrated locality development and improvement in outcomes Officer and Delivery, and Chief Nurse representation reprioritised delivery plans Committee during 2021/22. on System Efficiency Board. • Chair representation on ICS Governance 06.11.2020 Meeting with Director of Strategy and Delivery. Hill Group. Dickenson work has now concluded, Joint Partnership Board level Risk Cause: Breakdown of • Lay Member input into future ICS workshop. communications are being agreed which will require sign off via Governance agreements • Lay Member for Patient and Public individual organisational governance processes. A bi-monthly Place and conflicting objectives Involvement is a member of ICS Integrated newsletter for staff and public will be launched from November. The across joint commissioning. Assurance Committee. Provider Alliance Emergency & Care programme went live from • Chief officer and Director of Strategy and October with further actions around the Provider Woundcare Delivery repesentation on JCCCG Sub Group programme which will be launched 1 December 2020. Non-recurrent • Director of Strategy and Delivery attendance funding has been agreed to support the Complex Lives & Vulnerable at monthly SYB Directors of Commissioning Adults programmes. The ICS Governance review has commenced. Meeting Risk score remains the same. • SYB Joint Commissioning Plan. • Temporary Internal Governance 23.07.2020 Meeting with Director of Strategy and Delivery. Arrangements and Controls During Covid Discussions are being undertaken at Place level to re-evaluate place Pandemic i.e Healthcell governance arrangements in light of the Covid pandemic response, • The Covid 19 Governance Structure has aiming to conclude these discussions by the end of Qtr2. Hill Risk Consequence: been reviewed and updated for Wave 2 Dickenson have been commissioned to work with the Partnership Board around models of joint working. In terms of actions • Complexity within the completed, mini-commissioning teams are now in place for Starting commissioning cycle and Well and Aging Well, a support post to the Provider Alliance has now contracting with providers. been recruiting and working on the place plan priorities, in addition • Reduction in quality the Commissioning review of support to ICS work streams was experience and financial completed. Risk score has not changed. sustainability. Gaps in Gaps in control and assurance and Reference Risks Current Controls Internal and External Assurances Positive Assurance timescale for Actions to be taken Progress Against Actions timescales for Rating remedial action

remedial action

Current Risk Current

Director and Director

Responsible Initial Risk Rating Risk Initial Operational Lead Operational Lead Action Committee/ End Board for Where can we gain evidence that Areas where we do Date delegation What could Areas where we What controls/systems do we have in place the controls / systems we are What evidence shows we are not have adequate of Actions Happen and Identified Date are not receiving

Target Risk Rating Risk Target that are operating at this level and assist in placing reliance on are effective reasonably managing our controls /systems in CO4 - 4.2 Lead Should the Risk evidence that Detail the Actions Taken Update on Actions, is the plan on track

the delivery of aims and manage / mitigate internally / externally? risks and our objectives are place or existing

Total Total Likely Materialise, What is Likely controls / systems risks. Date and Name of Committee or being delivered controls /systems the Impact are effective

Board are not effective

Impact / Consequence / Impact Consequence / Impact

Strategic Objective 4: Work collaboratively with partners to improve health, care and reduce inequalities in well governed and accountable partnerships.

Outcomes i) Improvement • Communication & Engagement Strategy. External Assurances: • Governing Body approval of None None • Review meeting to take 21.06.2021 - The CCG's Communications and Engagement strategy 2021-22 in quality as part • Equality & Diversity Strategy - incorporating our • Health & Wellbeing Board minutes - Revised Communication & place with HealthWatch was presented to EEC and Governing Body in May and June respectively and of the ICS approach to health inequalities and our equality Chair & Chief Officer representation. Engagement Strategy. regarding support to the CCG approved. Currently recruiting a Band 5 Communications and Engagement delivery objectives. • Healthwatch Contract monitoring. • Public Sector Equality Duty and priorities for 2021/22. Officer to join the team. Expected to be in post midsummer 2021. Promotion of objectives. • Engagement & Experience Committee (EEC). • Healthwatch monthly reporting to EEC. Internal Audit Report updated • CCG Communications and the Covid-19 vaccination programme is still the main focus for the team along • Doncaster Inclusion & Fairness Forum - CCG • IAF Patient and Public Involvement EEC February 2018 – significant Engagement Strategy to be with planning communications for the public about what to expect in accessing membership. rating - Green Star, by NHS England. assurance. agreed in Quarter 1 (2021/22) primary care services post-Covid. A social media pain medication public Risk description: • Strong relationship with Healthwatch Doncaster, •CCG 2019/20 IAF score rated as • Complaints Report to EEC. awareness campaign will be launched in July. Review meeting with Healthwatch ii) Achieve Engagement & who also sit on our Governing Body. 'Outstanding' by NHS England • You Said, We Did. still to be arranged. Working with SYB ICS comms cell and HR on frequent and Patient and prevention: Doncaster • Health & Wellbeing Board - local collaborative • IAF Patient and Public Involvement • Recommendation of the Annual consistent internal messaging and engagement with staff over the ICS transition Public Place does not work to improve health outcomes and address rating Green by NHS England. Patient and Public Involvement in 2022. Risk score remains the same. Involvement achieve the move health inequalities; Health & Wellbeing Board Statement by EEC in October NHSE towards tackling challenge of CCG plans. Internal Assurances: 2019. 20.04.2021 - Meeting with Senior Risk Owner. Deep Dive undertaken at Audit requirements inequalities and move • Cross-Doncaster Communication & Engagement • Governing Body approval of E&D • CCG IAF Patient and Public Committee March 2021. CCG Head of Communications and the Gypsy Traveller towards greater self- Group, revolving chair across Doncaster Health and Strategy - July 2018 involvement assessment by NHS link workers are now in post. The CCG's communications and engagement care prevention and Social Care organisations, supporting public • Minutes of Engagement & Experience England, rated as Green Star. strategy will be presented to both the Engagement and Experience Committee patient empowerment. engagement in the Place Plan. Committee. • Recognition from SYB ICS that and Governing Body during quarter 1 (2021/22) for agreement. The focus • Monthly Health and Social Care communications • Governing Body minutes, written Doncaster is an exemplar for continues to be on vaccinations and Covid19 response and also availability of group, Chaired by Head of Communications & agreement for co-working with Local patient, public and stakeholder Primary Care. A review meeting is to take place with HealthWatch regarding Engagement, DCCG - to align agendas and reduce Authority. engagement for all things COVID- support to the CCG and priorities for 2021/22. Risk score remains the same. iii) Achieve duplication • Delivery of the Communication & 19. actions and • Commissioning of Healthwatch Doncaster to lead Engagement Strategy. • EEC approval of E&D Annual 18.01.2021 - Meeting with Senior Risk Owner. The CCG 2019/20 IAF score has outcomes within public engagement on the ICS Plan. • Delivery plan reports on experience and Report in February 2020 been confirmed at 'Outstanding' and the CCG engagement assessment has Joint • Member of the South Yorkshire & Bassetlaw engagement to EEC and published on been confirmed as Green. The CCG has recruited to replace Head of Commissioning Shadow Integrated Care System - Comms and CCG Website. Communications and Engagement and recruitment is underway for Gypsy and Health and Engagement Group. • Lay Members report back from ICS to Traveller link worker. A System communications and engagement subgroup has Social Care • Qualitative dashboard developed. EEC. been implemented for the Covid vaccination programme. The Doncaster Strategy Risk Cause: • Engagement workshops with NHSE. • CCG staff intranet news stories, forums Communications Cell continues with a focus on Covid response. The BAME • Failure to engage • Combined structure for Communications and and blogs. survey has been completed and a Primary Care BAME network has been Director of with Doncaster Engagement workforce. • Committee coversheets include established, the second meeting is scheduled in January. BCF funding has been Executive Strategy & population on place Apr-19 3 4 12 2 4 8 6 • Joint health and social care commissioning reduction in health inequalities. Mar-22 agreed for further development of the inclusion and fairness forum. Committee Delivery plan vision and strategy. • Posts on social media accounts - actions. • CCG IAF Patient and Public involvement Facebook and Twitter 02.11.2020 - Head of Communications and Engagement Review. • Place Plan assessment. • Minutes posted on DCCG website, along Still awaiting CCG 2019/20 IAF score, NHS England considering moving to a iv) Ensure the objectives will not be • CCG staff intranet - Connect. with papers for every EEC meeting place based assessment, details awaited. Place plan engagement on reporting of achieved. Eg. • The new location finder for My NHS services is • 2019/20 Annual Report and AGS which transformation work is currently paused due to pandemic response; however a reducing health Demand in to acute now live and accessible from the homepage of NHS contains specific information on CCG and 12 months on piece has been pulled together and ready to be published (likely to inequalities is services is not Doncaster CCG. This links direct through to MyNHS Place communication and engagement be after the second national lockdown). CCG worked with Healthwatch in terms transparent reduced. and enables patients to find local NHS and care activity of patient experience around video and online consultations during pandemic; across the three services - such as GP, dentist and other services. • Governing Body is live streamed for report due to be published imminently. The CCG has reviewed the CCG website Life Stages. • Constitution sets our statutory obligations for public viewing and it is now more accessible, particularly for people that need the content Public Involvement translating. No changes to risk score. Primary Care myth busting campaign • Place Plan Communication & Engagement continues, along with Health Bus posts alerting patients to additional GP Strategy appointments if they cannot get an appointment at a convenient time with their • Temporary Internal Governance Arrangements local practice. Key priorities for Doncaster place currently at plans for the second and Controls During Covid Pandemic i.e national lockdown – the Doncaster comms cell will collectively determine comms Communications Cell which meets weekly and messaging. • The Covid 19 Governance Structure has been reviewed and updated for Wave 2 28.07.2020 - Head of Communications and Engagement Review. Currently awaiting CCG 2019/20 IAF score, NHS England considering moving to a place based assessment, details awaited. Place plan engagement on transformation Risk Consequence: work is currently paused due to pandemic response. Place supported a survey Patient quality and being undertaken by RDaSH around patient experience linked to mental health experience and services during pandemic. CCG are working with Healthwatch in terms of patient financial sustainability. experience around video and online consultations during pandemic. The CCG have reviewed the CCG website and will be looking to make it more accessible. No changes to risk score. Gaps in Gaps in control Internal and External assurance and Reference Risks Current Controls Positive Assurance and timescale for Actions to be taken Progress Against Actions Assurances timescales for remedial action

remedial action

Directorand

Responsible Responsible

CurrentRatingRisk

Initial Risk RatingRisk Initial Operational Lead Operational Lead Committee/ Action Where can we gain Board for evidence that the Areas where we End Date What evidence Areas where we do delegation of What controls/systems do we controls / systems are not What could Happen and shows we are not have adequate Actions DateIdentified have in place that are we are placing receiving

Should the Risk TargetRatingRisk reasonably controls /systems Detail the Actions CO5 - 5.1 Lead operating at this level and reliance on are evidence that Update on Actions, is the plan on track

Materialise, What is the managing our risks in place or existing Taken

Date and Name of effective Impact / Consequence / Impact Impact / Consequence / Impact Committee or Board

Strategic Objective 5 - Managing the organisation through the close down of CCG's and transitioning to new NHS ICS Body

Outcomes i) Established ICS • Executive Committee are External Assurances: • Quarterly Corporate • Awaiting HR • Confirmation of • Completion of CCG 21.06.2021 - Meeting with Senior Risk Owner. New Governance responsibility for deploying • Staff Commitment Assurance Reports Framework to support designate Commissioning Functions corporate objective and risk identified by Strategy &OD organisational resource (under Board Level) as which are presented to the transition appointments to Mapping for ICS Forum. As part of the ICS transition arrangements an ii) Established Risk Description: There is a • Constitution, Standing Orders, set out in the Integration Executive Committee, • Awaiting Financial ICS chair and Review and consideration employment guarantee has been provided for below Board place based risk to the CCG's capacity and Governance Meeting Structure, and innovation: working Audit Committee and arrangements for chief executive of supporting HR Level employees which offers staff a level of security. The arrangements resources in meeting its Risk Management, Information together to improve Governing Body transition positions and framework for Transition CCG have held staff briefs and team timeouts to discuss statutory obligations and Governance, Health & Safety, health and social care • Financial updates at other executive Working with Doncaster the transition arrangements, currently awaiting the HR iii) Delivery of maintaining effective Emergency Preparedness and for all both Executive roles Place Partners to develop framework which will be issued in May 2021. A staff CCG statutory Doncaster Place partnership Mandatory & Statutory training • SY&B approach and Committee and • Confirmation of maturity matrix listening exercise was held 9th June 2021 which will requirements for working. • Workforce is a standing agenda timeframe for transition Governing Body where all inform an ICS FAQs document. An ICS Design 2021/22 item on the Executive Committee • Guidance on the • Overview of staff commissioning Framework describes the future ambitions for key areas • ICS Transformation working Employment absence and staff functions and and further guidance on the Employment Commitment iv) Assured by groups with CCG representation Commitment turnover roles will be has been published. Internal Audit on • Working with Doncaster Place • ICS Design • Executive Committee located Governance and Partners to develop the Place Framework minutes (also reported Risk maturity matrix to Governing Body) Management. Established Place Based Partnership Arrangements and Internal Assurances: Governance Risk Cause: This is due to the • Staff Survey 2020, anticipated ICS transformation over 95% would changes during 2021/22 recommend DCCG as a place to work indicating a high degree of job satisfaction

Director of HR and Executive Apr-20 3 4 12 3 3 9 6 Mar-22 Corporate Committee Services

Meeting name Governing Body Meeting date 2 September 2021 Chair and Chief Officer Report Title of paper

Executive / Dr David Crichton, Clinical Chair Clinical Lead(s) Jackie Pederson, Chief Officer Author(s) Cheryl Rollinson, Head of Corporate Governance

Status of the Report

To approve To consider / discuss

To note X

Purpose of Paper - Executive Summary

1. Introduction The purpose of this report is to update the Governing Body on issues relating to the activity of the Doncaster Clinical Commissioning Group (DCCG) of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper.

2. This month the paper includes updates on the following areas:

CCG Update: • 2020/21 CCG Annual Assessment • Safe Return to CCG Premises • SYB ICS Development • SYB Health and Wellbeing Hub

National Update: • NHS England Chief Executive Appointment • 2021/22 NHS Pay Awards • Covid19 Vaccinations of Children and Young People • Easing of Lockdown Step 4 – 16 August 2021

Recommendation(s)

The Governing Body is asked to note the report.

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Page 1 of 5

Impact analysis Quality impact Neutral Equality Neutral impact Tick relevant box

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

Sustainability Nil impact Financial Nil implications Legal Nil implications Management Paper is for information. No relevant interests. of Conflicts of Interest Consultation / N/A Engagement (internal departments, clinical, stakeholder & public/patient) Report None previously presented at Risk Nil analysis Assurance CO1 - 1.1 Framework

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Chair and Chief Officer Report 2 September 2021

1. CCG Update

1.1 2020/21 CCG Annual Assessment NHS England and NHS Improvement have a legal requirement to undertake an annual assessment of CCG performance each year. The approach for 2020/21 has been simplified due to the continued impact of Covid-19. In place of an overall rating, the CCG has received a narrative assessment of our performance which confirms and summarises key points from the year-end assessment review meeting. A copy of the outcomes letter is appended to this report for information.

1.2 Safe Return to CCG Premises A proposal has been shared with employees and staff side representatives regarding a phased return to the premises. A three month trial of the new arrangements will commence from the 1 September 2021 with reduced numbers. Prior to the new arrangements, a handbook has been issued which sets out the requirements for each of our three base points, White Rose House, Sovereign House and 722. In the meantime, staff have been asked to arrange a one-to-one with their line manager to undertake an individual risk assessment prior to any return.

1.3 SYB ICS Development In July the draft Health and Care Bill was passed from the House of Commons to the Committee stage. Locally the SYB ICS is on track to become a statutory body from April 2022 with Pearse Butler formally announced as the Independent Chair and Chair Designate for SYB ICS. Pearse’s start date is yet to be confirmed but we look forward to working with him. A ministerial statement was published during July setting out the decisions on proposed ICS boundary changes. The decision will see the district of Bassetlaw now aligning with the Nottingham and Nottinghamshire ICS rather than South Yorkshire. We continue to work with our ICS colleagues to understand how this decision impacts on the SYB transition. In addition, a System Development Progression Tool has been made available to ICS’s which sits alongside the ICS Design Framework and other guidance. The tool is intended to inform development priorities by enabling ICSs to understand where their main system development gaps are and to use this to identify development priorities and associated implementation timelines to accelerate and embed system working.

Page 3 of 5

Several guidance documents and resources were published on the 19 August 2021, including:

• Draft model constitution - available on the FutureNHS Collaboration Platform

• List of statutory CCG functions to be conferred on ICBs - available on the FutureNHS Collaboration Platform

• HR Framework for developing Integrated Care Boards

• Building strong integrated care systems everywhere: guidance on the ICS people function

• ICS implementation guidance: ICB readiness to operate statement (ROS) and checklist - available on the FutureNHS Collaboration Platform

• ICS Implementation Guidance: Due Diligence, Transfer of People and Property from CCGs to ICBs and CCG Close Down - available on the FutureNHS Collaboration Platform

• Interim Guidance on the functions and governance of the Integrated Care Board A dedicated ICS Guidance Workspace has been created on the FutureNHS Collaboration Platform. The CCG, along with ICS System Leaders, will work though the guidance for implementation and system readiness.

1.4 SYB Health and Wellbeing Hub The SYB Health and Wellbeing Hub is hosting a launch event for staff to find out more about how to access free counselling, self-help and wellbeing webinars. The event is taking place on 7 September 2021.

2. National Update

2.1 NHS England Chief Executive Appointment On the 28 July 2021, Amanda Pritchard was formally announced as the Chief Executive of NHS England and is the first female to hold the role since the health service was established in 1948. Amanda replaced Simon Stevens at the end of July. More information can be found on the NHS England website: https://www.england.nhs.uk/2021/07/amanda-pritchard-appointed-nhs-chief- executive/

Page 4 of 5

2.2 2021/22 NHS Pay Awards The government has accepted the recommendation of a 3% pay award uplift for NHS staff for 2021/22. Pay awards will be backdated to 1 April 2021. Further information can be found from the following links: • https://www.nhsemployers.org/news/202122-nhs-terms-and-conditions- service-pay-materials • https://www.nhsemployers.org/news/202122-pay-award-doctors-and- dentists

2.3 Covid19 Vaccinations of Children and Young People On the 19 July 2021, the Joint Committee on Vaccination and Immunisations (JCVI) issued a press release regarding offering vaccines to children at increased risk of Covid19. The full press release is available on the Government website.

2.4 Easing of Lockdown Step 4 – 16 August 2021 As part of Step 4 of the Governments Covid19 roadmap, from Monday 16 August, individuals who are double jabbed or aged under 18 will no longer be legally required to self-isolate if they are identified as being a close contact of a positive Covid19 case. With 75% of people having received both doses of the vaccine, the majority of adults will no longer need to self-isolate if they are contacts. For more information about this please visit the government website: https://www.gov.uk/government/news/self-isolation-removed-for-double-jabbed- close-contacts-from-16-august

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South Yorkshire & Bassetlaw Integrated Care System 722 Prince of Wales Road Sheffield S9 4EU

02 August 2021

Dr David Crichton, Chair - Doncaster CCG Jackie Pederson, Accountable Officer - Doncaster CCG

Dear David & Jackie,

2020/21 CCG annual assessment

NHS England and NHS Improvement have a legal requirement to undertake an annual assessment of CCG performance. The approach to the 2020/21 assessment has been simplified due to the continued impact of Covid-19 and the change in priorities to respond. This approach means that CCGs will no longer be given an overall rating, as this has been replaced by a narrative assessment of CCG performance.

The 2020/21 narrative assessment is based on the operational priorities set out in July and December 2020, focussing on CCGs’ contribution to local delivery of the overall system plan for recovery, with emphasis on the effectiveness of working relationships in local systems.

This letter summarises the key points of the discussion at the year-end assessment review meeting for Doncaster CCG, that focussed around the following five priority areas.

Improve the quality of service

Doncaster CCG has effectively supported the local Place, and wider South Yorkshire & Bassetlaw System throughout 20/21, and has:

• responded to Covid-19 demand including taking enabling actions to ensure the effective use of resources;

• supported the system to ensure a return to delivery of near-normal levels of non- Covid-19 health services; • maintained systems and processes to ensure oversight of quality and patient experience; • taken account of lessons learned during the first Covid-19 peak, in a way that locks in beneficial changes and explicitly tackles fundamental challenges including support for staff, and action on inequalities and prevention; • supported the system to respond to other emergency demands and manage winter pressures; and • taken effective action to support the health and wellbeing of its workforce

Doncaster has continued to build on its approach to integrated care with the provider collaborative in Doncaster taking on formal responsibility for urgent and emergency care within an outcome-based Alliance contract; the first collaborative in SYB to work in such a way which offers important learning for the whole system.

The CCG also used the strength of its partnership working to enable a rapid and resilient response to the pandemic in spring 2020 and through the year. An example of this is the integrated care home model proved an effective means of supporting the care of vulnerable people and used to great effect digital technology to deliver remote care.

Reduce health inequalities

Doncaster CCG has supported the delivery the eight urgent actions to address inequalities in NHS provision and outcomes – as identified in the Phase three response to Covid-19 pandemic.

The CCG has provided a robust set of evidence to demonstrate a response to all aspects of the national request to deliver the eight urgent actions to address inequalities in NHS provision and outcomes. A strong point is the work undertaken on digital pathway development, where learning could be shared with other CCG areas.

We particularly note the work with traveller communities through the pandemic and your use of community insights to deliver the COVID vaccination programme.

On a more strategic level, the CCG’s work with the Council to support the development of Voluntary Action Doncaster provided an important route into third sector support for all communities during the pandemic.

For primary care, the establishment of the second BAME network in England has provided an important opportunity to understand more about and start to address the inequalities experienced by staff and patients.

Involve and consult the public

Doncaster CCG has described the various ways in which it identifies and engages with deprived communities, Black, Asian and Minority Ethnic communities, inclusion health populations and people with disabilities (people with Learning Disabilities/ autism or both, people experiencing mental ill health and people experiencing frailty) and the full diversity of the local population. The continued work with Healthwatch has been important in developing and utilising community insights to inform service delivery during the pandemic.

Comply with financial duties

Doncaster CCG has delivered its break-even target in year and contributed to the reduction of system deficits, as confirmed in the CCG 20/21 Annual Accounts.

The CCG has delivered the Mental Health Investment Standard; and the CCG’s administrative costs are within its running cost allocation.

Leadership and governance

Doncaster CCG continued to demonstrate effective leadership and governance throughout 20/21, including:

• effective systems and processes for monitoring, analysing and acting on a range of information about quality, performance and finance, from a variety of sources including patient feedback, analyses of access to services and experiences of service users, so that it can identify early warnings of a failing service; • effective system leadership and progressed partnership working, underpinned by governance arrangements and information-sharing processes, including evidence of multi-professional leadership; and • continued support to the established joint commissioning arrangements across SYB and within Doncaster.

In addition to the work of the CCG team, as chair and accountable officer, you have personally led key areas at system level including the continued care of people with

learning disabilities, the seasonal flu and COVID vaccination programmes and the primary care input to the Cancer Alliance.

Overall

Throughout the last 7 years, the strength of leadership from the CCG has been evident in the strategy and outcomes you have delivered for people living in Doncaster.

The partnerships you have built are strong and resilient enabling an effective response to the pandemic and putting Doncaster in a leading position as we move into more formal integrated care arrangements.

Thank you for the whole CCG team’s dedication and commitment throughout a period of unprecedented challenge and for your own personal leadership through this time.

The CCG may also wish to publish a summary of the 2020/21 annual assessment.

We look forward to working with you and continuing to support your CCG through this transitional year, in improving healthcare for your local population and system.

Yours sincerely,

▪

Sir Andrew Cash Alison Knowles

System Leader Locality Director – South South Yorkshire & Bassetlaw Yorkshire & Bassetlaw Integrated Care System NHS England & NHS Improvement | North East & cc Yorkshire

Enclosure B

Chief Executive Report

Health Executive Group

10th August 2021

Author(s) Andrew Cash

Sponsor Is your report for Approval / Consideration / Noting For noting and discussion

Links to the ICS Five Year Plan (please tick)

Developing a population health system Strengthening our foundations

Understanding health in SYB including Working with patients and the prevention, health inequalities and public population health management

Empowering our workforce Getting the best start in life

Better care for major health Digitally enabling our system conditions

Innovation and improvement Reshaping and rethinking how we flex resources

Building a sustainable health and care Broadening and strengthening our system partnerships to increase our opportunity

Partnership with the Sheffield Delivering a new service model City Region

Transforming care Anchor institutions and wider contributions Making the best use of resources Partnership with the voluntary sector

Committment to work together

1 Where has the paper already been discussed?

Sub groups reporting to the HEG: System governance groups:

Quality Group Joint Committee CCGs

Strategic Workforce Group Acute Federation

Mental Health Alliance Performance Group

Place Partnership

Finance and Activity Group

Transformation and Delivery Group

Are there any resource implications (including Financial, Staffing etc)?

N/A

Summary of key issues

This monthly paper from the System Lead of the South Yorkshire and Bassetlaw Integrated Care System provides a summary update on the work of the South Yorkshire and Bassetlaw health and care partners for the month of July 2021.

Recommendations

The SYB ICS Health Executive Group (HEG) partners are asked to note the update and Chief Executives and Accountable Officers are asked to share the paper with their individual Boards, Governing Bodies and Committees.

Chief Executive Report

SOUTH YORKSHIRE AND BASSETLAW INTEGRATED CARE SYSTEM

Health Executive Group

10th August 2021

1. Purpose

This paper from the South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS) System Lead provides an update on the work of the South Yorkshire and Bassetlaw health and care partners for the month of July 2021.

2. Summary update for activity during July

2.1 Coronavirus (COVID-19): The South Yorkshire and Bassetlaw position

Our overall vaccination numbers remain very high. Over 85.7 per-cent have been vaccinated across cohorts 1-12 of the Joint Committee on Vaccination and Immunisation (JCVI) recommended priority list with 71.6 per-cent having also received second doses. Much of our efforts are now focused on reaching our unvaccinated populations, in which an estimated 173,000 have not yet had their Covid vaccinations, and planning for a possible ‘booster’ campaign in the autumn.

Rates of Covid across SYB rose dramatically during July rise but are now falling. The region was impacted by Euro 2021, with cases rising towards the end of the tournament as people mixed and while each of our places are seeing a fall in rates, they all remain relatively high.

On average, SYB hospitals have 25/30 per cent occupancy with Covid patients. The number of deaths is rising and are at levels similar to those in September 2020.

Demand for primary care services continues to be high, alongside increases in hospital bed occupancy and rising admissions to accident and emergency (A&E) departments across SYB. There is an increase in respiratory viruses which is adding increased pressures on our system.

At the same time, there has been an increase in staff absences relating to Covid, both in terms of being infected but also from the NHS Test and Trace app. New national guidance was issued in July to support frontline NHS and social care staff to attend work rather than self-isolate (in exceptional circumstances), helping to safely reintroduce staff who are able to effectively demonstrate they are Covid-negative.

2.2 Regional update

2.2.1 Leaders meeting

The North East and Yorkshire (NEY) Regional ICS Leaders meet weekly with the NHS England and Improvement Regional Director. During July, discussions focused on the ongoing Covid response and vaccination programme, urgent and emergency care and winter resilience, planning and recovery and ICS development (including feedback from the NEY transition oversight group).

2.3 National update

2.3.1 New Chief Executive Officer (CEO) of NHS England.

Amanda Pritchard has been appointed as the new Chief Executive Officer of NHS England. Amanda is the first woman in the health service’s history to hold the post, which she took up on Sunday August 1, replacing Sir Simon Stevens.

As NHS chief executive, she will be responsible for an annual budget of more than £130 billion while ensuring that everyone in the country receives high quality care. She takes up the role after serving as the NHS’ Chief Operating Officer (COO) for two years.

Her appointment follows an open and competitive recruitment process by the Board of NHS England and NHS Improvement.

2.3.2 NHS staff awarded The George Cross

More than 1.1 million NHS staff were awarded The George Cross by Her Majesty The Queen to mark the NHS’ 73rd anniversary.

The award serves as a poignant reminder of the courage, resilience and sacrifices made since the beginning of the Covid Pandemic to protect our most vulnerable communities. The award also acknowledges colleagues who sadly lost their lives to Covid and receive this award posthumously. 2.4 Integrated Care System update

2.4.1 System Development Plans

All 42 ICSs across England have developed System Development Plans setting out how they will establish statutory ICSs.

SYB discussed its draft plan at the July Health Executive Group meeting and subsequently shared the plan with NHS England. The focus is now on the key steps which will need to be taken to establish the new organisation ready for April 1st 2022 and the required work to transition people and functions. This work is being overseen by the ICS Development Steering Group, established at the beginning of this year by partners and CCGs respectively. Further national guidance is expected to support local systems.

2.4.2 Boundary decision

Earlier this year, Ministers asked NHS England to set out options for boundary alignment in integrated care systems in specific geographies where upper-tier local authorities currently work across more than one ICS footprint. The working principle was that coterminous boundaries deliver clear benefits in integration between local authorities and NHS organisations.

Following an assessment of the impact of changes for Bassetlaw, the Secretary of State announced (July 22) that the district of Bassetlaw would align with the Nottingham and Nottinghamshire Integrated Care System. The change will take effect from 1st April 2022.

Until then, Bassetlaw remains a part of South Yorkshire and Bassetlaw Integrated Care System (SYB ICS). As the transition towards and development of statutory ICS bodies progresses, Bassetlaw CCG and its staff will increasingly work with Nottingham and Nottinghamshire ICS to design the future.

In the meantime, the change and transition work that is taking place in SYB will continue to include Bassetlaw CCG and its staff will continue to be supported by SYB.

2.4.3 National designate appointments

• Appointment of Independent Chair/Chair Designate

Pearse Butler has been appointed the South Yorkshire and Bassetlaw Integrated Care System Independent Chair and Chair Designate of the future organisation, the South Yorkshire Integrated Care Board (SY ICB). The announcement is part of the transformation of the ICS to become a statutory body by April 2022.

Following a recruitment process, Pearse, who recently moved to the area and was previously chair at Blackpool Teaching Hospitals NHS Foundation Trust, has been approved by the Secretary of State. He joins the ICS on 1st September 2021

He is very keen to join the SY ICS and continuing the great work of the ICS and I am sure partners will join me in welcoming Pearse into the SY Partnership and we look forward to working with him.

• Appointment of Chief Executive designates

The appointments process for the chief executive appointments are due to begin in mid-August and expected to conclude by end October.

2.5 Yorkshire & Humber Academic Health Science Network – Impact Report 2021

The Yorkshire & Humber Academic Health Science Network (Yorkshire & Humber AHSN) has celebrate a successful year for health innovation across the region.

Their newly published Impact Report (2020 – 2021), showcases some of the developments initiated across SYB during the Covid pandemic including the Agile Workforce Project and Fit Fans. These projects were led by SYB’s Innovation Hub which has also helped to secure research and innovation bids worth £240k for our region.

We have also worked closely with the AHSN to deliver our Digital Care Homes project and supporting our Clinical Commissioning Groups (CCGs) to adopt pulse oximeter devices to enable high-risk Covid patients to accurately monitor and manage their symptoms at home.

2.6 Tackling obesity report – The King’s Fund

The 'Tackling Obesity' report by The King’s Fund sets out a clear agenda for change to support health and care systems to take greater preventative action in reducing harm from excess weight gain.

SYB is featured as a case study in the report (page 25) highlighting our multifaceted approach to tackle obesity; our collaborative work with local authority partners, our improved referral pathways into weight management services and our work to encourage greater physical activity among staff through green initiatives/wellbeing programmes.

2.7 Sheffield Olympic Legacy Park sustainable vision

Sheffield Olympic Legacy Park set out its vision to create a lasting environmental legacy for Sheffield in July.

Project Lead Richard Caborn outlined plans for the next stage of investment and development at the world’s only Olympic legacy park outside a host city during a recent visit (July 22nd) with Councillor Douglas Johnson, Sheffield City Council’s Executive Member for Climate Change and Environment, and other councillors.

The environment is one of the four legacy themes of the Park which is reflected in the second phase of development which includes plans for improvements to public transport and cycling links to the unique site as well as opening up access to Sheffield and Tinsley Canal. Through the four themes of sport, community, environment and economy, the Park is uniquely delivering a long- lasting legacy from the London 2012 Olympic and Paralympic Games that was at the heart of the UK’s bid.

SYB ICS is part of a region-wide partnership (Legacy Park Ltd) which also comprises Sheffield City Council, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Hallam University, Sheffield City Trust, Sheffield Children’s NHS Foundation Trust, and Yorkshire & Humber Academic Health Sciences Network and Darnall Well Being.

2.8 Sheffield Hallam University pledges ‘civic’ action

As part of a new Civic University Agreement launched in July, Sheffield Hallam University (SHU) has pledged to provide more opportunities to become an apprentice, double the annual intake of students studying to become healthcare professionals (by 2025) and to develop their newly opened Early Years Community Research Centre (EYCRC).

South Yorkshire Mayor, Dan Jarvis MP has also allocated £100,000 funding to help expand the successful GROW school mentoring programme, founded in the summer of 2020 with the Northern Powerhouse Partnership, to help regional schools address the disproportionate impact of Covid on young people and their education

The agreement is fully supported by SYB ICS, local authorities, other educational providers, the South Yorkshire Combined Authority and the Local Enterprise Partnership.

3. Finance

At month 3 the system has a surplus of £19.8m which is £16.4m favourable to plan. The forecast is a £2.7m surplus which compares to a break even plan. The Elective Recovery Fund threshold has been raised from 85% to 95% in the second quarter in the year. This will impact on planned income by circa £22m. An exercise will be undertaken as part of month 4 reporting to assess the impact of this on the forecast position.

Capital spend at month 3 is £17.7m which is £1.5m higher than plan. Forecast spend is £121.4m which is £12.6m greater than plan. Further work will be required to mitigate against the forecast deficit which is due to the temporary work in relation to the critical incident in the Women & Children’s block at Doncaster Royal Infirmary.

Further bids are being sought for the next phase of hospital developments to bring the total to forty. Expressions of interest are sought by 9 September with final decisions expected in Spring 2022.

Andrew Cash System Lead, South Yorkshire and Bassetlaw Integrated Care System

Date: 4th August 2021

Minutes of the Virtual Executive Committee Held on Wednesday, 16 June 2021, 9am

Present J Pederson Chief Officer (Chair) Dr D Crichton Clinical Chair H Tingle Chief Finance Officer A Russell Chief Nurse A Fitzgerald Director of Strategy & Delivery L Devanney Director of HR & Corporate Services

In J Whittaker Senior Corporate Services Support Officer attendance: (Minutes) A Molyneux Head of Medicines Management (Item 6) S Brown Strategy and Delivery Manager (Item 7)

Action 1. Apologies

There were no apologies received.

2. Declarations of Interest

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

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

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups:

None declared.

Declarations of interest from today’s meeting:

Dr Crichton declared an interest in Item 6, Quarterly Prescribing Update. There was agreement for Dr Crichton to remain present at the meeting but would not be party to the decision-making process.

3. Minutes from Previous Meeting held on 19 May 2021.

The minutes of the meeting held on 19 May 2021 were approved as a correct record.

4. Matters Arising not on the Agenda

There were no items raised.

5. Notification of Any Other Business

There were no items raised.

6. Quarterly Prescribing Update

A Molyneux presented an update to the Committee on the Medicines Management Delivery plan and QIPP, which included the pressures on the system and effects.

A Molynuex talked through the Medicines Management Team QIPP Report, June 2021 and advised around £83k of savings have been made and key progress during this period inlcudes: • Two Band 7 Pharmacist and three Pharmacy Technicians recruited to support the QIPP programme and are awaiting start dates. Adverts are currently out for up to three further pharmacists. • Doncaster Indicative Budget Scheme (DIBS) refined, published and with PCNs for sign-up. • Minor Ailments Schemes was launched last week.

There have also been a number of challenges and issues as follows: • Sign-up to the DIBS scheme has been slow so far. • Access to practices remains limited at present, although DIBS should help with this. • Block payment is preventing savings on out of tariff drugs and the commencement of the stoma service.

In terms of next steps, this includes: • Completion of recruitment of Band 7 Pharmacist/Technicians. • Communicate delivery plan modules with practices. • Work with finance to give practices access to their low efficiency areas. • There may be a method by which contract payments between CCG and providers can be changed for specific services despite the block payments. This is being investigated at an ICS level.

The Committee were also made aware of the modification to the DIBS scheme to allow practices that do not reach their individual budget to still receive a payment if their PCN reaches its budget.

The Executive Committee was asked to:

• Discuss the update and approve the modification to the DIBS scheme.

The delay with data for DIBS was acknowledged but that this is out of our control as the NHS Digital Prescription Cost Analysis (PCA) runs 2.5 months behind real time.

The Executive Committee: • Discussed and approved the modification to the DIBS scheme.

7. Endometrial Lynch Syndrome

S Brown presented the proposal shared by the SYB Cancer Alliance to commission Lynch Syndrome testing for Endometrial Cancers, provided by Sheffield Teaching Hospitals (STH).

This proposal would aid in the identification of those patients where an

inherited, genetic condition known as Lynch Syndrome was responsible for their endometrial cancer and for whom surveillance and preventative strategies to minimise the risk of other cancer types, may be required. While the majority of testing will be undertaken by STH, 3% of patients with an endometrial cancer diagnosis are expected to also require onward

testing at The Leeds Teaching Hospitals NHS Trust (LTHT).

Lynch Syndrome testing has already been established across the colorectal cancer pathway as per 2017 NICE Guidance. In October 2020, NICE published a similar recommendation for Lynch Syndrome testing, as standard, in the endometrial cancer pathway. This proposed service follows best practice and NICE guidelines associated with Lynch Syndrome testing of endometrial cancers. NICE evaluated this approach as having a 93% probability of being cost effective compared with no testing.

This service is recommended to commence in July 2021 and would require funding at Place level. Costs have been developed based on DBTHFT Endometrial Cancer diagnoses 2018 and 2019 which equates to £11,384 p.a. A two thirds DCCG and one third BCCG split would be advocated, which would equate to a DCCG cost of £7,589.33. It is anticipated that funding will require adjustment to the block arrangements with the potential for any cost per case arrangements in the longer term to be negotiated by Sheffield CCG as the Lead Commissioner. It was raised that DBTHFT are supportive of the proposal.

The Executive Committee was asked to: • Note and approve the proposal to commission STH to undertake Lynch Syndrome testing on individuals diagnosed with Endometrial cancers within Doncaster.

There will be additional local CCG costs per case associated with preventative interventions, surveillance tests including colonoscopy and

the potential referral of ‘at risk’ relatives who may also require surveillance testing.

This initiative supports delivery of the NHS Long Term Plan ambition that by 2028 the proportion of cancers diagnosed at stages 1 and 2 will rise to 75% and 55,000 more people each year will survive their cancer for at least five years after diagnosis.

The Executive Committee: • Noted and approved the proposal to commission STH to undertake Lynch Syndrome testing on individuals diagnosed with Endometrial cancers within Doncaster.

8. White Rose House – Return to Premises

L Devanney advised a health and safety review had been undertaken at White Rose House.

The Head of Corporate Governance, Health and Safety Lead and Clinical Team Leader undertook the health and safety review to consider the proposed arrangements for the return of clinical staff to White Rose House prior to the fourth step of the Governments roadmap in easing restrictions.

A paper was shared with the Committee, which detailed the further actions identified following the review.

It was highlighted that the return of staff to the premises is only safe/effective provided everyone follows the guidelines and it was raised there are informal champions in the team who do raise and challenge any behaviours that are not in line with Covid-19 guidance.

Whilst it was recognised that there may be one or two individuals who may not be in every day due to working hours, this could pose a potential business continuity issue if there was a positive test within the team that affects a large portion of the clinical staff having to self-isolate. This resulted in a review of the Business Continuity Plan by the Chief Nurse and it has been deemed isolation would have no impact on working arrangements.

The Executive Committee was asked to: • Note the arrangements and outcome of the review.

L Devanney confirmed the clinical team were now fully back working from White Rose House, explained the rationale for this and that arrangements will remain under review to ensure adherence to guidance.

It was agreed for consideration to be given to the inclusion of wearing face coverings into the policy.

The Executive Committee: • Noted the arrangements and outcome of the review.

9. Community Diagnostic Hub

H Tingle shared an update on the Community Diagnostic Hub (CDH), which covered the following key points:

• CDH primary aims • CDH model • CDH funding 2021/2022 • Capital available of £23.38 million NEY 2021/2021 • Revenue £16,74 NEY (£105 mil – ERF) • Recurrent revenue funding – baseline/growth • Infrastructure £250k (for 2 years) • Planning timetable • Key risks – uncertain future revenue funding

Initial proposal for Doncaster - Mexborough Montagu Hospital • Year 1 – CT and MRI mobiles • Year 2 – permanent CT scanner, GI Endoscopy and mobile MRI.

Modified SYB proposals for Doncaster - Mexborough Montagu Hospital • Year 1 – CT and MRI mobiles • Year 2 - modified phase 2 subject to capital funding now includes the development of one fully functional endoscopy room in addition to the continuation of the mobile imaging secured in phase 1

SYB capital has been identified: • Capital cost of £120,000 in 2021/2022 Phase 1 • £7.8 million in 2022/2023 Phase 2

H Tingle and A Fitzgerald to discuss who will link into this from a commissioning perspective.

The Executive Committee noted the updated SYB proposals for Doncaster.

10. Planning and Contracting 2020/2021

The following Planning and Contracting update was received by the Executive Committee:

Planning • All plans have been submitted accordingly to NHS England (NHSE) and these will be shared for information at a future Governing Body Meeting.

The Executive Committee noted the Planning update.

H Tingle advised there was nothing to update from a contracting perspective.

11. Performance update

Ageing Well A Fitzgerald presented the Ageing Well report, which reflects 2020/2021 performance and delivery areas.

All Ageing Well actions were reviewed in respect of Covid-19 and the Phase 3 NHS Response. As a result, several actions were either delayed or superseded by new actions. Six actions remain delayed due to Covid- 19.

Of the performance indicators within this life stage, the following are off track against target: • People aged 65 and over being admitted to hospital as an emergency. • People aged 65 and over being admitted to hospital with a hip

fracture. • Percentage of people with Dementia who have been diagnosed.

Dementia Diagnosis – it was agreed for A Fitzgerald to share the recovery A Fitzgerald plan with the Executive Committee and for this to be the focus when Ageing Well is next discussed at the August Governing Body.

Hip Fractures – shown as increasing in the Ageing Well report last year and A Fitzgerald to ask for further information regarding the increase. A Fitzgerald

The Executive Committee noted the update.

12. Elective Care

A Fitzgerald provided an update on the current position for the end of April 2021 as follows:

• DCCG now has 776 patients waiting over 52 weeks at DBTHFT, which is a reduction of 201 from last month. 52% are trauma and orthopaedic patients. • Diagnostics - data needs to improve and there is a continued high demand for MRI and CT. • Recovery Plan – this has been shared by DBTHFT, the focus of which is getting capacity back online. • Continue to monitor and focus on transformation. • DBTHFT are part of the national Accelerator Programme, which will involve: . Super weekends planned throughout July/August 2021. . Further focus on Independent Sector (insourcing/outsourcing).

. Focus on trauma and orthopaedic pathways across all three sites to increase throughput. . Creation of a day case elective hub with a focus on trauma/orthopaedics/ophthalmology. . Booking and validation hub to support/manage additional activity. • As a CCG we are involved in the demand management with Primary Care for which we have an outpatient transformation plan.

It was noted that we should receive May’s position by the end of this week.

The Executive Committee noted the update on Elective Care.

13. Items for inclusion in the next Governing Body Chair & Chief Officer’s Report

The following items were identified for the July Governing Body Chair & Chief Officer Report:

• Staff Brief - Listening Exercise • HR Framework summary • Note the delay in step four of the roadmap • Announcement of the ICS Chair to be added to the report once this is confirmed.

14. Escalation of Risk

A detailed discussion was held around the on-going concerns for Ophthalmology. This has been raised at the Quality & Patient Safety

(QPS) Committee where it was agreed there is a quality risk and was escalated and put on to the QPS risk register.

An update will be provided at the next QPS meeting in terms of progress made with cleansing and numbers. If no further progress is made at that time, it was agreed for this to be escalated on to our Corporate risk register A Russell/ and for an update to be provided to the Governing Body in terms of L Devanney escalation/de-escalation.

15. Bring forward Agenda

Executive Committee July

• Draft return to premises proposals

August

• Liberty Protection Safeguards (LPS)

Strategy & Organisational Development Forum

Future items

• NHS frameworks from White Paper • CCG Due Diligence process

Governing Body

July

• Planning

16. Any Other Business

No items raised.

17. Date and Time of Next Meeting Wednesday 21 July 2021, 9am

Executive Committee Meeting Wednesday 21 July 2021 from 9am Boardroom, Sovereign House and via Microsoft Teams

Present: J Pederson Chief Officer (Chair) Dr D Crichton Clinical Chair H Tingle Chief Finance Officer A Russell Chief Nurse A Fitzgerald Director of Strategy & Delivery

In K Connolly Senior Corporate Services Support Officer attendance: (Minutes) C Ogle Associate Director for Primary Care & Commissioning (Items 6 & 7) S Barnes Interim Estates Lead (Item 6) A Small Senior Finance Manager (Items 8 & 9) C Rollinson Head of Corporate Governance (Items 12 & 13)

Action 1. Apologies

Apologies were received from the following:

• L Devanney - Director of HR & Corporate Services

2. Declarations of Interest

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups:

None declared.

Declarations of interest from today’s meeting:

Dr Crichton declared an interest in items 7, 9 and 10.

There was agreement for Dr Crichton to remain present at the meeting for items 7 ‘TARGET Update’ and 9 ‘Local Enhanced Service Uplift for 2021/2022’ but would not be party to the decision-making process . It was also agreed Dr Crichton would leave the room for item 10 ‘Initial Health Assessments for Looked After Children’.

3. Minutes and Action Log from Previous Meeting

Minutes The minutes of the meeting held on 16 June 2021 were approved as a correct record.

Action Log The open and closed action logs were reviewed and updated.

4. Matters Arising not on the Agenda

There were no items raised.

5. Notification of Any Other Business

There were no items raised.

6. Primary Care Estates - Rossington Estates Project

The Executive Committee welcomed S Barnes and C Ogle to the meeting to update the Executive Committee on and seek support for the following:

1. Rossington GP Hub Project – a) approach taken to, and results of, scoring the scheme options, b) the proposal for next steps to developing the Business Case and c) note the shortfall in capital funding; 2. Mexborough GP Hub Project – update on the project delivery route through a third party developer and the future increase in CCG revenue commitment; and 3. Executive project sponsors – proposal to allocate an executive sponsor for each of the projects in the CCG capital programme.

The Committee agreed on the following:

1. Rossington GP Hub Project – approved the preferred option, the next steps and noted the shortfall in capital funding. If funding not available will have to pause and look at alternative options. 2. Mexborough GP Hub Project – noted the project delivery route through a third party developer and the future increase in CCG revenue commitment; and

3. Executive Project Sponsors – agreed and approved the proposal to allocate an executive sponsor for each of the projects in the CCG capital programme.

7. TARGET Update

C Ogle provided the Committee with a quarter three and four report in relation to the various aspects of TARGET (Time for Audit, Research, Guidelines, Education and Training) and any practice primary care events.

Due to the Covid-19 pandemic TARGET recommenced in July 2020 on a virtual basis. TARGET is not held in August or December and the November TARGET sessions were cancelled due to the rising number of infections caused by the COVID-19 pandemic and the increased workload. Primary care events and TARGET 4-6 sessions remain

suspended.

The implementation of the MOU to recoup costs of backfill for non- attendance remains a challenge.

The Committee were asked to: • Consider and note the quarter three and quarter four reports for TARGET for 2020/21 as well as plans for 2021/22 • Consider next steps in relation to the implementation of the MOU in terms of the in-house TARGET sessions where evidence has

not been provided or payment has not been made for previous quarters.

The Committee: • Considered and noted the quarter three and quarter four reports for TARGET for 2020/21 as well as plans for 2021/22 • Discussed and considered the next steps in relation to the implementation of the MOU in terms of the in-house TARGET sessions where evidence has not been provided or payment has

not been made for previous quarters.

Action - A Fitzgerald and C Ogle to hold a planning meeting to discuss AF and agree the next steps. CO

J Pederson to write to the practice to request the required information or JP evidence of mitigating circumstances. As per the MOU, the practice to be advised that funds would be withheld if the information was not provided.

Dr D Crichton did not partake in any discussion or decision making for this item.

8. Targeted Lung Health Check Update

The Executive Committee welcomed A Small to the meeting to update the Executive Committee on the first quarter of activity of the Targeted Lung

Health Checks (TLHC) Programme.

The Executive Committee were asked to:

• Note the update on the TLHC programme • Note the issues risks to the TLHC programme.

A Small advised the Committee the key risks with the programme are:

• Scanning volumes have been lower than anticipated resulting in a

financial risk. Actions: activity and finance review meeting scheduled with AML at the end of July to review the assumptions made in the tender modelling and pull together a plan for the remainder of the year. Continue to monitor the scanning volumes. Flag with the national

team. • Take up for the lung health checks is lower than anticipated which means that we are unable to meet the completion date of all LHCs and initial scans by March 2022. Actions: Good communications campaign to promote the service

and to address/reduce fears. Revisions to patient pathway to reduce the risks as far as possible. Remodelling of cohort to manage expectations.

Action - The Executive Committee agreed C Glazebrook would report CG back to Executive Committee at September’s meeting with an update on deadline and to also confirm that the whole of Doncaster is covered by the programme.

The Executive Committee:

• Noted the update on the TLHC programme • Noted the issues and risks to the TLHC programme.

9. Local Enhanced Service Uplift for 2021/2022

A Small outlined the proposed inflationary uplift on the GP and Pharmacy Contract Local Enhanced Services payments for 2021/22.

The Executive Committee were asked to agree to the CCG proposal of 1.3% inflationary uplift on the GP and Pharmacy Local Enhanced Services payments as outlined in the paper in 2021/22.

The CCG reviewed and applied an uplift for the GP and Pharmacy Local Enhanced Services payments in 2020/21 following a period where the uplift to prices had not previously been applied. For 2021/22, for the prices to remain in line with the current year’s inflation, the CCG propose that an uplift in line with the Standard Contract and National Tariff inflation of 1.3%

be applied to both the Pharmacy and General Practice Local Enhanced Service payments for 2021/22. This uplift is the gross cost uplift inflation that has been applied in the Standard Contract and does not include any efficiency expectations. This paper outlines the proposal and CCG’s position on the inflationary uplift.

The Executive Committee agreed to the CCG proposal of 1.3% inflationary uplift on the GP and Pharmacy Local Enhanced Services payments as outlined in the paper in 2021/22.

Action - The Executive Committee agreed for the proposal to go to Primary AS Care Commissioning Committee for noting.

Dr D Crichton did not partake in any discussion or decision making for this item.

10 Initial Health Assessments for Looked After Children

Dr D Crichton left the room for this item.

H Tingle advised the Committee the current provider (Bentley Surgery) of Initial Health Assessments for Looked After Children has approached the CCG with concerns that the provision of the above service is not financially viable and that they are considering service notice on the contract. A number of options were presented in the paper for the Executive Committee to consider.

The Executive Committee were asked to: • Note the request received by Bentley Surgery • Discuss the options available to respond to this request • Agree the recommendation to increase the assessment rate to £265 per assessment in line with the current market rate and for this to be backdated to 1st January 2021.

Action - H Tingle to check the procurement for the service. HT

The Executive Committee: • Noted the request received by Bentley Surgery • Discussed the options available to respond to this request • Agreed the recommendation to increase the assessment rate to £265 per assessment in line with the current market rate and for this to be backdated to 1st January 2021.

11. Patient Transport Service Contract Extensions

H Tingle presented a paper to the Executive Committee seeking support for a 12-month extension of the current South Yorkshire and Bassetlaw (SYB) Patient Transport Service (PTS) contracts delivered by Yorkshire Ambulance Service NHS Trust (YAS), First4Care and Premier Care Direct (PCD) in order to enable sufficient time for commissioners and

providers to establish the future needs and service model going forward following the impact of COVID.

The Executive Committee were asked to: • Recognise the significant impact that COVID has had on patient transport services and clinical pathways. • Recognise the risk of attempting to forecast within the next few months, both the required model and potential volumes of PTS for the next 5 years given that providers are still developing models of care to reflect the learning and impact of COVID and that these discussions have yet to conclude. • Note and support the decision made by NHS Sheffield CCG, as lead to the Yorkshire Ambulance Service (YAS) contract to extend this contract by 12 months and publish a VEAT notice. • As lead Commissioner for the Premier Care Direct (PCD) renal PTS contract support the proposed 11-month contract extension and recommend this to the other SYB CCG’s. • Support the extension of the First4Care on the day discharge contract. • Support the SYB CCG’s Contracting Teams working with the procurement team to publish a VEAT notice to the marketplace and work with the current providers to extended service provision.

The Executive Committee agreed to the recommendations.

12. 2021/2022 Organisational Risk Assessment

The Executive Committee welcomed C Rollinson to the meeting to the meeting to update on the 2021/22 Organisational Risk Assessment that has been undertaken by the shared Health & Safety Service hosted by NHS Rotherham CCG.

The assessment identifies the following hazards with corresponding actions to manage the risks in year:

• Fire in occupied premises • Excessive water leak / Electrical failure / Gas explosion or failure • Carbon monoxide poisoning • Staff suffering from stress and mental health • Injuries or illness due to working at workstation or using portable electronic equipment such as laptops or working from home • Slips trips or falls due to inappropriate use of stairs, high level storage, or other trip/slip hazards • Lifting, moving, or carrying equipment or goods • Travelling for work

• Injury or anxiety due to violent or aggressive behaviour or

intimidation or Harassment/ bullying.

• Lone working / stress or anxiety or other harm due to lone working

/ becoming isolated and unaided / lack of building security

• Loss of organisational and staff personal property /assets due to burglary, total building loss, or other partial building issue

The assessment has been reviewed by the Corporate Governance Team and approved by the Director of HR and Corporate Services.

Action - The Executive Committee queried the annual Portable Appliance CR Testing (PAT), C Rollinson to pick this up with L Devanney and LD feedback.

The Executive Committee noted the 2021/22 Organisational Risk Assessment.

13. National Covid19 Inquiry – Internal Preparation

C Rollinson shared a paper with the Executive Committee on the National Covid-19 Inquiry and NHS Doncaster CCG’s internal preparation which will commence Spring 2022.

Key Points • Earlier this month NHS England (NHSE) advised local NHS organisations that they must start preparing for the statutory public inquiry into the COVID-19 pandemic. • Any organisation might be called upon to provide evidence for the statutory inquiry, and individuals may be required to give evidence under oath. • To prepare for the Inquiry, system leaders are asked to consider four key areas of action:

o ensuring robust and comprehensive records management

o embedding systematic approaches to log key leavers, carry out exit processes and retain contact details

o considering wellbeing support for staff who may have to provide evidence.

o appointing a named inquiry lead • NHSE confirmed they will be issuing a ‘stop notice’ internally to instruct staff to retain all documents. A copy can be obtained on request should you wish to adapt it for use within your own organisation. • NHSE will provide a single point of contact for all inquiry queries, and for sharing support on good practice (e.g., training) in the meantime organisations can email any questions to [email protected].

Action Taken to Date • CCG inquiry leads identified Director of HR & Corporate Services o o Head of Corporate Governance • CCG single point of access identified Doncaster CCG central EPRR mailbox o

• A list has been provided by central HR of any leavers in roles 8a and above during 2020/21. The service has confirmed that last known contact details are still retained on ESR if required. • Head of Corporate Governance is creating a Covid19 records inventory to show where key records are saved on the CCG S:Drive.

Next Steps • Advise staff via DCCG Managers and Staff Briefing of the inquiry and ask them to start thinking about what Covid-19 records they have and where they are stored to inform the inventory. • Consider further guidance when made available.

Action - The Executive Committee requested an update at the next CR Managers meeting. An update will also be included in the next Chair and Chief Officer report presented at Governing Body.

The Executive Committee requested that staff are given advice and training as required to ensure they are fully able to comply with the CR requirement.

14. Planning and Contracting 2021/2022

H Tingle and A Fitzgerald provided the Executive Committee with a verbal update on Planning and Contracting 2021/2022.

Conversations have started for the finance and contracting arrangements for the six-month period from 1 October 2021 to 31 March 2022 (H2) which will be more challenging than the period 1 April 2021 to 30 September 2021 (H1). Providers will remain on block contracts until the end of the year. A workshop for learning from H1 and preparation for H2 is planned for September.

The Executive Committee noted the Planning and Contracting 2021/2022 update.

15. Continuing Healthcare QIPP Update

A Russell shared a report with the Executive Committee which provided feedback from the QIPP Board which took place 21 June.

The QIPP Board received a summary report following a review of eligibility assessments by CHS Healthcare. The report outlines the key findings and recommendations which are being progressed. The Chair of the QIPP Board requested that the paper be discussed at the Executive Committee.

Action - A Russell advised the Executive Committee he would bring the Individual Placements Shared Governance chart to the August meeting. The Executive Committee agreed this should be included as a standing

item on the agenda for future meetings from September. To add to the KC forward planner.

16. Finance Report

No finance report received.

HT Action - H Tingle to circulate the finance report to the Executive All Committee and members to provide feedback on the report.

The finance report to be a standing agenda item for future meetings.

17. Performance Update - Starting Well

A Fitzgerald presented the Starting Well report, which reflects 2020/2021 performance and delivery areas.

Key Performance Indicators

• Ensure that all Schools are utilising the reformed toolkit for SEMH and engaging with MHST and locality teams  65% In house foster provision by mixed economy of overnight short breaks provision by March 2022. Currently

figures stand at 57% In House and 43% IFA

• Reduce the number of Out of Authority Education Placements by 20% by the end of the year  Total number at the end of the quarter is 104, with no new

placements in April, May and June.

Action - A Fitzgerald to check the 20% target is correct. AF

• Increase the number of young carers identified and who have the

opportunity of an appropriate assessment  The numbers of young carers identified and assessed appropriately has increased to 280 (quarter 4 2020- 2021). This is an increase from 263 the needs of young carers have increased during the on-going pandemic so it

would be expected that more young carers would have been identified by partners.

• Ensure that at least 90% of Children receive a diagnosis decision within 18 weeks of referral for ADHD

 This pathway has been further impacted by Covid-19 and not likely to meet the 90% target during 2020/21. A meeting with DCCG Commissioning, Quality and Performance teams with RDASH representatives has been arranged to identify a way forward with an appropriate recovery trajectory

Action - A Fitzgerald to have a discussion at the next Directors of AF Commissioning meeting regarding ADHD referrals.

The Executive Committee noted the update.

18. Elective Care

A Fitzgerald provided an update on the current position for the end of June 2021 as follows:

• RTT performance improved marginally to 73.96% in June • The following specialties are below 70%: o Urology o ENT o T&O o General Surgery & Plastic Surgery • Patients waiting 52 weeks decreased by over 20% (from 965 to 770) • RTT waiting list size increased by 0.27% (from 27705 to 27776) • Diagnostic waits performance deteriorated in June to 55.59% • Patients waiting over 6 weeks increased by 14.7% (4824 to 5533) • The following were under 50% seen within 6 weeks’: o Flexi Sigmoidoscopy o Gastroscopy o Peripheral Neurophys o Non-Obstetric Ultrasound o MRI

The Executive Committee noted the update on Elective Care.

19. Items for inclusion in the next Governing Body Chair & Chief Officer’s Report

The following items were identified for the September Governing Body Chair & Chief Officer Report:

• National Covid 19 Inquiry • Acknowledge 19th July (step 4 of roadmap) • Extending Covid Vaccine to 12 – 17-year-olds • Phase 3 of Vaccination Programme

20. Escalation of Risk to the Governing Body

The Executive Committee agreed there were no risks identified to escalate to the Governing Body.

21. Bring Forward

The Executive Committee revised the forward plans for Executive Committee, Strategy and Organisational Forum and Governing Body. The following updates were made:

Executive Committee • Individual Placements Shared Governance – August • Individual Placements – standing item from September • Liberty Protection Safeguards (LPS) - future agenda item

Strategy & Organisational Development Forum • Health and Care Bill (white paper) – August • Safeguarding – August • Planning for H2 – September • Financial Plans – H2 - September • CCG Due Diligence – September • CCG Transition - September • Locality Commissioning – October • Review of Contracts 2021/2022 - November

Governing Body • Healthwatch Doncaster Annual Report – September • Planning for H2 – October • Financial Plans – H2 - October • Review of Contracts - December

22. Any Other Business

No additional items were raised.

23. Date and Time of Next Meeting:

Wednesday 18 August 2021 at 9am - Boardroom, Sovereign House and via Microsoft Teams

Minutes of the Quality & Patient Safety Committee Held on Thursday 6 May 2021, 9.30 am Via Microsoft Teams

Present: Dr E Jones (Chair) Secondary Care Doctor A Russell Chief Nurse A Ibbeson Interim Deputy Chief Nurse, Head of Quality & Designated Nurse for Children’s Safeguarding & LAC Dr R Kolusu GP Governing Body Member Z Head Lead Nurse for Infection Prevention and Control and Quality Lead for Primary Care L Denman Deputy Designated Nurse Safeguarding Adults and All Age Individual Placements Quality Team M Booth (left 11.00 am) Specialist Rehabilitation Case Manager S Evans (left 11.40 am) Transforming Care Specialist Placements Case Manager G Wood Deputy Designated Nurse LAC and Safeguarding Children A Johnson Court of Protection/Personal Health Budgets Lead Practitioner I Boldy Head of Individual Placements J Rayner Senior Officer for Quality H Joerning (arrived 10.00 am) Patient Experience Manager A Molyneux Head of Medicines Management

In attendance: J Whittaker Senior Corporate Services Support Officer (Minutes) J Forrestall Joint Ageing Well Lead Commissioner (Item 8)

Action

1. Welcome, Introductions and Housekeeping The Chair welcomed everyone to the meeting.

2. Apologies Apologies were noted from: • A Stothard, Quality & Patient Safety Manager

3. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups: None declared.

Declarations of interest from today’s meeting: None declared.

4. Minutes From Previous Meeting held on 04 March 2021 The minutes of the meeting held on 04 March 2021 were approved as a correct record.

5. Action Log Update The Quality & Patient Safety Committee Action Tracker was updated accordingly.

6. Matters Arising not on the Agenda No items raised.

7. Notification of Any Other Business

• Complex Investigation update (as part of Item 19)

8. Care Home Evaluation Further to the Governing Body meeting held in April 2021, Dr Jones felt it would be advantageous to receive evaluations at the Quality & Patient Safety Committee meetings and to receive and discuss the action plan that is being developed. J Forrestall attended today to deliver a detailed presentation to the Committee which covered the following: The Framework • Enhanced primary and community care support. • MDT support including coordinated health and social care support. • Falls prevention, reablement and rehabilitation including strength and balance. • High quality palliative and end of life mental health and dementia care. • Joined up care between health and social care. • Workforce development. • Data, IT and Technology.

Implementation There are four phases as part of the implementation: • Phase One - Implementation

• Phase Two – Implement new areas of work and continue to embed Phase One principles • Phase Three – Workforce Development • Phase Four – Prevent

MDTs • Initially commenced weekly to ensure every resident had an MDT and are currently moving to monthly as part of Phase Two.

Progress • 43 out of 48 care homes commenced. • Over 1600 reviews (to January 2021). • It has reduced the time taken for the referrer in completing referrals and reduced the number to community nursing. • Relationship building. • Ensuring alignment to End of Life, Dementia and neighbourhood frailty project.

Enhanced primary and community care support • Home rounds • Advanced Care Plans • Structured Medicines Reviews • Hydration and nutrition • Oral health • Sleep • Access to “out of hours”/urgent care when needed.

Next Steps • Action Plan (including workforce development/digital/contract/governance). • Include embedding care plans across the system. • Ensure alignment to other aspects of Ageing Well agenda (EOL, dementia, neighbourhood frailty project). • To work with digital regarding care plan sharing. • Now starting to see the impact of this work and it was raised it will be interesting to see the data around outcomes moving forward.

Dr Kolusu commended the team for all the hard work that has been undertaken and reported that the multi-disciplinary approach in care homes has worked very well with core members regularly attending and that it would be beneficial for this to be maintained in the future. Dr Kolusu raised more clarity is required around clinicians following advanced care plans/previous decisions made. J Forrestall advised a small working group is due to be established to look at this in more detail.

A Russell commented that the work has been undertaken under difficult circumstances and has been implemented at pace and has given impetus to further improve and develop care within care homes.

The Committee thanked J Forrestall for attending and to all those involved in the hard work that has been undertaken. Acknowledgement was also given to the on-going positive work that is taking place.

9. Primary Care Update Z Head presented the report to the Committee, which details the activities undertaken by Doncaster CCG (DCCG) to support quality in Primary Care.

In terms of Coronavirus (Covid-19,) things are starting to settle down and discussions are being held on the future of the Covid-19 Co-ordination Hub (CCHub). The number of staff testing positive has dropped dramatically over the last month. The focus now is ensuring that staff continue to follow guidance whilst restrictions start to be lifted.

The most pressing issue in Primary Care is the ability for residents to contact practices, for which we will be looking at additional support on how this can be achieved.

Doncaster Covid Vaccination Programme continues at pace and have now administered over 200,000 doses, which includes second doses. Over 65% of the adult population have received their first dose in Doncaster. There continues to be a significant number of enquiries to both the CCG and GP Practices regarding vaccinations. Further guidance is expected soon around Boosters.

Acknowledgement was given to the system wide effort across Doncaster throughout the Covid-19 pandemic.

Influenza Vaccination – the local flu planning group is looking at the 2021/2022 Influenza vaccination programme later this year.

Primary Care Matrix - the Primary Care Information Sub-Group was suspended due to the Covid-19 pandemic. The Primary Care Matrix is continually being updated as business as usual. There are now on-going conversations on how the group will re-establish.

National Reporting and Learning System (NRLS) – no patterns or trends have been identified.

Case Conference Reporting - case conference reporting has continued throughout the Covid-19 response, where all providers have faced significant challenges. Response numbers continue to fluctuate month on month.

Workforce – there has been successful recruitment to the post of Primary Care Quality Nurse.

Care Quality Commission (CQC) – currently looking at ways of working and how they can work remotely moving forward.

The Committee noted the comprehensive report and the huge amount of work that is being undertaken within Primary Care.

10. Medicines Management Update A Molyneux presented the report and the key highlights were as follows:

Medicines Safety – the Medicines Management Team (MMT) has been involved in urgent support to local care facilities where there have been medicines management concerns. A medication review has been undertaken of the processes in two local facilities and have worked with the

relevant Incident Management Group (IMG) to make suggestions to improve the medicines management of local authority commissioned services.

A Band 7 role is currently being advertised for which an element of this will be reserved for care home support in terms of answering questions and

giving steer to incidents.

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDaSH) – conversations held with RDaSH around sodium valproate and how this is dealt with in terms of pregnant women and ensuring information

is being sent out appropriately to GP Practices.

There is also some work being done across RDaSH, DBTHFT and Primary Care in terms of the use of a steroid card.

Doncaster & Bassetlaw Teaching Hospital Foundation Trust (DBTHFT) – there is a new national initiative of ‘Discharge Medicines Service’ where it requires acute trusts to send additional information at discharge to community pharmacies and primary care network pharmacists. The MMT are working with DBTHFT and RDaSH to facilitate this process.

A number of formulary updates have been brought to the Committee that have required slight modification to fit with the primary care landscape including weblinks and designation of the first and second line choices.

Primary Care – Patient Group Directions (PGDs) to enable a minor ailments service in Doncaster to use prescription-only medicines (PoMs) has been released to providers and will go live when contracts are signed. The new and revised scheme will move away from over-the-counter products and instead, focus on items which usually require a prescription.

The team continues to populate the new Medicines and Product directory. This aims to improve quality by bringing together commissioning information.

The MMT has continued working and contributing to vaccinations where

localities/roving team require input as well as attending the Covid Vaccination Meetings and Governance Group.

Significant clarity has been brought to the governance between the APC, MMG and provider governance meetings.

The Committee noted the update.

Terms of Reference – Medicines Management Group (MMG) and Area Prescribing Committee (APC) – A Molyneux presented the updated version of the Terms of Reference to the Committee for both MMG and APC and described the rationale for these.

The question was raised as to how do we highlight our concerns as a

Committee about future governance arrangements for APCs, MMG etc in terms of roles and responsibilities. Assurance was provided that appropriate conversations are taking place around how we transfer to new ICS arrangements and ensuring appropriate lines of accountability to new bodies. Following discussion, there was agreement for “Transition to future J Whittaker structures of NHS arrangements” to be added as a standing agenda item for this meeting moving forward.

The Committee approved the updated Terms of Reference for both MMG and APC.

APC Traffic Light System Commissioning Policy - this was shared with the Committee who were advised that it is the role of the Doncaster and Bassetlaw APC to finalise Traffic Light System for products in line with the authorised outputs from the constituent providers and Doncaster and Bassetlaw CCGs. This document provides further information on those statuses and how statuses are allocated.

The Committee received and noted the APC Traffic Light System Commissioning Policy.

Pain Management Project - the report was shared with the Committee which summarises information on the pain management project for NHS Doncaster CCG. Further updates to be provided at future meetings in regards to how we are progressing with this complex but very important work.

The Committee received and noted the Pain Management Project Report.

11. Doncaster & Bassetlaw Teaching Hospital Foundation Trust (DBTHFT) A Ibbeson presented the report, and the following key points were highlighted:

Ophthalmology – maintaining high level discussions via the DBTHFT

Contract Board to ensure appropriate engagement and the monthly Task and Finish Group continues to take place with appropriate representation. There are still significant challenges in terms of patient quality services and patient safety and this continues to be monitored accordingly via the applicable forums.

In terms of Hydroxychloroquine Screening, on-going conversations are still taking place as to where this service might sit.

In summary, solutions are being explored in order to be able to move forward and issues continue to be escalated accordingly via the Contract Board.

Mortality Team – recent discussions have highlighted the large amount of time that staff members are taking in speaking to bereaved families and carers over the last year due to the lack of visitation available as a result of Covid-19 restrictions and this telephone contact has been so important. Despite the really difficult circumstances, the team have continued to maintain improving standards throughout and the CCG wanted to express their thanks for the time and care taken to support the bereaved during these very challenging times.

The Quality Team continue to work closely with and support DBTHFT as required.

The Committee noted the report.

12. Rotherham, Doncaster & South Humber NHS Foundation Trust (RDaSH) A Ibbeson presented the report to the Committee, and highlighted the following:

Section 117 reviews – on-going discussions are being held via FPIG and CQRG. The waiting list for Section 117 reviews has been highlighted as being in need of reconciliation in conjunction with the Local Authority. Currently, a number of patients are awaiting reviews. Due to this, a piece of work needs to take place to enable an understanding of patients who can be reviewed and discharged and those which need to continue receiving reviews based on their need of continued support, placement requirements and after care following S117 care provision. The need to re-establish previous structures such as Individual Placement Steering group was raised and for this to be factored into recovery plans moving forward.

Challenges remain within Children’s Eating Disorders service and All Age ADHD pathway. Several business cases have been received from RDaSH, which will be the focus of the next Contract Board.

It was raised that as a collective of Commissioners to RDaSH, there has been agreement to additional funding into Children’s Eating Disorder Service for which a basic position has been adopted for additional capacity within RDaSH. Recognition was given to the need to develop a further understanding of the requirements of the service moving forward.

We continue to work closely with and support RDaSH as required.

The Committee noted the report and concerns raised.

13. Specialised Placements Update Report M Booth presented the report and provided an overview of the work being undertaken within the Specialist Placements work stream and the highlights were as follows:

Since the last report, there have been seven new admissions and two discharges and one death, of a neuro-rehabilitation patient. This increases the total patient number to 43, the same figure as in December. There are currently three (female) specialised rehabilitation patients within the borough of Doncaster, and four (male) patients elsewhere within the ICS footprint. Out of Area Psychiatric Intensive Care Unit (PICU) placements have risen from one to three.

M Booth continues to take part in the Doncaster Mental Health Complex Recovery Transformation Team Project for which part of its remit is to develop a new High Dependency Unit in-patient rehabilitation service within the RDaSH Tickhill Road estate, as well as transforming and improving local community-based rehabilitation provision.

It was raised we need to continue to ensure appropriate rehabilitation can be delivered in a timely manner to patients.

The Committee noted the report.

14. Transforming Care Programme Report S Evans presented the report which provides a brief summary of the work taking place under the regional Transforming Care Programme (TCP), and the progress made and challenges faced at a local level.

Adults – from the nine patients we currently have in hospital, we have potential discharge plans in place for two of these patients in May 2021. It was recognised we have some extremely complex cases currently in hospital, which can impact on the discharge pathways put in place due to the need to ensure they are safe and effective for everyone involved.

Children’s – there have been two children admitted to Tier 4 beds since the last meeting. One of those admissions was very brief and the child was discharged after four weeks and is back with their family in Doncaster. A post Care, Education and Treatment Review (CETR) is arranged in May to review all actions/recommendations following discharge.

We still have one child in a Tier 4 bed and this is expected to be a longer admission. We continue to receive updates from the patients care coordinator and have invites to all in-patient meetings.

The training commissioned on behalf of Doncaster CCG by NHS England (NHSE) to carry out 12 training sessions between January 2021 and the end of March 2021 has now been completed to a total of 265 delegates from all over the country. Positive feedback has been received and shared with

NHSE who are looking at how this can be developed moving forward over the next 12 months.

The Committee noted the update.

15. Care Home Annual Report L Denman presented the Annual Report and highlighted the following:

We are now starting to see the impact the enhanced support is having within care homes and conversations are taking place regarding the next steps.

For noting, is that we have now moved on to the next phase regarding care home cells, which involves looking at targeted training to be able to enhance

the quality of the care provided and will be at looking at covert medication for this quarter and how we support care homes to follow guidance and enact policies and procedures accordingly. Other areas of training will include

Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

As of today, there are currently no outbreaks in care homes within Doncaster and the decision has been made to stand down the care home MDT and re- establish in the future if needed.

Due to some issues being highlighted around care planning etc, the suggestion was put forward in regards to producing an education package around care homes and associated settings. This package would be extended to other providers/GPs as part of the strategic direction and on- L Denman going work with care homes. L Denman agreed to take forward this action with the team and for a progress update to be provided at a future meeting.

Thanks were expressed to the team for their continued hard work.

The Committee noted the report and the on-going work that is being undertaken.

16. Continuing Healthcare Annual Report L Denman presented the Annual Report to the Committee and the following key points were highlighted:

From April 2021, the Continuing Healthcare (CHC) function will be focusing on recovering to a position pre Covid-19 pandemic with a main focus on undertaking reviews.

The team are exploring as to how more robust links can be made with partners from other areas in order to provide assurance on the quality of out of area placements.

Thanks were expressed to the team for their continued hard work and for significantly changing their remit throughout this difficult time.

The Committee noted the report and the on-going work that is being undertaken.

17. Learning Disabilities Mortality Review (LeDeR) I Boldy provided a verbal update as follows: • For noting is that LeDer is in a period of transition currently and that reviews are on hold and will not be undertaken until the new system commences at the end of June 2021. • We are currently in a situation where we have a number of outstanding cases. • The new system is a national imperative rather than local. • The new system will be a refreshed approach, with the intention to look at the review process as a whole and for a check-in process to be established in terms of which cases will require a full review. • Systems and process will be very different and the intention is to incorporate Autism spectrum disorder (ASD) deaths into the process as well as LD towards Autumn time.

The LeDeR Annual Report will be submitted to the July meeting, which will be a true reflection of what Covid-19 has meant in terms of the number of cases. It was noted that cases are up to 35 this year compared to 18 last year.

The Committed noted the update.

18. Infection Prevention and Control Update Z Head presented the report to the Committee as follows: • There have been no MRSA cases during April 2021. • For the month of April there has been one outbreak in a care home and two outbreaks in school settings. All of these outbreaks of infection were due to Covid-19. Multi- agency support meetings have been undertaken and support provided to services affected. • There are no current outbreaks in care homes within Doncaster. • The number of staff testing positive has dropped dramatically over the last month. The focus now is ensuring that staff continue to follow guidance whilst restrictions start to be lifted. • Three Health Care Assistants have been recruited to support Infection Prevention and Control across care homes, including homes providing elderly care, the care of those living with learning disabilities and supported living environments in Doncaster. • There is a current outbreak in a homeless shelter of Group A streptococcus for which a response has been formulated by providers to put swabbing and antibiotics in place. There is on-going work around this.

It was raised that Z Head is new to this post and recognition was given to the knowledge and skillset that she can bring to this role and that she continues to learn and build on current working relationships within providers as well as beginning to develop new ones.

The Committee noted the progress and challenges in respect to infection prevention and control within this reporting period.

19. Patient Experience Report H Joerning presented the report which provides a summary of the Complaints, MP Enquiries, Concerns and Solicitors letters received during Quarter 4 of 2020/2021.

There has been a total of 827 contacts made with the Patient Experience Department in Quarter 4 and complaints for the CCG remained low during Quarter 4.

The Patient Experience Team continue to provide support to the Covid-19 vaccination programme, for which a significant number of enquiries continue to be received. The team attend the daily Covid-19 vaccination meetings, where possible, and raised they continue to receive invaluable support from all teams as needed regarding this.

MP enquiries were high, mainly related to Covid-19 vaccinations, and an informal process was set up between the CCG and the MP Offices to allow their administration team to contact the Patient Experience Team directly to aid in timely and supportive responses and feel this has worked really well.

It was raised we will be looking at the support provided around Covid-19 vaccinations and how this becomes a sustainable model as we move forward into phase 2 of the vaccination programme.

Thanks were expressed to the Patient Experience Team for the unprecedented work during these difficult circumstances.

The Committee noted the detailed report.

20. Doncaster Serious Incident Annual Report The Annual Report was received and noted by the Committee and no concerns were raised.

21. Premier Care Direct (PCD) Update Report The report was noted by the Committee and no concerns were raised.

It was highlighted PCD have worked closely with the CCG to improve their systems and processes in order to provide the assurance required and the situation is much improved from last year in regards to quality and service delivery. PCD and the CCG continue to meet on a monthly basis with exception reporting being provided. The CCG are assured on the services provided by PCD at this time.

The Committee noted the update.

22. Fylde Coast Medical Services (FCMS)

Due to time constraints, it was agreed for this item to be deferred to the next meeting, but it was highlighted there were no issues by exception.

23. YAS Integrated Urgent Care Q4 Quality Report The report was noted by the Committee and it was raised we have requested improved transparency around YAS to add to our levels of assurance.

The contract for YAS is held by Greater Huddersfield CCG however the Quality Contract is managed by Sheffield CCG.

24. Corporate Risk Register and Escalation of Risks to Governing Body It was noted that the most updated version had not been attached to include the risk around Ophthalmology as agreed at the last meeting and this will be shared with the Committee. A Russell

No additional risks were added following today’s meeting.

25. Caldicott Log & Caldicott Work Plan (Exceptions) It was raised that there are no current issues impacting on patient safety and quality. There has been a significant amount of Caldicott activity due to an on-going investigation and we are utilising Caldicott principles to work with organisations to release and share information.

As raised at the last meeting, as a CCG, we are currently managing significant amounts of personable identifiable data for staff and are processing data in relation to vaccinations of health care and social care workers and patients. It was noted there are appropriate Data Protection Impact Assessments (DPIA’s) in place.

The Committee noted the update.

26. Quality & Patient Safety Committee Reporting Matrix It was agreed for the following items to be added: • LD Specific Review (July) • Transition to future structures of NHS arrangements

27. Receipt of Minutes The following sets of minutes were noted by the Committee: • Medicines Management Group (MMG) – 11.03.21 • Area Prescribing Committee (APC) – 25.02.21 • Incident Management Group (IMG) - 10.03.21 & 24.03.21 • Acute Clinical Quality Review Group (ACQRG) – 09.02.21 & 09.03.21 • RDaSH Clinical Quality Review Group (CQRG) –18.02.21 & 17.03.21

28. Any Other Business

No items raised.

29. Date and Time of Next Meeting Thursday 1 July 2021, 9.30 am – 12.00 midday

Engagement & Experience Committee (EEC) Meeting Thursday 3 June 2021, 10.00 am – 11.30 am via Microsoft Teams

Present: S Whittle (Chair) Lay Member for Patient & Public Involvement, NHS Doncaster Clinical Commissioning Group (CCG) Dr M Pande GP Lead, South Locality A Fitzgerald Director of Strategy & Delivery, CCG C Casey Head of Communications and Engagement, CCG D Woodcock Performance and Intelligence Manager, CCG A Goodall Chief Operating Officer, Healthwatch Doncaster C Batty Public Health Improvement Coordinator, Doncaster Council M Taba Gypsy and Traveller Link Worker W Smith Gypsy and Traveller Link Worker

In attendance: C Ogle Associate Director of Primary Care and Commissioning, CCG K Connolly Senior Corporate Services Support Officer, CCG (Minute Taker)

Agenda Subject Action Ref Required By 1. Welcome and Introductions

S Whittle welcomed everyone to the meeting.

2. Apologies for Absence

S Whittle noted apologies of absence from the following:

• A Smith - Senior Communications & Engagement Officer, CCG • A Edwards - Corporate Governance Manager, CCG • H Joerning - Patient Experience Manager, CCG • D Atkin - Public Governor (Doncaster), DBTHFT • L Robson - Public Health Theme Lead

3. Declarations of Interest

S Whittle reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).

Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the

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secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups: None declared

Declarations of interest from today’s meeting: M Taba declared a Non-Financial Personal Interest as he is a voluntary member of the Board of Trustee for Friends, Families and Travellers (FFT) Trust. He also declared an Indirect Interest as his wife, Alina Luminita Taba, is working in a similar role as a Community Connecter for Doncaster Council. S Whittle thanked M Taba and advised the declarations of interest would be noted and he wouldn’t need to declare for each meeting.

4. Minutes from Previous Meeting

The minutes from the previous EEC meeting, held on 6 May 2021, were approved as a correct record.

5. Action Log Update

Both the open & closed action logs were updated:

• 3 actions closed • 0 actions remain open • new actions

The updated open action log is circulated with the minutes of this meeting.

6 Notification of Any Other Business

There were no notifications of further business for discussion.

7. Priority Area – Deep Dive on Living Well (Primary Care Services)

S Whittle welcomed C Ogle to the EEC Meeting to provide members with an update on Primary Care Services.

Engagement already undertaken:

• Bentley Surgery and Nelson Practice merger and development of merger manual

• Development of the GP Additional Care Fund • Primary Care Cell • PCN engagement • Practice managers biweekly meetings

• COVID vaccination and mass testing

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• Estates Project groups • Ongoing engagement with Local Representative Groups (LPC

for Pharmacy ear care service and minor ailments service changes for example) • Enhanced Health in Care Homes • Low Calorie Diet and Second Nature Pilots (Diabetes)

• Gender Reassignment • ICS level

Impact of Engagement

There has been a real sense of community and removal of bureaucratic boundaries in the joint effort to beat coronavirus. The infrastructure has enabled speedy decisions to be made when needed and there has been an openness and transparency that has been aired. It has not been without its challenges however the significant effort to deliver the vaccination programme led by Primary Care

Doncaster has really brought the practices and the PCNs together in a positive way.

Progress is being made on estates projects which have secured significant investment from the ICS pot. Links have been made between the CCGs focus on vaccination and the Local Authority’s on mass testing to join up the two agendas where it makes sense to do so. Testing of different approaches to weight loss for people with diabetes. Peer support across the ICS for tackling the agenda.

Development of approach for primary care collaboratives.

Development of new service specifications for ear care delivered in pharmacies and for a specialist GP (s) to deliver gender dysphoria services (subject to business case approval).

What, if anything, has changed as a result of the engagement: • Additional consultation requirements for patients registered with Bentley Surgery and Nelson practice as requested by Overview

and Scrutiny Panel; delay in action to close Scawthorpe surgery as a result of concerns raised • Reinvestment of funding from proactive care back into primary care in turn for delivery of key objective around prescribing • Database of volunteers to support COVID vaccination programme with partners signing up to MOU to enable implementation • Statistics about the diabetes pilots can be shared at the meeting

All communication currently remotely via teams, email or telephone we have had no face-to-face meetings since the start of the pandemic. There is a regular update to primary care staff sent out by the comms team, this is under continuous review.

Further Engagement

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• During June drop-in sessions with practices to enable questions to be raised about the GP Additional Care Fund.

• Outcome of the further engagement on the Bentley merger to be fed back to OSC. • TARGET 4-6 sessions to address pathway issues

Engagement is ongoing through existing structures as the need arises.

We will always ensure that a quality and equality impact assessment is undertaken for key commissioning decisions to make sure protected characteristics are engaged with. In the last year these have been undertaken in relation to the proactive care service and the proposed closure of Scawthorpe surgery.

M Taba asked what criteria for engagement is in place for new clinics. C Ogle explained the government provides the funding for the clinics, they look at existing practices and what the needs of the community are and where the need is to channel efforts.

Regarding Low Calorie Diet and Second Nature Pilots (Diabetes). CB C Batty suggested a representative from the council attend the next KC meeting to discuss a couple of areas including the Tier 2 and 3 weight management services/ food network and the food advertising work.

Dr Pande queried where she can refer for the low-calorie clinics. C Ogle advised this is a National Prevention Programme run by Reed. Patients can self-refer. C Casey to look at the Primary Care update, CC which goes out on Wednesdays, to make sure all information required

is included.

S Whittle and the Engagement and Experience Committee thanked C Ogle for the very detailed update.

8. Healthwatch Doncaster Update

A Goodall provided EEC members with a verbal update on Healthwatch Doncaster.

The key points were as follows:

• Covid-19 vaccination survey – will be shared widely • Finalising report on vaccination hubs - will be sent out today • Mental Health Communications and Engagement Sub-group formed • 2020/2021 annual report – focusing on non-face to face KC engagement – finalised and published at the end of June. Will come to next month’s EEC meeting. • Moving ahead with Daily Dose and Facebook Live – themed weeks including Covid Vaccine, BAME Community, Digital Inclusion. Heavily supporting the Covid-19 vaccine and accessing the vaccine.

• Looking at problems accessing NHS dental services

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The Engagement and Experience Committee noted the update.

9. ICS Update

A Fitzgerald advised the Engagement and Experience Committee that a listening exercise from the ICS Human Resources lead is planned for CCG staff for 9th June at the monthly staff brief.

The Engagement and Experience Committee noted the update.

10. AGM Update

The next Annual General meeting date has yet to be arranged.

11. 360 Stakeholder Survey

C Casey to check with L Devanney if the 360 Stakeholder Survey has been completed.

12. BAME Communications Report

C Casey provided Committee members with an update on BAME and Equality:

• Working with public health and community workers to encourage hard-to-reach groups to be vaccinated • Drop-in clinic at Hexthorpe on 11th-12th June • A second pop-up vaccination site has been arranged at the mosque for the upcoming weekend • 300 people were vaccinated at a pop-up clinic at Dearne Valley on 29th May • Vaccination clinics at Keepmoat and Rutland House this upcoming weekend

EEC members noted the informative update.

13. Minutes for Noting:

The notes from the Health Ambassadors meeting, held on 24th May 2021, were noted by the Experience and Engagement Committee.

14. Escalation of Risks to the Governing Body

There were no risks identified to escalate to Governing Body.

15. Any Other Business

There was no further business raised for discussion.

16. Date & Time of Next Meeting:

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Thursday 1 July 2021, 10am – 11.30am, via Microsoft Teams

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Engagement & Experience Committee (EEC) Meeting Thursday 1 July 2021, 10.00 am – 11.30 am via Microsoft Teams

Present: S Whittle (Chair) Lay Member for Patient & Public Involvement, NHS Doncaster Clinical Commissioning Group (CCG) Dr M Pande GP Lead, South Locality A Fitzgerald Director of Strategy & Delivery, CCG C Casey Head of Communications and Engagement, CCG A Smith Communications and Engagement Manager, CCG D Woodcock Performance and Intelligence Manager, CCG A Goodall Chief Operating Officer, Healthwatch Doncaster L Robson Public Health Lead - Working Age and Healthy Lives, Doncaster Council D Atkin Public Governor (Doncaster), DBTHFT M Taba Gypsy and Traveller Link Worker W Smith Gypsy and Traveller Link Worker

In attendance: P Tarantiuk Strategy and Delivery Manager – Learning Disabilities, CCG J King Commissioning Manager, Doncaster Council K Connolly Senior Corporate Services Support Officer, CCG (Minute Taker)

Agenda Subject Action Ref Required By 1. Welcome and Introductions

S Whittle welcomed everyone to the meeting.

2. Apologies for Absence

S Whittle noted apologies of absence from the following:

• A Edwards - Corporate Governance Manager, CCG • H Joerning - Patient Experience Manager, CCG • K McGuire – Patient Experience Administrator, CCG

3. Declarations of Interest

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The meeting was noted as quorate.

Declarations of interest from sub committees / working groups: None declared.

Declarations of interest from today’s meeting: No new declarations declared. Previous declarations of interest of Committee members have been noted.

4. Minutes from Previous Meeting

The minutes from the previous EEC meeting, held on 3 June 2021, were approved as a correct record.

5. Action Log Update

Both the open & closed action logs were updated:

• 3 actions closed • 0 actions remain open • 3 new actions

The updated open action log is circulated with the minutes of this meeting.

6 Notification of Any Other Business

There were no notifications of further business for discussion.

7. Priority Area – Deep Dive on Living Well (Learning Disabilities and Autism)

S Whittle welcomed P Tarantiuk and Julia King to the EEC meeting to

provide members with an update on Learning Disabilities and Autism Services.

Engagement already undertaken

Doncaster’s All Age Learning Disability and Autism Strategy 2021-2024 was jointly developed by Doncaster Council and NHS Doncaster CCG, statutory and non-statutory partners and people with lived experience of Learning Disability and / or Autism during 2018/2019.

Speak-Up and Inclusion North were commissioned to undertake a range of engagement events across Doncaster with people with lived experience of Learning Disability and / or Autism. The aim was to

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ensure a wide range of people were engaged and involved, to co- produce the Strategic Intentions, and identify the most importance priorities for people with Learning Disability, Autism, and their families and carers.

Speak UP and Inclusion North planned and delivered a phased programme of engagement activity including face to face events held to develop the framework, with further sessions and online surveys to help prioritise the areas of importance.

Four planning sessions, followed by a further 12 engagement sessions were held across the Borough with people with lived experience of Learning Disability, Autism, parents, families and carers. The outputs of the exercises were then ranked by people with lived experience to prioritise the key areas for development of the strategy.

Since the approval of the strategy in March 2021, the LD&A programme is now progressing across five key work-streams, and three cross-cutting themes, detailed below, and as identified by people with lived experience. As the programme aims to be personalised and person-centred, engagement of people with lived experience is at the core of planning and delivery.

5 priority Areas

Diagnosis of Autism a) b) Education and Inclusion c) Employment d) Carers and Short Breaks e) Housing and Support

3 Cross Cutting Themes

a) Health Inequalities b) Those in Transitions (Children and Young People) c) Transforming Care

Overarching Strategy and development of Programme Plans:

1. Learning Disability and Autism Partnership Boards 2. Carers / Parents 3. People from Minority Ethnic Groups 4. Engagement in each of the Workstreams

Impact of Engagement

People with lived experience of learning disability and / or Autism chose to adopt the Transforming Care Programme vision for the LD&A strategy: “We believe that children, young people and adults with a learning disability and/or autism have the right to the same opportunity

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as anyone else to live satisfying and valued lives, and to be treated with dignity and respect. They should have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives.”1

(Transforming Care 2015).

Through the engagement that has been undertaken so far, the Strategy has been written in a way that ensures people, not services, are at the heart of the work being planned and delivered. The same approach is being adopted in the development of the work-plans, their delivery and the oversight needed to ensure they continue to meet the stated aims and objectives.

A key issue of importance to the Partnership Boards has been the development and delivery of the Education and Inclusion, and

Employment plans. Members of the Autism Board in particular are keen to see key elements of the plans progressing, and how the two work-streams link together. The Workstream lead has been invited to attend the next Partnership Boards to present the current plans; and ensure the views of the boards are addressed within the plans, and have opportunity to get involved in the Task and Finish Groups.

The programme will deliver a communications plan to enhance people’s awareness of the work being delivered, and opportunities to get involved, which will continue to expand over the coming months.

What, if anything, has changed as a result of the engagement:

A key success of the Strategy so far has been that it is co-produced, written and presented for sign off with people with lived experience. The strategy is written as ‘You Said, We Did, and Next We Will..’

Accountability for delivery is to people the plans are aimed at. Partners need to focus on the impact the plans will have on people who use services, raising the importance of ensuring people with lived experience are included across each stage of delivery of the strategic aims.

The programme is in the early stages of implementation, and the foundation stones of co-production are becoming more embedded in practice. The Partnership Boards have direct involvement and influence on the direction of travel of the workplans, their development, delivery and challenge.

Further Engagement

The workstream plans are in development currently and due for sign off next week. It is anticipated that each plan will include evidence of how

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the plans are underpinned by engagement and involvement with people with lived experience.

Questions from Committee members:

Dr M Pande queried if the LD form of referral be populated on Ardens SystmOne / or Emis templates for ease of access. P Tarantiuk to look PT into this and feedback.

S Whittle queried what the data is regarding the number of people with learning disabilities and autism received the Covid vaccination. J King advised it currently stands at around 86%.

AS S Whittle requested the template to be added to the NHS Doncaster (completed) CCG website.

S Whittle and the Engagement and Experience Committee thanked P Tarantiuk and J King for the very informative update.

Post Meeting Note Query - how do GPs request a Learning Disability assessment and why are some referrals rejected

Response - referrals can be made by completing the single access referral form (SARF). The form is also available electronically via the RDaSH public website: http:// www.rdash.nhs.uk/ The completed form can be emailed to: [email protected] Faxed to: 01302 796159 Posted to: Learning Disabilities, via Main Entrance, 2 Jubilee Close, Tickhill Road Hospital, Tickhill Road Site, Balby, Doncaster, DN4 8QH

The referral may be rejected if there is no clear reason for the diagnosis so it is important to detail how a diagnosis of LD will support the patient to access health or social care services. A member of the RDaSH Learning Disability health action team (Duty nurse number: 01302 796155) often support GPs, care coordinators etc to add in additional details when required.

Members of the social care team in the Local Authority can confirm this is the process they use when they feel there is a need to support individuals and families but require an LD diagnosis in order to support.

The matter will be raised at the next annual health task and finish group on 15th July to ascertain if this is a common query amongst other practices.

The Data Quality team will be requested that the document is to be embedded into practice folders if this is needed. D. Woodcock is reviewing data on referrals: number of referrals, from where, accepted, rejected and reason for rejection to understand what actions are required.

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Post Meeting Note from D Atkin I can find no reference to the current system of referring to an Education Health Care Plan (EHCP) when determining the value to be derived from the further education of young people with learning difficulties. This I believe I mentioned during the meeting? If not it was remiss of me in that EHCP assessment is the corner stone of determining the most appropriate path-way of the further education for an individual, having regard to the 5 priority areas and 3 cross cutting themes outlined in the presentation.

On reflection I may not have mentioned this concern being viewed to be a ‘conflict of interest’ my being a Director of a College providing further education of young people with learning difficulties?

8. Patient Experience Update

The Patient Experience and Complaints Management Annual Report 2020/21 (1 April 2020 to 31 March 2021) was shared and noted by the EEC members.

As no-one from the Patient Experience Team was present at the meeting S Whittle requested the report should come back to the next KC meeting in August for discussion. (completed)

9. Healthwatch Doncaster Update – Annual Report 2020/2021

A Goodall presented the Healthwatch Doncaster Annual Report 2020/2021 to EEC members.

The highlights from the year were as follows:

Reaching Out • 3567 people contacted Health Doncaster in the past year • 91,196 people received advice and information through Zoom and Facebook

Responding to the Pandemic • 2 new services (in addition to maintaining support for all of our existing groups and networks) this year to support and engage with our local communities in the pandemic • Engagement was undertaken with 3567 people this year in projects and surveys – their voices helped make changes and improvements throughout the pandemic

Making a Difference to Care • 8 reports were published about the improvements people would like to see to health and social care services • 100% of our reports have been shared locally and we are actively reviewing progress on the recommendations that we made.

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Health and Care that Works for you • 31 volunteers helped us to carry out our work. In total, they contributed 577 hours of valued and valuable time. • 8 staff are employed, 62% of whom are full time equivalent, which is the same as the previous year. • £189,693 has been received in funding for the local Healthwatch contract from our local authority in 2020-21 – this is 12% less than the previous year.

Top three priorities for 2021-22 1) Restart community engagement and listen to local people about their experiences of accessing services 2) Mental Health – listen to people’s experience of mental health support in Doncaster 3) Access to Dental Care – review and investigate the provision of local Dental services for local people

Next steps • Transforming the way that we work – Healthwatch Doncaster will be more agile and community-based • Maintaining digital engagement alongside face-to-face engagement • Continue to focus on listening to people from communities whose voices are seldom heard

The Engagement and Experience Committee noted the extremely informative report and thanked A Goodall for presenting it. The full report has been sent out to EEC members.

10. ICS Update

This item was not discussed due to time restraints.

11. Public Health Update on Food/Weight Management

L Robson provided EEC members with a Public Health update on food and weight management.

There is one weight management service in Doncaster at present (the Tier 2 service was decommissioned a few years ago). A tier 3 weight management service for pre-bariatric patients is in place with funding from the Better Care Fund until 2023. A community-based pilot for a tier 2 service will hopefully be in place in early Autumn (funding provided by PHE). This will link into the Be Well Doncaster model and the compassionate approach to weight currently being developed in public health.

There will also be an enhanced weight management service for GPs for referrals soon. A high fat, salt, sugar, piece of work around council advertising policy is also being undertaken at present.

There is also a food network called Doncaster food network looking at

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food projects/growing, and waste/climate change initiatives and the Delicious Doncaster food festival is due to take place on 23rd-25th July.

EEC members thanked L Robson for the update.

12. BAME Communications Report

C Casey provided Committee members with an update on BAME:

The Main focus continues to be Covid and the vaccination programme – this will soon be followed by booster jabs and flu jabs programme. We’re still working closely with public health and community link workers to encourage lesser heard groups to be vaccinated - particularly at the moment central area of Doncaster where there’s more poverty and deprivation. A plan has been drawn up of appropriate venues – still to be finalised to help reach those more vulnerable groups and target groups. A summary of recent pop-ups and drop-ins is as follows:

• 2nd dose Belle Vue Mosque – 320 • 2nd dose Gurdwara – 590 • St James Mosque – 220 • St John's Balby – 160 • Iqbal Poultry – 160 (filming for NHSE) • Complex Lives – 65 • Hexthorpe 270 (over 2 Days) 11 and 12 June A drop-in weekend took place on 26 - 27 June with around 5300 people vaccinated – 20% 18–29-year-olds who we consider a target group with another planned for 10-11 July. Allied to some of this will be a presentation at our next meeting from our Gypsy Roma and Traveller community workers to give you a flavour of their work and progress.

EEC members noted the informative update.

13. Escalation of Risks to the Governing Body

There were no risks identified to escalate to Governing Body.

14. Future Meetings

S Whittle asked EEC members how they wish to proceed with future meetings when restrictions are lifted, either in person or by Microsoft Teams. The general consensus was a mixture of both.

15. Any Other Business

There was no further business raised for discussion.

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16. Date & Time of Next Meeting:

Thursday 5 August 2021, 10am – 11.30am, via Microsoft Teams

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Minutes of the Primary Care Commissioning Committee (Public) Held on Thursday 10 June 2021 at 12.30 pm via Zoom

Voting Members S Whittle Lay Member (Chair) Present: J Pederson Chief Officer, CCG H Tingle Chief Finance Officer, CCG A Russell Chief Nurse, CCG A Fitzgerald Director of Strategy and Delivery, CCG Dr M Pande South Locality Lead GP

Non-Voting C Ogle Associate Director for Primary Care & Commissioning, CCG Members K Roberts Primary Care Manager, CCG Present: Dr N Alsindi Clinical Lead Primary Care, CCG A Ibbeson Interim Deputy Chief Nurse & Designated Nurse for Children’s Safeguarding & LAC, CCG A Small Senior Finance Manager, CCG S Barnes Interim Estates Lead, CCG J Telford Healthwatch Representative P Barringer NHS England Representative D Eggitt Chief Executive Officer, LMC

In attendance: L Tully Lay Member (observing) K Connolly Senior Corporate Services Support Officer, CCG (minutes)

Meeting Start 12.30 pm Action

1. Apologies for Absence

Apologies for absence were received from:

• Z Head Lead Nurse Primary Care Quality, CCG

2. Declarations of Interest

The meeting was noted as quorate.

Declarations of interest from sub committees / working groups: None noted.

Declarations of interest from today’s meeting: S Barnes noted that he is also undertaking a similar role for estates for Rotherham CCG. The chair decided that there was no risk of undue gain or influence for all parties concerned.

3. Notifications of Any Other Business

No items were raised.

4. Minutes from Previous Meeting

The minutes of the last meeting held on 13 May 2021 were approved as an accurate record.

5. Matters Arising not on the Agenda

There were no matters arising not on the agenda raised by the Primary Care Commissioning Committee.

6. Action Tracker

The Primary Care Commissioning Committee discussed and updated each item on the Action Tracker.

• AP100 – completed, will report by exception in future can remove from action tracker • AP134 – closed (on agenda) • AP135 – completed, can be removed • AP136 – C Ogle to discuss at the next Clinical Director’s meeting and feedback, A. Ibbeson to be linked into conversations • AP137 – to be presented at the Confidential meeting in July to ensure confidence in the report before sharing in public • AP138 – completed, on agenda

The latest updates can be viewed on the shared Action Tracker.

7. Finance and Contracting

7.1 Primary Care 2021/2022 Budget Position

H Tingle and A Small presented a report to the Primary Care Commissioning Committee outlining the 2021/22 budget position for NHS Doncaster CCG for 2021/22 for the Primary Care Delegated Co-Commissioning Budget devolved from NHS England. The report also outlined the local element of Primary Care Services which includes Local Enhanced Services.

Due to the Covid-19 pandemic the 2021/22 Financial Year has been split into H1 and H2 for planning purposes. H1 covers April 2021 to September 2021 and H2 covers October 2021 to March 2022. The CCG has only been given an allocation to cover H1 currently therefore the paper covers this period. This has been calculated at a National level and has reverted back to the previous Delegated Budget Allocations.

For Doncaster CCG the overall allocation for Delegated Co-Commissioning for the H1 period is £24,652k. Included within this allocation is growth of £1,504k.

It is anticipated, in line with the guidance, that the CCG will also receive further allocations to cover the Care Home Premium, further IIF indicators and additional funding for the Additional Roles Reimbursement scheme.

The CCG has reviewed the actual costs in 2020/21 and planning assumptions for 2021/22 to build up the required budgets for the financial year. The budget required for the Primary Care Delegated Co-Commissioning services for 2021/22 is £26,782k. This is an increase in budget of £2,510k on the 2020/21 budget pro rata to half of the year.

The main areas of increase are additional investment into the ARRS, QOF and Impact and Investment fund and increases to the Global Sum baseline payments based on the National uplift.

The overall position shows that the funding required for the H1 period of the 2021/22 financial year to cover the Delegated Co-Commissioning expenditure is £824k more than the allocation received.

There is no formal QIPP target or expectations that any QIPP is to be delivered at this time however it is not clear what may be required for the rest of the year.

The Primary Care Commissioning Committee approved the 2021/22 planned budget position and noted the issues relating to the current level of allocation.

7.2 Primary Care Investment 2020/2021 and Additional Funding for Covid Costs and Capacity

H Tingle and A Small presented a report to the Primary Care Commissioning Committee showing a breakdown of the additional investment made into Primary Care in 2020/21 financial year. It also highlighted the additional funding into General Practice for COVID related costs and capacity.

There has been a significant increase in the amount of funding recorded on Note 5 of the CCG Accounts relating to GP Contracts between 2019/20 and 2020/21 financial year. The Accounts in 2020/21 show a £4.7m increase in spend.

The main areas of increase as previously highlighted to the Committee are as follows:

• Additional investment into the Additional Roles reimbursement scheme

£1.6m • Additional funding in PCN DES including the Impact and Investment fund £0.6m • Additional contract funding linked to the Contract Inflation £1.3m • Additional funding for COVID costs and capacity £1.1m

During 2020/21, as per the guidance, the CCG gave Practices four opportunities to claim for COVID related costs that were incurred. The total funding paid to General Practice for COVID related expenditure in 2020/21 was £381k.

The CCG received additional funding of £861k for COVID capacity in 2020/21 which was passed through to Primary Care Doncaster and has supported the following areas-

• To provide the vaccinations to the housebound and care home patients. • To provide roving teams for pop up vaccination clinics to reach the hard- to-reach patients. • The cost of data quality resource to support the vaccination programme. • To support practices capacity.

For 2021/22 the CCG is anticipating a further allocation of around £650k for COVID capacity funding (amount to be confirmed by the ICS) as per the National letter and notification of £120m additional funding to support General Practice.

As Nationally recommended and part of the response to the pandemic, it was agreed that some of the Extended Access would be stepped down for a period but key services such as first2physio and the health bus continued.

During 2020/21, due to the pandemic, National guidance was received instructing CCGs to provide an income guarantee to General Practice for certain elements of the contract. The total guaranteed funding for Doncaster CCG Practices in the financial year 2020/21 for these elements was £1.5m.

There were also income guarantees in relation to the QOF achievement for

2019/20 and for an element of the QOF points in 2020/21.

As part of the new Enhanced Service that was launched to fund the COVID vaccination programme, for each vaccine that is administered the Practice receives £12.58 per vaccine, £25.16 per course of vaccinations. This payment is made direct to the PCNs via NHSE. The total estimated adult population eligible for the vaccine in Doncaster is around 259,000 which equates to additional funding of £6.5m for the Practices.

Further support was also available to PCNs relating to additional Clinical Director Support of £193k in 2020/21 and admin support of £18k. Further Clinical Director funding is anticipated in Q1 of 2021/22 of £180k. There is also an additional £10 per patient made payable to PCNs for vaccinating patients in care homes.

As part of the agreement for the PCNs to set up the COVID vaccination sites, there is central funding on a pass-through basis to cover the costs of these sites including the lease costs and set up costs incurred.

A Fitzgerald advised regular conversations take place in the Primary Care Cell meetings around the Covid Capacity Fund.

The Primary Care Commissioning Committee noted the additional investment in Primary Care in 2020/21 as outlined in the report.

7.3 Primary Care Estates Strategy - Implementation Plan Update

S Barnes provided a monthly update to the Primary Care Commissioning Committee on the implementation of the CCG Estates Strategy.

Work is ongoing for the following projects:

1. Bentley Hub Project – the project board met in May and was attended by by DMBC, DCCG & the practices • Progressing the various Heads of Terms for the contractual agreement • Progressing the adjacent land title to register title • The Project Initiation Document (PID) has been updated ahead of the stage gate review. We are working towards a formal issue (July / August) to NHSE for their approval.

2. Rossington Health Centre – First pass at the options have been shared with the practices and comments taken on board. The options are being refined and costed and a preferred option will emerge in due course. We are working towards a formal issue September/October to NHSE for their approval.

3. Mexborough GP Led Project – The developer has been progressing the project and the CCG has been updated on progress. The DV has been engaged and put in contact with the developer. The CCG is supporting the progression of the business case and is working with the GPs and development team on the project.

4. Scott Practice Extension and Reconfiguration – Updating the cost plan and PID ahead of the stage gate review. We are working towards a formal issue (July / August) to NHSE for their approval.

5. Petersgate Practice Extension and Reconfiguration Project – the project has progressed with outline design, cost and scope developed. PID has been updated ahead of the stage gate review.

S Barnes informed the Primary Care Commissioning Committee he attended the SYB PMO and NHSE capital project stage gate review earlier that day and had a positive meeting. He advised obtaining supplies is an issue at the moment and the costs for supplies is increasing which will impact on the programme as a whole

He referred to the data gathering project which had commenced and would influence the estates strategy refresh.

The Primary Care Commissioning Committee thanked S Barnes for the informative report and noted the contents.

7.4 Primary Care Networks Update

C Ogle shared a report to update the Primary Care Commissioning Committee of the work with Primary Care Networks. It focuses on the Investment and Impact Fund process and feedback on the extended hours service.

Investment and Impact Fund

To be eligible to receive the 20/21 total achievement payment by end July 2021 and any in year achievement payment or year-end achievement payment for 21/22 a PCN must commit in writing to the commissioner to reinvest any IIF achievement payment into additional workforce, additional primary medical services and/or other areas of investment in a core network practice (e.g., equipment, premises).

Extended Hours

The Network Contract DES requires PCNs to provide extended hours access over and above the CCG commissioned extended access service.

PCNs must provide additional clinical appointments that satisfy the following:

• Are available to all registered patients in the PCN • May be for emergency, same day or pre booked appointments • Are with a health care professional or another person employed or engaged to assist that health care professional in the provision of health services • Are held outside of core hours (i.e., before 8am or after 6.30pm Monday to Friday or weekends) • Are in addition to extended access service sessions provided by the same practice/PCN • Are held at times taking account of patients expressed preferences based on available data at practice or PCN level and evidenced by patient engagement • Equate to a minimum of 30 minutes per 1,000 registered patients per week • Be provided at the same days and times each week with sickness and annual leave absences covered • Be face to face, telephone, video or online consultations provided that a reasonable number of face-to-face appointments are available where appropriate.

S Whittle asked if a GP or nurse must be available for the extended hours service. C Ogle advised a Health Professional or person assisting a health professional must be available.

The Primary Care Commissioning Committee noted the update in relation to the Investment and Impact Fund process and considered the feedback on extended hours.

7.5 Extended Access Update C Ogle shared a report to update to the Primary Care Commissioning Committee on the extended access service commissioned from Primary Care Doncaster Ltd.

The Committee has received quarterly updates on the extended access programme as part of the GP Forward View report in the past. The last report was for quarter 3 (October to December 2020).

As previously reported the contract for extended access ended on 31 March 2021 but a single tender waiver has been put in place to enable it to continue for a further twelve months by which time the service should be transitioned to the Primary Care Networks. A revised service specification is expected during the next few months.

In the meantime, the services have been significantly affected by the COVID-19 pandemic with services suspended from March – mid September 2020 and then again from early December 2020 with the exception of a limited health bus service operating. This was to enable the capacity and funding to be used to support the COVID vaccination hubs and the Community COVID hub (CCHUB)

The extension of the contract has provided an opportunity to reconsider the extended access offer in the light of the current situation and to support the transition to PCNs by 31 March 2022.

A Fitzgerald commented on the clear report and how the contract has provided flexibility with the relationship with Primary Care Doncaster.

The Primary Care Committee noted the update on the Extended Access Service

8. Quality

8.1 Interim Exception Report

A Ibbeson provided the Primary Care Commissioning Committee with a brief verbal update and advised there were no issues to escalate.

Approximately 75% of the Doncaster population have received their first dose of the Covid vaccination with 52% having received their second dose. Approximately 330,000 people have now being vaccinated against the virus.

The Primary Care Commissioning Committee noted the update.

9. Strategy and Planning

9.1 Primary Care Cell Update

K Roberts provided the Primary Care Commissioning Committee with an update on the Primary Care Cell and the headline areas of work they are currently undertaking:

• Clinical Covid Update including … o Pulse Oximetry@Home o Virtual Ward

o Blood Pressure Monitoring Restarting Spirometry o • COVID Vaccinations • Managing Practice Pressures & Key Messages • Risk Register • Dedicated COVID Capacity Meeting • Digital Primary Care

S Whittle requested a paper on the future of the Primary Care Cell meetings to be brought to the next meeting with different options on the future of primary care KR/AF cell meetings.

The Primary Care Commissioning Committee noted the information provided in relation to the Primary Care Cell update.

10. Forward Planner

The Primary Care Commissioning Committee noted the Forward Planner, no additional items were added.

11. Items to Escalate to Governing Body

The Primary Care Commissioning Committee agreed there were no items to escalate to Governing Body.

12. Risk Register

The Primary Care Commissioning risks come to the Primary Care Commissioning Committee to make the members aware of current risks.

The risks have been reviewed with the Head of Service and Corporate Governance Manager. There are currently two Primary Care risks which the committee need to be sighted on: -

CO3-PCP014 (Lack of workforce sustainability and Primary Care Workforce Strategy in Doncaster which clearly highlights current position and future plan). Update – 07.06.2021 - Whole Systems Partnership work underway with focus on population health and workforce. PCN recruitment plans implemented for

2020/21 and further developed for 2022. Revised plans required by end August 2021. Retained GP commencing at Scott Practice in July.

CO3-PCP016 (Practice is currently not registered to provide services under the Health and Social Care Act as required by CQC). Update 07.06.2021 - The Practice is registered with the CQC. Request the Primary Care Commissioning Committee close the risk.

Additions / Removals

There have been no additions or removals to the Risk Register since it was last reviewed.

The Primary Care Commissioning Committee:

a) Reviewed the Primary Care risks on the Corporate Risk Register and confirmed all risks are appropriately scored and described.

b) Considered and agreed the request for the closure of risk CO3- PCP016

c) Confirmed that they are assured that appropriate actions are taking place to mitigate potential impacts and consequences

d) Didn’t identify any new risks

13. Any Other Business

No items were raised.

14. Date and Time of Next Meeting

Thursday 8 July 2021 at 12.30pm - live streamed via Zoom.

Meeting Closed 1.45pm