Virtual Governing Body
To be held on Thursday 6 August 2020
From 1pm until 3pm
VIRTUAL GOVERNING BODY To be held on Thursday, 6 August 2020 at 1pm A G E N D A
Ref Item Enclosure Led By Action Required 1. Apologies for Absence Verbal Dr Crichton For noting
2. Declarations of Interest Verbal All For noting
3. Minutes of the meeting held on 2 July Enc A Dr Crichton For approval 2020
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. Healthwatch Annual Report Enc B A Goodall For noting
Assurance
9. Quality & Performance Report Enc C A Fitzgerald & For noting A Russell • Spotlight Report on Living Well
10. Finance Report Enc D H Tingle For noting
11. Chair and Chief Officers Report Enc E Dr Crichton For noting
Items to Note
12. Integrated Care System CEO Report Enc F Dr Crichton For noting
Receipt of Minutes
13. Receipt of Minutes Enc G Dr Crichton For noting
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Ref Item Enclosure Led By Action Required • Engagement & Experience Committee – Minutes of the meetings held on 4 June 2020. • Primary Care Commissioning Committee – Minutes of the meeting held on 11 June 2020.
14. Any Other Business Verbal Dr Crichton For discussion
15. Date and Time of Next Meeting For noting Thursday 3 September 2020 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 2 July 2020 at 1pm
Members Dr D Crichton NHS Doncaster Clinical Commissioning Present: Group (CCG) Chairman (Chair) J Pederson Chief Officer, CCG H Tingle Chief Finance Officer, CCG A Russell Chief Nurse Dr E Jones Secondary Care Doctor L Tully Lay Member P Wilkin Lay Member S Whittle Lay Member Dr M Khan Locality Lead, Central Locality Dr R Kolusu Locality Lead, East Locality Dr M Pieri Locality Lead, North Locality Dr M Pande Locality Lead, South Locality
Formal Attendees A Fitzgerald Director of Strategy and Delivery, CCG Present: L Devanney Associate Director of HR and Corporate Services, CCG A Goodall Healthwatch Doncaster Representative
In J Satterthwaite PA to Chair and Chief Officer (Minute attendance: Taker) P Hemingway Head of Communications A Harrington Interim Head of Strategic Commissioning and Transformation (Item 12 Quality and Performance Report G Wood Deputy Designated Nurse LAC and Safeguarding Children (Item 12 Quality and Performance report)
Action 1. Apologies for Absence
Apologies were noted from :
• Dr R Suckling, Director of Public Health • P Holmes, Doncaster Council Representative
2. Declarations of Interest
The Chair reminded Governing Body members of their obligation to declare any interest they may have on any issues arising at Governing Body meetings
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which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub committees / working groups:
None declared.
Declarations of interest from today’s meeting:
None declared.
3. Minutes From the Previous Meetings held on 4 June 2020
The minutes of the meetings held on 4 June 2020 were approved as a correct record.
4. Matters Arising not on the Agenda
Primary Care Commissioning Committee Terms of Reference
There were minor formatting changes to the Terms of Reference and it was deemed unnecessary for them to be presented to the Governing Body again.
5. Notification of Any other Business
There was no notification of further business to discuss.
6. Questions from Members of the Public
The following questions was received from a Member of the Public:
There has been an increase in Paramedics in Primary Care due to their skills and training making them ideally suited providing recruitment and a fresh approach to care management and same day urgent care.
Are there any plans to utilise / increase or increase the number of paramedics in primary care across the Doncaster CCG area?
1 NHS England, 2017. Next Steps on the Five-Year Forward View. 2 NHS England, 2016. General Practice Forward View. 3 NHS England, 2019. Investment and Evolution.
A Fitzgerald gave the following response:
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Thank you for your question relating to the number of paramedics based in primary care services in Doncaster.
NHS Doncaster CCG commissions an Emergency Care Practitioner (ECP) service which uses very similar skill sets to those of paramedics. We recently reviewed our ECP service as part of our work to scope out and agree a new model of urgent and emergency care that will go live in October 2020. This model will maintain the number of ECPs that we have already.
In addition, Primary Care Networks (PCNs) are currently developing their workforce plans to ensure that primary care services continue to develop in line with the NHS Long Term Plan, the General Practice Forward View and the wider NHS Investment and Evolution document, as identified in your question.
Paramedics form one of a number of additional roles that PCNs can recruit to and receive funding for however the funding for these roles will not be released until 21/22. PCNs will want to ensure that any additional paramedics they recruit will not duplicate roles that already exist across Doncaster, but instead will work with our existing ECPs to provide services for patients in Doncaster.
7. Patient Story
The Patient Story featured Sophie who became a first time Mum in October 2019. Sophie has pre-existing health conditions and is a shielded patient and she has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).
Sophie encountered the following difficulties:
• Journey described as ‘chaotic and hectic’ • Repeated visits due to health problems and lost samples • Lack of consistency, communication and responsiveness to needs and wants (not knowing what is happening/birthing plan) • Delayed discharge from maternity ward’23.30pm discharge not ideal when it is cold and raining’
What worked well for Sophie:
• Nurses at the induction visit ‘good experience’ • Support from nurses post-delivery at the hospital ‘brilliant night staff’ ‘lovely male midwife’ • Routine post-natal support in the community – Midwife
What needs to change:
• Consistency of staff • Communication • To be more informed
Dr Crichton explained that there were elements of Sophie’s story which allowed her to undertake a more formal process which required further discussion and
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action. The Head of Midwifery at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) has reported that they are working with the Maternity Voices Partnerships of which Sophie is a member and environmental improvements have been made and staff training in new mothers implemented and an invitation has been extended to Sophie to re-visit the Maternity unit. G Wood, Deputy Designated Nurse Looked After Children and Safeguarding Children NHS Doncaster CCG advised that it was timely to re-visit improvements in Maternity Services.
J Pederson queried where progress will be formally reported and was advised that the CCG has a Clinical Quality Review Group (CQRG) Sub-Group for Maternity, Neo-natal and Paediatric care and the Quality and Patient Safety Committee receives reports from the group as part of a check and challenge process.
Dr Crichton informed the Governing Body that Healthwatch Doncaster has commenced a consultation with the public regarding their experiences accessing appointments via video or telephone which will run for a period of one month.
8. Primary Care Commissioning Committee Annual Report
L Tully presented the Primary Care Commissioning Committee Annual Report to the Governing Body for endorsement prior to submission to NHS England. It provides assurance to NHS Doncaster CCG Governing Body and NHS England with regard to the delivery of the Primary Care Commissioning Committee work programme for the period 1 February 2019 to 31 January 2020.
Dr Crichton observed inconsistency between the cover sheet and the report in that the Governing Body was asked to endorse the Report and not approve it.
The Governing Body endorsed the Primary Care Commissioning Annual Report prior to submission to NHS England.
9. Policy for Commissioning Cryopreservation
A Russell presented the Policy for Commissioning Cryopreservation to the Governing Body and explained that the policy and has previously been presented to the Clinical Reference Group for discussion.
The proposed policy sets out the commissioning position on the provision of cryopreservation for a patient about to undergo a medically necessary procedure or intervention which may permanently impair their future fertility, for example chemotherapy, radiotherapy or gender dysphoria treatment.
This policy follows the available national clinical guidelines including those published by NICE (CG156 Fertility problems: assessment and management).
The revised policy outlines the commission criteria and specifies that the CCG will only fund storage of gametes and embryos for an initial 10 year period. If
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storage is desired for longer than 10 years then a funding application should be made by the Individual Funding Request (IFR) panel.
The policy also states that: • For females; the CCG will fund one cycle of egg retrieval, with or without fertilisation. If fewer than ten eggs are retrieved then one further cycle can be offered. • For Males; The CCG will commission a maximum of three semen samples.
The changes to the proposed policy are not in relation to the commissioning criteria, but more to offer clarity around the scope, definitions, monitoring arrangements and policy review considerations.
It is important to note that approval of cryopreservation does NOT guarantee future funding of assisted conception or fertility treatment. Should the patient wish to pursue NHS funded fertility treatment, the local eligibility criteria will apply at that stage.
In line with equality and diversity it is imperative NHS Doncaster CCG has this policy in place to support those who require cryopreservation, as a result of a protected characteristic.
A Russell requested that the Governing Body approve the Policy for Commissioning Cryopreservation which will replace the existing policy.
S Whittle queried if there had been public consultation regarding the policy. A Russell stated that it has been drafted by the Individual Funding Request (IFR) Team however would seek clarification with the Team. A Russell
The Governing Body approved the Policy for Commissioning Cryopreservation.
10. Staff Survey Results
L Devanney presented the Staff Survey 2019 Summary Report for noting by the Governing Body. It details the key findings from the results of the 2019 staff survey. The report details the scores and highlights some of the key areas against the themes within the staff survey. The scores are summarised as follows:
Equality, Diversity and Inclusion: 9.7 Health and Wellbeing: 7.6 Immediate Managers: 7.8 Morale: 6.9 Quality of Appraisals: 6.5 Quality of Care: 7.5 Safe Environment – Bullying and Harassment: 9.6 Safe Environment – Violence: 9.9 Safety Culture: 7.4 Staff Engagement: 8.5 Teamwork: 7.3
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NHS Doncaster CCG rated above the national average across 10 of the themes and just below with 1 theme (Safe Environment – Violence).
L Devanney explained that under normal circumstances the CCG would have worked with Staff Side and the Colleague Engagement Group on a detailed action plan however due to the COVID-19 pandemic we have concentrated on the Health and Wellbeing of our staff and alternative ways of working.
Line Managers have been asked to hold Personal Development Reviews (PDRs) with their staff with the view to ensuring that last year’s objectives have been met. It was considered that now is not the appropriate time to set new objectives for the forthcoming year.
A detailed staff survey report is available on the CCG website.
The Governing Body noted the Staff Survey 2019 Summary Report.
11. Doncaster Place Recovery & Reset
A Fitzgerald explained that in March 2020 NHS England set out four phases to the national COVID-19 recovery and transformation programme as follows:
COVID-19 level 4 incident response Phase 1- Phase 2 - COVID-19 level 4 incident response and critical services switch on Phase 3 - Ongoing COVID-19 management and NHS open for business Phase 4 - New NHS
Phase 2 work has commenced at organisational and Doncaster Place level to evaluate changes made in response to COVID-19, and determine which of those changes we plan to now maintain across the Health and Social Care system in Doncaster. Similarly work is taking place across the South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) to also determine areas where collaboration across the wider patch can bring benefit for our respective
local places.
There is a commitment that as a Place partnership we take every opportunity to ensure that the learning from and improvements made through the COVID-19 response are evaluated and maintained as part of the recovery and reset process.
The Principles agreed to support this were:
• All recovery and reset should be undertaken in a prioritised and safe fashion.
• Where appropriate “Digital First” should be considered. • We should adopt a locality approach to all recovery and reset where appropriate. • Our approach should be guided by innovation and the engagement and leadership of the front line.
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• We should learn from workforce and estate changes made during the COVID-19 response. • Our recovery and reset should be sustainable and based upon a future demand model.
A small, multi-organisational task and finish group is now taking forward the partnership process to review recovery and reset at a Place level, linking in with the work also taking place across Team Doncaster. A list of priority areas for partnership focus is in development, shaped by the local drive to have a limited number of key focus areas. The priority areas have also been reviewed in the context of the Doncaster Place Plan and the original Areas of Opportunity – a number of these have now been accelerated, whilst others have been paused. Each of the priority areas listed will be reviewed using a locally developed rapid review methodology, tested out on the discharge pathways review.
The ICS has been part of a regional recovery cell with NHS England North East
Yorkshire reviewing approached across cells related to:
• Mental Health and Learning Disabilities • Procurement (in particular personal protective equipment) • Workforce • Critical Care • Hospital Elective Care
• Ambulance
This work has been played into the South Yorkshire ICS governance and Doncaster Place. In June 2020 an exercise has taken place to analyse and cost recovery for rest of 2020/2021.
In particular the need to demonstrate:
• Baseline capacity - the level of capacity available/activity possible during the
remainder of the financial year (without further investment) utilising our
current resources (beds, workforce etc) adjusted for COVID-19 IPC compliance requirements • The resource/investment requirements (capital, revenue, workforce) to address the capacity gap arising from the above – secondary acute care, step down/discharge, mental health, community & primary care • The aim is to understand what resources the system would need to deliver: Baseline capacity plus 20%, and o o Critical care capacity (based on pre-COVID-19 baseline) plus 50%
This work currently continues for the CCG in collaboration with providers. Plans will be further informed by Stage 3 NHS Guidance (and further national financial clarifications) expected in July 2020.
A SYB ICS “Stress Testing” event will also take place on 1 July 2020 which will test the Doncaster systems ability to respond to a second COVID-19 surge in infection rate.
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The ICS has also commissioned the South Yorkshire Academic Health Science Network (AHSN) to lead work across the ICS evaluating respective system responses and developing a suite of best practice for potential spread across the ICS.
The Governing Body was asked to:
• Note the approach taken to recovery and reset in Doncaster. • Note the approach taken to recovery and reset across the South Yorkshire and Bassetlaw ICS.
Dr Pieri highlighted that the provision of Out of Hours and Urgent Care at Mexborough Montagu Hospital was halted due to COVID-19 and queried when this would be re-instated. A Fitzgerald responded that there is currently no definitive timescale for the services to be re-instated however it will be part of
the recovery and reset process.
Dr Pieri enquired how we can ensure that a robust system and process is in place regarding Test and Trace. L Devanney informed the Governing Body that the Infection Prevention and Testing Cell meet every Thursday. Dr Joseph, Public Health is confident that Doncaster is doing better than expected. We have a governance process in place in response to any infection rates which is chaired by Dr Suckling, Director Public Health. The Data Cell has produced some impressive work on locating ‘hot spots’.
Dr Crichton advised that Dr Suckling has populated a video on YouTube which
advises that it is not currently considered appropriate for Doncaster to go in
local lockdown however continuous monitoring is taking place. P Hemingway P agreed to share the link to the video to Governing Body members. Hemingway
Dr Jones stated that there has been increased pressure on Mental Health and Learning Disabilities (LD) services due to COVID-19 and will continue for the foreseeable future. We must make sure that we make use of the structures in place to pro-actively monitor Mental Health and LD patients if we note an increased trend.
J Pederson reported that the CCG is looking into Mental Health in detail and we need to continue with the health checks for LD patients in Primary Care. It would be beneficial to focus on LD in a future Strategy & Organisational Development Forum meeting and in the Living Well Spotlight Report in August 2020.
The Governing Body:
• Noted the approach taken to recovery and reset in Doncaster. • Noted the approach taken to recovery and reset across the South Yorkshire and Bassetlaw ICS.
12. Quality and Performance Report
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A Fitzgerald presented the Quality & Performance Report for noting by the Governing Body.
The following key areas were highlighted:
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT)
• Accident and Emergency – Performance improved in May 2020 to 94.7% but remained below the 95% target. This is the highest performance since June 2018. This is due to a collective response from partners. There has been a reduced demand in A&E during COVID-19.
Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)
• Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service was below the April 2020 1.58%% target at 1.55%. • IAPT 6 weeks RTT – Performance for DCCG patients in RDASH services decreased to 39.3% during April against the 75% target. Phases 1 and 2 have made an impact on waiting lists. • IAPT recovery rate – Performance fell below the 50% target in April to 45.6%.
A Fitzgerald informed the Governing Body that NHS Doncaster CCG is in constant dialogue with DBTHFT regarding services being brought back on line however there will be significant changes in the approach particularly in the use of more digital appointments.
P Wilkin highlighted 52 week waits and asked if the CCG has assurance from DBTHFT that patients are continuing to be cared for. He was advised that DBTHFT approach is not how long patients are on the waiting lists but on clinical prioritisation. J Pederson added that we need to be mindful that this may take some time to resolve as there are limitations on DBTHFT due to specific COVID-19 areas within the hospital.
S Whittle asked how we compare to other CCGs in SY&B and was advised that we are in a similar position however we have been successful in being able to access the Independent Sector. There are challenges across the region and we are working through the re-installation of services.
Dr Pande queried the progress and performance of the CCHUB and if the CCHUB would verify the death of a patient due to COVID-19 between the hours of 9pm and 6am. A Fitzgerald reported that it responded well to the pandemic. There has been a significant decrease in demand and therefore it has become more of an advice and guidance service however there is flexibility to step up the service is there is a second wave of COVID-19 later in the year. A Fitzgerald agreed to liaise with the Clinical Lead of the CCHUB regarding the A Fitzgerald verification of death query.
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Spotlight Report – Starting Well
A Harrington, Interim Head of Strategic Commissioning and Transformation at Doncaster Council attended the Governing Body to give a presentation on Children and Maternity which gave an update on the outcomes within the Starting Well delivery plan for both health and social care outcomes which included the work being carried out as part of the Localities Outcome with an update on the current position and next steps. The areas of focus were:
• Maternity key milestones and future projects • Reduce Neuro-developmental Pathway Waiting times key milestones • Development of a new Service Specification for Children’s Community Nursing • Care and Education • Localities Commissioning • Long term solutions to COV)D-19 response • Medium Term COVID-19 Recovery Plan • Next steps to recovery
S Whittle queried the percentage of smoking in pregnancy and how this cohort of patient is dealt with. The Governing Body was informed that for Quarter 4, the percentage is 15.2% and they are prioritised by the midwives as to what pathway they will follow and signposted to smoking cessation services.
Dr Kolusu highlighted perinatal mental health and asked of patients are seen by mental health nurses of mental health midwives. He was advised that they are seen by the perinatal team who are midwives trained in mental health. G Wood G Wood agreed to circulate information on the perinatal service to Governing Body
members.
S Whittle asked how we ensure that those children with Special Educational
Needs and Disability (SEND) are not forgotten. A Harrington stated that they
have able to continue at school throughout the pandemic. A Multi-disciplinary
Team (MDT) approach is taken for those patients who are of concern. G Wood
added that a group has been established for children who attend A&E and are
in a mental health crisis. There is still a lot of work to be undertaken as not
going to school and poverty can impact on a child’s mental health.
Dr Crichton thanked a Harrington and G Wood for attending the Governing Body.
The Governing Body noted the Quality and Performance Report.
13. Finance Report
H Tingle presented the Finance Report for noting by the Governing Body. The report sets out the financial position as at the end of May 2020.
The CCG is currently working with an interim financial regime for April – July (Month 1-4) only due to the Covid-19 pandemic. Therefore at this time there are
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no set financial targets for the CCG to meet and no QIPP expectations. The financial regime for the remainder of the year is not yet known.
Due to the coronavirus outbreak the 2020/21 planning and contracting round was suspended in mid-March. NHS England and Improvement have issued guidance on how CCG’s need to work with providers during the interim period. The following summarises some of the current arrangements –
• The CCG’s main NHS providers are being paid on a block basis, the value of which was determined centrally by NHS England. This is only for contracts that exceed a set value. No other payments will be made to any other NHS providers by the CCG at this time. • CCG’s are reimbursing their main acute provider for all other contractual activity that they would usually receive from their smaller contracts. For Doncaster CCG this is Doncaster and Bassetlaw Hospital NHS Foundation Trust. • Primary Care income streams are being protected at 2019/20 levels as a minimum including national Direct Enhanced Service (DES) and Local Enhanced Service (LES) payments. • Individual placement costs are still being reimbursed and the CCG is working closely with numerous providers who are having to be flexible in terms of their delivery of care at this time. • Non NHS providers are being reviewed on an individual basis. Income streams are not guaranteed for this cohort of providers and depend upon the levels of service being provided at this time, and whether they are deemed critical to the Covid-19 response. Providers are being encouraged to seek other government support where necessary. • Additional funding is available to support the Covid-19 response and returns are being regularly submitted to NHS England on additional costs incurred that are in line with the guidance. Governance around the agreement of additional costs is being maintained in line with usual processes. • The new Discharge Protocols are also being centrally funded by NHS England including funding for any new packages of care that are initiated during this period in order to safely discharge a patient from hospital or avoid a hospital admission.
The above regime is currently in place until the end of July 2020 and further guidance is expected shortly to inform the regime for the remainder of the financial year.
Further guidance is awaited regarding the financial regime for the remainder of the year, however it has been confirmed that the block arrangements for NHS providers will continue. It is anticipated that additional allocations will be on a prospective basis and not retrospective, however it is not clear if the additional allocations will be given to the ICS, place, or direct to CCG’s and providers. This is clearly a risk to the CCG’s financial position this year if we are expected to break-even.
CCG’s and providers have been asked to submit high level revenue and capital plans for the remainder of the year to aid discussions at the Treasury. These
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have been based on a number of scenarios including that current activity levels continue and also that additional activity will start to take place as the year progresses.
It is anticipated that a detailed plan will be required and the guidance around this is expected in mid-July.
There are a number of risks facing the CCG. The CCG has transformation and delivery plans and it is not clear how some of this can be progressed as there is uncertainty around investment and additional funding. It is not clear if the CCG will be expected to make any Quality Innovation Productivity and Prevention (QIPP) savings in year or if these will be offset by additional top ups.
It is not known what activity and capacity providers will be able to deliver in year and what the impact of this will be on the underlying demand for future years. It is not clear if the regime for 2021/2022 will revert back to the original position and therefore what the impact of the current regime will have on the CCG’s recurrent underlying position moving into next year.
Clear guidance around the Mental Health Investment Standard is awaited as it is uncertain if this is a requirement for 2020/2021 and how CCG’s can progress this under the current regime when investments are not allowed. Further guidance is awaited on this.
The Governing Body was asked to note the current financial position and the expectation around additional allocations so that the CCG breaks even. It was also asked to note the restrictions currently in place around investments, the uncertainty around efficiency savings and delivery of the Mental Health Investment Standard.
J Pederson stated that the CCG is currently documenting innovation for this year and how we would have released funds. We acknowledged there are some barriers to transformation however the use of non-face to face appointments via digital means will help to drive some.
Dr Jones highlighted that Payment by Results (PbR) was meant to incentivise and reduce demand but the implementation of the block contract is counter- productive and asked how the CCG is to manage this and free the Acute Trust of deficit. H Tingle advised that the cash in the system is not enough to pay for activity but we are trying to secure a position where a perspective top up may make them financially viable for the rest of the year.
H Tingle reported that the CCG is keen to reach a break even position. It is anticipating that the COVID-19 costs will be funded and there are justifiable reasons for an overspend. The CCG remains optimistic that it will receive allocations and will bid for the top up fund. There are still savings to be made from a prescribing perspective and an outlineof an incentive scheme is being developed with the view to be implemented later this year.
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The Governing Body noted the current financial position and the expectation around additional allocations so that the CCG breaks even. It also noted the restrictions currently in place around investments, the uncertainty around efficiency savings and delivery of the Mental Health Investment Standard.
14. Integrated Care System CEO Report
The Governing Body noted the Integrated Care System CEO Report.
15. Receipt of Minutes
The following minutes were received and noted by the Governing Body:
• Engagement & Experience Committee – Minutes of the meetings held on 7 May 2020. • Primary Care Commissioning Committee – Minutes of the meeting held on 14 May 2020.
16. Any Other Business
There was no other business discussed.
17. Date and Time of Next Meeting
Thursday 6 August 2020 from 1.00pm.
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Meeting name Governing Body Meeting date 6 August 2020
Title of paper Healthwatch Doncaster Annual Report 2019-20
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.
In 2019-20 Healthwatch Doncaster heard from over 5,400 people about their experiences of health and care locally. We have published 12 reports on a range of topics including the NHS Long Term Plan, Emotional Health and Wellbeing, Access to GP services, the Respect forms and process, Urgent and Emergency Care Services and Enter and View reports from local care home providers.
As a local Healthwatch organisation, we were recognised by Healthwatch England by being awarded for National Outstanding Achievement for the work on the NHS Long Term Plan that we led and co-ordinated across the South Yorkshire and Bassetlaw Integrated Care System.
We continued to support the development of engagement and involvement in community groups and organisations by investing over £10,000 in our Micro-Grants programme and we have supported 29 volunteers and 20 students on placements to contribute over 1000 hours to projects, meetings and working with the Healthwatch Doncaster Team.
Healthwatch Doncaster has agreed a 2-year extension to the current contract with
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Doncaster Council. The extension to the contract will be a joint contract with Doncaster Council and NHS Doncaster CCG. The contract will be extended from 1 August 2020 – 31 July 2022.
Healthwatch Doncaster has set out its priorities for 2020-22 and they include:
• Covid-19 – the experiences and impact of the Covid-19 pandemic and lockdown on local people • Cancer – a qualitative report based on people’s stories of the cancer pathway in Doncaster • Mental Health Services – how do people access mental health services locally and have there been changes as a result of Covid-19 • Missed Appointments – revisiting the Missed Appointments project to review the implementation recommendations of our first report • Care and Support at Home – how has domiciliary care changed since our last report • Re-imagining engagement and involvement – learning lessons from lockdown about using digital tools to support engagement
Healthwatch Doncaster’s full 2019-20 Annual Report can be downloaded here: https://www.healthwatchdoncaster.org.uk/wp-content/uploads/2020/06/FINAL- Healthwatch-Doncaster-Annual-Report-2019-20.pdf
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
Report Exempt from Public Disclosure
Yes No X If yes, detail grounds for exemption:
Impact analysis The Healthwatch Doncaster Annual Report 2019-20 is for information and Quality impact noting
The Healthwatch Doncaster Annual Report 2019-20 is for information and Equality noting 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 The Healthwatch Doncaster Annual Report 2019-20 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 2019-20 is for information and departments, noting clinical, stakeholder and public/patient) Report previously NONE presented at Risk The Healthwatch Doncaster Annual Report 2019-20 is for information and analysis noting Corporative Objective / NONE Assurance Framework
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Annual Report 2019-20 | Healthwatch Doncaster 2 Contents
Message from our Chair 3 About Us 4 Our Vision 5 Highlights from our year 6 What were our priorities in 2019-20? 7 Asking local people about the NHS Long Term Plan 8 Sharing our learning at the National Healthwatch England Conference 9 People tell us about their access to GP services 11 Helping improve Urgent and Emergency Care provision 12 Hearing how local people look after their emotional health 14 Healthwatch Doncaster’s Micro-Grants 15 Young Healthwatch Champions 16 & 17 Michael Smith’s story 18 Covid-19 19 Facing A Pandemic 20 Our Volunteers 21 Volunteers’ influence 22 Enter and View 23 Patient Stories 24 Thank You 25 Signposting and Information 26 Social Media 27 Choice for All Doncaster 28 Doncaster Keeping Safe Forum 29 Patient Participation Network 30 Health Ambassadors 31 Our Finances 32 Priorities for 2020-21 34 Message from our Chief Operating Officer 35 Thanking our partners 36 Contact Us 37 Annual Report 2019-20 | Healthwatch Doncaster 3 Message from our Chair
It is impossible to write anything about our last year at Healthwatch Doncaster without mentioning the ongoing effect of the Covid-19 virus on the whole world. My thoughts and sympathies go out to everyone who has been affected by this insidious disease and to the families and friends of the many who have lost their lives.
Because of our place in the public life of the Borough, Healthwatch Doncaster has seen at first hand the incredible efforts of our local hospitals, GPs and other medical and care services in treating citizens. We add our heartfelt thanks to those of everyone else. I would also like to acknowledge the sterling work of Doncaster Council as personified by the Director of Public Health, Dr Rupert Suckling.
We were quick to react to the situation by moving our staff to home working in March and adapted with team discussions and interaction with stakeholders through online meetings. My thoughts and sympathies go out to There is plenty about our efforts during 2019-20 in this report everyone who has and I would like to thank staff, volunteers and Board members, been affected by this who have helped us become more successful in our Covid-19 disease endeavours.
Linda Crundell left her position on the Board and I’d like to thank her for her contribution, including being involved in our Enter and View Planning Group.
At the time of publication, our Vice-Chair Debbie Hilditch left her role and I would like to thank her for her help and support. Her part in the organisation’s move to a independent Community Interest Company was crucial, alongside her strategic and project leadership.
Steve Shore Healthwatch Doncaster Chair Annual Report 2019-20 | Healthwatch Doncaster 4 About us
Here to make care better The network’s collaborative effort around the NHS Long Term Plan shows the power of the Healthwatch network in giving people that find it hardest to be heard a chance to speak up. The #WhatWouldYouDo campaign saw national movement, engaging with people all over the country to see how the Long Term Plan should be implemented locally. Thanks to the thousands of views shared with Healthwatch we were also able to highlight the issue of patient transport not being included in the NHS Long Term Plan review – sparking a national review of patient transport from NHS England.
We simply could not do this without the dedicated work and efforts from our staff and volunteers and, of course, we couldn’t have done it without you. Whether it’s working with your local Healthwatch to raise awareness of local issues, or sharing your views and experiences, I’d like to thank you all. It’s important that services continue to listen, so please do keep talking to your local Healthwatch. Let’s strive to make the NHS and social care services the best that they can be. I’ve now been Chair of Healthwatch England for over a year and I’m extremely proud to see it go from strength to strength, highlighting the importance of listening to people’s views to decision makers at a national and local level. Sir Robert Francis, Healthwatch England Chair Annual Report 2019-20 | Healthwatch Doncaster 5
Photograph Credit: Irene
Photograph Credit: John Burke
Our vision is simple
Engage Healthwatch Doncaster will engage you in conversations about your experiences of local health and care services.
Inform You will inform us about what is important to you and what changes and improvements you want to see in Doncaster.
Influence We will use your stories, experiences, voices and opinions that have been shared with us to influence change and improvement in local health and care services in Doncaster. Annual Report 2019-20 | Healthwatch Doncaster 6 Highlights of our year 29 volunteers helped to carry out our work, contributing over 745 hours of their time 20 students undertook a placement to support their studies and develop their career pathways
£10,200 shared with local community groups as part of the Micro-Grants scheme
5,405 comments received about health and social care through our online feedback centre, or through a survey focusing on a specific topic
294 people contacted Healthwatch Doncaster for advice and information or questions about local support
12 reports published including our projects on the NHS Long Term Plan, emotional health, access to GP services and outcomes from Enter and View visits Annual Report 2019-20 | Healthwatch Doncaster 7
What were our priorities in 2019-20?
NHS Long Term Plan The views of local people were shared with the South Yorkshire and Bassetlaw Integrated Care System and helped shape their system-wide response to the NHS Long Term Plan
What’s YOUR story? We were aware that a lot of people had stories about how they managed their own emotional health needs or helped others with their emotional health needs. We listened and shared their voices with local services so that improvements can be made
Access to GP services When we are out and about talking and listening to people, access to GP services is often a topic of conversation. We talked to over 1500 people with a focus on the working age population. The outcomes and recommendations from this report have been shared with our local CCG
Urgent and Emergency Care The Healthwatch Doncaster volunteers wanted to spend 24 hours in Urgent and Emergency Care. Our strong working relationship with our local Acute Trust enabled us to get access across the Urgent and Emergency Care system and to talk to people at various stages of their care and treatment
Micro-Grants We have continued to support the development of community groups and organisations through our innovative Micro-Grant programme. Developing networks of support was a focus for us this year.
Young People Healthwatch Doncaster loves to support and develop the skills of students and young people. We have continued to develop Young Healthwatch and student placement opportunities Annual Report 2019-20 | Healthwatch Doncaster 8
Asking local people Healthwatch Doncaster analysed all the data about the NHS Long and information, leading to a detailed report shared with the ICS and presented to the Term Plan collaborative partnership of strategic leaders. The report was used by the ICS to develop and write their local response to the NHS Healthwatch Doncaster were the co- Long Term Plan based on what they have ordinating Healthwatch for analysing heard from local people. the feedback, surveys and focus group responses from across the South Healthwatch Doncaster were invited to help Yorkshire and Bassetlaw Integrated facilitate workshop discussions at the NHS Care System (ICS) – Barnsley, Expo in September 2019 along with other co- Bassetlaw, Doncaster, Rotherham and ordinating Healthwatch organisations. The Sheffield – about the NHS Long Term discussions were helpful and formed part of Plan. the NHS Assembly’s engagement and response to the NHS Long Term Plan. Over 1,300 people shared their views and told us what they would do to improve the At the Healthwatch National Awards in NHS as part of the Long Term Plan and there Birmingham in October 2019, local were 15 local focus groups that had more in- Healthwatch from South Yorkshire and depth conversations with people about their Bassetlaw were announced as the winners of thoughts and feelings about the NHS. the Outstanding Achievement Award for their collective work on the NHS Long Term Plan. The report findings showed: There was particular mention of the work • 88% of people who completed the survey that had been done to engage with a wide told us they agreed with the Plan’s range of people and the focus groups that commitment towards ‘prevention, choice had engaged groups of people whose voices and control and promoting independence are not often heard or listened to. and self-care’ • A third of survey respondents said they or someone they cared for had used local services and support to manage their mental wellbeing and emotional health • People told us that digital proposals were important, including having access to services using a phone or computer; making appointments online; having results communicated quickly and talking to their doctor when they can. Picture: from left to right - Healthwatch Doncaster Chief Operating Officer Andrew Goodall and Sir Robert Francis, Healthwatch England Chair alongside colleagues from Healthwatch Nottingham and Nottinghamshire Annual Report 2019-20 | Healthwatch Doncaster 9 Sharing our learning at “It was very gratifying to be able to share the National knowledge gained through many years working with volunteers and, more recently, Healthwatch England from my volunteer management studies to conference make a contribution to the development of Sandie Hodson – Volunteer Co- the wider network,” said Sandie (pictured ordinator and Engagement Officer – and below). Andrew Goodall – Chief Operating Healthwatch Doncaster has supported a Officer – developed a workshop number of students on placements over the presentation in two parts. Sandie last three years with great success. Young shared her knowledge about recruiting people have learned and developed and the and supporting volunteers and Andrew organisation has benefited from their skills talked about supporting student and enthusiasm. placements in Healthwatch Doncaster. Healthwatch Doncaster are clear that when “I had an extremely positive response from students come in to the organisation that attendees especially local Healthwatch who they are treated like a member of the team do not have the structures and processes in and supported to complete work that will place to fully support a robust volunteer benefit local people. programme.” 10
Hampole, Doncaster Photo Credit: Healthwatch volunteer Annual Report 2019-20 | Healthwatch Doncaster 11
Over two months, Healthwatch Doncaster gathered feedback and comments by talking to local people
The following recommendations were People tell us about proposed to help improve experiences: their access to GP • Make patients aware of other healthcare services provision • Inform patients about signposting to Access to GP services has been a appropriate clinicians or services common theme from patient • Encourage the use of digital and online feedback to Healthwatch Doncaster services to book appointments/request and we have heard many stories prescriptions from patients about their experiences. Service providers including the Local Medical Council, NHS Doncaster Clinical In the summer of 2019, we engaged with Commissioning Group (CCG) and Primary over 1500 local people to gather their Care Doncaster were receptive to the experiences with findings shared with findings and recommendations and service providers and published in a recognised that “there is report. more to be done to continue to improve access and The findings show there is a variation in experiences of care the services that people of Doncaster received”. experience in relation to accessing GP services. 55% of respondents In October 2019, NHS Doncaster were not satisfied with the CCG launched a campaign, which service they received for aims to raise awareness of the wide a number of reasons. range of services that exist in Primary Care and encourage the Difficulty in telephone access, use of IT to access services in order patients waiting a long period to enhance the experience of to get an appointment and accessing GP services for local lack of awareness of other people. health care services were common themes. Annual Report 2019-20 | Healthwatch Doncaster 12
Healthwatch Doncaster staff and volunteers visited urgent and emergency care services in the Borough
• Urgent Treatment Centre at Doncaster Helping improve Urgent Royal Infirmary and Emergency Care • Same Day Health Centre provision As a result of our involvement in the 24 Hours in Urgent and Emergency Care In September 2019, Healthwatch project, our Volunteer Co-ordinator and Doncaster undertook a project to two of our volunteers have been involved gather people’s experiences of in the following: Urgent and Emergency Care services in Doncaster. • Sitting on a grants panel to consider bids to the South Yorkshire and Bassetlaw The services that were involved in this Integrated Care System Innovation Fund were: for Urgent and Emergency Care Services • Bringing the patient perspective to the • The Emergency Department at commissioning process for Same Day Doncaster Royal Infirmary: staff and Health Centre services in Doncaster volunteers visited the department during a busy night shift and spoke to patients, This has ensured that the patient voice is relatives and staff heard in the commissioning process. • Minor Injury Departments at Doncaster Royal Infirmary and Mexborough Montagu The project report can be viewed at: Hospital www.healthwatchdoncaster.org.uk/urgent andemergencycarereport
Sue, Healthwatch Doncaster volunteer, shares her experience of the Emergency Department at Doncaster Royal Infirmary ”When I went to A&E at 9pm, I was humbled by what I saw. The professionalism and the care given by the staff was wonderful. It didn’t matter what their job title was, the Sister fetching a bed, changing a bed; everyone just got on with it. They were all pleasant and introduced themselves to the patient, I thought they did a wonderful job”
Annual Report 2019-20 | Healthwatch Doncaster 14
From left to right: Natalie, Sophie, Elle and Jill at the Doncaster Pride celebration event Hearing how local need help. people look after their The need for appropriate and timely emotional health referrals from GPs and timely appointments from specialist services was In August 2019, we attended the a feature of views received and some Recovery Games and the Doncaster people reported accessing private Pride event to gain views on how therapies due to long waiting times. people support others to stay emotionally well. The project A number of individuals told us about the focussed on our qualitative themed lack of mental health resources, the need approach “What’s YOUR Story” to for a holistic approach where an individual gather extended narratives via audio has physical and emotional difficulties and recordings. the need for integrated working particular between health and social care services. Our aim was to identify the main themes and gaps in support for people with There was a gap identified for Youth emotional difficulties, particularly those in Gender Identity Services locally. recovery and the LGBTQ+ community, to influence local services. A number of recommendations for organisations across Doncaster were The receptiveness of 13 people who were made within the report and shared with willing to tell their own stories or stories of services. how they supported others was inspiring.
The importance of the support that family and friends provide was a key theme. However, it was recognised that they themselves need support to fulfil this role.
Talking to others who have been through similar experiences, hobbies and physical and practical help were also key findings.
Barriers included social stigma and individuals themselves accepting that they The team at the Recovery Games Annual Report 2019-20 | Healthwatch Doncaster 15
Healthwatch Attendees were able enjoy some Doncaster’s spellbinding stage magic from Magi-Cal. Micro-Grants We have invited every organisation who We’ve been able to support 21 has worked with us throughout the community groups in 2019-20 and duration of our micro-grant programme to we have allocated £27,000 in Micro- reconnect with us and explore the Grant funding over the past three possibilities of bringing organisations years. together to create a mutually beneficially network of Voluntary, Community and A launch event was held to help generate Faith Sector organisations. new and recurring interest, which featured some of our previous recipients, It will also provide an opportunity for such as Doncaster Alcohol Services and organisations to skill share, help support Doncaster Central Learning Centre. It each other through crucial times and offered the opportunity for questions to celebrate each other’s successes. be answered prior to the funding round being opened for applications. Our vision for this network is what grassroots organisations are all about: Our annual celebration event, delivered at people helping people. As we move the newly renovated Doncaster Wool into the next phase of establishing this Market (pictured above), had the pleasure network, we invite any community of hearing from some of the projects, organisation who believes they can bring which were funded as part of the 2018 additional value and benefit to get in programme. touch with us and get involved. Annual Report 2019-20 | Healthwatch Doncaster 16
Young Healthwatch Champions
At Healthwatch Doncaster, we want students were able to access in-house young people to have their voices heard safeguarding awareness training to help boost and to gain insight on how the Health their understanding of safeguarding and how and Social Care sector works. We want to identify people at risk. to support young people who will be the leaders of tomorrow. Alongside our student placement opportunities, we also launched our monthly With this in mind, we developed our Young meet up sessions which offer a safe space for Healthwatch programme to help health and young people to meet and discuss relevant social care students who required a provider issues. Topics included mental health support placement to complete their educational for young people, where do I go for sexual qualifications. They also gain awareness and health issues, gender identity, visible vs skills needed to develop their careers. Our invisible health conditions and many more. programme developed into the ‘Young Healthwatch Champions’. Future plans will see Young Healthwatch have a stronger digital presence utilising social This opportunity enabled us to build on media platforms and video calling will be used existing connections with Doncaster College to as a way of supporting more young people create a strong partnership of directing through the peaks and pitfalls of everyday life. students to apply for our placement opportunities. Once we had interviewed and selected students for placements, sessions were delivered in two 4-hour weekly segments. Young people were mentored and supported throughout their placement.
Sessions included: visits to organisations within our existing networks so that students were able to see how services were delivered. For example, community space ‘Sober Social’, delivered by Doncaster Alcohol Services, gave the students opportunity to meet people in recovery from substance misuse whilst also speaking with the community professionals.
In addition to this, a representative from a local learning disability peer support group delivered a presentation to help raise the young people’s awareness of the learning Activities during the meet-ups always involve creativity! disability community. Furthermore, the Annual Report 2019-20 | Healthwatch Doncaster 17
A huge thank you to students Amber C, Amber M, Beth, Bethany, Caitlin, Chloe, Cameron, Elisha, Holly, Janine, Jessica D, Jessica W, Jenani, Kacey, Kacie-Lea, Lauren, Leah, Mara, Melissa, Natalia, Sharni for their contribution to the work of Healthwatch Doncaster during vocational placements.
Read how Natalia, Mara, and Holly found their placement experience..
What did you enjoy the most?
Mara: I enjoyed all the activities I took part in and the support I have been given. I appreciated the way I have been treated by the Healthwatch Doncaster team
Natalia: I really have enjoy the fact that I got to take part in the Micro-Grant project and I got to directly take part in what it means to work for them
Holly: I enjoyed learning about Clinical Commissioning Groups and completing the suicide awareness course.
Did the placement enhance your learning?
Mara: I feel more than confident to say that Healthwatch Doncaster provided me with the opportunity of improving my knowledge and skills
Natalia: The placement definitely enhanced my learning as I got to listen to a lot of people with much more knowledge than I have and I picked up interesting things and facts
Holly: I learnt a wide range of things to do with health and social care which will be useful for my course
Did you feel the team supported you appropriately?
Mara: The team provided me with the best support. They asked me to get involved in their project, which made me feel worthy and helpful
Natalia: Always listened to what I had to say and made sure I was pleased and comfortable with the environment and with the tasks.
Holly: No one was impatient with me when I had questions or when I did not fully understood the task. Annual Report 2019-20 | Healthwatch Doncaster 18
Michael Smith’s story Joining us originally on a student placement in 2018, Michael shares his reflections on creating videos, films and animations Healthwatch Doncaster as he embarks on his new college course in 2020 What is the piece of work you are most proud of? “The introduction video because it gave me new skills as I hadn’t tried a first person perspective before. The more I did it the more I felt comfortable. I felt so proud of the video.”
How would you describe your personal development from when you joined us in February 2018 to February 2020? “It has been positive as I’ve grown in confidence due to the people I’ve met during projects. When I started my new course, it helped me to deal with new surroundings and adapt quicker.” Michael holding the trophy for Healthwatch Doncaster’s input at a video editing course How would you describe the support you What would you say to prospective received from our staff team, our students considering a placement with volunteers and our Board? Healthwatch Doncaster? “They would always ask me how things “I highly recommend it to anyone looking were going. As time went on, I asked for for experience, it’s a good work more support when I needed it. For environment. The people are nice and example with Sandie, I did a video for the made me feel welcome.” homecare and support project and she was very helpful, giving me ideas on how Michael did some video work she wanted it.” involving the volunteer group.
He was very professional. Is there any training you’ve enjoyed? I learnt about software to create videos He put interviewees at their using my phone at training I attended ease which minimised their with Akhlaq in Leeds. Plus, we came home anxiety about being on camera. with a trophy for our group work! A testimonial from Healthwatch Doncaster’s volunteers on Michael Annual Report 2019-20 | Healthwatch Doncaster 19
Covid-19
Our Chief Operating Officer Andrew Home working and engagement through Goodall explains how Healthwatch digital channels is now part of the new Doncaster reacted to the Covid-19 normal. The team have developed new pandemic.. services and ways of engagement through the Reaching Out project and the Daily Covid-19 did not take us by surprise – Dose of Healthwatch Doncaster. there were lots of reports from Italy and Spain about the impact and scale of All of our meeting and support changes need to defeat it – but national conversations take place through Zoom or changes did happen very quickly. Facebook Live and it has given us all the opportunity to become more efficient and I am proud to say that Healthwatch streamlined in our approach to agile and Doncaster, as a team and an organisation, remote working. were able to react quickly and effectively in response to the pandemic and the Our journey through the Covid-19 national ‘lockdown’. pandemic and into recovery and renewal will be a steady one and one that we will The Healthwatch Doncaster team were up use to maintain our presence in and running on Zoom and using remote communities and our support for local working immediately and we were able to people and groups through digital tools. provide accurate and up to date information through our website and Healthwatch Doncaster will still be through our social media channels. listening to local people about their experiences of health and care and we will still be championing the voice of local people to improve the quality of health and care services. Healthwatch Doncaster – Facing A Pandemic written by Jill Telford
A dedicated team where do I start, Each one passionate about playing their part. Covid-19 came our way, And in our house we had to stay!
Not to be beat, We took our seat! Engagement with others remained in our heart, But in a Pandemic where do we start?
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.
Reaching Out became a must, We had to get the situation sussed. Tell us what you think, talk to us REGISTER online, don’t get the bus
When we have your details, we’ll pick up the phone, Whilst you sit on the couch in your own home. So to pass the time and have a chat, Complete the registration it’s as easy as that
Another addition Daily Dose, Monday to Friday, Download Zoom, Call at 11.00 I’d say You’ll need a code to enter the meeting, Find it on Facebook or Twitter then get comfy seating.
Make a Difference Monday starts the week, On Tuesday people talking, is what we seek. On Wednesday stories of health and social care we want to hear, Whilst Thursday we offer “Tech” support - no fear.
Reaching Out and Daily Dose, what we offer to aid, To all of you who in your homes you have stayed. Covid-19 how has it been for you? Talk to us, tell us your view. Our Volunteers Annual Report 2019-20 | Healthwatch Doncaster 22
Volunteers’ influence
Some of the work that the Healthwatch Doncaster Volunteers have been involved in during the period covered by this report are:
• Regularly attending volunteer meetings where we discuss issues relating to health and social care both locally and nationally: These enable us to identify areas of work that our Healthwatch may want to develop.
• Planning and implementation of our Enter and View programme: Our Enter and View Healthwatch Doncaster team at the Recovery Planning Group have been instrumental in Games in August 2019 helping to develop our Enter and View • Taking part in engagement activities to programme and supporting our Authorised promote Healthwatch Doncaster Representatives. “Being part of the Healthwatch • Representing the patient’s voice in focus Doncaster team on the day of the groups, grants panels and as part of the Recovery Games was great fun even commissioning process. One example is the though it was rather wet. We spoke Urgent and Emergency Care project, here’s to loads of people about how to what one of our volunteers had to say about maintain good emotional health and being involved in the tendering process for a gathered feedback on services.” local service: “Our role was to score and moderate parts of the bids from a service Words from Healthwatch Doncaster user’s perspective. It’s wonderful to know that Volunteer Sue the patient’s view is taken into account alongside the financial and clinical parts of the process.”
Want to volunteer with Healthwatch Doncaster? If you want to join our enthusiastic volunteer team, then contact us today! Website: www.healthwatchdoncaster.org.uk/getinvolved Telephone: 01302 965450 Email: [email protected] Annual Report 2019-20 | Healthwatch Doncaster 23
Enter and View
During the period covered in this report our Authorised Representatives have undertaken the following visits to local care homes (scheduled visits for March 2020 were postponed due to the Covid-19 pandemic):
Care Home Date Reason for visit Recommendations
Woodlea, Doncaster 17.4.19 Proactive Yes - minor
Stenson Court, Balby 15.5.19 Proactive Yes - minor
Roman Court, 23.5.19 Proactive Yes - minor Mexborough The Old Rectory, 25.6.19 Proactive Yes - minor Armthorpe Headingly Court, 25.9.19 Proactive Yes - minor Edlington Headingly Park, 17.10.19 Proactive Yes - minor Edlington Thorndene, 19.12.19 Proactive Yes - minor Doncaster
The reports from these visits can be found here: https://www.healthwatchdoncaster.org.uk/reports/
We carry out follow up visits 3-6 months after our original visit to see which, if any, of our recommendations have been taken on board by the providers. This enables us to measure the impact of our Enter and View programme in terms of improved experience for the recipients of the service, to date this has been mostly positive.
The services that we visit appreciate our input and tell us that it is useful to have an independent opinion on where service delivery can be improved.
It is great to see things through fresh eyes, we are here every day caring for people and sometimes it’s hard to see the bigger picture. We appreciate your input because if we can improve things even further we are happy to do it A quote from a Care Home manager about Healthwatch Doncaster Enter and View visits Annual Report 2019-20 | Healthwatch Doncaster 24
Patient Stories
NHS Doncaster Clinical Commissioning Group have monthly Governing Body meetings.
Patient stories are scheduled at each meeting for members of the public to share their experiences of local health and care services.
Since June 2019, Healthwatch Doncaster have facilitated the patient stories for the Governing Body and we have supported local people to share their experiences of health and care services.
It was agreed that use of the Life Stages – Starting Well, Living Well and Ageing Well – would be a good approach for the focus of each meeting.
Stories so far have included:
Lower back pain management
Work of the Young Advisors
Frailty services
Support for young people with Autism
Mental Health services
Life in a care home
Support for Children and Young People with additional health needs
Primary care services
This initiative has been very successful and feedback from the Governing Body members and participants has been very positive. The Governing Body have assured those attending that the information they have received will be used to influence future service delivery.
Annual Report 2019-20 | Healthwatch Doncaster 26
Signposting and Information
This year we helped 294 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 • Talking to people at community events • Promoting services and information that can help people on our social media channels
How did people contact Healthwatch Doncaster?
6% 8%
35%
34%
16%
Telephone Email Website Social Media Office Annual Report 2019-20 | Healthwatch Doncaster 27
Twitter Facebook Instagram 739,398 Total reach
4,206 Post engagements
1,974 Number of posts
1,850 Video views
Our Facebook post sharing information about the NHS Long Term Plan reached over 25,000 people across April and May Annual Report 2019-20 | Healthwatch Doncaster 28
Choice for All Doncaster (ChAD)
ChAD and Rossington SMILE were ChAD were contacted by Joanne successful in receiving a micro-grant Blockley (Patient Advice and Liaison from Healthwatch Doncaster to put Team leader) from the local Acute together a package about scams/social Trust to see if they could give their media. This enabled us to visit Lifewise opinions on proposed feedback forms to find out more information to create for the Friends and Family Test. Many three short video clips on different simplified amendments were proposed scenarios and write a song working with and fed back to Joanne, who thanked Mark Coley, from Rotherham Doncaster ChAD for their prompt, detailed and and South Humber NHS Foundation constructive response. Trust
Following the work which ChAD had In December, ChAD and Rossington been involved in on the All Age Learning SMILE members took part in a photo Disability and Autism Strategy, they shoot and filming at Diamond Activity were invited to attend the Scrutiny Panel and Therapeutic Services (formally The at the Civic building where Doncaster Solar Centre). All involved will feature in Councillors and commissioners asked a short film and brochure to promote questions about difficulties people with a the service and activities available. Learning Disability encounter. Find out more about us and the work we do
Telephone: 07834 686858 Email: [email protected] Facebook: www.facebook.com/chadoncaster Website: www.chadindoncaster.com Annual Report 2019-20 | Healthwatch Doncaster 29
Doncaster Keeping Safe Forum
The Forum’s campaigns and development of greater main purpose partnership working between is to help organisations who work with adults and keep children. people in Doncaster safe Our annual Keeping Safe event (pictured and well. below) was a festive feast. It was opened by John Woodhouse, Chair of the Joint We achieve this in multiple ways, which Adults and Children Safeguarding Board. include hosting a bi-monthly Forum, Dr Alan Billings, South Yorkshire Police developing social media platforms and an Commissioner, then shared details of the annual event highlighting the great newly established Violence Reduction achievements of keeping people safe and Unit. well throughout the year.
Our Forum has grown with membership extended to people and professionals who have an active interest in safeguarding children, because we felt there was a crossover of relevant issues and a need for greater awareness.
Naturally, this influenced the variety of guest speakers who attended the Forum. We received information from South Yorkshire Fire and Rescue, Voiceability, Highlights also included Jodie Keegans’ Victim Support and Doncaster Culture and Survivors Story about domestic violence Leisure Trust, to name a few. and a showcase of how local groups are helping to contribute to a safer Doncaster. Special thanks goes to Ian Walker – Gamblers Anonymous – who shared his A local Primary School choir, who joined personal journey about struggling with a us midway through the event, sang gambling addiction. He also shared how modern Christmas songs which added a gambling can affect anyone at any age special sparkle and festive feel to an from school children to older people. informative and enjoyable day.
The Forum has identified a representative to attend the local Keeping Safe sub- group of Joint Safeguarding Boards to share insight and ideas on local Annual Report 2019-20 | Healthwatch Doncaster 30
Patient Participation Group Network This includes bringing the Primary Care Network representatives together with our Patient Participation Group representatives to discuss and support a way forward for positive community change.
The NHS Digital app was been trialled and tested with a small number of practices during the autumn and winter months, which then saw a Borough wide Showcasing the Network at an outreach event roll out of digital services enabling in Doncaster with this informative display board patients to book appointments and order repeat prescriptions through the NHS Our Patient Participation Group App. The PPG Network were shown how Network (PPG) supports local PPG the new mobile application could benefit members to come together from patients during the trial phase so they across the localities and were able to share this information with communities in Doncaster and share their own patient groups prior to the knowledge and insight. Borough wide release.
The PPG Network enables Healthwatch Over the previous year, network speakers Doncaster to act as a conduit between have included: Tina Hope and Liz Leggott local patients and the local Clinical from Primary Care Doncaster who shared Commissioning Group. This enhances relevant updates on the extended access communication channels and helps service, which is now branded ‘More influence service development at a Choice, More Appointments’; Clinical strategic level. Director Ben Scott shared his vision about how his locality will be moving forward Our PPG network have seen a range of and Julie Magee, the Neighbourhood Co- developments in Primary Care. A series of ordinator for the South locality. The PPG Primary Care networks have developed Network’s own carer representative across the localities within the local area shared new information on carers and the of Doncaster with a Locality Co-ordinator new ‘jointly’ app that connects everyone supporting community participation. who is involved with an individual’s care. Patient Participation Groups have been invited to be actively involved within their Finally, ‘Sharing Best Practice’ has been own localities. reintroduced and consolidated into an informative resource to help support the on-going development of Patient Participation Groups. Annual Report 2019-20 | Healthwatch Doncaster 31
Health Ambassadors People with seldom heard voices are not often listened to but our Health Ambassadors initiative helps the more marginalised communities within Doncaster have an opportunity to speak up and have their say on local health and social care services.
We have representatives from the following communities: Trans Mission - representatives of the • Transgender transgender community - at Doncaster Pride 2019 • BAME All issues raised have been appropriately • Deaf addressed with the local Clinical Commissioning Group and discussions are • LGBTQ+ ongoing to find solutions where possible.
• Asylum seekers This year we have recruited representatives from the veteran’s Every meeting, each Ambassador offers community, the deaf community, the an update on their community with mental health community and young regards to what struggles they are people with autism. Moving forward, currently facing and any positive changes future plans include recruiting a that are happening. This provides a Dementia representative and a young supportive space where Ambassadors can carers representative. offer to help each other. Meetings have seen guest speakers from Topics of discussions throughout the year Doncaster Council’s Equality and Diversity have highlighted: video relay service – is team, the Voluntary, Community and it being utilised enough in health settings Faith Sector support team, a such as GP or hospital appointments?, representative from Healthwatch barriers faced by asylum seekers when Sheffield and colleagues from NHS they wish to access GP and dental Doncaster Clinical Commissioning Group. appointments, concerns around access and communication to and from the local sensory team and issues regarding prescribing medication for transgender individuals. Annual Report 2019-20 | Healthwatch Doncaster 32 Our Finances
We are funded by our Local Authority under the Health and Social Care Act (2012). Our core contract value is £216,360. We also received income from other services that we delivered.
19% Staffing costs
Premises costs 9% Running costs £276,745
72%
5% 83% funding received 10% from Doncaster Council
7% 8% funding received from NHS Doncaster CCG £276,745
10% additional income from other work
5% income from our reserves 78% Hooton Pagnell Photo Credit: Irene Photo Credit: Healthwatch volunteer
Lound Hill Photo Credit: John Burke Photo Credit: Healthwatch volunteer
Hill Farm Photo Credit: Healthwatch volunteer Our Doncaster Annual Report 2019-20 | Healthwatch Doncaster 34
Our priorities for 2020-21
Healthwatch Doncaster’s priorities and projects are influenced by what we hear from local people and partners from across the Borough.
Covid-19: How will people access health Cancer: The lived experience of and social care services? What will be their people going through the cancer experience of how services operate in the pathway in Doncaster. ‘new normal’.
Mental Health services: How do people Missed Appointments: Revisiting the access Mental Health support services in project that we completed in 2017 to Doncaster, in light of the increase in evaluate the impact of the changes to demand relating to the Covid-19 hospital appointments, based on our pandemic? recommendations from our original report
Care and Support at Home: Talking to Re-imaging engagement and people about their experiences of care and involvement: We want to continue to support at home in the local community. deliver creative and innovative ways of Have things changed and improved since engagement, involving local people and our last report in 2018? service providers to co-produce projects using online tools during the Covid-19 Pandemic. Annual Report 2019-20 | Healthwatch Doncaster 35
Message from our Chief Operating Officer
The year started off with active engagement in local communities across a number of key projects and then finished off with the Covid-19 pandemic. The pandemic did not knock us off our stride – it enabled us to finish the year off by engaging with people over Zoom and Facebook Live.
In 2019-20, Healthwatch Doncaster reinforced our commitment to Engage, Inform and Influence. The Healthwatch Doncaster team with the trophy as a result of the work around the Long Term Plan Engage: Healthwatch Doncaster set up and delivered another successful Micro-Grants programme and we supported all the organisations that we have funded over the last 3 years to come together as a network. Influence: Healthwatch Doncaster continue to We led on a key piece of work across South be a loud voice for the views of local people Yorkshire and Bassetlaw talking to people at the Health and Wellbeing Board, about the NHS Long Term Plan and we Safeguarding Boards, Governing Bodies and received national recognition for our work Committees. Not only are we a loud voice but locally and regionally. the voices of local people come through in the reports that we write and the Inform: Healthwatch Doncaster have recommendations that we make. We continue continued to provide high quality and to work with partners to influence an signposting information and support to local improvement in the quality of local health and people. We have developed the ‘What’s Your care services Story’ approach to engagement in community events and used this to listen to people’s experience of emotional and mental health support services in Doncaster. Healthwatch Doncaster have worked closely with local Andrew Goodall partners to deliver a key piece of work finding Chief Operating Officer out about people’s experience of accessing GP Healthwatch Doncaster services locally. Annual Report 2019-20 | Healthwatch Doncaster 36
Thanking our partners
Healthwatch Doncaster has really community organisations – without your positive strategic and operational support we would not have been able to hear partnerships and relationships across as many voices and listen to as many stories health and social care in Doncaster. It is and experiences of local health and care through these networks and services. relationships that we can overcome barriers and support local people’s Healthwatch Doncaster supports some voices to continue to shape and specific networks and groups. You will have influence local services. heard about the work of these groups and the voices of group members throughout this Healthwatch Doncaster focussed on a report. number of key projects in 2019-20 and we were able to deliver these to our usual high Thank you to Choice for All Doncaster for standards by working closely with all of our speaking up on behalf of people with a partners. Without these strong, local Learning Disability. relationships we would not be able talk to as many people receiving care and support from Thank you to the Keeping Safe Forum for the great services in Doncaster. sharing messages and information to keep local people safe. Healthwatch Doncaster are only as successful and effective as the partnerships that we Thank you to the Health Ambassadors for have forged locally and for us these supporting people, whose voices are not partnerships are strong and long-standing. often heard, to speak up and speak out.
We would like to thank our key local partners Thank you to the Healthwatch Doncaster for all their help, support and challenge over Volunteers for getting involved in our the last 12 months: engagement work, for leading on Enter and • NHS Doncaster CCG View and for coming up with new ideas for • Doncaster Council projects and pieces of work. • Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH) Finally, thank you to the Patient Participation • Rotherham, Doncaster and South Humber Group (PPG) Network for speaking up on NHS Foundation Trust (RDaSH) behalf of your individual PPG and patients so • Primary Care Doncaster that we can support continued improvement • Local Medical Committee in Primary Care. Norma Carr – Chair of the • Local Pharmaceutical Committee PPG Network – is stepping down as Chair • South Yorkshire and Bassetlaw Integrated from June 2020 onward. Thank you for your Care System passion, motivation and contributions Norma. You have supported the PPG Network to Our local networks and relationships enable grow and develop through challenge, local people’s voices and opinions to make a learning and reflection. The PPG Network will difference and improve local services. continue to grow and maintain the support for local PPGs. We have only been able to deliver the high quality reports and recommendations by working in partnership with local groups and Annual Report 2019-20 | Healthwatch Doncaster 37 Contact us
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Company Number: 10158147 © Copyright Healthwatch Doncaster 2020
Meeting name Governing Body Meeting date 6th August 2020
Title of paper Quality & Performance Report
Executive / Mr Andrew Russell, Chief Nurse Clinical Lead(s) Mr Anthony Fitzgerald, Director of Strategy & Delivery Performance and Intelligence Team Author(s) Quality Team
Status of the Report
To approve To consider / discuss
To note x
Purpose of Paper - Executive Summary This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (DCCG) Governing Body which due to reporting restrictions or information potentially identifiable to a patient level have not been included within the main report. This report reflects 2019/20 and 2020/21 performance and includes a focus on 2020/21’s Living Well SDP.
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/.
As detailed in May, August’s report continues to adopt the national reporting approach with Phase 3 recovery plans awaited. Organisations are now in discussion with NHS England and producing recovery plans to recover baseline positions pre- Covid-19.
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.
1
The key areas of change, both positive and negative, to note since the last report are:
NHS Doncaster Clinical Commissioning Group (DCCG) Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance decreased to 61.4% during June and remains below the 92% target (Page 5). The total waiting list size remains within target. 52 week waits – There were 49 DCCG patients waiting over 52 weeks for treatment at the end of June (Page 10). Patients waiting less than 6 weeks for a diagnostic test – Performance in June failed to meet the 99% target at 36.0% (Page 11) Cancer 2 week waits – Performance during May 2020 met the 93% target at 97.9% (Page 15). Cancer breast symptoms – Performance during May 2020 failed to meet the 93% target at 87.5% (Page 17). New measure: Cancer 28 days faster diagnosis standard – Performance during May 2020 was 85.5% (Page 17) Cancer 31 day waits – Performance during April 2020 failed to meet the 96% target at 92.9% (Page 18). Cancer 62 day waits – Performance during April 2020 failed to meet the 85% target at 72.5% (Page 20).
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance deteriorated to 58.8% in June below the 92% recovery trajectory (Page 5). 52 week waits – There were 52 patients at the Trust waiting over 52 weeks for treatment at the end of June 2020 (Page 10). Patients waiting less than 6 weeks for a diagnostic test – Performance improved in June to 35.5% below the 99% target (Page 12). Accident and Emergency – Performance decreased in June 2020 to 93.2% remaining below the 95% target (Page 13). Cancer 31 day waits – Performance during May 2020 met the 96% target at 97.9% (Page 18). Cancer 62 day waits – Performance during May 2020 failed to meet the 85% target at 81.6% (Page 20).
Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH) Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service was below the May 2020 target (3.2%) at 2.95% (Page 24) IAPT 6 weeks RTT – Performance for DCCG patients in RDASH services increased to 59.2% during May against the 75% target (Page 24) IAPT recovery rate – Performance remained below the 50% target in May at 44.3% (Page 25) Other Commissioned Services 2
Yorkshire Ambulance Service – All categories met their respective targets (Page 22).
Delivery Plan Reporting Full summary of 2019/20 reporting and Living well May 2020 position (Page 29)
Recommendation(s) The Governing Body is asked to:
Note the Quality and Performance Report Report Exempt from Public Disclosure
If yes, detail grounds for exemption: Yes No x
Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report.
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result Impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability Nil impact Financial Nil implications Legal Nil Implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.
Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) Report previously N/A presented at Risk Risks are captured in the Executive Summary. Analysis 3
Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework
4
Section 1: National Frameworks and Measures
1.1: NHS Constitution Measures
1.1.1 Referral To Treatment (RTT) Performance (Oversight Framework Measure - OF)
Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks
Commissioner Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 June-20
Doncaster CCG 86.8% 87.1% 86.5% 87.0% 87.6% 87.7% 87.5% 89.2% 90.5% 89.7% 82.6% 73.5% 61.4%
Rightcare Peer Group 88.6% 88.5% 88.0% 87.8% 87.7% 87.3% 86.4% 86.5% 86.4% 83.5% 75.5% 65.3% Doncaster and Bassetlaw Teaching 86.6% 86.7% 85.7% 86.4% 87.1% 87.2% 86.8% 88.8% 90.4% 90.1% 82.2% 72.3% 58.8% Hospitals Foundation Trust (DBTHFT) England 86.2% 85.7% 84.9% 84.7% 84.6% 84.3% 83.6% 83.4% 83.1% 79.6% 70.6% 61.6%
Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%
5
Performance for Doncaster Clinical Commissioning Group (DCCG) patients at all Trusts was 61.4% in June 2020, 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 deteriorated over the last 2 years with 3 clear stages of continual deterioration. Latest performance is below the normal range of the service, affected adversely during the Covid-19 pandemic. The DBTHFT waiting list is validated down to 12 weeks which may have a negative impact on reported performance. Eighteen specialties are failing to meet the 92% standard for DCCG:
Cardiology (63.1%) Cardiothoracic surgery (57.7%) Dermatology (80.5%) Ear, Nose & Throat (52.5%) Gastroenterology (77.8%) General Medicine (72.1%) General Surgery (63.5%) Geriatric Medicine (74.2%) Gynaecology (69.6%)
6 Neurology (68.2%) Neurosurgery (72.0%) Ophthalmology (59.3%) Other (68.5%) Plastic Surgery (69.7%) Rheumatology (71.0%) Thoracic Medicine (65.4%) Trauma and Orthopaedics (T&O) (50.3%) Urology (55.6%)
The waiting list shape for Doncaster CCG patients at any provider is shown below, highlighting that the majority of patients are waiting less than 18 weeks. The CCG monitors the waiting list weekly and is in regular contact with DBTHFT and North Lincolnshire and Goole Foundation Trust for the most up to date position on patients waiting over 38 weeks in order to try to reduce long waiters, including those who may breach 52 weeks.
DBTHFT’s June 2020 position deteriorated from 72.3% in May to 58.8% in June. The additional recovery actions planned in April were compromised by the impact of Covid19.
7 Twenty Four specialties failed to meet the standard at DBTHFT in June:
Breast Surgery (89.8%) Cardiology (64.0%) Dermatology (77.9%) Diabetic Medicine (63.6%) ENT (52.4%) General Medicine (71.8%) General Surgery (62,2%) Geriatric Medicine (76.1%) Gynaecology (73.6%) Medical Opthalmology (64.0%) Nephrology (73.6%) Ophthalmology (57.9%) Oral Surgery (33.0%) Orthodontics (36.4%) Paediatric Cardiology (54.4%) Paediatrics (84.5%) Pain Management (83.4%) Podiatry (32.0%) Respiratory Medicine (69.2%) Rheumatology (61.4%) T&O (48.9%) Upper Gastrointestinal Surgery (45.4%) Urology (55.8%) Vascular Surgery (73.2%)
During June 2020, in line with the Trust’s Stabilisation and Recovery Plan, some routine outpatient activity has resumed. In line with national guidance no routine elective activity has taken place due to the limitations on theatre utilisation and elective bed capacity.
The Trust continues to see a reduction in referrals affecting the RTT position by reducing the overall denominator of the waiting list.
8
Numerous services are already working at 100% clinic capacity using all mediums available including telephone and video consultations. Face to face consultations remain limited due to social distancing requirements. A small number of specialties will be unable to provide 100% of their clinic capacity for the foreseeable future due to the nature of the specialty e.g. Head & Neck where the majority of patients need to be seen on a face to face basis and the necessity for both medics & surgeons to cover new ‘post Covid-19’ rota's to support provision of in patient care. Remaining services are working on plans to deliver 100% of outpatient clinic capacity by using alternative methods of service delivery and extended delivery to accommodate social distancing regulations.
Although activity is stepped up, there will not be a direct correlation with performance improvement as some of the prioritised patients will not be 18 weeks+.
As previously reported and following national guidance all elective in patient activity is being prioritised by clinical need and routine patients are not yet being seen.
1.1.2 Waiting List Size (OF)
The expectation nationally has been revised to ensure that the number of patients on incomplete pathways is maintained below or at the waiting list size at the end of January 2020 by March 2021. The number of DCCG patients on incomplete RTT pathways increased in June
9 2020 by 1176 patients to 19476, however continues to achieve target (22206). The Trust is aiming to maintain validation of patients at 12 weeks on the Patient Tracking List (PTL) going forwards.
1.1.3 52 Week Breaches (OF)
52 Week Waits –Incomplete Pathways
Provider Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20
Doncaster CCG 1 0 0 1 0 0 1 1 0 0 6 20 49
DBTHFT 0 0 0 3 1 1 1 1 1 1 10 27 52
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
The number of breaches has increased since April 2020 primarily due to Covid-19. The number of DCCG patients waiting over 52 weeks rose to 49 in June 2020.
DBTHFT are currently reporting 52 people waiting 52 week or longer for treatment at the end of June 2020. Twenty-five of these patients were reported breaches in May.
Twenty-six of these patients are DCCG patients with 15 breaches in T&O, 4 breaches in ENT, and 2 breaches in urology. The 5 other breaches that DBTHFT are reporting are in vascular, respiratory, ophthalmology, general surgery and gynaecology.
RTT training and improved administrative systems will mitigate against further similar breaches. With routine elective work currently on hold the CCG anticipate that there will be 52 week breaches until routine work resumes and the backlog is addressed. As part of DBTHFT recovery plan, the Trust now needs to move urgently to reinstate work to improve underpinning administrative and validation processes, building on progress made before COVID-19.
Full breach reports from DBTHFT will be sent to DCCG once completed.
10 1.1.4 Diagnostics (OF)
Patients waiting less than 6 weeks for a Diagnostic test
Commissioner Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20
Doncaster CCG 98.7% 99.3% 98.6% 99.3% 99.2% 98.7% 95.8% 94.6% 99.2% 90.0% 38.2% 29.2% 36.0%
Rightcare Peer Group 97.3% 97.0% 96.0% 95.8% 96.9% 97.0% 95.2% 95.3% 97.3% 91.8% 38.9% 37.7%
DBTHFT 98.7% 99.1% 98.7% 99.3% 99.3% 98.6% 96.2% 95.4% 99.1% 89.9% 36.9% 28.4% 35.5%
England 96.5% 96.8% 96.0% 96.5% 97.1% 97.2% 95.8% 95.6% 97.2% 89.8% 44.6% 41.5%
Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%
11 Performance for DCCG in June 2020 increased to 36% of patients waiting less than 6 weeks for a test (5669 breaches) below the 99% target. Performance is below the statistical process control limits on the chart above which indicates performance is outside the normal variation expected for the service. Since March performance has been severely impacted by the COVID-19 situation.
DBTHFT’s June 2020 position improved to 35.53% against a standard of 99%. The table below shows the diagnostic modalities that were impacted by Covid-19. Due to the National and Local response to the pandemic from 18th March 2020, the majority of the Trust’s routine activity ceased, limiting their ability to see patients already in the system and those referred in within the 6 week timeframe.
Longest Breach Exam Type <6W >=6W Total Performance (weeks) MRI 533 1199 1732 30.77% 24 CT 1067 1235 2302 46.35% 27 Non-Obstetric Ultrasound 1786 3327 5113 34.93% 31 DEXA 209 353 562 37.19% 24 Audiology 0 265 265 0.00% 24 Echo 245 430 675 36.30% 15 Nerve Conduction 27 125 152 17.76% 21 Sleep Study 30 33 63 47.62% 15 Urodynamic 2 91 93 2.15% 27 Colonoscopy 218 377 595 36.64% 23 Flexible Sigmoidoscopy 65 138 203 32.02% 19 Cystoscopy 125 145 270 46.30% 25 Gastroscopy 225 505 730 30.82% 26 Total 4532 8223 12755 35.53%
Diagnostic services for ‘two week waits (suspected cancer)’ and urgent patients continues with primary care being urged to continue referring patients through these pathways. Teams continue to assess all request cards to ensure urgent patients are seen in order of clinical priority. There is a robust process in place to ensure that no urgent patients are missed, with an internal Standard Operating Procedure in place for clinical triage.
12 Due to national guidelines & social distancing measures all diagnostic modalities will only be able to offer a percentage of their pre-Covid capacity and as with other elective services patients will be seen in order of clinical priority and not longest waits so any increase in activity will not have a direct correlation with an improvement in performance.
Recovery plans for all diagnostic modalities have now been submitted and agreed with the majority of modalities now offering routine capacity. Social distancing and patient flow have been a priority to ensure all patients and staff remain safe while providing increased levels of access to diagnostics.
Waiting patients continue to be reviewed & risk stratified, with patients being booked in order of clinical need.
Communication continues with the Integrated Care System to ensure an equitable approach across the region and to take advantage of capacity offered from other parts of the region.
1.1.5 A&E attendance to admission, transfer or discharge (OF)
A&E attendances under 4 hours from arrival to admission, transfer or discharge Aug- Feb- May- Provider Jun-19 Jul-19 Sept-19 Oct-19 Nov-19 Dec-19 Jan-20 Mar-20 Apr-20 June-20 19 20 20 DBTHFT (all attendances, based on 91.4% 90.4% 88.1% 88.7% 90.3% 85.9% 82.3% 84.8% 85.4% 88.0% 90.9% 94.7% 93.2% daily reported figures) DBTHFT (Type 1 88.4% 87.7% 84.2% 83.8% 87.8% 82.5% 76.8% 79.4% 80.4% 84.4% 92.5% 93.9% 91.7% attendances) England (all 86.4% 86.5% 96.3% 85.4% 83.6% 81.4% 79.8% 81.7% 82.8% 84.2% 90.4% 93.5% 92.8% attendances)
Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
13
Covid-19 has continued to impact on both EDs with departments split into 2 areas to manage 2 simultaneous pathways (yellow & blue patients).
Compared to June 2019, the Trust saw 17% fewer attendances. This mainly consisted of a reduction in ‘minors’ patients at Doncaster Royal Infirmary (DRI) and a significant reduction in paediatric patients across all sites.
DRI has continued to see high acuity of type 1 presentations and there has been a continued increase in non-Covid related presentations. Throughout June 2020 a review of the split of Covid and non-Covid patients has taken place and resulted in a paper being presented to the Executive Team to seek approval to increase non-Covid capacity within the Departments. This was authorised with implementation taking place from 1st July 2020.
Earlier Senior Assessment, ‘Super-tracking’ of patients by a Senior Doctor and Emergency Assessment Unit continue to deliver improvements in flow particularly on the DRI site.
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.
14 1.1.6 Cancer Measures
DBTHFT are participating in the testing phase of the Clinically-led Review of Standards (CRS) for cancer as 1 of 13 sites nationally. As part of the testing there will be a change in reporting with 2 week wait for breast symptomatic reporting no longer available for the Trust to be benchmarked. An additional Faster Diagnosis Standard will be trialed during this period and is defined as a ‘Maximum four weeks (28 days) from receipt of urgent General Medical Practitioner, General Dental Practitioner or Optometrist referral for suspected cancer, breast symptomatic referral or urgent screening referral, to the point at which the patient is told they have cancer, or cancer is definitely excluded’.
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 under ‘Other Reason’. For all other measures ‘Other reasons’ relate to all miscellaneous reasons.
2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP
Aug- Sep- Q2 Oct- Nov- Dec- Q3 Jan- Feb- Mar- Q4 Apr- May- Commissioner 19 19 19/20 19 19 19 19/20 20 20 20 19/20 20 20
Doncaster CCG 95.8% 96.7% 95.0% 94.8% 94.7% 94.2% 94.6% 92.8% 95.8% 94.6% 94.4% 92.5% 97.9%
Rightcare Peer Group 93.7% 94.5% 94.1% 94.9% 95.2% 95.4% 95.2% 94.5% 94.7% 95.3% 94.8% 83.8% 96.5%
Cancer Alliance 94.6% 94.9% 93.7% 93.9% 94.0% 94.6% 94.2% 93.5% 95.3% 94.9% 94.6% 89.1% 98.0%
England 89.3% 90.1% 90.2% 91.4% 91.3% 91.9% 91.5% 90.1% 92.8% 91.9% 91.6% 88.0% 94.2%
Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%
15
Performance in May of 97.9% was above the target of 93% with only 11 breaches within the month. The 11 breaches were categorised as followed: Administrative Delay (1), Patient Choice (1) and 'Other Reasons' (9), which has been used to identify where Covid-19 has impacted the pathway. Urology was the only tumour group to perform below the desired 93% performance at 85.7%, 5 breaches from 35 patients seen, all of which were delayed as a result of Covid-19 breach reasons. The remaining breaches were distributed across the following tumour groups; Breast (2), Gynaecology (2), Skin (1) and Lower GI (1).
The longest an individual had to wait to be first seen was 59 days, in the Urological Tumour Group due to a Covid-19 related breach.
Local intelligence from within the Cancer Team at DBTHFT indicates that there has been a reduction of 53% in the number two week wait patients seen in April and May. The decreasing number of referrals has been highlighted at Cancer Programme Board and a recovery plan is being developed. The Performance Intelligence Team are working closely with the Cancer Team at DBTHFT monitoring cancer referrals, showing that referrals and booked appointments are starting to recover to normal average amounts from the first week of June. The numbers of referrals have increased in the first two weeks in July where eight of the nine major tracked tumour groups have shown an increase of 20% above the pre-covid19 average referral numbers.
16 2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)
Aug- Sep- Q2 Oct- Nov- Dec- Q3 Jan- Feb- Mar- Q4 Apr- May- Commissioner 19 19 19/20 19 19 19 19/20 20 20 20 19/20 20 20
Doncaster CCG 98.1% 100% 95.8% 98.5% 95.1% 92.2% 95.2% 92.1% 100% 97.6% 96.5% 100% 87.5%
Rightcare Peer Group 91.3% 94.7% 91.3% 92.7% 95.3% 93.7% 93.9% 94.7% 94.5% 91.1% 93.5% 89.1% 88.2%
Cancer Alliance 93.3% 97.6% 91.1% 94.6% 93.9% 90.4% 93.0% 90.8% 93.5% 89.9% 91.3% 90.9% 97.4%
England 85.9% 88.0% 85.3% 89.9% 87.5% 84.3% 87.3% 83.6% 87.3% 86.1% 85.6% 80.9% 93.7%
Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%
Performance in May 2020 was below the target of 93% at 87.5% due to the 1 breach within the month. The breach was due to ' Other reasons' meaning it was a Covid-19 related breach. The patient had to wait 15 days to be first seen from referral.
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 definitely excluded Commissioner Aug- Sep- Q2 Oct- Nov- Dec- Q3 Jan- Feb-20 Mar- Q4 May- Apr-20 19 19 19/20 19 19 19 19/20 20 20 19/20 20 Doncaster CCG 80.6% 73.7% 79.1% 79.5% 80.9% 82.8% 81.0% 78.9% 83.3% 81.0 81.2% 72.1% 85.5% %
The standard operating contract for the 2020/21 financial year has 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.
17 Both Upper GI and Urology were the 2 lowest performing tumour groups at 69.5% and 51.9% respectively. When breaking down into Confirmed and ruling out of Cancer, the performance was 85.7% and 86.5%.
31-day wait from diagnosis to first definitive treatment for all cancers Aug- Q2 Q3 Q4 May- Commissioner Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 19 19/20 19/20 19/20 20 Doncaster CCG 96.4% 95.9% 96.1% 96.9% 96.2% 98.4% 97.1% 95.2% 94.1% 95.6% 95.0% 92.9% 92.9%
Rightcare Peer Group 96.6% 96.2% 96.3% 96.6% 97.3% 96.9% 96.9% 96.0% 96.4% 96.9% 96.4% 97.9% 95.4%
Cancer Alliance 96.8% 97.2% 97.1% 97.1% 97.8% 96.9% 97.3% 96.1% 96.7% 96.9% 96.5% 95.7% 94.2%
DBTHFT 100% 100% 98.8% 100% 100% 100% 100% 97.8% 99.2% 100% 99.1% 98.5% 97.9%
England 96.1% 95.5% 96.0% 96.2% 95.9% 96.0 96.0% 94.6% 96.3% 96.7% 95.9% 96.3% 93.9%
Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%
18 There were 7 breaches within May 2020, resulting in performance of 92.9% compared to the 96% target. The 7 breaches were in the following tumour groups; Head & Neck (1), Lower GI (2), Lung (2), Skin (1) and Upper GI (1). The breaches were as a result of the following reasons; Other Reasons (4), Patient initiated delay (2) and Treatment delayed for medical reasons (1). There were a total of 3 treatment pathways that were delayed as a result of Covid-19, 2 in Lower GI and 1 in Skin. The longest an individual had to wait from Decision to Treat was 63 days, in the Lower GI tumour group and was a Covid-19 related breach requiring Surgery.
It has been noted that although the total number of treatments has decreased during the pandemic, the total that has had a surgical treatment has increased compared the first 2 months of the previous year. The Performance and Intelligence Team is working with the Cancer Team at DBHT to monitor the split of both first and subsequent treatment modalities compared to previous years.
It is expected that the impact of the Covid-19 pandemic on treatments will be seen in the coming months as the total number of patients requiring a first treatment increases as capacity is reducing.
31 day wait for subsequent treatment Aug- Q2 Q3 Q4 May- Commissioner Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 19 19/20 19/20 19/20 20 Surgery - Doncaster 95.2% 94.7% 97.0% 96.0% 91.7% 100% 96.5% 92.3% 100% 73.9% 90.2% 100% 90.3% CCG Radiotherapy - 92.0% 90.5% 92.8% 93.0% 89.6% 84.6% 89.1% 81.8% 100% 93.0% 91.4% 95.4% 93.3% Doncaster CCG Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% Drug Regimen - 100% 100% 100% 100% 100% 100% 100% 97.6% 100% 100% 99.0% 100% 87.0% Doncaster CCG Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%
In May 2020 all 3 of the treatment modalities for subsequent treatments failed to meet performance targets. Surgery and Radiotherapy both achieved 90.3% and 93.9% respectively against the 94% target. Drug Regimens achieved 87% against the 98% target. All 3 of the treatment modalities had 3 breaches for the month. 6 of the breaches had the breach reason 'other reason' associated to them whilst the other breaches were due to capacity issues. Of the 'other reason' breaches, 1 associated to a Covid-19 breach.
The longest an individual had to wait was 79 Days for Drug treatment with the delay reason being 'other reason'.
19 62-day wait from urgent GP referral to first definitive treatment for cancer (OF) Aug- Q2 Q3 Q4 May- Commissioner Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 19 19/20 19/20 19/20 20 Doncaster CCG 83.3% 88.7% 85.0% 81.8% 76.9% 78.8% 79.4% 80.8% 65.0% 88.5% 79.2% 72.6% 72.5%
Rightcare Peer Group 78.1% 76.6% 77.7% 77.1% 75.7 77.0% 76.6% 75.0% 73.4% 81.7% 77.0% 78.7% 73.5%
Cancer Alliance 79.1% 80.3% 79.7% 77.0% 77.9% 79.7% 78.2% 75.5% 73.7% 81.2% 77.0% 77.6% 71.7%
DBTHFT 87.0% 95.0% 87.3% 83.9% 87.8% 85.0% 85.5% 82.5% 72.7% 88.2% 82.0% 79.3% 81.6% Sheffield Teaching Hospitals Foundation 74.0% 68.0% 73.4% 73.8% 76.8% 74.3% 72.6% 69.8% 70.5% 77.5% 72.9% 67.2% 70.1% Trust (STHFT) England 78.5% 76.9% 77.7% 77.2% 77.4% 78.0% 77.5% 73.6% 73.8% 78.9% 75.6% 74.3% 69.9%
Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%
20 Doncaster CCG performed at 72.5% against the 85% target. There were a total of 11 breaches within the following tumour groups; Lower GI (4), Head and Neck (3), Skin (1), Urological (1), Gynaecological (1) and Lung (1). 8 of the breaches were associated to 'other reasons’, 5 of which were Covid-19 related breach pathways. The 2 local Covid-19 related breaches were delays to diagnostic testing. The remaining 3 breaches were associated to complex diagnostic pathway (2) and Patient initiated delay to diagnostic testing (1). Of the 11 breaches, 9 of those were as STH as treating provider, 6 of which were 'other reasons'. There were 2 104+ day breaches in May, one at 128 days in the Lower GI and the other at 116 in the Skin tumour group. For the lower GI breach, the reason was patient initiated delay to diagnostic testing.
The 104+ day breaches are being monitored by Cancer Programme Board and assurances will be provided by the Cancer Leads and will continue to be presented at Clinical Quality Review Group on a quarterly basis. The Performance and Intelligence Team has been in discussion with the Cancer Team at DBHT regarding the 62 Day Patient Tracking List (PTL) and current referral numbers within the system. The details below provide assurance that DBTHFT are capturing the required patients. The PTL shows the number of patients that have had a first appointment but are still on the pathway without a decision to treat date and therefore can be awaiting diagnostics etc. for either a conformation or ruling out of cancer. As of 19th July, there are 405 patients waiting to be seen and 666 patients who have had their first appointment and are awaiting further diagnostics. 26 of those are considered to be waiting between 63 and 103 days and 52 patients have been waiting beyond 104 days. This is a reduction of 6 from the previous week. 12 of the patients are to be reviewed and have diagnostic tests within the next 10 days and a further 18 patients are aged 70+ and have been potentially been under isolation or have stated they won’t be attending hospital at the current time. Demographics of patients has largely attributed to increased patient tracking lists within Trusts. This will be continued to be monitored within the team.
62-day wait from referral from an NHS screening service or Consultant Upgrade to first definitive treatment for all cancers Aug- Q2 Q3 Q4 May- Commissioner Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 19 19/20 19/20 19/20 20 Doncaster CCG – 75.0% 78.6% 80.0% 100% 100% 75.0% 95.5% 77.8% 100% 90% 88.9% 100% 0% screening service Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Doncaster CCG – 73.3% 40.0% 67.4% 96.9% 60.0% 85.7% 67.9% 78.6% 70.0% 66.7% 71.8% 60.0% 50.0% consultant upgrade
21 There was 1 breach within the month resulting in performance of 0% against the 90% target. The single breach was in the lower GI tumour group, completing the pathway on day 103 with the breach reason 'other reason' associated to it. The full breach reason was that the pathway was impacted by Covid-19, there was a clinical pause to the pathway as the treatment modality was surgery.
There were a total of 4 breaches in May 2020 resulting in performance of 50% against the 85% target. The breaches were within the Lung (3) and Urological (1) Tumour Groups. The breach reasons associated are as follows; 'Other reasons' (2), Out-patient Capacity inadequate (1) and Complex Diagnostic Pathway (1). There was 1 breach related to Covid-19, the treatment had to change due to guidance/risk stratification.
1.2 NHS National Contract Key Performance Indicators
1.2.1 Yorkshire Ambulance Service (YAS)
Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20 Apr 20 May 20 June 20 Category 1 (Life threatening injuries and illness) target of 00:07:18 00:07:28 00:07:46 00:06:53 00:07:10 00:08:01 00:07:17 00:07:10 00:06:59 average time less than 7min Category 1 target 90% of times 00:12:30 less than 15 min 00:12:46 00:13:15 00:11:54 00:12:32 00:13:25 00:12:32 00:12:16 00:12:15 Category 2 (Emergency) target of average time less than 18 00:21:50 00:23:11 00:27:11 00:17:55 00:18:50 00:23:53 00:15:16 00:12:23 00:13:37 min Category 2 target 90% of times 0:45:14 less than 40 min 00:49:02 00:58:00 00:36:39 00:38:27 00:48:52 00:29:18 00:22:37 00:25:32 Category 3 (Urgent) target 90% 02:09:54 of times below 2 hours 02:18:58 02:56:47 01:31:24 01:45:19 02:15:01 00:59:40 00:45:58 00:56:44 Category 4 (Less urgent) target 90% of times below 3 hours 02:59:54 02:39:07 03:18:01 02:15:22 02:19:00 02:56:35 01:55:44 01:36:37 01:45:33 Category 5 (Lowest acuity) target 90th centile Target TBC 01:29:49 01:21:09 01:49:08 01:04:35 01:28:13 01:41:53 00:55:55 00:25:16 00:40:19
All measures met target during June 2020.
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.
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During May a ‘halo’ YAS staff member was based at Doncaster Royal Infirmary to help reduce the time between handover to the hospital and turnaround time for ambulances at the site. This was stopped in June but with the option to call staff into this role as required.
Section 2: Provider Exception Report
The following section of the report details performance by exception (those measures either rated Red or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH and other commissioned services. Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance as a whole for DBTHFT and Doncaster sites for RDASH, and does not simply relate to services provided to DCCG. Due to the COVID-19 pandemic NHS England and NHS Improvement have directed NHS organisations to reduce routine reporting requirements to free up capacity and manage responses. Some areas agreed with Providers are included below.
2.1 Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT)
This section only includes measures in the DBTHFT contract currently not meeting target which are not included in the constitution measures in Section 1.
No DBTHFT measures have been identified for reporting during the month.
23 2.2 Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)
This section only includes measures in the RDASH contract currently not meeting target which are not included in the constitution measures in Section 1.
Latest Measure Month Target Update performance
Improving May 2.95% 3.2% 5.00% DCCG and RDASH continue to hold monthly Access to 2020 4.00% meetings to discuss ongoing issues with the Psychological 3.00% service with a focus on the workforce required to Therapies 2.00% meet the target. A recovery plan is in place and 1.00% (IAPT) – 0.00% will be reviewed within these meetings. The Cumulative impact of Covid-19 will also be discussed with the percentage of service offering additional telephone and digital people entering IAPT Access Target interventions. Face to face treatment has been treatment as a ceased. proportion of people with anxiety or depression (OF) (RDASH specific DCCG data) IAPT – People May 59.2% 75% Performance improved to 59.2% in May 2020 but referred will 2020 remains below the 75% target. receive treatment within Staffing issues have impacted on the response 6 weeks time of the service. (RDASH specific DCCG data) As previously identified performance should continue to improve from May onwards.
24 IAPT Recovery May 44.3% 50% Performance fell again during May to 44.3%. – At least 50% 2020 of people will The impact of Covid-19 in new ways of working achieve along with the staffing issues set out above both recovery by end contributed to the poorer outcomes. Additional of treatment staff have been recruited and unvalidated (RDASH specific performance data for May shows improvement. DCCG data)
2.3 Other Quality Elements for Inclusion
Primary Care
During the current COVID-19 pandemic, all patients contacting their practice continue to be triaged remotely. This is to assess clinical need and identify any symptoms of COVID-19. Consultations are still being carried out remotely where possible however; face to face consultations with non-symptomatic patients are being carried out if clinically necessary.
Practices are focussing on the restoration of routine services, including screening, in ways that are safe for both patients and staff, taking into consideration social distancing PPE requirements and decontamination.
Patients who are diagnosed and/or symptomatic of COVID-19, or those who are self-isolating due to living in a household with someone who is diagnosed and/or symptomatic, continue to be assessed remotely by a clinician if they have primary care needs. If a face to face consultation is deemed to be clinically necessary, they are referred to the COVID-19 Coordination Hub (CCHubb) which although currently is receiving very low numbers of calls is an expert advice and guidance service for General Practice and relevant others in managing difficult suspected or confirmed Covid-19 patients. Where a direct assessment of the patient by the CCHub is required, there are a number of options available; remote telephone or video assessment, home visits and access to the roving oxygen saturation assessment service.
Plans for the influenza vaccination programme are underway and new ways of working are being explored by the Primary Care Networks with support from the CCG and NHS England. The latest influenza immunisation guidance from NHS England is due imminently and this will clarify the requirements from Primary Care and other providers.
25 National Reporting and Learning System
During the current COIVD19 pandemic, NRLS reporting has continued and collated and logged for identification of any local patterns and trends no patterns or trends have been identified. Practices do have the ability to submit reports without sharing them with us, or to submit reports anonymously; however they are strongly encouraged to share their reports with us to enable any local trends to be highlighted and learning shared.
Continuing Healthcare
Following nationally published guidance in March 2020 all Continuing Healthcare Decision Support Tools were stood down and the Continuing Healthcare Team was redeployed to support with the COVID19 discharge pathway.
The team are continuing to work 7 days a week as part of the multi-disciplinary team. The team are overseeing the management, of nursing bed based discharges and are continuing to do their case management, with main focus being hospital avoidance.
Care Homes
The current status of the pandemic across the borough improves week on week. The number of deaths of care home residents currently stands at 111, with 41 dying in hospital and 70 dying in homes. Please note that this data is as of the 23rd July 2020.
The exact numbers of infected and symptomatic people fluctuates each day, but care home residents currently account for 41% of the Doncaster deaths (111 out of 273). We continue to collect and collate data on each care home on a daily basis, with a continued positive trend in both staff and patient infection rates.
As of the 23rd July 2020 there were no COVID cases with care homes.
Safeguarding
Safeguarding Adult Reviews / Serious Case Reviews
There have been one new Safeguarding Adult Reviews commissioned during this reporting period. Doncaster CCG is supporting the review from a Primary Care perspective with records secured and chronology developed.
26 Lessons Learnt Reviews
There have been no new Lessons Learnt Reviews commissioned by the Doncaster Safeguarding Adults Board during this reporting period.
Domestic Homicide Reviews
During quarter three the Domestic Homicide Review Panel met to consider a case for review. At the time of the meeting the cause of death for the victim had not been confirmed therefore; it has been agreed that the panel would reconvene for consideration following the cause of death being confirmed. The cause of death remains outstanding therefore; the group are yet to reconvene.
The CCG received notification of a further two incidents which took place in June 2020. One of the Domestic Homicide Review has also been logged on the STIES system as a Serious Incident. The Domestic Homicide Review Panel are yet to convene to discuss these cases however; the CCG have secured the patient records and developed chronologies.
Child Death
The child death which was reported in January 2020 remains open to the partnership. The Doncaster Safeguarding Children’s Partnership (DSCP) has identified all relevant children that may inform and / or form part of the review. The Rapid Review has now commenced with two independent reviews in post. The health partnership have worked together in order to develop all key chronologies to support this review.
During this reporting period there has been a further child death with initial meetings taken place. The Deputy Designated Nurse and Chief Nurse have been involved within these meetings and are supporting the process accordingly. It is yet to be established whether a Safeguarding Practice Review / Lessons Learnt Review will take place.
Social, Emotional and Mental Health Proactive Monitoring and Support
As previously reported, following an increasing number of children and young people presenting at the Emergency Department with suicidal ideation or having taken an overdose, the Social Emotional Mental Health Proactive Monitoring and Support Group was established.
27 The group are currently meeting on a fortnightly basis to ensure a timely response to all children and young person. The group is working well with key representation and information sharing from all agencies taking place.
Shielded Children
The CCG, RDaSH and Local Authority continue to work closely to ensure the management of the shielded children and children living with a shielded adult are receiving the support they require during the COVID19 pandemic. The systems and processes established continue to work well with positive joint working.
Section 3: NHS Oversight Framework (no update available)
Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Due to this, national reporting on the NHS Oversight Framework has been suspended.
Section 4: South Yorkshire and Bassetlaw Integrated Care System Assurance Report (no update available)
Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Due to this further updates on the Integrated Care System are not available at this time.
28 Meeting name Governing Body Meeting date 6th August 2020 Title of paper Living Well Life Stage Report
Executive / Ailsa Leighton, Deputy Director, Strategy & Delivery Clinical Lead(s) Performance and Intelligence Team Author(s)
Status of the Report
To approve To consider / discuss
To note x
Purpose of Paper - Executive Summary This report sets out the key quality and performance updates to be noted by the Governing Body from the quarterly updates provided by DCCG and Doncaster Council staff in relation to the 2020/21 Living Well Life Stage Strategic Delivery Plan.
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.
Living Well 2020/21 – Due to reporting restrictions or capacity issues linked to the Covid-19 pandemic some of the 11 actions and associated outcomes have not been started or are unavailable at time of writing.
Recommendation(s) The Governing Body is asked to:
Note the key quality performance areas for attention.
Report Exempt from Public Disclosure
x If yes, detail grounds for exemption: Yes No
Impact analysis Quality Positive quality impact from a consistent focus on quality outcomes. impact Specific quality impact as identified in the report.
Equality Tick impact relevan
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t box
An Equality Impact Analysis/Assessment is not required for x this report.
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 The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts employed in secondary employment by organisations referenced in this of Interest report: please see Register of Interests for details.
Consultation / Engagement (internal departments, N/A 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
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Section 1: Living Well Delivery Plan 2020/21
1:1 Actions
Due Completion Action Update Date (%) Low level interventions, based in our neighbourhoods Work closely with system 31/03/21 75% Work continues virtually with partners of this agenda and culminates in a quarterly partners on Cancer meeting with partners across place and system level including; Commissioners, Local prevention and awareness Authority, Cancer charities and Public Health England. Recent reporting published by rising including Cancer Research United Kingdom (CRUK) has deemed Doncaster at place level at improvement in rates of outlier when focusing on; deprivation score, number of new cases treated, persons smoking/alcohol, diet, screened for bowel cancer, two week wait referrals resulting in a diagnosis and two obesity, exercise - linking week wait referrals. Be Clear on Cancer update to be provided September 2020. too hard to reach groups. Continue to monitor impact on Be Clear on Cancer campaign recruiting community champions to share messages of awareness raising with the population Deliver suicide 31/03/21 100% Complete. bereavement service across Doncaster Borough Develop a delivery plan for 31/03/21 Action lead for Prevention strand of strategy identified. Prevention workshop had been whole systems 'Prevention' planned but did not take place due to COVID19 lockdown (to be rearranged). A draft strand of the homelessness strategy implementation plan has been developed and submitted to Directors for strategy feedback. Develop the neighbourhood 31/03/21 25% PCNs have been fully engaged in the primary care cell COVID response which delivery model, including engages with all partners. The Neighbourhood Co-ordinators employed by PCD are "local solutions", ensuring involved in the locality cell work established by Doncaster Council. The covid response that primary care networks to care homes as an example has ensured that PCNs are fully embedded in the locality (PCNs) are embedded into response to multi-disciplinary team working. the approach, recognising
31 that this action cuts across Starting, Living and Ageing Well. Once developed, deliver the actions agreed, with a focussed approach on the agreed neighbourhood outcome for Living Well. Increase opportunities 31/03/21 25% Update – July 2020 offered by technology, Technology Enabled Independence Board established – core exploring technologies such membership of the board has been refreshed and now includes Principle as Brain in Hand Occupational Therapist (DMBC) and Head of Service for Adult Social Care & Support (DMBC). Board requested a Task & Finish Group to scope out current assistive technology offer and gap analysis. Assistive technology champions identified in every adult social care team. Case example scenarios have been provided by broad range of adult social care teams – to look at identifying areas of opportunity where technology could be part of a solution to improving someone’s independence, meeting a need or improving overall quality of life.
Project in LD Services – ‘Brain in Hand’ Targeted assistive technology project in learning disability services agreed as an opportunity to take forward. The project will focus on use of assistive technology to support individuals with a learning disability to be more independent, live life to full potential and become less reliant on formal care. The project will focus on the cohort of individuals with a LD living in supported living, who receive support with a range of daily living tasks. Through scoping technology solutions available - Brain in Hand (assistive technology application) identified as piece of technology that could be utilised to support individuals with LD to develop daily living skills, meet need and ultimately lead to less reliance on formal care.
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Contact made with business manager for Brain in Hand. Presentation on use and benefits of brain in hand delivered to social care colleagues. Project plan to be drawn up to look at introduction of brain in hand.
Reduce social isolation 31/03/21 60% Building on the good practice carried out during Covid-19 a briefing paper/proposal on through the further a SIA Community Hub/Helpline was tabled at the Community Cell Supported in development of the Social principle however waiting on a final decision. Isolation Alliance Co-ordinated access to services when needed Reduce follow-up 31/03/21 50% A digital focus through telephone/video/patient ed follow up (PLFU). appointments, Through the Elective step-down (Phase 1) digital consultation now introduced. encompassing patient initiated follow-up as alternatives to conventional face to face follow-ups. Collaborate across SYB to 31/03/21 0% e-RS Capacity Alerts work stream led by South Yorkshire and Bassetlaw (STB) implement e-RS Capacity Integrated Care System (ICS). Proposed to commence with Ear, Nose and Throat and Alerts to offer choice at the Gynaecology. Start date awaited from SYB ICS. point of referral, facilitating improved access to elective services thereby reducing the need to offer choice to patients at 26 weeks. Expand IAPT (Improving 31/03/21 50% Expansion investment decisions made. Additional Health Education England training Access to Psychological capacity being accessed for expansion and workforce retention / resilience. Long Term Therapy) capacity in line Condition and Core condition / demographic focus areas progressing but some natural with national mandated COVID related hesitancy and engagement issues. prevalence trajectories. Continue expansion of IAPT regarding Long Term Condition offers and lowering age (<18) and increasing age (>75) offer and uptake.
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31/03/21 10% Update July Maximise use of alternatives to urgent care Due to the Covid-19 pandemic face to face primary care appointments have been through: converted to remote triage and telephone/video consultations. There is willingness - Increasing the availability across Primary Care to continue with these models of delivery post COVID. and use of primary care The Extended Access hubs have also been stood down and work is underway on the appointments, through future model for Extended Access when it is re-instated. provision of and communication about Direct Booking has been temporarily switched off for the SDHC and OOH services, due extended access, on line to the Covid-19 pandemic. However FCMS is currently in discussions with Adastra to consultations and direct turn their direct booking face-to-face appointments in to triage appointments. booking from NHS 111 - Reducing ambulance GP Practices were required to provide telephone appointments for 111 to book directly conveyance rates to A&E into for patient triage until the end of June however locally a decision has been made to and increasing see & treat continue with these slots being available to 111. or use of alternative conveyance pathways As part of the response to the COVID Pandemic, YAS changed their triage model and - Developing the Doncaster redeployed a cohort of Clinical staff into their “hear and treat” model. At the same time CAS (Community there was also an increase in the use of the “see and treat” model and both of these Assessment Service) to actions have seen a significant reduction in conveyance rates between April and June. respond to NHS 111 calls However numbers have started to increase again therefore discussions are taking and provide local clinical place with YAS to understand this and ascertain whether they are able to sustain the advice to either resolve the increase in their “hear and treat” model (due to staff capacity). call or direct patients to the most appropriate local The UEC procurement has been complete and the Provider Alliance is now in the alternatives mobilisation stages. A Project Group has been established and the key focus will be - Ensuring 2 hour home the development of the CAS and in particular looking at how we can develop the response appointments CCHUB model as part of the CAS. made available to ambulance services and Due to the Covid-19 pandemic and the requirement to implement the Rapid Discharge other locally identified pathway, all resources have been focused on this pathway to ensure timely discharge services for appropriate into the community. Rapid Response has seen a recent decline in referrals and further patients in the community comms have been sent out to Primary Care on this.
Optimise the take up of 31/03/21 40% National flu guidance was released in May and this identified the eligibility groups to be
34 population screening and the same as last year but with the possible inclusion of Year 7 children. A 2nd set of immunisation programmes, guidance is expected in mid July and it is anticipated that this may also include the over including flu 50 year age group.
A local Flu planning group has been established and is meeting on the weekly basis. There are been a commitment to work collaboratively across Primary Care with Primary Care Network Directors and the LPC expressing an interest to work together to agree on cohorts of patients for their services. Recent guidance on the administering of vaccines has meant that the vaccinations can now be delivery at PCN level and plans are in place to move this forward.
Due to the complexities with delivering the flu vaccination this year, alternative methods of delivery are being explored such as the Health Bus and Drive through clinics. The draft flu plan will be complete by the end of July. Increase in integrated 31/03/21 25% 50 more council users added since April, increased usage in RDASH to support the Doncaster Care Record updated discharge pathway. (iDCR) usage Stakeholder engagement activity to relaunch the integrated Doncaster Care Record (iDCR) was paused due to the Covid-19 response.
Usage stats to be provided via RDASH, but we expect usage will continue to grow across settings. Holistic delivery of care and support Fully implement the 31/03/21 75% The second interim report of the LWABC Programme was published April 2020 and is Macmillan LWABC available for review, as required. However work continues on all areas of the Recovery Programme including: e- Package. Electronic Holistic Needs Assessment (eHNA) or paper HNA logged through holistic needs assessment the Macmillan system via the use of tablets from within DBTH, Aurora and Macmillan (eHNA) and care plan; e- Living Well service. Further work continues to increase assessments across all treatment summaries specialities and to train the Cancer Care Co-ordinators (non-qualified) to fully shared with patients and implement the use of eHNAs. The patient is able to complete their eHNA at home, in GP; Cancer Care Review the waiting room or with their nurse specialist in clinic, or where appropriate with a by GP or practice Cancer Cancer Care Co-ordinator. If not electronic, all HNAs carried out paper-based and all Champion for 100% to be logged onto the Macmillan System. 60% of all e-HNAs carried out within DBTH applicable patients; "Right are undertaken at the End of Treatment and therefore work continues to bring this By You" programme forward to Initial diagnosis or Start of Treatment, being repeated as appropriate
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throughout the treatment pathway and beyond. Out of the 3 LWABC tumour sites; Breast HNAs are predominantly an end of treatment exercise, while Colorectal HNAs primarily occur at initial diagnosis. In Urology, HNAs tend to be completed at the start of, or during treatment.
The development of e-Treatment summaries is progressing, and continue to be shared in a hard copy format awaiting electronic development. Collaboration with primary care continues to integrate care through both treatment summaries and the cancer care review (CCR) (currently out to consultation Nationally). Regarding the CCR (and wider front-end objectives around Early Diagnosis), engagement has occurred with PCN Leads to identify cancer champions in order to take forward this work. The aim for the CCR is to design and implement a revised template to enable a collaborative approach to encourage buy-in at the appropriate time for patient review.
Regarding general Health & Well-being, a number of projects have been identified to support H&WB, all of which are in the preliminary stages. The focus will likely focus on nutrition and exercise initially, by creating nutrition-focused sessions for during treatment and developing an exercise programme with Doncaster Culture Leisure Trust. This element of work in addition to the Primary Care Macmillan ‘Right By You’ has stalled due to COVID-19.
Full review of current adult 31/03/21 0% Strategic Transformation Lead start date delayed. and older adult Community Living Well Lead not being pursued by joint commissioners. Mental Health models to prepare and align with both It should be noted that Community delivery has significantly modified due to COVID, LTP expectations and local with this presenting potential accelerated gain opportunities. requirements from 2021. Develop all age adaptive 31/03/21 15% Development opportunity impacted by COVID. Some COVID informed learning on models for functional MH Crisis models particularly. IAPT <16 progressing. - including ADHD, Eating Disorder proposals, At Risk Mental State (EIP), IAPT, Adult Crisis reach and equity Review of floating support 30/09/20 A draft implementation plan has been developed for the Care and Support strand of the
36 offer including mapping of Homelessness and Rough Sleeping strategy and submitted to Directors for feedback. existing provision Draft implementation plan will be reviewed to reflect learning from the delivery of (commissioned, non- services during COVID19. Desktop review of provision has been undertaken. commissioned, St Leger Homes, Complex Lives Alliance), where they are delivering it, identifying duplications and gaps to develop commissioning intentions Increase personalised care 31/03/21 100% Rights to personalised care and support is now enshrined by the law, by virtue of the and support planning, Care Act. In Doncaster there is a strong commitment to self-directed support and personal health budgets strength based practice when carrying out such assessments and support planning. and consider the future Adult Social Care in Doncaster are committed to and have embedded strength based development of Social practice in assessment and support planning. In September last year (2019) the Prescribing, linking in with Strength Based Practice framework was launched. local Primary Care The practice framework in Doncaster around self-directed support and support Networks planning is deep rooted in core principles of personalisation. The position in Doncaster is that for everyone who requires care and support, consideration must firstly be given to a direct payment. Individuals are actively encouraged by Social Workers to take up direct payments.
Social Prescribing Link Workers Link In year 6 link workers have been appointed and are aligned to and embed within the PCN’s. The post are funded until 31 March 2024
Personal health Budgets continue to be offered to new and existing VHC Cases. Each case is afforded a case manager who works with the individual to identify their care needs and how best these can be delivered. This is manifested in the development of care/support plan that recognises the individual needs of the service user and the different approaches available.
Build on the work started in 31/03/21 10% New discharge pathway put in place following national guidance; a review is now 2019/20 across the health underway to determine how to lock in the opportunities from this change and determine
37 and social care system the model moving forwards. Note due to the impact of Covid-19 expectations (including the High Impact regarding bed occupancy levels many change. Change Model) to reduce length of stay, work towards 92% bed occupancy rates and reduce delayed transfers of care Develop Physical Disability 31/03/21 60% Work on hold from a commissioning perspective during Covid-19, this is due to the lead accommodation offer and officer overseeing Domiciliary Care, plans will be developed during recovery to ensure wrap round care and move back to BAU. support services Prior to lockdown presentation to portfolio holders (Racheal Blake and Glyn Jones) had taken place and next steps discussed.
Overview of work to date shared with Karen Lythe as new chair of the Homes for All Board. Develop the place based 31/03/21 15% Whole Systems Partnerships (WSP) have been commissioned to undertaken the work workforce strategy, to that will inform the strategy. Work had been stalled due to COVID-19 however has now include future workforce recommenced. A proposal is being produced to all 5 CCGs across South Yorkshire requirements and the and Bassetlaw and the scope will be extended to include primary care workforce. The design/ delivery of training next step is a piece of engagement work to progress with the plan and it is likely that and education to reskill this will take place during August and September. existing staff and train new staff Deliver identified actions 31/03/21 15% Adult ASD diagnosis against the priority areas set out within the Learning April to June 2020; Disability and Autism ASD service partially stopped Strategy: • Continuing support with people on their caseload. - Diagnosis - • New diagnostics on hold education and inclusion - • Case by case review for priority employment • Requires face to face appointments - family and carers - • Can work with clinic with PPE. housing and support • Referral list to review for priorities. (including short breaks) • Need to understand future investment and funding
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- health inequalities - transitions Previous work started with RDaSH around the ASD diagnosis service to address the waiting times and after diagnosis support. Business case reviewed by CCG late summer 2019 which was at quite a high cost increase for the service and it had some crisis support added into it.
CCG and RDaSH reviewed this business case and agreed to keep the crisis support separate, instead RDASH to use the already established Crisis and Intensive Support (CAIS) team. One of the forensic nurses had just left her post in the CAIS team which left a vacancy in the team. We agreed this vacancy should be filled with an ASD specialist nurse because the Forensic Liaison Service (FOLS) could support where any forensic knowledge gaps appear. In November the ASD specialist nurse was appointed to the CAIS team and so far is working really well.
RDaSH and CCG met in September to discuss what we needed from the ASD service again. It was identified the waiting list to the service continued to rise so asked RDaSH to present in the business case on what they needed as a non-recurrent resource to bring the waiting times down to fit with NICE guidance and then what resource they would need following the reduction in waiting times to retain within NICE guidelines.
Received an addition to the original business case in December, comments added by CCG and fed back to RDaSH as noted in FPIG however. This business case has not been received as yet from RDaSH and is on the agenda for FPIG.
A task and finish group was set up for 25.03.2020 but was cancelled due to COVID responses.
June 2020 Commissioning and contracting from DCCG met via MS Teams to discuss the business case. Contracting advice was that under the current block payment funding arrangements/guidance from NSHE we are currently unable to make any new investment decisions therefore would not be in a position to approve a business case. CCG finance and contracts are waiting for further guidance around what the payment arrangements will be for the rest of the year and whether the CCG will be able to make any investment decisions.
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DCCG commissioning and RDaSH service manager met to request an update to the business case with patient waiting numbers and to ascertain what the service is currently financially receiving to understand the full cost of the investment and staffing model.
RDaSH Adult ASD diagnosis service added to agenda on the contracting board for beginning of July.
During Experience and Engagement Committee it was requested Primary care be involved in the understanding of referral route for the service.
Housing and Support – In Jan / Feb the project plans were revised and refreshed, with further detail to be agreed against timelines and allocation of actions at the next meeting, prior to approval by the LD and Autism Partnership Boards. The workstream is due to meet again in August 2020 (first meeting since start of Covid). 1. The Strategic Housing Needs Assessment is underway, (Campbell Tickell on behalf of South Yorkshire ICS). Report due Sept 2020. 2. Travis Gardens SLS development, Residential care contract extended for further 6 months from July 20, to enable the development works to be carried out and the Landlord to be appointed prior to development as Supported Living Service. 3. Management of voids agreement shared with existing landlords, with final negotiations / signatures nearing completion. 4. Stocktake of current provision is underway, with ongoing negotiation with SYHA to increase SLS capacity across existing properties. 5. Options appraisal for In house residential service underway to be completed by end July 20. 6. See also update of Shared Lives below.
Short Breaks – The All Age Delivery Plan for Short Breaks has been developed, including the key areas 1) engaging with carers and individuals who currently access short breaks - what they
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feel currently works well and what improvements they would like to see. 2) Analysis of the data to complete strategic needs assessment. 3) Development of current in house bed based respite service, to use this differently. 4) re-fresh of short breaks offer - exploring other opportunities for a more blended approach to short breaks (not solely focused on bed based) 5) Enhancing the Shared Lives offer to include short breaks (see update below) 6) Producing easily accessible information in regards to short breaks offer Next meeting to be held in July 2020.
Shared Lives - Monthly working group meetings due to be re-established from July 2020. 1. Significant progress been made in communication and working relationships between key stakeholders. 2. Communication & Engagement plans have been aligned between the provider and the Council Communications teams. To be signed at end of July. 3. The referral process has been reviewed, revised and signed off. 4. The payment banding tool developed and to be signed off at next meeting. 5. A service review of Shared Lives was undertaken and a report summarising the findings to be completed and shared with the Housing and Short Breaks work-streams.
Responsive and accessible care in a crisis Embed new statutory & 31/03/21 20% Recruitment largely complete and delivering gain. Active acute liaison pathway and third sector assets for Crisis liaison model design temporarily suspended due to COVID. Good progress on Resolution / Home partnership development as a consequence of COVID, and commitment to further Treatment / Alternative pathway mapping for UEC connected agencies – tying together CCG, RDaSH, SYP, Places / Acute Psychiatric YAS, Adult Social Care, PH. Alternative third sector models progressing – with full Liaison / Suicide Prevention operation of Safe Space and gradual but delayed mobilisation of High Intensity User & Response Support. and Suicide Attempt Response & Prevention programmes. Implement the Homeless 31/03/21 A draft implementation plan has been developed for the Accommodation strand of the and Rough Sleeping Homelessness and Rough Sleeping strategy and submitted to Directors for feedback. Strategy, with a focus on: Draft implementation plan will be reviewed to reflect learning from the delivery of
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- rapid re-housing services during COVID19. - hostel re-modelling including assessment hub Hostel re-modelling:- - substance misuse Liaised with legal re: lease arrangements with landlords. accommodation and Liaised with both hostel landlords seeking views of reducing capacity in support hostels and impact. - expansion of Housing First Liaised with current support provider on a similar basis. Updated hostel briefing paper and meeting scheduled for 8 July 2020 to feedback and obtain a steer. Approval to extend current homelessness contract for a further 12 months as a result of COVID19 impact to support re-modelling work
Expansion of Housing First: Currently engaging with additional providers of Housing First accommodation Linked in Complex Lives to draw up a list of 21 individuals as potential tenants of Housing First. Proposals made to MHCLG re: re-purposing Rough Sleeper Initiative funding allocation to support pump priming of Housing First
Substance Misuse Accommodation & Support: Approval to extend current contract for a further 12 months during which time the contract is intended to be subsumed into the wider Aspire treatment contract in order to test out local delivery of an integrated treatment and accommodation model. This will inform joint commissioning potential in the future.
COVID19 local response to homelessness informed by the “Everyone In” government directive to find emergency accommodation for those who were rough sleeping by 27 March 2020 followed by a requirement to accommodate individuals presenting as homeless during the pandemic. This has involved the use of existing capacity of the current homelessness pathway along with additional emergency accommodation within two hotels in the borough. As at 30 June 2020, 84 individuals were accommodated in
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hotel accommodation. Personal housing plans are in place for the majority with a preferred move on destination (e.g. private rented sector, supported housing, hostel) identified. Lessons learned from COVID19 to inform the content and deliver of the strategy implementation plans.
Person centred support for people with complex needs Review of forensic LD 31/03/21 60% June 2020 pathway aligning to regional South Yorkshire Police requested a meeting with representatives from the ICS to build and national inpatient and implement prevention and diversion training. This is aimed at individuals with a trajectory with a focus on forensic risk to understand consent around sex and staying safe to as a proactive building appropriate and measure to avoid individuals becoming criminalised. Doncaster to pilot through PMSR sustainable community MDT approach involving FOLS, ASD diagnosis services, RDaSH service manager, provision CCG commissioning and quality members and the CAIS team.
Springwell lane closed which has resulted in a reduced step up/down community forensic provision for the local area need. Danescourt remain in service but not as a flow through step up/down provision.
Firshill rise block booking 1 bed for Doncaster remains on hold due to current block payment funding arrangements/guidance from NSHE we are currently unable to make any new investment decisions. Agreed in principle by CCG SMT in March. This will be reviewed again when able to do so.
Enhanced Provider Framework review is required to assess the measures and outcomes however due to COVID planning and responses this has reduced the capacity to carry out. Mobilisation meetings continue to progress community discharge for those patients already referred and accepted to the framework. Funding of care packages not yet agreed in panel due to no destination of discharge set at this time.
LD pathway subgroup to Clinical Quality Review Group re-established on 23rd June. Action to set up patient flow meetings between CCG and RDaSH to highlight upcoming needs of service provision and case review of current needs for patients placed out of area.
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Work alongside the Mental 31/03/21 10% Mental Health Alliance meetings and planned housing workshop not progressed due to Health Alliance to COVID-19. undertake a distinct piece of work linked to Mental Mental Health Alliance Meetings are taking place again virtually so moving forward it Health & Housing to will be through this route the work will progress. understand issues, barriers and develop action plan as appropriate The DCCG and Council 31/12/20 25% This work progressed between the two teams but stalled as a technical development Performance Teams will due to other emergency work (e.g. Flood, Covid etc.). work to provide a more advanced experience Future joint work between DCCG and DMBC in this field is likely to be more influenced based approach for by the legacy of the joint working established through the Covid data cell – e.g. flow reporting against delivery models, population segmentation. plan key identifiable priorities
1.2 Performance measures and outcomes
A number of information and outcome lines are currently unavailable due to continuing prioritisation due to the Covid-19 pandemic. These lines will be developed and reported as workflows return to normal.
Ensure at least 450 Doncaster patients are receiving a Personal Health Budget 600 400 Target 200 2019/20 0 2020/21 Qtr 1 Qtr 2 Qtr 3 Qtr 4
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Ensure that at least 60% of Doncaster patients on a GP SMI register receive Physical Health checks 100% Target 50% 2019/20 0% 2020/21 Qtr 1 Qtr 2 Qtr 3 Qtr 4
Reduce the number of Delayed Discharges of care for Doncaster patients 800.0 600.0 Target 400.0 2019/20 200.0 0.0 2020/21 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Increase the amount of Doncaster patients accessing IAPT services against estimated need 6.5% 6.0% Target 5.5% 2020/21 5.0% Qtr 1 Qtr 2 Qtr 3 Qtr 4
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Cancer 62 day standard for Doncaster patients 90% 85% Target 80% 2019/20 75% 2020/21 Qtr 1 Qtr 2 Qtr 3 Qtr 4
Reduce out of area inappropriate MH out of area placements to zero 1,500 1,000 Target 500 2019/20 0 2020/21 Qtr 1 Qtr 2 Qtr 3 Qtr 4
Reduce the number of out of Area placements for LD patients 10 Target 5 2019/20
0 2020/21 Qtr 1 Qtr 2 Qtr 3 Qtr 4
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Increase Social Prescribing per 1000 population 2019/20 8 referrals 6 per 1,000 4 population Target 2 0 Qtr 1 Qtr 2 Qtr 3 Qtr 4
Increase Personalised care and support planning
400
Target 200 2020/21 0 Qtr 1 Qtr 2 Qtr 3 Qtr 4
Decrease the percentage of Doncaster patients that are smokers 20% 15% 10% Target 5% 20/21 0% Qtr1 Qtr2 Qtr3 Qtr4
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Reduce the Suicide rate per 100,000 using 3 year rolling average 15 10 Actual 5 Target 0 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20 2019-21
Increase the Life Expectancy in Males (years) 80 60 40 20 0 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18
Increase the life expectancy in females (years) 80 60 40 20 0 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18
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Meeting name Governing Body Meeting date 4 August 2020
Title of paper Finance Report June 2020 (Month 3)
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 June 2020 for consideration by the Governing Body.
The CCG is currently working with an interim financial regime for April – July (Month 1-4) only due to the Covid-19 pandemic. Therefore at this time there are no set financial targets for the CCG to meet and no QIPP expectations. The financial regime for the remainder of the year is not yet known.
The report also outlines:
• The risks that the CCG is currently facing • Details around the rest of the financial year • The CCG’s Financial Summary (Appendix 1) • The CCG’s current spend related to Covid-19 (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 At the time of writing any additional allocations for non-Covid related overspends have not been confirmed. The CCG has however received an Financial allocation for the Covid Spend as at the end of May but not for June as implications yet. There is therefore a risk of overspend which the CCG may be asked to manage. 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 Risk of NHSE not funding the additional costs being incurred above the Risk defined allocation and not funding costs associated with Covid-19.Risk of analysis the current regime around investment, QIPP and MHIS. Corporative Objective / CO4 - maintain spend within allocations overall. Assurance Framework
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NHS DONCASTER CCG
2020/21 FINANCE REPORT MONTH 3 – JUNE 2020
1. Introduction
This report provides the financial position for NHS Doncaster CCG for 2020/21 as at the end of June 2020 (Month 3). Due to the interim financial regime the CCG does not have any specific targets to achieve. The CCG has been notified of its allocation based on expenditure as at Month 11 2019/20 adjusted for inflation and a few other minor adjustments.
2. Current Position
Due to the coronavirus outbreak the 2020/21 planning and contracting round was suspended in mid-March. NHS England and Improvement have issued guidance on how CCG’s need to work with providers during the interim period. The following summarises some of the current arrangements –
• The CCG’s main NHS providers are being paid on a block basis, the value of which was determined centrally by NHS England. This is only for contracts that exceed a set value. No other payments will be made to any other NHS providers by the CCG at this time. • CCG’s are reimbursing their main acute provider for all other contractual activity that they would usually receive from their smaller contracts. For Doncaster CCG this is Doncaster and Bassetlaw Hospital NHS Foundation Trust. • Primary Care income streams are being protected at 2019/20 levels as a minimum including national DES and LES payments. • Individual placement costs are still being reimbursed and the CCG is working closely with numerous providers who are having to be flexible in terms of their delivery of care at this time. • Non NHS providers are being reviewed on an individual basis. Income streams are not guaranteed for this cohort of providers and depend upon the levels of service being provided at this time, and whether they are deemed critical to the Covid-19 response. Providers are being encouraged to seek other government support where necessary. • Additional funding is available to support the Covid-19 response and returns are being regularly submitted to NHS England on additional costs incurred that are in line with the guidance. Governance around the agreement of additional costs is being maintained in line with usual processes. • The new Discharge Protocols are also being centrally funded by NHS England including funding for any new packages of care that are initiated during this period in order to safely discharge a patient from hospital or avoid a hospital admission.
The above regime is currently in place until the end of July 2020 and further guidance is expected shortly to inform the regime for the remainder of the financial year. The CCG was showing an over spend at Month 3 of £1,038k of which £793K
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relates to costs directly incurred as a result of Covid-19. The forecast position is £3,392k which includes a forecast of £1,347k overspend on Covid-19 costs. The CCG has received an allocation in Month 3 to cover the cost of Covid-19 incurred to the end of May. Attached at Appendix 1 is a summary of the financial position that was submitted to NHS England for Month 3. It is anticipated that retrospective allocations will be provided for the Covid costs for June and the additional expenditure above allocation that is being incurred.
A summary of the position is as follows
Area of spend Variance Detail £’000’s Acute services -1,068 Underspend on Non NHS Acute contracts CHC 584 Cost of placements Prescribing 485 Under accrual from 19.20 and increased costs in year Delegated Co- 459 Shortfall in allocation – increased PCN costs Commisioning Other Programme 549 Mainly PTS costs related to Covid-19 Running Costs 210 Reduced Allocation Other minor -181 Total 1,038
The CCG, along with all other CCG’s, have been asked to provide additional information regarding the current variances to NHS England together with further information to support the Covid-19 costs being incurred.
It should be noted that the NHSE model used to calculate the allocation, has resulted in some of the allocations not being sufficient. For example the Delegated Co- Commissioning budget is lower than the allocation received last year and is therefore not sufficient to fund the additional investments in primary care that are required as per the Forward Plan. Also the running costs budget is less than the notified allocation, it has been advised that this has been reduced as some CCG’s utilise running cost underspends to offset programme costs so nationally they have top sliced the running costs budget. All of these issues are not just affecting Doncaster CCG and have been flagged to NHSE.
3. Month 5 – Month 12
Further guidance is awaited regarding the financial regime for the remainder of the year, however it has been confirmed that the block arrangements for NHS providers will continue. It is anticipated that additional allocations will be on a prospective basis and not retrospective, however it is not clear if the additional allocations will be given to the ICS, place, or direct to CCG’s and providers. This is clearly a risk to the CCG’s financial position this year if we are expected to break-even.
CCG’s and providers have been asked to submit high level revenue and capital plans for the remainder of the year to aid discussions at the Treasury. These have
Page 4 of 5 been based on a number of scenarios including that current activity levels continue and also that additional activity will start to take place as the year progresses.
It is anticipated that a detailed plan will be required and the guidance around this is expected in mid-July.
4. Risks
There are a number of risks facing the CCG at the moment that the Governing Body need to be made aware of. The CCG has transformation and delivery plans and it is not clear how some of this can be progressed as there is uncertainty around investment and additional funding. It is not clear if the CCG will be expected to make any QIPP savings in year or if these will be offset by additional top ups.
It is not known what activity and capacity providers will be able to deliver in year and what the impact of this will be on the underlying demand for future years. It is not clear if the regime for 2021/22 will revert back to the original position and therefore what the impact of the current regime will have on the CCG’s recurrent underlying position moving into next year.
Clear guidance around the Mental Health Investment standard is awaited although it has been signalled that this will be a requirement for 20/21.It is not clear how CCG’s can progress this under the current regime when investments are not allowed and NHS providers are on block arrangements.
5. Conclusion
The Governing Body are asked to note the current financial position and the expectation around additional allocations so that the CCG breaks even. They are also asked to note the restrictions currently in place around investments, the uncertainty around efficiency savings and delivery of the MHIS.
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NHS DONCASTER CCG - SUMMARY FINANCIAL POSITION MONTH 3 2020/21 APPENDIX 1
Month 3 Total incl Covid Covid Costs Month 4 Forecast Total Covid Costs Forecast Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Revenue Resource Limit (in year) 134,501 134,501 0 179,012 179,012 0
Acute services - NHS (Block) 63,993 64,013 20 0 0 0 85,324 85,351 27 0 0 0 Acute services - Independent/commercial sector (outside of Nationally procured) 2,890 1,806 -1,084 0 0 0 3,853 2,587 -1,266 0 0 0 Acute services - Other non-NHS -6 0 6 0 0 0 -8 0 8 0 0 0 Acute Services - Other Net Expenditure -17 -27 -10 0 0 0 -23 -40 -17 0 0 0 Acute Services 66,859 65,791 -1,068 0 0 0 89,145 87,898 -1,248 0 0 0
MH Services - NHS (Block) 10,416 10,367 -48 0 0 0 13,888 13,901 13 0 0 0 MH Services - Independent / Commercial Sector (outside of Nationally procured) 5,199 5,309 109 0 0 0 6,932 8,021 1,089 0 0 0 MH Services - Other non-NHS 189 131 -58 0 0 0 252 241 -11 0 0 0 MH Services - Other net expenditure -141 -235 -94 0 0 0 -188 -514 -325 0 0 0 Mental Health Services 15,663 15,572 -91 0 0 0 20,883 21,649 766 0 0 0
Community Health Services (ISFE) 11,346 11,357 11 72 104 32 15,104 15,116 12 72 123 51
Continuing Care Services (ISFE) 9,701 10,286 584 300 633 333 12,835 13,712 876 300 786 486
Prescribing 14,892 15,377 485 0 0 0 19,856 20,742 886 0 0 0 Community Base Services 1,310 1,211 -99 0 0 0 1,746 1,707 -40 0 0 0 Out of Hours 0 0 0 0 0 0 0 0 0 0 0 0 £1.50 per head PCN Development Investment 122 115 -6 0 0 0 162 162 0 0 0 0 GP IT Costs 339 399 60 90 104 14 422 437 15 90 104 14 PC - Other 341 285 -56 0 0 0 454 343 -111 0 0 0 Primary Care Services (ISFE) 17,004 17,388 384 90 104 14 22,642 23,392 750 90 104 14
General Practice - GMS 6,428 6,614 186 0 0 0 8,571 8,821 250 0 0 0 General Practice - PMS 1,201 1,425 224 0 0 0 1,601 1,900 299 0 0 0 Other List-Based Services (APMS incl.) 598 554 -44 0 0 0 798 702 -96 0 0 0 Premises cost reimbursements 1,508 1,621 113 0 0 0 2,010 2,171 161 0 0 0 Primary Care NHS property Services Costs - GP 0 0 0 0 0 0 0 0 0 0 0 0 Other Premises costs 14 17 3 0 0 0 19 23 4 0 0 0 Enhanced services 254 443 190 0 0 0 338 607 269 0 0 0 QOF 806 525 -281 0 0 0 1,075 1,033 -42 0 0 0 Other - GP services 70 139 68 52 123 71 76 151 75 52 123 71 Primary Care Co-Commissioning (ISFE) 10,879 11,337 459 52 123 71 14,488 15,407 919 52 123 71
Other Programme Services (ISFE) 1,928 2,477 549 455 798 343 2,419 3,242 823 455 1,179 724
Total Commissioning Services 133,379 134,207 828 969 1,762 793 177,516 180,415 2,899 969 2,315 1,346
Running Costs (ISFE) 1,122 1,331 210 0 0 0 1,496 1,989 493 0 1 1
Total CCG Net Expenditure 134,501 135,539 1,038 969 1,762 793 179,012 182,404 3,392 969 2,316 1,347 NHS DONCASTER CCG - SUMMARY OF COVID COSTS MONTH 3 APPENDIX 2
Total April May June FOT to M4 Category YTD £000 £000 £000 20/21 £000 £000 OOH capacity/CHUB * 0 122 38 160 203 PPE (scrubs) 25 9 0 34 34 Hospital Discharge Programme 124 332 432 888 1,307 Daycare Support 0 0 83 83 83 Care Home Digital Support 0 0 79 79 79 Sickness Cover 0 10 1 11 11 Renal Transport Costs (bulk heads and additional resources) 87 80 57 224 315 GP Bank Holiday Cover 52 0 0 52 52 Primary Care Additional Costs 0 0 86 86 86 Community Equipment Costs 0 38 18 56 56 SMS costs 0 89 0 89 89 Minor costs incl. comms 0 1 0 1 1 Total costs 288 681 794 1,763 2,316
Note * OOH/CHUB costs in May include £55k from April omitted in error Meeting name Governing Body Meeting date 6 August 2020
Title of paper Chair and Chief Officer Report
Executive / Dr David Crichton, Clinical Chair Clinical Lead(s) Jackie Pederson, Chief Officer Cheryl Rollinson, Head of Corporate Governance Author(s) Paul Hemingway, Head of Communications and Engagement
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: • 2019/20 Annual Report and Accounts • NHS 72nd Birthday • South Yorkshire & Bassetlaw (SYB) System Reset • Healthwatch Doncaster Survey
National Update: • GP Patient Survey 2020 • NHS Reset Campaign • NHS Parliamentary Awards 2020
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:
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Impact analysis Quality impact Neutral Neutral
Tick relevant box
Equality An Equality Impact Analysis/Assessment is not required for this report. X impact An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of Paper is for information. No relevant interests. Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Nil analysis Assurance CO1 - 1.1 Framework
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Chair and Chief Officer Report 6 August 2020
1. CCG Update
1.1 2019/20 Annual Report and Accounts Our Governing Body formally approved the CCG’s 2019/20 Annual Report and Accounts at its extra-ordinary meeting held 24 June 2020. A shorter, interactive version of the report will be available later this year and our Annual General Meeting (AGM) will take place on the 2nd September 2020. Further details will be made available on our website https://www.doncasterccg.nhs.uk/.
1.2 NHS 72nd Birthday On 5 July 2020 the NHS celebrated its 72nd anniversary. Whilst the health service has seen many changes over the years and faced many challenges, the coronavirus pandemic has presented the greatest challenge yet. We would like to take this opportunity to say ‘Thank You’ to our employees, partners and members of the public for their continued support and response during these unprecedented circumstances.
1.3 South Yorkshire & Bassetlaw (SYB) System Reset A SYB workshop, led by the Army, was held in July to consider contingency planning as part of the plans to manage potential coronavirus outbreaks. Participants included senior leaders from across Health and Social Care organisations, the learning from working through different scenarios will be built into local plans as they are revisited. Planning for Phase Three of the SYB coronavirus pandemic response continues. Guidance from NHS England and NHS Improvement to inform the process is expected imminently.
1.4 Healthwatch Doncaster Survey We are working closely with Healthwatch Doncaster, Primary Care Doncaster and our GP Practices to gain feedback from Doncaster patients who have accessed healthcare appointments from their local practice via video or telephone calls during the Coronavirus pandemic. Feedback from these experiences will inform and shape the development of future services provided in the local community. The survey can be accessed here.
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2. National Update
2.1 GP Patient Survey 2020 Results from the latest GP patient survey 2020 are now available on the NHS England and NHS Improvement website; the survey ran from between 2nd January 2020 and 6th April 2020.
2.2 NHS Reset Campaign This is a new campaign led by the NHS Confederation focussing on how the health and care system should look like in the aftermath of the coronavirus pandemic. ‘The role of health and care in the local economy: A five-point plan for every system’ is a helpful strategy for local NHS and social care organisations to consider in their approach to local place-based economic and social recovery and reset.
2.3 NHS Parliamentary Awards 2020 NHS England and NHS Improvement have launched their annual parliamentary awards for 2020. This award is designed to encourage health and care organisations to engage with local MPs and recognise the successful work which happens locally. Deadline for nominations is Friday 7 August 2020.
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Enclosure C
CHIEF EXECUTIVE REPORT
July 2020
Author(s) Andrew Cash, Chief Executive Officer
Sponsor Andrew Cash, Chief Executive Officer
Is your report for Approval / Consideration / Noting
For noting and discussion
Links to the STP (please tick)
Invest and grow Reduce Treat the whole Join up health primary and inequalities person, mental and care community care and physical Standardise Simplify urgent Use the best acute hospital and emergency Develop our technology care care workforce
Work with Create financial patients and the sustainability public to do
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 (SYB ICS) provides a summary update on the work of the SYB ICS for the month of June 2020.
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.
1
South Yorkshire and Bassetlaw Integrated Care System
CHIEF EXECUTIVE REPORT
July 2020
1. Purpose
This paper from the South Yorkshire and Bassetlaw Integrated Care System System Lead provides an update on the work of the South Yorkshire and Bassetlaw Integrated Care System for the month of June 2020.
2. Summary update for activity during June 2020
2.1 Coronavirus (Covid-19): The South Yorkshire and Bassetlaw position
There continues to be an ongoing decline in new cases, including the number of Covid-19 cases in South Yorkshire and Bassetlaw. This sustained reduction in new cases allows the system to firmly look ahead towards Phase Three from August 2020 to April 2021 - resetting the NHS.
There are a number of key concerns for health leaders as the NHS recovery process looks to restore services. Issues raised include restoring the NHS amidst workforce challenges, potential lengthening of waiting lists, and strict infection control measures – all of which will significantly impede capacity.
Supplies of Personal Protective Equipment (PPE) have improved significantly, particularly sterile gowns and sterile gloves and alternative suppliers through the support of Heads of Procurement have been sourced. General PPE continues to improve though there remain some concerns about the supply of PPE in Primary Care, and this remains a high priority.
PCR testing (testing of swabs to see if people have the virus) continues to be in a strong position. SYB labs have capacity to undertake testing of NHS and social care patients and staff. In addition, members of the public with symptoms have access to swabbing via the regional testing sites at Doncaster Airport and Meadowhall as well as via the mobile testing units (MTUs) that are sited most days at Barnsley County Way, Rotherham AESSEAL stadium and Dearne Valley Leisure Centre. The MTU at Meadowhall continues to be one of the five busiest in England, typically undertaking more than 400 swabs per day.
For antibody testing, approximately 50% of all NHS staff in SYB have now been tested (up to 22nd June) although this varies between each of SYB's five Places; Doncaster and Bassetlaw were first to have the analytical capacity in the lab and most staff there have been tested.
With regards to the NHS reset, there is now a very strong case being considered for returning to fewer hospital Covid treatment sites in SYB. This would see the scale-down of the Covid surge capacity response, mirroring the original scaling up in March. At the same time, partners are now resuming some services, focusing on clinical priorities for those who most urgently require treatment. Cancer care continues to be one of the main priorities in SYB’s system recovery plans and partners are working to review and reprioritise patients.
The System also has a role in supporting reset in the community. Working with partners in primary care and the community there is a need to ensure that population health and the needs of our communities post-Covid are understood and supported. This includes the plans that are underway for how to manage the follow-up and rehabilitation needs of patients who have had Covid.
Each of SYB’s Local Authorities has a robust Local Outbreak Plan which is supported by a regular flow of data and led by Directors of Public Health. With the recent further easing of lockdown
2 measures at the beginning of July, partners’ Plans took into account the potential for increase in demand, particularly in relation to urgent and emergency services.
2.2 National update
On June 9th, there was a joint session between ICS and STP Independent Chairs and Executive leaders with senior colleagues at NHSE where the future of system working was discussed. The event was one of a broader conversation on the future of systems, alongside further opportunities to be involved in the coming months.
2.3 Regional Update
The North East and Humber Regional ICS Leaders continue to meet weekly with the NHS England and Improvement Regional Director to discuss where support during Covid-19 should be focused. Discussions during June focused on improving BAME inclusion, outbreak management arrangements, support for care homes, supporting urgent and emergency care as public confidence returns and planning for Phase Three.
2.4 Planning for Phase 3 and Phase 4
Further NHS planning guidance and a financial framework are expected in mid-July. A first draft SYB System Plan, which is an amalgamation of all five Place Plans, is currently in development. It takes into account constraints such as workforce, estates management, infection control and PPE while also incorporating examples of best practice in SYB and nationally. There will be a final submission at the end of July.
To support the planning process, a workshop to stress test the restoration of broader health and sustainment of care services in a COVID environment with partners took place on June 1st. This valuable exercise explored four possible scenarios across Places, offering opportunities for colleagues across health and care to analyse local plans in order to make improvements. Feedback from the session was very positive, with the learning now being built into local plans.
2.5 Identifying and embedding transformational change across SYB and capturing learning from the Covid-19 crisis
The ICS Programme Management Office is working with the Yorkshire and Humber Academic Health Science Network to capture views of senior leaders and colleagues from across SYB's health and social care organisations to feed into the joint project: ‘Identifying and embedding transformational change across SYB and capturing learning from the Covid-19 crisis’. To accurately capture and understand the innovation that is emerging, views are being gathered from those directly involved in the implementation of the rapid changes through an extensive consultation exercise.
2.6 Cancer update
Cancer care continues to be one of the main priorities in SYB’s system recovery plans. Partners are working to review and reprioritise patients who have previously been on waiting lists. Those patients who have waited for a long time already and are a priority clinically are very much at the forefront of efforts to receive fast-track diagnostic and treatment services.
The results of the recently published NHS England and Improvement commissioned National Cancer Patient Experience Survey saw SYB 2% above the national average in the areas of patients thinking they were seen ‘as soon as necessary’ (86%) and the length of time ‘waiting for tests to be done being about right’ (90%). The survey monitors national progress on the patient’s experience of cancer care and acts as a driver to improve quality at local level. This is strong evidence of the excellent work taking place across SYB.
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2.7 Planning for Flu
Modelling for influenza infections in the UK is now starting to take place as preparations for winter get underway, with a recognition that this could occur alongside a further Covid-19 peak. This is firmly on the radar of SYB’s testing cell which has started to devise a winter testing strategy to support the system level planning. Supporting this work will be a system level flu strategy, which will be made up of five Place plans and a SYB Flu Board.
2.8 Accelerating NHS progress on health inequalities during the next stage of COVID recovery
The disproportionate impact on people from Black, Asian and minority ethnic communities, people living in areas of high deprivation and inclusion health groups shows starkly the health inequalities which persist in England today. The NHS Long-Term Plan commits the NHS to addressing health inequalities and much excellent work is underway already, particularly focused on medium and long-term action. But progress needs to be accelerated; responding to and recovering from COVID calls for more focused, additional and immediate actions.
To address this, NHS England and Improvement have established a Task and Finish Group, composed of a range of system leaders and voluntary sector partners, to focus on what specific, measurable actions should be taken by the NHS in the next few months. The Group will take account of feedback and ideas already received from BAME organisations, the VCSE sector, local systems and others.
This work is distinct from but complementary to the dedicated work on the NHS as an employer being led by the Chief People Officer on supporting our BAME NHS staff and implementing the NHS Workforce Race Equality Standard.
In SYB, the response to health inequalities is being taken forward by Workforce Leads, Kevan Taylor and Dean Royles.
2.9 Support for the Centre for Child Health Technology (CCHT)
The Sheffield MPs wrote to the Government to outline their support for a new world class research and innovation facility in Sheffield. The Sheffield Children’s Hospital sponsored Centre for Child Health Technology (CCHT) at the Sheffield Olympic Legacy Park would be a multi-million transformational project supported by regional partners and international businesses including IBM Watson Health, Cannon Medical, Phillips and the South Yorkshire and Bassetlaw Integrated Care System. The site would span over 51,000 square metres, delivering world-class clinical and technical innovations to support children’s health and wellbeing in SYB and beyond.
2.10 Sheffield City Region devolution deal agreed
South Yorkshire’s devolution deal has finally been agreed and brought to the House of Commons. This is a significant step forward for South Yorkshire’s economy and our congratulations go to Dan Jarvis, Mayor of the Sheffield City Region, and his team on this fantastic achievement. Once passed into law, an additional £30million pounds will be allocated to Sheffield City Region for regeneration projects supporting local growth and transformation. This is a great example of partnership working and its long-term impact is likely to shape the lives of the population for years to come.
2.11 Volunteers and Carers
Partners recognised the thousands of carers in SYB during Carers Week (8-14 June). Many of the patients who visit GP surgeries or go into hospital are cared for by a relative or have caring responsibilities themselves. Carers Week was a timely opportunity to thank them for all they do and particularly for their vital role in helping vulnerable people manage their health and care needs during the coronavirus outbreak. 4
It was also National Volunteers Week 1-7 June. Likewise, volunteers bring significant added value to health and care organisations with their experience and talent and the week was a great opportunity to thank the many thousands of volunteers in South Yorkshire and Bassetlaw for all they do.
3. Finance update
A new national financial framework is being developed to cover the period from August 2020 to March 2021 which is built upon the financial framework adopted for the period from April 2020 to July 2020. This will form part of the planning guidance is due to be released shortly.
The system has submitted capital plans to the region which total £47.1m which cover both the ‘base case’ and ‘stepped up case’ planning assumptions provided for this exercise. Further work is being undertaken to prioritise these schemes if the system is provided with a cash limited financial envelope to cover such expenditure.
From March to July 2020, commissioners and providers have been funded at actual cost to enable a break even position each month. From August 2020 to March 2021 this will be replaced with a cash limited sum which will replace the retrospective top-ups to commissioners and providers to allow them to break even and to reimburse costs associated with COVID 19. The intention is to provide systems rather than organisations with a financial envelope.
Andrew Cash System Lead, South Yorkshire and Bassetlaw Integrated Care System
Date: 6 July 2020
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Engagement & Experience Committee (EEC) Meeting Thursday 4th June 2020 from 10am – 11am via Microsoft Teams
Present : S Whittle (Chair) Lay Member for Patient & Public Involvement, NHS Doncaster Clinical Commissioning Group (CCG) P Hemingway Head of Communications & Engagement, CCG R Mather Senior Communications & Engagement Officer, CCG A Smith Senior Communications & Engagement Officer, CCG H Joerning Patient Experience Manager, CCG A Edwards Corporate Governance Manager, CCG Dr M Pande G.P, South Locality Lead A Goodall Chief Operating Officer, Healthwatch Doncaster In attendance: K Connolly Senior Corporate Services Support Officer (Minute Taker), CCG
Agenda Subject Action Ref Required By 1. Welcome and Introductions
S Whittle welcomed everyone to the virtual meeting.
2. Apologies for Absence
S Whittle noted apologies of absence from the following :
• A Fitzgerald - Director of Strategy and Delivery, CCG • L Robson - Public Health Theme Lead • A Coggan - Head of Performance and Intelligence, CCG • D Atkin - Doncaster Health Ambassador Group Chair • Dr V Joseph - Public Health Representative
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 secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk
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The meeting was noted as quorate.
Declarations of interest from sub committees / working groups:
None declared
Declarations of interest from today’s meeting:
None declared
4. Minutes From Previous Meeting
The minutes from the previous EEC meeting, held on 5th March 2020, were approved as a correct record with the following amendment:
Item 9 - Healthwatch Monthly Update
‘Dr Pande commented that long term video consultations are not always appropriate as they take longer. She asked if there is any option to send photos i.e. a lesion.’
Amended to … K Connolly
‘Dr Pande commented that long term video consultations are not always appropriate as they take longer. Photo options were also discussed and can be included in clinicians’ feedback.’
5. Action Log Update
Both the open & closed action logs were updated :
• 2 actions closed • 3 actions remain open • 2 new actions
The updated open action log will be circulated with the minutes of this meeting.
6. Notification of Any Other Business
There was one item of notification of further business for discussion.
7. Complaints Update Quarterly Report
H Joerning provided the following answers to questions raised by Committee members from May’s Complaints Report:
Annual Comparison Data
Why such a huge jump to 422 contacts received for 2019/2020?
We have been supporting the Medicine Management Team with
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triaging enquiries due to medication switches, If you look at the change in their numbers from approx. 13 per quarter to aprox 50 per quarter this provides a spike in numbers of +150 on top of any other hot spots such as the PLCV (procedures of low clinical value) letters. If you look at the figures in section 5 you will be able to see exactly what enquiries are coming in and the area they link to. We had planned a piece of work to look at why people were contacting CCG in the first instance rather than going to the provider – however with C- 19 we are all working together to ensure issues are dealt with so this piece of work has been paused at the moment.
Concerns - Website accessibility issues for the deaf community
What issues?
This was escalated to A. Russell on 18.03.2020, as there have been discussions around using Browsealoud for our site along with the Easy Read documents I am working on.
P Hemingway updated the Committee to confirm that work is taking place with the DCCG web provider, RDaSH to look at options. Browsealoud is very costly and was used by RDaSH for a period of two years with very little use. P Hemingway confirmed that once the options had arrived and preferred option chosen, the committee would be informed.
Compliments
The Committee members asked if compliments could be shared with appropriate teams.
K McGuire will send these direct to you on a separate email as they may have gone to the generic email last time.
H Joerning advised Committee members there has been a significant drop in complaints this year, 20 in total. There is a stringent process in place and this has played a huge part in complaints dropping quarter after quarter.
The Engagement and Experience Committee noted the update.
8. Healthwatch Monthly Update
A Goodall provided Committee members with a verbal update on Healthwatch Doncaster, the following areas were highlighted:
• Online engagement is continuing throughout the Doncaster community • Recovery and renewal plan • Telephone support is accessible if required to help reduce isolation and loneliness • Looking at shielded list for extra support if required
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• Integrated Facebook into Zoom meetings, also using Facebook Live • DBTH happy with survey results
S Whittle asked if Healthwatch Doncaster are working with any other Volantary Care organisations? A Goodall advised they are not but will look into and assist if they are struggling with capacity.
The Committee members noted the informative update and thanked A Goodall.
9. AGM Update
P Hemingway advised Committee members a virtual Annual General Meeting via Microsoft Teams has been arranged for Wednesday, 2nd September 2020 from 3.30pm – 5.30pm. Confirmation to be sent out soon.
The Committee members noted the AGM update.
10. ‘Draft’ 2019-20 NHS Doncaster CCG Annual Report
P Hemingway presented the Final ‘Draft’ 2019-20 NHS Doncaster CCG Annual Report to Committee members.
S Whittle commented on how comprehensive the report is.
Dr Pande requested her full name is used for the report. A Edwards to A Edwards request L Devanney to amend.
The Committee members noted the report.
11. Review of Engagement Activities during the Coronavirus Outbreak
R Mather updated Committee members on Engagement Activities during the Coronavirus Outbreak.
Work is continuing with ICS across South Yorkshire and Bassetlaw (SYB). Looking at engagement across the whole system.
Information has been provided for a paper ICS is putting together.
The Committee members thanked R Mather for the update.
12. Any Other Business
A Goodall requested clarification for focus areas for EEC and Governing Body as patient stories are resuming from July. P Hemingway advised Living Well will come to EEC in July.
K Connolly K Connolly to update the EEC forward plan.
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13. Date & Time of Next Meeting:
Thursday 2nd July 2020 from 10am – 11am via MS Teams
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Minutes of the Primary Care Commissioning Committee (Public) Held on Thursday 11 June 2020 at 12.30 pm Via Microsoft Teams
Voting L Tully Lay Member (Chair) Members S Whittle Lay Member Present: H Tingle Chief Finance Officer A Fitzgerald Director of Strategy and Delivery J Pederson Chief Officer A Russell Chief Nurse, CCG
Non-Voting C Ogle Associate Director of Primary Care & Members Commissioning Present: K Roberts Primary Care Manager A Russell Head of Quality- Vulnerable People Z Head Lead Nurse Primary Care Quality Dr D Eggitt Local Medical Committee (LMC) Representative P Barringer NHS England Representative Informatics Programme Manager Dr N Alsindi Clinical Lead for Primary Care & Long Term Conditions J Telford Healthwatch Representative Dr M Pande Locality Lead GP
In Attendance: M Gibbons Primary Care Support Officer (Minutes) K Smith Senior Officer, Digital Primary Care C Empson Informatics Programme Manager
Meeting Start 12.30 pm Action 1. Apologies for Absence
None 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
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The meeting was noted as quorate.
Declarations of interest from sub committees / working groups: None declared.
Declarations of interest from today’s meeting: None declared.
3. Notifications of Any Other Business
No items were raised.
4. Minutes From Previous Meeting held 14 May 2020
The minutes of the last meeting held on 14 May 2020 were approved as an accurate record.
5. Matters Arising not on the Agenda
No matters arising.
6. Action Tracker
The Committee discussed and updated each item on the Action Tracker. The latest updates can be viewed on the Action Tracker.
7. Finance & Contracting
7.1 Interim Exception Report H Tingle gave a verbal Finance update. Finance submitted a final 2019- 2020 year end summary to the last committee. The Finance team have sent out a template to practices giving them an opportunity to apply for COVID related costs, which were related to the pandemic. They are expecting this to come back by the end of the week they will then have a review and submit this onto the national template.
7.2 Primary Care Estates Strategy Implementation Plan Update
The Doncaster Primary Care Estate Strategy Implementation and Improvement Plan was published in May 2019 and progress has now commenced delivering the plan. The following sets out activities that have been undertaken in month and will be progressed in the following month.
S Barnes is meeting the PCN’s regarding developing their own estates strategies. C Ogle and S Barnes met with the CCG Programme Board and ICS Capital Programme Board. The CCG Programme Board was an opportunity to update on local schemes with the wider partnership as the
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Enc A board includes property services, CHP and the local authority. It was useful to ensure that we were all on the same page, as our plans have implications for all of those stake holders. At the ICS meeting there is still a lot of work ongoing to manage the programme.
It is anticipated that the programme business case will need to be submitted by the end of September, which means that the PCCC will need to approve it as a draft in our September meeting. This will be entered on to the forward planner for that meeting M Gibbons
S Barnes is attending a commercial workshop on 16 June. C Ogle and S Barnes will attend a Stage Gate Review in July to assure the national team that the individual projects are progressing well. The main outstanding issue (to split down the PCN project into the separate component parts) is now complete. It is expected that the national team will require information on the following:
• Task and finish groups have now been set up for each project. • To agree a timeline and identify the critical path we are following. • To look at the clinical model for each of the schemes, provide assurance that what will be delivered in the premises is critical to the space that we need, and look at the COVID response and how this has impacted. • We will be expected to have looked at the impact of digital working on space on know how we are refreshing the model in light of this knowledge. • They must provide assurance that as we get closer to the financial implications, where the commitment is signed off at a CCG level, that we have considered procurement and commercial implications. We must demonstrate how we engage with the clinicians and patients around ongoing developments.
The Project Management Office (PMO) is looking into how we can access development moneys to fund architects and design.
New for Old is a national programme for designing integrated hubs within a national plan for redevelopment. The intention is to streamline the process to have a nationally agreed model for an integrated hub.
NHS England have asked for bids for premises improvement grants with priority on Infection, Prevention and Control to manage the safety of staff and patients. The CCG has asked for the proposals by the end of June The money has to be spent by the end of March 2021.
C Ogle then gave a brief update on two of the projects: Bentley Proposal: Is to use the library building just around the corner from the Bentley Surgery. There is some ongoing work to look at the land around the library and to
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confirm the space requirements. Funding has been secured for One Public Estate to progress the next steps of this development.
Mexborough: Is probably the next furthest along, working with a third party developer around the plans for a new surgery, which would incorporate the new surgery and Mexborough Health Centre. They are having further discussions with the PCN around the implications for the PCN footprint.
8. Quality
8.1 Interim Exception Report Z Head gave a verbal report. COVID-19 work is continuing with practices. The new guidance came out on 29 May version 3 of the Standard Operating Procedure (SOP) is asking practices to consider how they will re-start services again. NHS England is now sending out cytology appointments.
TARGET will resume in July, with virtual training on Infection, Prevention and Control with a special focus on COVID-19.
There have been no more CQC reports published since the last Committee meeting. CQC inspections are currently suspended unless there are exceptional concerns.
J Pederson advised the Committee that COVID-19 Test and Trace strategy has begun. Practices and the CCG will be informed if a COVID patient has been in a Practice. It has been confirmed that individuals wearing PPE and adhering to social distancing rules at the time are not classed as a contact. It is important this message is highlighted to Primary Care.
9. Strategy & Planning 9.1 Delivery Plan 2020/21 K Roberts and C Empson gave a Presentation on the current year’s delivery plan. Delivery Plan milestones are split into 4 key areas, identified by national guidance and local priorities. There are 39 key milestones identified across General Practice, inequalities and risk management.
The digital work stream has a bigger priority in this current work plan. Integration and use of the NHS app is awaiting further guidance. COVID-19 has expedited some online consultation conversations with increasing interest from practices. Primary care Estates forms a larger part of the Delivery Plan this year with
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Enc A reduction in void space, new builds, delivery of the strategy being key areas. PCN, working priorities include workforce, the national DES and care homes work. It is important to note that we are in June and the delivery plan should have been in place from April. Milestone updates will be brought to the committee in the near future. Some actions have been completed and significant work has been undertaken. C Empson then gave a presentation on Measurable Outcomes The measures would cover improving access, improving digital uptake and ensuring care is in the right place. Financial savings metrics are still under development.
9.2 Evaluation & Recovery K Roberts talked to the evaluation and recovery plan shared with the agenda papers. He thanked E Serfozo for his support in developing this document. The document covered all national and local areas affected, stood down or reduced as a result of the covid-19 pandemic. The actions have been discussed at the primary care cell, exploring the clinical criteria, evaluations and risk assessments in terms of how we stand these services back up and when. With particular reference to Primary Care Commissioning Committee there are particular actions that fall under the committees remit. The Primary Care Delivery Group and the Information Sub Group both feed up into this committee and were stood down initially until 30 June. We are obliged to review when these meetings are stood back up and when they come into effect. We recommend at the moment that a lot of the conversations happening in Delivery Group and Information Sub Group are happening via the current cells in place such as the Health Cell, Primary Care Cell and Data Cell we would like The Committees permission for these services to remain stood down until the end of July and for The Committee to review again at a later date. The membership of the Primary Care Cell was discussed and it was confirmed that other colleagues are invited to join the Cell as and when required, similar to that of the Primary Care Delivery Group.
The Committee discussed the governance of the Primary Care Cell, and noted that the discussions are not currently held in a public arena or shared into a public arena. The Committee acknowledged that the Cells were set up quickly in response to the COVID-19 pandemic to allow timely responsive. The Committee agreed that all decisions made at the Primary Care Cell must be documented and then reported at the Primary Care Commissioning Committee. The importance of independent challenge
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during any decision making process was also discussed and noted.
The Primary Care Commissioning Committee approved the extension of the review date for the Primary Care Delivery Group and Primary Care Information Sub Group until 31 July 2020. K Roberts agreed to present a further paper detailing governance arrangements of the Primary Care Cell at the July 2020 meeting. K Roberts
9.3 Primary Care Network Update The paper was circulated prior to the meeting. Doncaster achieved 100% coverage by our practices into PCN’s, on the same footprint as previously agreed last year. There will be some changes to the Clinical Directors, as B Scott is leaving at the end of June and we have now been formerly notified that he will be replaced by 3 GPs Dr K Singh, Dr D Coleman and Dr M Boon on a job share basis. All 3 GP’s will do one session each. C Ogle has asked for clarity regarding who is going to cover what. K Mansfield and Dr Shah from East respectively have been re-elected for a further 12 months. For the North Dr V Kumar and S Teanby-Clark have been extended for 3 months until 1 September, when this leadership will be reviewed. C Ogle confirmed that the appointment of clinical directors is the role of the PCN and the CCG does not have a role in the appointments.. As part of the next steps all PCNs are required to sign a Network Agreement by the end of June 2020. The PCN’s have to develop workforce plans by the end of August 2020. All the PCN’s have been asked for confirmation of how they spent the £1.50 per head monies in 19/20 with a deadline of 30 June. The Committee noted the update.
10. Forward Planner
The Committee noted the Forward Planner.
It was agreed to discuss the Primary Care, Care Home response at the July or August 2020 Meeting. All other additions as discussed in the meeting will be added to the planner as agreed. M Gibbons
It was noted that a Development Session is due, L Tully agreed to explore this further outside of the meeting. L Tully
11. Any New Potential Risks
No new risks were identified at today’s meetings.
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12. Any Other Business
No items were raised. 13. Date and Time of Next Meeting
Thursday 9 July 2020 at 12.30 pm
Meeting Closed 13:38 pm
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