Questions from members of the public will be received under Item 4; if submitted in advance in line with the protocol on the CCG’s website: http://www.blackburnwithdarwenc cg.nhs.uk/about-us/governing- body-meetings/
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING Wednesday 17th January 2018 at 1 pm Meeting Rooms 1 and 2, Blackburn Central Library Town Hall Street, Blackburn BB2 1AG
A G E N D A
Item No: Agenda Item Member Responsible Report PUBLIC PARTICIPATION 1. Chair’s Welcome Mr Graham Burgess Verbal
2. Apologies for Absence and Confirmation of Quoracy Mr Graham Burgess Verbal
3. Declarations of Interest relating to items on the agenda Mr Graham Burgess Verbal Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Governing Body Secretary in advance of the meeting.
4. Questions from Members of the Public Mr Graham Burgess Verbal
5. Pennine Lancashire Safeguarding Annual Report Mrs Janet Thomas Presentation 2016/17 PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 6. Minutes of the Meeting held on 8th November 2017 Mr Graham Burgess Attached 6.1 Extract from Part 2 of the Minutes of the Meeting held on Attached 8th November 2017
7. Matters Arising Mr Graham Burgess 7.1 Action Matrix Attached
8. Clinical Chief Officer’s Report Dr Penny Morris Attached
9. Chief Finance Officer’s Report Mr Roger Parr Attached
10. Contract, Quality and Performance Report Mr Roger Parr/ Attached Dr Malcolm Ridgway 11. Eat Well Move More Shape Up Strategy: Year 1 Update Professor Dominic Attached and Harrison Presentation FOR INFORMATION 12. Review of Register of Interests Mr Iain Fletcher Attached
13. Sub-Committees and Groups’ Minutes Mr Iain Fletcher Attached
14. Joint Committee of Clinical Commissioning Groups Mr Graham Burgess Attached
15. Any Other Business All Verbal
16. Date and Time of Next Meeting: Mr Graham Burgess Verbal Wednesday 7th March 2018 in Meeting Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960)
PART 2 (APPROXIMATELY 3 PM) A/18 Minutes of Part 2 of the Meeting held on 8th November Mr Graham Burgess Attached 2017
B/18 Matters Arising Mr Graham Burgess Attached B/18.1 Action Matrix
C/18 Pennine Lancashire Clinical Commissioning Groups’ Dr Malcolm Ridgway Attached Confidential Provider Update
D/18 System Update Mr Graham Burgess/ Verbal Dr Penny Morris E/18 Any Other Business All Verbal
Types of Conflict of Interest
Type of Interest Description Financial This is where an individual may get direct financial benefits from the consequences of a Interests commissioning decision. This could, for example, include being: • A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; • A shareholder (or similar owner interests), a partner or owner of a private or not-for- profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. • A management consultant for a provider; • In secondary employment (see paragraph 56 to 57); • In receipt of secondary income from a provider; • In receipt of a grant from a provider; • In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider • In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and • Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). Non-Financial This is where an individual may obtain a non-financial professional benefit from the Professional consequences of a commissioning decision, such as increasing their professional Interests reputation or status or promoting their professional career. This may, for example, include situations where the individual is: • An advocate for a particular group of patients; • A GP with special interests e.g., in dermatology, acupuncture etc. • A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); • An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE); • A medical researcher.
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Type of Interest Description Non-Financial This is where an individual may benefit personally in ways which are not directly linked to Personal their professional career and do not give rise to a direct financial benefit. This could Interests include, for example, where the individual is: • A voluntary sector champion for a provider; • A volunteer for a provider; • A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; • Suffering from a particular condition requiring individually funded treatment; • A member of a lobby or pressure groups with an interest in health. Indirect This is where an individual has a close association with an individual who has a financial Interests interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include: • Spouse / partner; • Close relative e.g., parent, grandparent, child, grandchild or sibling; • Close friend; • Business partner.
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Subject to approval at the next meeting
CLINICAL COMMISSIONING GROUP (CCG) Item 6 Minutes of the Governing Body (GB) Meeting held on Wednesday 8th November 2017 at 1 p.m. in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG PRESENT: Mr Graham Burgess Chair (Chair) Dr Penny Morris Chief Clinical Officer Mr Roger Parr Deputy Chief Executive/Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Quality and Primary Care Dr Adam Black General Practitioner (GP) Executive Member Dr Preeti Shukla GP Executive Member Dr John Randall GP Executive Member Mr Paul Hinnigan Lay Member – Governance Dr Nigel Horsfield Lay Member Mrs Janet Thomas Executive Nurse/Associate Director of Quality and Commissioning Professor Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council (BwD BC) (Part) IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Mrs Elizabeth Fleming Head of Urgent Care, NHS East Lancashire and BwD Clinical Commissioning Groups (Item 17.114 only) Mrs Pauline Milligan Governing Body Secretary
Min No: 17.102 Chair’s Welcome
The Chair opened the meeting by welcoming all attendees and members of the public.
17.103 Apologies for Absence and Confirmation of Quoracy
Apologies for absence had been received in respect of Miss Claire Jackson, Director of Commissioning Operations, Dr Geraint Jones, Lay Member – Secondary Care Doctor (Retired) and Dr Zaki Patel, GP Executive Member.
The Chair confirmed that the meeting was quorate.
17.104 Declarations of Interest Relating to Items on the Agenda
The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG.
Declarations declared by members of the GB are listed in the CCG’s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/.
The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.
17.105 Questions from Members of the Public
No questions had been received from members of the public.
17.106 Minutes of the Annual General Meeting held on 6th September 2017
The minutes of the meeting were reviewed and accepted as an accurate record.
RESOLVED: That the minutes of the Annual General Meeting held 6th September 2017 were approved as an accurate record.
17.106.1 Minutes of the Meeting held on 6th September 2017
The minutes of the meeting were reviewed and accepted as an accurate record.
RESOLVED: That the minutes of the meeting held 6th September 2017 were approved as an accurate record.
17.106.2 Extract of Part 2 of the Minutes of the Meeting held on 6th September 2017
The Extract of Part 2 of the Minutes of the Meeting held on 6th September 2017 was accepted as an accurate record.
RESOLVED: That the Extract of Part 2 of the Minutes of the Meeting held on 6th September 2017 was approved as an accurate record.
17.107 Matters Arising/Action Matrix
Matters Arising
There were no Matters Arising which were not listed on the Action Matrix.
17.107.1 Action Matrix
The Action Matrix was reviewed and the following were noted:
Minute 16.096/17.023.1/17.040.1/17.059.1/17.081.1 – Stroke Update Dr Malcolm Ridgway agreed to coordinate a presentation to members in relation to Stroke Services.
Minute 16.101.1/17.023.1/ 17.040.1/ 17.081.1– Cancer Performance Update The Chair reported that he would write again to the Chief Officer of Greater Preston CCG. Mr Roger Parr agreed to check if the new Chief Officer of the CCG was also the Cancer Lead for the CCGs across the patch.
Minute 14.041 (iii)/ 17.081.1– – Chief Officer Report The Chair reported that the CCG would request that a member of the Fylde Coast attend a future meeting once the work was established. Mr Roger Parr stated that this was planned for early in the New Year.
17.108 Clinical Chief Officer’s Report
The Chair welcomed Dr Penny Morris to her first meeting as Chief Officer and she provided her first report; outlining the following areas of interest:
• Department of Health: o Winter Funding; o Nationwide Digital Services; o Trainee GPs; o Grant Scheme to Improve Mental Healthcare;
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o GP Indemnity.
• NHS England: o Appointment; o Innovation to Transform; o Winter Pressures.
• Public Health England: o Stoptober.
• Care Quality Commission (CQC) o State of Care Report; o Mental Health Services for Children and Young People.
• Health Education England (HEE): o New Training Scheme.
• Pennine Lancashire: o Together a Healthier Future Programme (TAHF)
• Blackburn with Darwen CCG o Clinical Chief Officer.
Questions and answers followed.
ACTION: Following an enquiry from Dr Adam Black regarding the national GP Practice target of 20% overall for patient online access, Dr Ridgway agreed to check and clarify the figure.
Following an enquiry from Dr John Randall and subsequent discussion, it was noted that a presentation on the TAHF and Accountable Care Systems would be provided to the GB December Development Session; with a further opportunity for a speaker to attend and update the GB at the February Development Session, if required. It was agreed that further information should be provided to the CCG Membership as soon as it was known.
RESOLVED: That the GB noted the content of the report.
17.109 Chief Finance Officer’s Report
Mr Roger Parr presented the report for month 6 and highlighted key elements.
He reported that the CCG was still on plan to deliver its business rules for this financial year. Its year to date surplus was just over £1.1m, in line with the financial plan; with a forecast to deliver a planned year end surplus of £2.2m and maintain the CCG’s risk reserve of 0.5% as per national guidance.
Mr Parr drew members’ attention to the changes to the CCG’s financial position as at month 6. There had been a cost increase in relation to Lancashire Teaching Hospitals NHS Foundation Trust’s (LTHT’s) activity and this had been offset against underspends by other acute providers. He confirmed that the reason for the cost increase was being investigated.
Mr Parr also drew members’ attention to the risks within the system and stated that these would be discussed in more detail at the Finance Scrutiny Group which followed the meeting.
Questions and answers followed.
ACTION: Following comments from the Chair and Mr Paul Hinnigan, Mr Parr agreed to pass on the GB’s positive feedback on the CCG’s current financial performance to all the staff involved in the work to ensure the CCG delivered its business rules at the end of the financial year.
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RESOLVED: That the GB noted the content of the financial summary and the financial position of the CCG at the end of September 2017.
17.110 Contract, Quality and Performance Report
Mr Parr presented the contracting section of the month 5 report and then deferred to Dr Malcolm Ridgway to highlight the key points related to quality and performance.
Mr Parr highlighted the following:
• Lancashire Care NHS Foundation Trust (LCFT) Mental Health Services (page 3): o Psychological Therapies – Mr Parr reported that activity was slightly ahead of the target; o Referrals/Admissions – the level of referrals had increased; however, admissions were slightly down. This was consistent with last year’s performance.
• East Lancashire Hospitals NHS Trust (ELHT) (page 4): o Accident and Emergency (A&E) – activity had reduced by almost 7% against plan; o Elective/Non-elective admissions – activity had reduced against plan; o Out-patient First Attendances – activity was below plan.
• Primary Care (page 5): o Out of Hours – activity was below plan; o Referrals – the number of referrals had decreased.
• LCFT - Community Services (page 6): It was noted that the process for reporting against variances (+/-10%) as agreed by the lead contractor would be in the form of an exception report in the month following the previous quarter.
• Other Significant Contracts (page 8): Mr Parr reported that activity for other providers was also under plan.
Dr Ridgway highlighted the following:
• LCFT – Mental Health Services (page 3): o Psychological Therapies – Dr Ridgway reported that the CCG was hitting the target; there were some issues in relation to staffing but work was underway to rectify this; o Memory Assessment Service (MAS) – the target was being met and work was still being undertaken to ensure sustainability. • ELHT – (page 5): o A&E 4 Hour – the September target had not been reached. Measures were being taken to improve staffing levels; o Trolley Waits – there were still some 12 hour breaches but work was being done to prevent further breaches. • Primary Care – (page 7): o CQC – Dr Ridgway reported that there now remained only one GP Practice to be inspected. Of those practices that had been inspected, all had been rated ‘good’; with the exception of one rated as ‘outstanding’ and one as ‘inadequate’. The ‘inadequate’ practice had been re-inspected and the results of the inspection were awaited. • LCFT – Community Services (page 6): o Referral to Treatment (RTT) (Incomplete) – there was an improvement in the Children’s Speech and Language Therapy (SALT) Service due to the recruitment of staff to vacant posts. • Other Significant Contracts (page 8): o RTT Incomplete – Dr Ridgway reported that there were delays in the system that Page 4 of 7
were related to patient flow through LTHT. Work was underway to increase capacity by holding extra clinics. o Cancer – 2 Weeks for an Urgent GP Referral for Suspected Cancer – there were pressures within the system, some of which were related to patient choice. o Cancer – Patients Receiving First Definitive Treatment for Cancer within Two Months – Dr Ridgway also reported that there were pressures which were being monitored by the Cancer Tactical Group.
Questions and answers followed.
ACTION: Following an enquiry from Mr Hinnigan, Dr Ridgway agreed to investigate the activity figures in relation to Community Stroke Services, in order to reassure the GB that there was no impact on the quality of care.
ACTION: Following an enquiry from Dr Penny Morris about the underperformance of the Treatment Rooms, the Chair requested that the Executive Team produce a report on the redesign of Treatment Rooms and bring it back to a future meeting.
ACTION: It was agreed that a discussion in relation to the potential re-calculation of some of the LTHT targets would take place outside the meeting and the results would be reported back to the next GB meeting.
RESOLVED: That the GB noted the content of the reports and supported the actions as identified.
17.111 Blackburn with Darwen Annual report of the Director of Public Health
Professor Dominic Harrison presented the report which consisted of two parts:
• State of the population’s health and well-being; • Conclusions and recommendations based on the state of the population’s health and well-being.
The theme for the 2016/17 report was ‘social movements for health’.
Questions and answers were taken throughout the presentation.
Professor Harrison highlighted the Borough’s demographics and compared the various data results for BwD to the national picture.
He drew members’ attention to key elements and explained the figures in relation to:
• main causes of death in BwD in 2014; • life expectancy; • healthy life expectancy; • mental health and well-being; • accidents; • sexual health; • employment sector; • local economy; • welfare reforms; • vulnerable groups;
Professor Harrison outlined future challenges and solutions in relation to:
• deprivation standardisation; • infant mortality; • a social movement for health; • creating healthy communities.
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Professor Harrison summarised that the Public Heath Annual Report recommended that the way forward should be to create a social movement for health to empower the public to get involved in affecting some of the risks; in order to change the increased risk of early death and avoidable disease.
Questions and comments followed.
RESOLVED: That the GB noted the content of the report.
17.112 Sub-Committees and Groups’ Minutes
Mr Fletcher presented the report, which included the minutes of the GB Sub-Committees and Groups for receipt and note by members, to inform the GB of delegated and key decisions taken and provide information regarding items of particular interest or potential risk.
There were no questions.
RESOLVED: That the GB noted the content of the report.
17.113 Joint Committee of Clinical Commissioning Groups
The Chair introduced the following documents for the information of members.
The Chair outlined the reports that had been presented to the November JCCCG meeting and requested that Mrs Pauline Milligan circulate the reports for the information of members.
17.113.1 Agenda for the Meeting on 2nd November 2017 17.113.2 Draft Minutes of the Meeting Held on 2nd March 2017 17.113.3 Draft Minutes of the Meeting Held on 6th July 2017 17.113.4 Draft Minutes of the Meeting Held on 7th September 2017
ACTION: Mrs Milligan to circulate the reports received for the 2nd November 2017 meeting.
RESOLVED: That the GB noted the content of the documents.
17.114 Accident and Emergency Board Report
Mrs Elizabeth Fleming attended for this item and provided an overview of the report and background to some of the work being led by the Accident and Emergency Delivery Board (A&EDB) on behalf of Pennine Lancashire.
Mrs Fleming explained that, nationally, performance in relation to the 4 Hour Standard had struggled and earlier in the year leaders from A&EDBs had attended a national meeting where they had been asked to develop recovery plans for their areas.
She outlined the Pennine Lancashire Recovery Plan and the key schemes set out within the plan to deliver the rapid recovery of the 4 Hour Standard. It had been agreed that the plan would focus on fewer schemes than previously and would mainly consist of:
• streaming at the front end of the Royal Blackburn and Burnley General Hospitals into more clinically appropriate areas; • patient flow within the hospitals; • discharge and recovery into the community.
Mrs Fleming drew members’ attention to the tracked performance against the Recovery Plan (page 5). The work had commenced in July and some gains had been made in terms of performance in August; however, some of this had been lost in September and performance recovery not been as good as had been hoped.
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Mrs Fleming concluded that the Pennine Lancashire Team was managed by a Senior Responsible Officer and the A&EDB would continue to focus its efforts into the above schemes to improve performance and deliver the Recovery Plan.
Questions and answers followed.
RESOLVED: That the GB considered and supported the content of the report.
17.115 Any Other Business
No further business was discussed.
17.116 Date and Time of Next Meeting
The next meeting will be held on Wednesday 17th January 2018 at 1 pm in Meeting Rooms 1 and 2 Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG.
The Chair thanked everyone for their attendance and input and the meeting closed.
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960).
Signed ………………………………………………. Chair ……………………………………………… Date
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CLINICAL COMMISSIONING GROUP (CCG) Item 6.1 Extract from the Minutes of Part 2 of the Governing Body (GB) Meeting held on Wednesday 8th November 2017 at 3 p.m. in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG PRESENT: Mr Graham Burgess Chair (Chair) Dr Penny Morris Chief Clinical Officer Mr Roger Parr Deputy Chief Executive/Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Quality and Primary Care Dr Adam Black General Practitioner (GP) Executive Member Dr Preeti Shukla GP Executive Member Dr John Randall GP Executive Member Mr Paul Hinnigan Lay Member – Governance Dr Nigel Horsfield Lay Member Mrs Janet Thomas Executive Nurse/Associate Director of Quality and Commissioning Professor Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council (BwD BC) (Part) IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Mrs Pauline Milligan Governing Body Secretary
Re-Confirmation of Apologies for Absence and Quoracy Apologies for absence had been received in respect of Miss Claire Jackson, Director of Commissioning Operations, Dr Geraint Jones, Lay Member – Secondary Care Doctor (Retired) and Dr Zaki Patel, GP Executive Member.
The Chair confirmed that the meeting was quorate.
Re-Confirmation of Declaration of Interests The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG.
Declarations declared by members of the GB are listed in the CCG’s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/
No declarations of interest were made with regards to items on the agenda at this point.
The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.
A/17 Minutes of Part 2 of the Meeting held on 6th September 2017
The Minutes of Part 2 of the Meeting held on 6th September 2017 were reviewed and accepted as an accurate record.
RESOLVED: That the Minutes of Part 2 of the Meeting held on 6th September 2017 were approved as an accurate record.
B/17 Matters Arising
There were no matters arising.
B/17.1 Action Matrix
It was noted that the action on the matrix had been completed.
C/17 Pennine Lancashire Clinical Commissioning Groups’ Confidential Provider Update
Dr Malcolm Ridgway presented the report, which provided the GB members with a briefing on new provider performance/quality issues that have occurred since the last meeting.
Dr Ridgway drew to members’ attention key issues in the report.
Questions and answers followed.
RESOLVED: That the GB received the report for information purposes.
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GOVERNING BODY (GB) MEETING - ACTION MATRIX PART 1 Item 7.1 Action Origins Action Owner Due Date Status GB Ref 16.096/17.023.1 Stroke Update The Chair requested that the Executive Team (ET) consider the questions and comments posed by members of the GB and produce a report in response to be presented to the appropriate forum for action and then the results reported back to the GB in early 2017.
17.040.1 Dr Chris Clayton agreed to investigate the current position related to Stroke Services and report back to the next meeting.
17.059.1 It was agreed at the June Development Session that stroke would be added to the agenda of the next Executive Team to Team Meeting with East Lancashire CCG.
17.081.1 Dr Nigel Horsfield reported that the Pennine Lancashire Quality Committee received a very good presentation from members of the Stroke Team, which included Nursing and Management staff and reported a significant improvement in the figures. The presentation was well received and it was agreed that it would be useful for the GB to receive a similar presentation. FEBRUARY 17.107.1 Dr Malcolm Ridgway agreed to coordinate a presentation to MR JANUARY DEVELOPMENT members in relation to Stroke Services. SESSION AGENDA
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16.101.1/17.023.1 Cancer Performance Update The Chair confirmed that a response had been received from the Chief Officer of Greater Preston CCG, who attends the Cancer Alliance Meetings, which had been circulated to members and suggested that a review of progress regarding the recommendations from the Lancashire and South Cumbria Acute Oncology Review should take place at the end of May.
17.040.1/17.081.1 The Chair reported that he would write again to the Chief Officer GB of Greater Preston CCG for an update on progress in the Autumn.
17.107.1 The Chair reported that he would write again to the Chief Officer of Greater Preston CCG. Mr Roger Parr agreed to check if the GB/RP JANUARY VERBAL UPDATE new Chief Officer of the CCG was also the Cancer Lead for the JANUARY MEETING CCGs across the patch.
17.041 (iii) Chief Officer Report The Chair referred to the content of section 3.3, which referred to the work on the Fylde Coast being highlighted as an ‘exemplar’ of good practice and requested that the Executive Team organise a briefing/presentation for the GB outlining what it means to be recognised as an ‘exemplar’.
17.081.1 The Chair reported that the CCG would request that a member of the Fylde Coast attend a future meeting once the work was established.
17.107.1 Mr Roger Parr stated that this was planned for early in the New EXECUTIVE FEBRUARY IN PROGRESS Year. TEAM
17.108 Clinical Chief Officer’s Report Following an enquiry from Dr Adam Black regarding the national GP Practice target of 20% overall for patient online access, Dr MR JANUARY VERBAL UPDATE Ridgway agreed to check and clarify the figure. JANUARY MEETING 17.109 Chief Finance Officer’s Report Following comments from the Chair and Mr Paul Hinnigan, Mr Parr agreed to pass on the GB’s positive feedback on the CCG’s RP NOVEMBER COMPLETED current financial performance to all the staff involved in the work to ensure the CCG delivered its business rules at the end of the financial year. Page 2 of 3
17.110 (i) Contract, Quality and Performance Report Following an enquiry from Mr Hinnigan, Dr Ridgway agreed to investigate the activity figures in relation to Community Stroke MR JANUARY VERBAL UPDATE Services, in order to reassure the GB that there was no impact on JANUARY MEETING the quality of care.
17.110 (ii) Contract, Quality and Performance Report Following an enquiry from Dr Penny Morris about the underperformance of the Treatment Rooms, the Chair requested ET MARCH IN PROGRESS that the Executive Team produce a report on the redesign of Treatment Rooms and bring it back to a future meeting.
17.110 (iii) Contract, Quality and Performance Report It was agreed that a discussion in relation to the potential re- calculation of some of the Lancashire Teaching Hospitals NHS ET JANUARY VERBAL UPDATE Foundation Trust (LTHT) targets would take place outside the JANUARY MEETING meeting and the results would be reported back to the next GB meeting.
17.113 Joint Committee of Clinical Commissioning Groups Mrs Pauline Milligan to circulate the reports received for the 2nd November 2017 meeting. PM NOVEMBER COMPLETED
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GOVERNING BODY MEETING
CLINICAL CHIEF OFFICER’S REPORT
Date of Meeting 17th January 2018 Agenda Item 8
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity X To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements X To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access X Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund X Access to Re-ablement and Intermediate Care X Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions X Access to high quality Urgent and Emergency Care X Scheduled Care X Quality √
Clinical Lead: Dr Penny Morris
Senior Lead Manager Mr Iain Fletcher Finance Manager Mr Roger Parr Equality Impact and Risk Assessment The report is for the information of members only. completed: GOVERNOVERNING BODY MEETING Patient and Public Engagement completed: The report is for the information of members only. Financial Implications The report is for the information of members only. Risk Identified The report is for the information of members only. Report authorised by Senior Manager: Dr Penny Morris Decision Recommendations
The Governing Body is requested to receive this report and to note the items as detailed.
Y
Report of the Clinical Chief Officer –17th January 2018 Page 2 of 13
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
17TH JANUARY 2018
CLINICAL CHIEF OFFICER’S REPORT
1) Introduction
This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Clinical Chief Officer’s (CCO) efforts have been directed since the last meeting.
2) Department of Health
2.1 Appointments
2.1.1 Secretary of State for Health and Social Care
Following a Cabinet reshuffle on 8th January 2018, the Right Honourable Jeremy Hunt MP was reconfirmed as the Health Secretary but also with explicit responsibility for Social Care, which was added to his job title.
2.1.2 Department of Health (DH) Board
The DH had previously confirmed that Jeremy Hunt had appointed Kate Lampard, Dame Sue Bailey, Sir Ron Kerr, Michael Mire and Professor Sir Mike Richards as Non-Executive Directors to the DH Board.
The new members will join Gerry Murphy, who has been reappointed to his role.
2.2 Children and Young People’s Mental Health
The Government has published proposals to improve mental health support for children and young people in England and over £300m has been available to fund them.
The Government is asking people for their views on the planned measures, which are set out in a green paper. The measures include:
• encouraging every school and college to have a ‘designated senior mental health lead’; • setting up mental health support teams working with schools, to give children and young people earlier access to services; • piloting a 4-week waiting time for NHS Children and Young People’s Mental Health Services; • a new working group to look at mental health support for 16 to 25-year-olds; • a report by the Chief Medical Officer on the impact that technology has on children and young people’s mental health, to be produced in 2018.
The consultation on the green paper will run for 13 weeks until 2 March 2018.
Further information via: https://engage.dh.gov.uk/youngmentalhealth/
Report of the Clinical Chief Officer –17th January 2018 Page 3 of 13 2.3 Cancer Specialists
The NHS is to employ more cancer specialists, to speed up cancer diagnoses and get more people into treatment more quickly. The specialists will be trained in areas where there are shortages. It is part of Health Education England’s (HEE) new Cancer Workforce Plan.
Announcements of extra provision include:
• 200 clinical Endoscopists – to investigate suspected cancers internally; • 300 reporting Radiographers – to identify cancers using x-rays and ultrasound; • support for Clinical Nurse Specialists – to lead services and provide quality care. The plan is part of a campaign to make sure patients are diagnosed quickly and get better access to innovative treatments that can improve survival rates.
For further information in relation to the Cancer Workforce Plan, please see Item 5.1.
2.4 Avoidable Deaths
The NHS will become the first healthcare organisation in the world to publish estimates of how many patients may have died because of problems in their care.
The publication follows a promise by the Health Secretary after a 2016 Care Quality Commission (CQC) report found that the NHS was missing opportunities to learn from patient deaths, and that too many families were not being included or listened to when an investigation happened.
The data will be published each quarter by individual Trusts. 171 of the 223 Trusts in England released their first estimates by the end of December.
Each Trust will make its own assessment of the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow Trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems.
The programme is likely to cover between 1,250 and 9,000 deaths, which research suggests is the number of deaths each year that may be down to problems in care – a fraction of the 19.7 million treatments and procedures carried out by the NHS in 2016 to 2017.
These deaths range from rare but high-profile failings in care, to those which involve terminally ill patients who die earlier than expected. These deaths may make up a large number of those caused by problems in care, showing the need to continue to focus on improving all care, including end of life care.
By collecting this data and taking action in response to failings in care, NHS Trusts and Foundation Trusts will be able to give grieving families an open and honest account of the circumstances that led to a death. This work is already happening in some parts of the NHS, for example at University College London Hospitals NHS Foundation Trust, which recently held its first memorial service for those who have died in its care.
The data will allow Trusts to learn from every failing in care, and then share lessons across the NHS to better protect patients in the future. For example, the Pennine Care NHS Foundation Trust, which as part of the Greater Manchester Partnership, is working across Greater Manchester on mortality reviews, so that lessons learned are shared with other providers for the good of patients across the area.
Report of the Clinical Chief Officer –17th January 2018 Page 4 of 13 3) NHS England
3.1 Appointment
On 13th November 2017, NHS England announced that Professor Stephen Powis has been appointed as its new National Medical Director. The role was subject to open competition and the appointment made by the Board of NHS England.
Professor Powis, 57, is currently Group Chief Medical Officer at the Royal Free London NHS Foundation Trust, and will succeed Professor Sir Bruce Keogh in his national role in the New Year. He is currently a practicing hospital consultant, a Professor of Renal Medicine at University College London as well as Chief Clinical Information Officer of the Royal Free Trust. He has also served on the Board of an NHS Clinical Commissioning Group, as chair of the Association of UK University Hospitals Medical Directors Group and a Board Member of Medical Education England. He was also Director of Postgraduate Medical and Dental Education for UCL Partners from 2010 to 2013. He combines extensive experience of specialist medicine with a deep knowledge of the digital challenges and innovation opportunities confronting the NHS.
3.2 European Nationals Working in the NHS
Following a letter from the Home Secretary to Health Chief Executives, Mr Simon Stevens, NHS England Chief Executive, issued a joint statement with Professor Sir Bruce Keogh and Professor Jane Cummings, Chief Nursing Officer for England. The statement welcomed the announcement that the Government had ensured that EU citizens living lawfully in the UK will be able to stay and enjoy broadly the same rights and benefits as they do now.
This followed agreement at the European Council for negotiations between the UK and the EU to move to a discussion about their future relationship before the UK’s exit from the EU.
The statement acknowledged that the NHS had always benefited from committed and talented health staff both trained here in Britain and who have chosen to work here from abroad.
EU nationals form an integral and vital part of the health and care family, and their skills and compassionate care directly benefit patients, families and communities. Their vital contribution to the NHS’s work together will continue and is greatly appreciated by all those we care for.
3.3 Workforce Race Equality Standard
The NHS has published it latest Annual Report into race equality.
The audit provides a comprehensive assessment of the experience of NHS employees from black and minority ethnic (BME) backgrounds, including whether or not they have equal access to career opportunities and receive fair treatment at work.
The 2017 Workforce Race Equality Standard (WRES) shows that an increasing proportion of senior nursing and midwifery posts are being filled by people from BME backgrounds, and that there has been a rise in senior BME leaders. The report confirms that an increasing number of Trusts has more than one Board Member from a BME background, with 25 Trusts being represented at board level by three or more people from BME communities.
However, the WRES demonstrates areas where the NHS needs to make further progress. Despite significant improvements in board and senior management representation, the overall number of BME background leadership positions is still not proportionate to the number of BME workers at other levels in the organisation.
Report of the Clinical Chief Officer –17th January 2018 Page 5 of 13 The report also highlights that although people from BME backgrounds are now less likely to be entered into disciplinary action than in 2016, this same group is 1.4 times more likely to go through this formal process than other members of staff.
Further information via: https://www.england.nhs.uk/2017/12/nhs-welcomes-important- improvements-for-race-equality-in-health-service-workforce/
3.4 Prescription Costs Consultation
NHS England has launched a public consultation on proposals to curb prescriptions for some ‘over the counter’ products such as dandruff shampoo and drops for tired eyes, freeing-up up to £136 million to expand other treatments for major conditions such as cancer and mental health problems.
Ending routine prescribing for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health, would free up NHS funds for frontline care.
The consultation does not affect prescribing of items for longer term or more complex conditions or where minor illnesses are symptomatic or a side effect of something more serious.
Over-the-counter products currently prescribed include remedies for dandruff, indigestion, mouth ulcers and travel sickness. The NHS each year spends:
• £4.5 million on dandruff shampoos – enough to fund a further 4,700 cataract operations or 1,200 hip replacements every year. • £7.5 million on indigestion and heartburn – enough to fund nearly 300 community nurses. • £5.5 million on mouth ulcers – enough to fund around 1,500 hip replacements.
If patients were to self-care for these three conditions alone, it would save the NHS £17.5 million allowing funds to be diverted to other areas.
Some of the products currently can be purchased over the counter at a lower cost than that which would be incurred by the NHS.
The over the counter medicines proposals for consultation include stopping the routine prescribing of products that:
• Have low clinical value and where there is a lack of robust evidence for clinical effectiveness, such as probiotics, vitamins and minerals; • Treat a condition that is considered to be self-limiting, so does not need treatment as it will heal/be cured of its own accord, such as sore throat or coughs and colds; • Treat a condition which could be managed by self-care, i.e. that the person does not need to seek medical care or could visit a pharmacist, such as indigestion, mouth ulcers and pain relief.
NHS England and NHS Clinical Commissioners have worked closely with GPs, Pharmacists and patient groups to develop and refine the list of conditions for which prescribing could be restricted, as well as where exceptions may apply. The Board of NHS England approved the launch of a public consultation on these proposals at its public meeting on 30 November 2017.
The savings form a key building block of the NHS’s 10 point efficiency plan contained in the Next Steps on the NHS Five Year Forward View, published in March 2017, and support the ambition to ensure greater value from the NHS’s £17.4 billion medicines bill, through improving health outcomes; reducing waste, over-prescribing and over-treatment; and addressing excessive price inflation by drug companies.
The consultation and guidance document is available here: www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/
Report of the Clinical Chief Officer –17th January 2018 Page 6 of 13
Members will be aware that the CCG implemented a Prescribing for Clinical Need Policy in July 2017.
3.5 Message from the Chief Executive to NHS Staff
On 23rd December 2017, Mr Simon Stevens thanked staff who would be caring for patients over Christmas and for all their work over a “pressurised year” for the NHS.
On Christmas day alone an estimated 97,000 nurses and 53,000 nursing assistants worked in hospitals whilst 12,000 midwives welcomed around 1,400 Christmas babies into the UK.
Around 12,000 ambulance staff, including paramedics, were on duty on Christmas day. In addition, around 176,000 care workers and home carers gave up their Christmas day, whilst an army of caterers produced around 400,000 Christmas dinners to enable patients in hospital to tuck into a festive feast.
It comes after a year that has seen NHS, and other emergency services staff, demonstrate their bravery, dedication and skill in response to the terrorist attacks in London and Manchester and the Grenfell tragedy.
In a video message released on social media he praised the contribution of all those, from porters to consultants and nursing leaders, who give up precious time with their families to look after the most vulnerable over the holidays.
3.6 NHS National Emergency Pressures Panel
The National Emergency Pressures Panel (NEPP) met for the second time on 2nd January 2018, chaired by Professor Sir Bruce Keogh, following its inaugural meeting in December.
The panel was set up in 2017 to advise Pauline Philip, NHS National Director for Urgent and Emergency Care, on pressure and clinical risk and brings together clinical leaders and experts from the Royal Colleges of Surgeons, Physicians, General Practitioners (GPs), Nursing, Public Health and the Care Quality Commission.
The panel noted that the NHS has been under sustained pressure over the Christmas period with high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at Accident and Emergency (A&E) Departments.
The panel formally recorded their thanks for the hard work of staff and noted that winter plans were having an impact including an increase in staff vaccinated against flu, improvements in helping patients return home when well enough, additional beds that have opened since the release of winter funding and the priority that hospitals were giving to the accident and emergency care.
However, they also made a series of recommendations to help hospitals handle the sustained pressure and activating the new NHS’s Winter Pressures Protocol. These include:
• Extending the deferral of all non-urgent inpatient elective care to free up capacity for our sickest patients to January 31. The panel reiterated that cancer operations and time-critical procedures should go ahead as planned; • Over and above this, day-case procedures and routine outpatient appointments should also be deferred where this will release clinical time for non-elective care; • The clinical time released from the above actions should be re-prioritised to: o Implement consultant triage at the front-door so patients are seen by a senior decision maker on arrival at the Emergency Department; o Ensure consultant availability for phone advice for GPs;
Report of the Clinical Chief Officer –17th January 2018 Page 7 of 13 o Maximise the usage of ambulatory care and hot clinic appointments as an alternative to Emergency Department attendance and/or hospital admissions; o Increasing support from Allied Health Professionals, for example physios and therapists, for rehabilitation and discharge; o Staff additional inpatient beds; o Ensure twice daily review of all patients to facilitate discharge. • To ensure patient safety comes first CCGs should temporarily suspend sanctions for mixed sex accommodation breaches; • Whilst overall the NHS is doing better than ever before in vaccinating health care workers there is significant variation between organisations. There should be an immediate prioritisation of vaccination of all frontline staff.
The recommendations build on action that is already being taken to increase capacity in the NHS following the announcement of additional funds in the Budget on 22 November. A significant proportion of the additional capacity is due to open in the next fortnight.
The NHS is taking these steps to ensure patients receive the best possible care over this challenging period.
The public are also being urged to play their part by using the NHS responsibly. Calling 111 is often a quicker and more convenient way of obtaining clinical assessment and advice in non-emergencies and allows staff in A&E to focus on the sickest patients. The Royal College of GPs has already set out three basic steps that all patients should consider before seeking an appointment with their GP for an acute illness including self-care, using online guidance from NHS Choices and consulting with a Pharmacist.
Members should note that, locally, plans for an elective pacing programme were discussed and agreed at the Pennine Lancashire A&E Delivery Board and were implanted as part of the winter planning process. This commenced on 18th December 2017 and will be in place until the end of January 2018.
To date, the directions above following the NEPP meeting on 2nd January have not required the programme to be amended; however, this position will be reviewed if the pressures persist longer than the current programme in place. The programme already includes adjustments in the event of an increase in demand. If necessary, this may necessitate adjusting the programme or extending elective pacing beyond January; however there are currently no plans to do so.
4) NHS Improvement
4.1 Appointment
It has been announced that Mr Ian Dalton has been appointed as the new Chief Executive of NHS Improvement on a permanent basis.
Mr Dalton has held a number of senior provider, regional and national NHS roles throughout his career including Chief Operating Officer and Deputy Chief Executive Officer at NHS England and Chief Executive of NHS North of England, the North East Strategic Health Authority and two acute Hospital Trusts.
Mr Dalton commenced in post on 4th December 2017.
5) HEE
5.1 Cancer Workforce Plan
Report of the Clinical Chief Officer –17th January 2018 Page 8 of 13 On 5th December 2017, HEE launched a Cancer Workforce Plan setting out how it will make sure the NHS has enough staff with the right skills to deliver improvements for people affected by cancer over the next three years. It provides detailed data on key professions so that local Cancer Alliances, HEE and employers can agree the actions needed to help recruit, train and retain the staff necessary to deliver improvements in cancer care.
Further information via: https://hee.nhs.uk/our-work/planning-commissioning/workforce- planning/cancer-workforce-plan
6) NHS Counter Fraud
6.1 Special Health Authority
In November the NHS Counter Fraud Authority (NHSCFA), a new Special Health Authority tasked to lead the fight against fraud, bribery and corruption in the NHS, was launched.
A new strategy for 2017 to 2020 explains how the NHSCFA will lead the fight against NHS fraud, and highlights how it will work collaboratively with our stakeholders in the NHS family and beyond to tackle the problem.
It is estimated that fraud costs the NHS over £1.25 billion each year. These losses impact on NHS services by taking away vital funds from patient care. Fraud is a growing problem in the UK as a whole and the NHS faces a wide range of fraud risks.
The NHSCFA will use intelligence to build a better picture of those risks. It will encourage fraud reporting, which plays a vital role in improving its understanding of fraud across the NHS. It plans to develop creative, innovative and proportionate solutions to identified risks, and will investigate organised and/or complex fraud.
Further information and the strategy are available via: www.cfa.nhs.uk and https://cfa.nhs.uk/about- nhscfa/what-we-do)
7) Lancashire and South Cumbria
7.1 Collaborative Approach to Pathology
Four Hospital Trusts in Lancashire and South Cumbria (L&SC) are collaboratively working together to improve pathology services for patients.
Blackpool Teaching Hospitals NHS Foundation Trust, East Lancashire Teaching Hospitals NHS Trust, Lancashire Teaching Hospitals NHS Foundation Trust and University Hospitals Morecambe Bay NHS Foundation Trust, have been working on this project for a number of months and have engaged with internal and external service stakeholders.
The project aims to provide a streamlined, sustainable pathology service which is clinically and cost- effective. This approach is part of a national strategy to transform both clinical and back office services in the face of financial and workforce constraints.
In L&SC, Pathology staff and other stakeholders have been fully involved in reviewing how services currently operate and are currently scoping options for different models of service provision.
7.2 Joint Committee of CCGs
Members of the public have been invited to observe the Joint Committee of CCGs (JCCCG), which is set to hold its next formal meeting in public on 11th January 2018 at Tan House Community Enterprise, Ennerdale, Tan House, Skelmersdale, WN8 6AN.
Report of the Clinical Chief Officer –17th January 2018 Page 9 of 13 The JCCCG is made up of GPs and Lay Members from each of the CCGs in L&SC. Chief Executives from Lancashire County Council, Blackburn with Darwen Borough Council (BwDBC), Blackpool Council, representatives from District Councils, local Healthwatch are not members of the Committee, but attend the meetings.
8) Pennine Lancashire
8.1 Together a Healthier Future (TAHF) Programme
Health and care chiefs in Pennine Lancashire have published a draft plan for health and care services in the area.
The draft plan is a blueprint to improve the health of people living in Pennine Lancashire, as well as improving health and care services in the area.
Over the last year, the Pennine Lancashire Accountable Health and Care Partnership has been working with residents, volunteers, Doctors, Nurses, health and care professionals, community workers and others to develop its plans for change. During the summer, health and care leaders listened to what people have had to say about health and care services, and about how they can be supported to live healthily. As a result, a draft Pennine Plan has been developed which outlines a number of innovative and exciting proposals designed to improve the health and wellbeing of people who live and work in the area.
The draft plan is a discussion document. It includes ideas and proposals that include some positive innovations and developments that it is hoped can be introduced in the area. It sets out how we can make our services the best that they can be. Our Doctors, Nurses, Pharmacies and other health care professionals can work better together in our neighbourhoods and we can improve hospital and urgent care services by providing more support in communities. Everyone’s help is needed to make the plan work by looking after their own health as much as they can, make healthy choices in their lives, use services appropriately and support their families and friends to live healthy lives.
The draft plan is available at http://togetherahealthierfuture.org.uk/pennine-plan/ and comments are welcome online at: www.surveymonkey.co.uk/r/DraftPenninePlanSurvey
9) BwD
9.1 CCG
9.1.1 Use of the Seal
The CCG is required by its standing orders to report to the Governing Body on the use of the CCG seal. The seal has been applied as follows:
Seal Date Contract Number Applied 002 31/10/17 Lease for CCG Headquarters (Fusion House) between Blackburn with Darwen (BwD) CCG and NHS Property Services.
The transaction has been recorded in the Register of Seals held in the Finance Department.
9.2 Local Authority
9.2.1 Office for Standards in Education, Children’s Services and Skills (Ofsted) Inspection
Report of the Clinical Chief Officer –17th January 2018 Page 10 of 13 BwDBC has been praised for its ‘early help and well-co-ordinated support’ by Ofsted Inspectors who rated Children’s Services in the area as ‘good’.
A team of eight Inspectors spent four weeks carrying out a rigorous inspection under the Government’s new Single Inspection Framework. The judgement, published on 8th December 2017, puts the Council in the top third of Local Authorities nationally and it’s one of only 6 out of 23 in the North West to have this rating.
The network of Children’s Centres and partnership working are highlighted as strengths in the report. Social Workers are described as being ‘very committed to helping children and protecting them from harm’.
Creative approaches and projects such as the work to protect children at risk of sexual exploitation and missing from home along with the work done to address concerns about radicalisation are also praised.
Other good practice was found in the leaving care team with ‘flexible and responsive’ services described. The Adoption Service was seen to be good with ‘doing the right thing’ for the children being a clear priority.
Ofsted separately inspected services for children with disabilities at the Appletree Centre in Blackburn in early October and judged them to be ‘outstanding’.
The Inspectors were concerned about high demand and capacity issues. Recommendations for improvement included making sure arrangements are planned well in advance before children move to Adult Services. They also offered a number of recommendations in relation to social care practice and procedure to help ensure that there are no unnecessary delays in responding to the needs of children.
10) News and Events
10.1 Royal College of General Practitioners (RCGP) Awards
I am pleased to report that Dr Neil Smith of Oakenhurst Medical Practice in Barbara Castle Way Health Centre, Blackburn, has been named as North West GP of the Year 2017.
Dr Smith, who is also the GP Cancer Lead across Pennine Lancashire, was given the award by the RCGP in the North West. The RCGP recognised his work as a GP and GP educator.
As Associate Dean at Manchester Medical School, Dr Smith developed a ‘grow your own’ policy to encourage medical students to stay and work in the area, improving the quality of education and encouraged medical students to go into a career in General Practice. As a result of this he has mentored scores of Junior Doctors, 24 of whom are now working as GP colleagues in his locality including six in his own Practice.
On behalf of the CCG, congratulations to Dr Smith on this well-deserved award!
10.2 GP Practice Awards
I am personally delighted to announce that a BwD GP Practice Manager, and the Practice Manager at my own GP Practice, has been awarded top spot in the GP Practice Awards.
Mrs Ann Neville, a Practice Manager at Darwen Healthcare, was awarded Practice Manager of the Year 2017 at the ceremony held in London on 30th November 2017.
Report of the Clinical Chief Officer –17th January 2018 Page 11 of 13 The GP Awards are designed to recognise, highlight, and reward the hard work and innovation that gets carried out every day in surgeries throughout the UK.
The award follows on from Mrs Neville’s success in industry magazine Practice in Management’s list of the country’s most inspiring Practice Managers last year.
She has been in her role for just three years yet in that time has resolved major problems with patient access introducing more flexibility in appointment structures to meet patient needs, brought in a more practical system for home visits and created a risk register to give preventative advice to patients who might develop diabetes. She regularly overcomes a number of challenges including working within financial constraints and making sure there are enough appointments to meet patient demand, as well as occasionally dealing with patient complaints and staffing issues.
On behalf of the CCG, congratulations to Mrs Neville on this well-deserved award!
10.3 New Year’s Honours
This year, health sector recipients make up 10% of all the New Year’s Honours and a rich breadth of vocations has been recognised:
• Knight Grand Cross for Medical Scientist, Sir Keith Peters; • Damehood for Chief Executive of the University Hospitals of Morecambe Bay NHS Foundation Trust, Jackie Daniel; • Damehood for the outgoing President of the Royal College of Surgeons, Clare Marx; • Damehood of the outgoing Chief Executive of the Devon Success Regime and Sustainability and Transformation Plan, Angela Pedder. • Commander of the Order of the British Empire (CBE) has been awarded to the Chair of the Welsh Ambulance Services NHS Trust, Michael Giannasi; • Member of the Order of the British Empire (MBE) to Neelam Farzana, who in 2007 set up The Listening Service to address a gap in provision of mental health support for the BME community.
Fifteen people living and work in Lancashire have been recognised, including two Members of Parliament who have been knighted:
• Mark Hendrick, MP for Preston; • Lindsay Hoyle, MP for Chorley.
Further awards granted are:
• Alan Scott, Deputy Director of North West Prisons, has earned a CBE for his services to the Prison Service and the community; • Pamela Birch, Executive Principal of Hambleton Primary School and Deputy Chief Executive Officer of Fylde Coast Academy Trust, earned an Officer of the Order of the British Empire (OBE) for services to education.
Nine MBEs have been granted in recognition for work in the community:
• Afrasiab Anwar, services to community cohesion in Burnley; • Joan Bamber, Governor of Dame Evelyn Fox and Newfield Schools, Blackburn, services to education; • Christopher Brown, Governor of Sir Tom Finney Community High School, services to children with special educational needs and disabilities; • Susan Fazackerley, services to the community in Lytham St Annes;
Report of the Clinical Chief Officer –17th January 2018 Page 12 of 13 • Lawrence Forshaw, Life President of Alder Grange School in Rossendale, services to education; • Carol Holt, flood incident manager of the Environment Agency, services to flood risk management and the environment; • Sajda Majeed, services to the community in Burnley; • Dr Melinda Tan, Rector of University of Central Lancashire Cyprus Branch Campus, for services to British higher education overseas and the promotion of bi-communal relations in Cyprus: • Alison Watson, Chief Executive Officer of Class of Your Own, services to education.
A British Empire Medal (BEM) has been granted in recognition for services in the community:
• Kathryn Heyworth, Burnley.
On behalf of the CCG, congratulations to all those who have received awards!
11) Meetings
Members may be interested to note the following meetings and events which have taken place during the course of the last two months:
8.11.2017 Governing Body 8.11.2017 Finance scrutiny Group 6.12.2017 Shadow Accountable Care System Development Workshop 6.12.2017 Governing Body Development Session 7.12.2017 Joint Committee of Clinical Commissioning Groups 12.12.2017 Blackburn Health and Wellbeing Board 13.12.2017 Commissioning Business Group 14.12.2017 Senate 20.12.2017 Team to Team to Team with East Lancashire CCG and East Lancashire Hospitals NHS Trust 20.12.2017 Partnership Leaders Forum 21.12.2017 Executive Joint Commissioning Group Workshop
12) Recommendation
The Governing Body is requested to receive this report and to note the items as detailed.
Dr. Penny Morris Clinical Chief Officer 8th January 2018
Report of the Clinical Chief Officer –17th January 2018 Page 13 of 13
GOVERNING BODY MEETING
Chief Finance Officer Report
Date of Meeting 17th January 2018 Agenda Item 9
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity y To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 3
Clinical Lead: N/A
Senior Lead Manager Mr Roger Parr Finance Manager Mrs Linda Ring Equality Impact and Risk Assessment N/A completed: Patient and Public Engagement completed: N/A Financial Implications N/A Risk Identified See report Report authorised by Senior Manager: Mr Roger Parr Y
Decision Recommendations The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of November 2017.
Governing Body Meeting Page 2 of 3
Executive Financial Summary Month 8 – Period Ending 30th November 2017
Year to Date (YTD) Full Year Forecast Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 Funds Available 166,453 166,453 0 252,044 252,044 0
Commissioning 124,322 123,872 450 185,985 185,302 683 Primary Care 34,707 36,058 (1,351) 53,171 55,236 (2,065) Corporate 5,050 5,030 20 7,468 7,402 66 Reserves 881 0 881 3,181 1,865 1,316 Balance 1,493 1,493 0 2,239 2,239 0
Summary Financial Position – The CCG is reporting a year to date surplus of £1,493k which is in line with the financial plan. The CCG is forecasting to deliver an year end of surplus of £2,239k in line with the financial plan. The CCG is currently holding a 0.5% risk reserve as per national guidance.
Commissioned Services Risks
• Healthcare Commissioning is reporting a YTD underspend of £450k • The QIPP target for the CCG is 3.4% of turnover and some schemes with a year-end forecast underspend of £683k. are scheduled to come on line during the year. • Primary Care Services are reporting a YTD overspend of £1,351k with • Acute activity levels continue to be a key factor in 2017/18. Schemes a forecast year end overspend of £2,065k mainly from prescribing and are in place to manage demand. primary care co-commissioning. Prescribing is reporting a YTD • Continuing health care and complex packages continues to be a key overspend of £1,381k and a year-end forecast overspend of £2,063k. risk as these are generally high cost and low volume. The CCG • Corporate Services are reporting an underspend of £20k and a continues to closely monitor this area of expenditure. forecast underspend of £66k at year end. • Prescribing expenditure is volatile and is monitored closely by the Medicines Management Team. The prescribing waste scheme Capital commenced in 2016/17 and is making significant savings. However the pressure from drugs classed as no cheaper stock obtainable is reflected • A combined budget for hardware replacement of the GPIT estates, in the YTD and forecast expenditure for Primary Care and offset this provision of mobile working and the upgrade all practices across benefit. Blackburn with Darwen CCG to Windows 10 has been submitted by NHS England on behalf of the CCG. Approval has been given to QIPP commence these schemes and expenditure of £200k is forecast. • The CCG has actioned £7.1m of QIPP savings to date and is ahead of plan to meet the full year savings of £8.6m. The CCG is reviewing services to identify where savings can be made to meet the target. The CCG plans to deliver the full target however there remains a risk of schemes yet to be actioned.
Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of November 2017. Governing Body Meeting Page 3 of 3
NHS Blackburn with Darwen CCG APPENDIX A
Summary Governing Body Report ‐ November 2017
Annual Forecast Budget to Date Expenditure to Date Variance to Date Annual Budget Annual Forecast Variance £000 £000 £000 £000 £000 £000
Revenue Resource Limit
Confirmed (166,453) (166,453) 0 (252,044) (252,044) 0 Anticipated 000000 Total Revenue Resource Limit (166,453) (166,453) 0 (252,044) (252,044) 0
Expenditure
Commissioning (Page 2) 159,029 159,930 (901) 239,156 240,538 (1,382) Corporate (Page 4) 2,741 2,741 0 3,950 3,984 (34) Reserves (Page 4) 881 0 881 3,181 1,865 1,316 Healthcare Sub Total 162,651 162,671 (20) 246,287 246,387 (100)
Running Costs (Page 4) 2,309 2,289 20 3,518 3,418 100 Total Expenditure 164,960 164,960 0 249,805 249,805 0
Surplus/(Deficit) 1,493 1,493 0 2,239 2,239 0
Better Payment Practice Code YTD Value (%) YTD Volume (%) FOT Value (%) FOT Volume (%) Target (%)
NHS 100.0 99.6 100.0 99.6 95.0
Non NHS 99.9 99.4 99.9 99.4 95.0 NHS Blackburn with Darwen CCG APPENDIX B
Healthcare Commissioning Report ‐ November 2017
Expenditure to Annual Forecast Budget to Date Variance to Date Annual Budget Annual Forecast Date Variance £000 £000 £000 £000 £000 £000
Acute Services
NHS contracts (includes Ambulance Services) 80,686 80,554 132 121,067 120,788 279 Non NHS Providers 4,645 4,384 261 6,993 6,577 416 NHS Contract Exclusions / Cost per Case 358 311 47 536 471 65 Non Contract Activity 1,170 1,172 (2) 1,756 1,818 (62) Other 92 92 0 92 88 4 Sub Total Acute Contracts 86,951 86,513 438 130,444 129,742 702
Mental Health Services
NHS contracts 10,652 10,652 0 15,860 15,860 0 Non NHS Providers 839 853 (14) 1,051 1,060 (9) IPA ‐ Complex Packages 550 624 (74) 825 936 (111) Non Contract Activity 202 196 6 339 330 9 Other 402 399 3 507 507 0 Sub Total Mental Health Services 12,645 12,724 (79) 18,582 18,693 (111)
Community Health Services
NHS contracts 9,488 9,488 0 14,232 14,232 0 Non NHS Providers 906 945 (39) 1,283 1,332 (49) NHS Contract Exclusions / Cost per Case 215 204 11 323 306 17 Non Contract Activity 000000 Hospices 701 697 4 1,051 1,046 5 Other 000000 Sub Total Community Services 11,310 11,334 (24) 16,889 16,916 (27)
Total Healthcare Contracts 110,906 110,571 335 165,915 165,351 564
Continuing Care Services
Continuing Care 4,377 4,074 303 6,518 6,070 448 Free Nursing Care 682 657 25 1,031 1,031 0 Sub Total Continuing Care Services 5,059 4,731 328 7,549 7,101 448
Primary Care Services
Prescribing 16,248 17,629 (1,381) 24,372 26,435 (2,063) Enhanced Services 940 930 10 1,406 1,397 9 Primary Care Co‐Commissioning 15,011 15,020 (9) 23,217 23,246 (29) Out of Hours 1,174 1,174 0 1,699 1,699 0 Commissioning 891 864 27 1,812 1,778 34 Other 443 441 2 665 681 (16) Sub‐total Primary Care services 34,707 36,058 (1,351) 53,171 55,236 (2,065)
Other Programme Services
Other Non Acute 5,163 5,157 6 7,729 7,730 (1)
Complex Cases & Individual Funding Requests 3,194 3,413 (219) 4,792 5,120 (328) Sub Total Other Programme Services 8,357 8,570 (213) 12,521 12,850 (329)
Surplus/(Deficit) 159,029 159,930 (901) 239,156 240,538 (1,382) NHS Blackburn with Darwen CCG APPENDIX C
Main Healthcare Contracts ‐ November 2017
Expenditure to Annual Forecast Budget to Date Variance to Date Annual Budget Annual Forecast Date Variance £000 £000 £000 £000 £000 £000
Acute Contracts Main Provider
East Lancashire Hospitals NHS Trust 68,767 68,773 (6) 103,151 103,159 (8)
Other Lancashire Providers
Lancashire Teaching Hospitals NHS FT 3,497 3,637 (140) 5,245 5,455 (210) Blackpool Fylde & Wyre Hospitals NHS FT 452 348 104 703 521 182 University Hospitals Morecambe Bay NHS FT 73 78 (5) 110 117 (7) North West Ambulance Service NHS Trust (Block) 4,890 4,923 (33) 7,335 7,343 (8) Sub Total Other Lancashire Providers 8,912 8,986 (74) 13,393 13,436 (43)
Greater Manchester Providers
University Hospital South Manchester NHS FT 316 245 71 316 245 71
Salford Royal NHS FT 248 303 (55) 372 454 (82) Royal Bolton Hospitals NHS FT 202 175 27 303 262 41 Wrightington, Wigan & Leigh NHS FT 585 583 2 878 874 4 Central Manchester University Hospital NHS FT 1,089 1,043 46 1,803 1,689 114 Pennine Acute NHS Trust 148 104 44 221 155 66 The Christie NHS FT 233 97 136 349 145 204 Sub Total Greater Manchester Providers 2,821 2,550 271 4,242 3,824 418
Merseyside Providers
Royal Liverpool & Broadgreen NHS Trust 110 168 (58) 165 251 (86) Sub Total Merseyside Providers 110 168 (58) 165 251 (86)
Independent Sector Contracts
BMI Healthcare (Beardwood, Beaumont, Gisburne) 3,871 3,673 198 5,807 5,510 297 Ramsay 314 251 63 495 376 119 Sub Total 4,185 3,924 261 6,302 5,886 416
Total Acute Contracts 84,795 84,401 394 127,253 126,556 697
Mental Health Contracts
Lancashire Care NHS FT (Block) 10,629 10,629 0 15,825 15,825 0 Calderstones Partnership NHS FT (Block) 000000 Greater Manchester West NHS FT 21 21 0 32 32 0 Total Mental Health Contracts 10,650 10,650 0 15,857 15,857 0
Community Health Contracts
Lancashire Care NHS FT (Block) 9,488 9,488 0 14,232 14,232 0 Total Community Health Contracts 9,488 9,488 0 14,232 14,232 0
Surplus/(Deficit) 104,933 104,539 394 157,342 156,645 697 NHS Blackburn with Darwen CCG APPENDIX D
Non Healthcare Commissioning Report ‐ November 2017
Annual Forecast Budget to Date Expenditure to Date Variance to Date Annual Budget Annual Forecast Variance £000 £000 £000 £000 £000 £000
Other Corporate Costs (Non‐Running Costs)
CSU re‐charge 347 346 1 519 519 0 NHS Property Services re‐charge 1,559 1,598 (39) 2,338 2,394 (56) Other 835 797 38 1,093 1,071 22 Sub Total Corporate Costs 2,741 2,741 0 3,950 3,984 (34)
Plan requirements & reserves
Reserves 881 0 881 3,181 1,865 1,316 Sub Total Reserves 881 0 881 3,181 1,865 1,316
Running Costs
CCG Pay 1,079 1,046 33 1,619 1,575 44 CSU re‐charge 886 884 2 1,324 1,324 0 NHS Property Services re‐charge 66 66 0 99 99 0 Other 278 293 (15) 476 420 56 Running Costs Reserve 000000 Sub Total Running Costs 2,309 2,289 20 3,518 3,418 100
Surplus/(Deficit) 5,931 5,030 901 10,649 9,267 1,382 NHS Blackburn with Darwen CCG APPENDIX E
Statement of Financial Position ‐ November 2017
November Statement of Financial Position £000
Non Current Assets Property, Plant, Equipment 0
Total Non Current Assets 0
Current Assets Trade and Other Receivables 3,272 Financial Assets 0 Inventory 298 Cash and Bank 110
Total Current Assets 3,680
Total Assets 3,680
Current Liabilities Trade and Other Payables (9,243) Other Liabilities 0 Provisions (1) Borrowings 0
Total Current Liabilities (9,244)
Total Assets less Current Liabilities (5,564)
Non Current Liabilities Trade and Other Payables 0 Provisions 0 Borrowings 0 Other Liabilities 0
Total Non Current Liabilities 0
Total Assets Employed (5,564)
Financed By General Fund (5,564) Revaluation Reserve 0 Donated Asset Reserve 0 Government Grant Reserve 0 Other Reserves 0
Total Equity (5,564)
GOVERNING BODY MEETING GOVERG BODGOVERNING BODY MEETING Contract, Quality and Performance Report
Date of Meeting 17 January 2018 Agenda Item 10
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor 9 outcomes and inequalities To work collaboratively to create safe, high quality health care services 9 To maintain financial balance and improve efficiency and productivity 9 To deliver a step change in the NHS preventing ill health and supporting people to live 9 healthier lives To maintain and improve performance against core standards and statutory requirements 9 To commission improved out of hospital care x CCG High Impact Changes Delivering high quality Primary Care at scale and improving access 9 Self-Care and Early Intervention 9 Enhanced and Integrated Primary Care and Better Care Fund 9 Access to Re-ablement and Intermediate Care x Improved hospital discharge and reduced length of stay 9 Community based ambulatory care for specific conditions 9 Access to high quality Urgent and Emergency Care 9 Scheduled Care 9 Quality 9 Clinical Lead: Dr Malcolm Ridgway – Director of Quality and Performance Mr Rogere Parr – Chief Financee Officer Senior Lead Manager Mr Rogere Parr – Chief Financee Officer Finance Manager Mrs Jill Marr – Senioro Finance Officer Equality Impact and Risk Assessment Not Required completed: Patient and Public Engagement completed: Not Required
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Financial Implications None identified at this stage Risk Identified Fluctuating performance and potential impact on the quality of patient care Report authorised by Senior Manager: Dr Malcolm Ridgway – Director of Quality and Performance Mr Roger Parr – Chief Finance Officer / Interim Deputy Chief Executive Y Decision Recommendations To note the contents of the report and support actions as identified.
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Contract & Information Quality & Performance Lancashire Care Foundation Trust (LCFT) Mental Health ‐ Executive Summary Lancashire Care Foundation Trust (LCFT) Mental Health ‐ Executive Summary Month 7 Month 7
Psychological Therapies – Blackburn with Darwen Clinical Commissioning Group (BwD Early Intervention Psychosis (EIP) – Concerns with the accuracy of the data were CCG) has a monthly access target of 275 which is required to deliver an annual access rate raised at the Performance and Effectiveness Group on 2nd November 2017. of 16.8% of estimated prevalence during 2017/18. The CCG’s year to date (YTD) Validated data for 2017/18 demonstrates a considerable underperformance performance, including the Long Term Conditions (LTC) IAPT Service, is above the level against the EIP: Seen within 2 weeks indicator, with October 2017 reporting Trust required to achieve this target: wide achievement of 9.5%. The Trust has attributed underperformance to the lack of timely referral processes and/or telephone/face to face treatment • LCFT IAPT (Core Service plus LTC): 1,704 Treatments contacts. LCFT advise that performance against this target has improved in o 14.8% annualised rate, based on year to date numbers November to 23.9% and further improved in December 2017. BwD CCG
• Lancashire Women’s Centre (Core Service plus LTC): 408 Treatments performance was reported at 16.7% in October 2017 decreasing to 9.1% in November 2017. o 3.6% annualised rate, based on year to date numbers
• Total: 2,112 Treatments o 18.4% annualised rate, based on year to date numbers
Referrals – At Month 7, BwD CCG referrals to LCFT Mental Health Services have decreased Progress on all actions will be monitored through the Performance and from 2016‐17 levels by ‐11 (‐0.6%), which is above plan by +172 (+11.2%). Effectiveness Group and the Quality and Performance Review Group. An updated th Admissions ‐ The number of admissions to Mental Health inpatient wards, including Out of briefing paper was due to be discussed at the LCFT Board Meeting on 4 January Area Placements (OAPs), is below the number admitted in the previous year i.e. 212 in 2018, which will be shared with Commissioners once approved. 2017‐18, versus 240 in 2016‐17 (‐28, ‐11.7%). Including OAPs, BwD CCG admissions are above plan +84 (+65.9%). While the plan is based on BwD CCGs weighted population, it is a Psychological Therapies – LCFT met the 50% Recovery target for BwD CCG in 33% reduction on last year’s outturn. This is being queried with LCFT and an update is October 2017 (50.5%), and is above target in year to date data (55.5%). Trust expected for the Month 8 report. performance (All CCGs) was 54.1% in‐month and is 55.1% YTD.
Bed Days ‐ Including Out of Area bed days, BwD CCG patients account for more than BwD Although a reduction has been noted in October 2017, long internal waits remain CCG’s weighted population share of bed days +1,770 (+27%). an issue for some treatments, particularly for high intensity interventions such as Cognitive Behavioural Therapy (CBT), 1 to 1 Psychological Wellbeing Practitioner Out of Area Placements (OAPs) – OAPs for 2017/18 year to date are 10 admissions (4.7% (PWP) sessions and Counselling. Concerns regarding long waits have been raised of all admissions) and 812 bed days (9.8% of all bed days). For both admissions and bed with the Trust as reporting demonstrates they are a national outlier. A ‘deep days, these are decreases on the same period last year, when OAPs accounted for 53 dive’ into the data has commenced and an update was expected to be presented admissions (22% of all admissions) and 1,574 bed days (20% of all bed days). at the Performance and Effectiveness Group on 4th January 2018. This is currently outstanding and an update has been requested from the Trust.
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As at the end of October 2017 there was 1 Blackburn with Darwen CCG patient Mental Health Baselines – LCFT have recently informed the CCG of an historic data issue waiting over 26 weeks. Service users waiting on the pathway are contacted where the contact activity reporting for some services has been including ‘note counts’ i.e. periodically by the Trust to ensure therapy is still required and that there are no notes made by clinicians about service users in their records have been classed as immediate concerns to escalate. ‘contacts’ for the purpose of activity reporting. The services affected by this issue are: MAS; Eating Disorders; Hospital Liaison and ADHD. ADHD – Q2 reporting on the 18 week referral to treatment data is currently outstanding for transitioning service users and has been followed up with the Since this has been practice for a number of years, it has been agreed that LCFT should Trust. continue to report contract data including the aforementioned ‘counts’ until the end of 2017/18. For 2018/19 the anomaly will be rectified and refreshed baselines agreed for the Ethnicity Coding – Data submitted by LCFT does not correlate with the nationally period. published data and has been queried with the Trust. An update will be provided once received. National reporting demonstrates 78% validity of ethnicity coding All other services are unaffected by this issue and performance data remains unaffected. with 22% coded as ‘default’. Under the rules of the indicator, ‘default’ coding is not accepted.
Unscheduled Care – Reporting against the target for the Mental Health Liaison Team (MHLT) to carry out assessment within 24 hours for ward referrals was expected from Q2; submission remains outstanding and has been followed up with the Trust.
Staffing/Workforce Reporting – Detailed staffing/workforce reporting with exception narrative has been requested from the Trust and discussions are ongoing to ensure reporting is fit for purpose. An updated reporting format is expected to be produced in January 2018 and will be reviewed and discussed at the monthly Quality and Performance Meetings.
Mental Health Network Vacancy Rate: The Establishment Vacancy Rate has remained fairly static in October 2017 at 11.77% against a threshold of 5.0%. The new Network have amalgamated the Specialist Services and Mental Health ongoing recruitment programmes, designed to target hard to fill posts and continue to effectively manage its delivery.
Mental Health Network Sickness Absence: Sickness absence has increased in October 2017 to 8.52% from 7.70% in September 2017, against a target of 4.5%. Network focus on Sickness Absence continues and remains a top priority and is the focus of the Back to Basics Sickness Absence Management Action Plan. Service Managers are working closely with HR to effectively manage sickness absence.
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Contract & Information Quality & Performance East Lancashire Hospitals NHS Trust (ELHT) ‐ Executive Summary East Lancashire Hospitals NHS Trust (ELHT) ‐ Executive Summary Month 7 Month 7
Point of Delivery (POD) Activity Variance £ Variance A&E 4 Hour – Given underperformance nationally against the 95% 4 hour target, A&E (including MIU) ‐1627 (‐4.8%) ‐£186K (‐4.5%) NHS England has set a trajectory for 2017/18 for: over 90% of emergency Elective (Ordinary + Day Cases) ‐49 (‐0.5%) +£73K (+0.8%) patients to be treated, admitted or transferred within 4 hours by September Elective Excess Bed Days ‐147 (‐32.7%) ‐£43K (‐36.2%) 2017; the majority of trusts to be meeting the 95% standard by March 2018; and Elective Costs Inc. Excess Bed Days +£31K (0.3%) for the NHS overall to meet the 95% standard by the end of the 2018 calendar Non Elective (NEL) Inc. Non‐Emergency (NE) +24 (+0.21%) +£695K (+3.5%) year. Locally, the 95% 4 hour waiting time target for A&E was not met in NEL + NEL NE Excess Bed Days ‐2003 (‐41.1%) ‐£465K (‐39.5%) September 2017 at East Lancashire Hospitals Trust (ELHT), with deterioration in performance at 87.51% (85.40% YTD). A 4 hour recovery action plan is being Non Elective Threshold Adjustment ‐£69k monitored via the A&E Delivery Board. Non Elective Costs Inc. Excess Bed Days +£161K (0.8%) Outpatients First Attends ‐1198 (‐6.0%) ‐£350K (‐7.7%) Ambulance Handovers – In October 2017, there was a decrease in the number of Outpatient Follow‐up Attends +838 (+2.0%) +£54K (+3.6%) ambulance handovers over 30 minutes (346) and an increase in ambulance Outpatient Procedure – New +301 (+5.6%) +£24K (+3.2%) handovers over 60 minutes (115), in comparison to 361 over 30 minutes and 67 Outpatient Procedure – Review +185 (+1.7%) +£40K (+3.3%) over 60 minutes in September 2017. Royal Blackburn Hospital continues to be Total Outpatient +126 (+0.2%) ‐£233K (‐2.9%) the busiest site in the North West for ambulance attendances, with surges in ambulance arrival causing pressure in the department especially in times of Inpatient Care is above plan on cost (+£73K, +0.8%) from below plan activity (‐49 spells, limited patient flow due to low bed availability within ELHT. The Ambulance ‐0.5%). This is due to Ordinary Elective activity (EL) showing higher costs, with notable Liaison Role has been reviewed and changed to a Clinical Co‐ordinator role, shifts in the grouping of spells, towards higher levels of complications/comorbidities. funding is in place until 31st March 2018. Key Performance Indicators have been However, below plan Excess Bed Days (‐147 bed days, ‐32.7%), has reduced Elective agreed and the role will be monitored through the fortnightly NWAS Liaison Admission costs by ‐£43K, ‐36.2%, resulting in a total over performance of +£31K (+0.3%). meetings. Outpatient Care is below plan on cost (‐£233K, ‐2.9%) from only marginally above plan activity (+0.2%). This is mostly due to the more expensive Outpatient First Attendances, 12 Hour Breaches ‐ In October 2017, there were 2 Mental Health 12 hour A&E being below plan in activity, while less expensive Follow‐ups are above plan in activity. breaches at ELHT. A teleconference has been held for all breaches in line with due process with key themes identified relating to bed availability. Non‐Elective Admissions including Non‐Emergency are above financial plan (+£695K, +3.5%); however activity is on plan. This is due to shifts in the grouping of spells towards Referral to Treatment (RTT) Incomplete – In October 2017, the RTT ‘Awaiting higher levels of complications/comorbidities. However, below plan Excess Bed Days (‐2003 Treatment’ standard (target 92% within 18 weeks) was not achieved at ELHT with bed days, ‐41.1%), has reduced the Non Elective Admission costs by ‐£465K, (‐39.5%) giving performance at 90.79% (91.90% YTD). However the standard was met for BwD a total over performance of +£161K (+0.8%). CCG patients with performance at 92.17% (92.55% YTD). 16 BwD CCG patients are currently waiting >36 weeks (of which 0 are > 52 weeks). Referral to Treatment – BwD CCG patients awaiting treatment at ELHT stands at 6,669 at month 7. This is a decrease from the previous month (‐214, ‐3.1%). Compared to the same month last year, this is a decrease of (‐383, ‐5.4%).
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Contract & Information Quality & Performance Primary Care ‐ Executive Summary Primary Care ‐ Executive Summary Month 7 Month 7
Out of Hours ‐ Compared to last year’s Month 7 data total activity for the Out of Hours Care Quality Commission (CQC) – CQC have now inspected 25 out of 26 practices service provided by ELMS is under plan YTD by ‐564 (‐5.2%). All elements are in Blackburn with Darwen. 23 practices have received ‘Good’ one practice underperforming: Dr Advice (‐125, ‐4.0%), Home Visits (‐103, ‐7.1%) and Primary Care ‘Outstanding’. attendances (‐336, ‐5.3%). The inspection due to be carried out at Pringle Street surgery has been cancelled Year to date ‐ Activity Full Year Forecast ‐ Activity and deferred to early next year. Pringle Street surgery has recently undergone 17/18 16/17 Variance Status 17/18 16/17 Variance Status significant refurbishment work, which has in part caused the delay to the CQC inspection. PC 5988 6324 ‐336 ‐5.3% G 10,518 11,108 ‐590 ‐5.3% G Attends Limefield Surgery was re inspected in September 2017 and improved their rating Dr 3011 3136 ‐125 ‐4.0% G 5,142 5,355 ‐213 ‐4.0% G to ‘Requires Improvement’. The CCG have been assured that all the improvement Advice areas have been met and the CQC will carry out their follow up visit early in the Home 1343 1446 ‐103 ‐7.1% G 2,358 2,539 ‐181 ‐7.1% G New year. Visits Nurse Forum ‐ The agenda of the forum continues to support education and an Total 10342 10906 ‐564 ‐5.2% G 18,018 19,002 ‐984 ‐5.2% G opportunity for all nurses to be involved in transformation and workforce development. The NHS England vaccination and immunisation team will be Alternative Provider Medical Services (APMS) General Practitioner Contracts – The attending the Nurse Forum in January to raise the issue re the fall in pre‐school decision regarding Bentham Road Surgery and The Waterside Practice will be advertised boosters and Measles vaccine uptake. on the 15th January 2018 with contract award on the 25th January 2018.
Quality and Outcomes Enhanced Services Transformation (QOEST) ‐ The QOEST plan continues to be progressed. Quarterly Quality and Performance Assurance meetings are on‐going. Planning for the next cycle has commenced with greater emphasis on access and sustainability.
Estates Technology Transformation Fund (ETTF) ‐ The West Scheme has been supported in principle by NHS England with funding released to further progress the outline business case, planning etc. Premises directions that will allow the implementation of schemes under the ETTF have still to be signed off by Parliament.
Workforce Development – As reported in the previous month, Health Education England (HEE) recently made available additional funding for 15 Advanced Practitioner MSc places across the Lancashire and South Cumbria (L&SC) Primary Care footprint. Due to the high
Governing Body Meeting 6 | Page number of applications only one of the six BwD applications was approved and the place awarded to a Practice Nurse at Primrose Bank Medical Centre.
In addition Local Primary Care (LPC) have arranged Care Navigation Training for frontline administrative staff to further develop their skills and ensure that patients contacting GP surgeries are signposted to the correct care professional. The training will commence at the end of January 2018. Care Navigation Training is part of the General Practice Forward View and utilises the central funding received by CCGs from NHS England.
Digital approaches in Primary Care ‐ In line with NHS England’s core requirements for improving access, BwD CCG is actively looking to improve access for residents in the borough through the use of digital approaches.
A cohort of 13 practices will be attending an action learning set and developing their own action plan in relation to patient online usage. This support programme has been arranged by the CCG in conjunction with the L&SC Digital Team and has been developed in order to help patients use the facility and increase practice utilisation rates.
In addition, practices and Primary Care Networks have been asked to be part of an L&SC programme which will support practices to further develop modes of digital delivery such as video consultations, health applications for phones and tablets and social media.
Referrals – Referrals to the CCG’s main hospital provider (ELHT) have decreased this year compared to the same period last year i.e. ‐954 (‐2.1% per working day). A reduction in referrals from GPs account for just under half (46%) of this decrease ‐438 versus 2016/17 (‐1.6% per working day).
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Contract & Information Quality & Performance Lancashire Care Foundation Trust Community ‐ Executive Summary Lancashire Care Foundation Trust Community ‐ Executive Summary Month 7 Month 7
The process for reporting against variances (+/‐10%) as agreed by Chorley and South Ribble Referral to treatment (RTT) Incomplete ‐ The 92% 18 weeks referral to CCG (CSR CCG) as lead contractor for LCFT Community Services is for the Trust to provide treatment (RTT) Incomplete target was met for BwD CCG LCFT Community an exception report in the month following the previous quarter. services patients in October 2017, with performance at 100% (94.3% YTD).
Adult Learning Disability Service (‐1753, ‐59.0%) ‐ The Trust advised that a review of the Treatment Room ‐ An unannounced quality visit was carried out on 22 figures indicated that there is a recording issue across the learning disability teams. The November at the treatment room at Barbara Castle Way Health Centre; this was activity recording system in Adult Learning Disabilities is a dual system using paper‐based carried out with LCFT quality leads and a CCG representative. The reports and clinical records with the addition of Electronic Care Records for recording contacts. A deep outcomes are currently being collated by LCFT and will be shared in due course. dive of the data continues in order to understand the full extent of the underperformance. The Trust has advised that until these investigations have been completed, it is difficult to Staffing – Challenges remain around the fragility of some smaller services. This propose an accurate recovery trajectory. The Trust has indicated that they will be in a has been noted in the Community Matrons and Continence Service in recent position to provide this at Month 8. weeks. LCFT have been requested to update on the impact to staff.
Children’s Learning Disabilities (+324, +54.1) – The Children’s Learning Disability service Community & Wellbeing Network Vacancy Rate: The Establishment Vacancy has had a number of groups running over the past 2 months which has increased the Rate has decreased in October 2017 at 9.52% against a threshold of 5.0%. activity figures. The Trust has advised that these groups are set to continue throughout the Vacancies are being actively recruited to with the average number of days to year. This will be reviewed with the Commissioner and the plan rebased for 2018/19, recruit at 42.4 days. following agreement through the CCGs governance structure. Community & Wellbeing Network Sickness Absence: Sickness absence has Community Stroke Service (‐574, ‐16.4%) – This is an improved position from M6 (‐645, decreased slightly in October 2017 to 6.25% from 6.48% in September 2017, ‐21.3%). LCFT has advised that the underperformance is due to a combination of vacancy against a target of 4.5%. Network focus on Sickness Absence continues and and sickness absence. The Trust is continuing to review vacancies in terms of skill mix in remains a top priority. Action plans are in place for significant long term sickness line with the Pennine Lancashire stroke specification which is currently being reviewed cases and are monitored and discussed with Care Group managers on a monthly with Commissioners and aim to start recruitment shortly. A locum has been employed basis. since the beginning of Month 7 to support Speech and Language therapy until permanent staff have been recruited. The Trust expects to be back within tolerance by Month 10. Staffing reports are discussed at the monthly Quality and Performance Review Meetings chaired by Chorley South Ribble CCG as host commissioner. Work is DESMOND (‐39, ‐18.9%) – This is an improved position from M6 (‐46, ‐27.1%). The ongoing with the Trust to present detailed analysis of the workforce data and underperformance for DESMOND contacts is due to sickness absence. BwD CCG has highlight staffing ‘hotspots’ in a timely manner. A new format report is expected agreed to work with the Trust to develop an action plan which should maintain the in January 2018. recovery trajectory and if achieved will give a year end position within the target performance range.
Diabetes Specialist Nursing Service (‐901, ‐27.0%) ‐ The underperformance has been due to staffing vacancies and long‐term sickness absence. The Trust has advised that the Governing Body Meeting 8 | Page trajectory set in M6 aimed for a recovery back to within ‐5% tolerance; however an additional vacancy from the end of November has further impacted on activity. It is unlikely that the service will be fully recruited to before M10 and this will further impact on activity with a projected end of year variance of ‐22%. The CCG are working with the Trust to review DESMOND and Specialist Nursing services and will provide a further update in month 8 report.
Community Intravenous Therapy (‐1107, ‐62.5%) ‐ The IV team continues to see a reduced number of referrals. From October 2017, the service has been redesigned to accept step down referrals only. LCFT are reviewing the impact of this and were due to provide a business case with options to improve activity on the 22nd December for consideration by the CCG. This has not yet been received and has been followed up with the service. The Trust is aware that the CCG need to reduce costs and the baseline will be amended to reflect this.
Pulmonary Rehabilitation Service (+899, +26.0%) ‐ The current position is due to the increased number of patients attending and successfully completing their course. This is due to intensive work contacting patients, building relationships with the service which has resulted in more patients completing a six week course. The Trust has advised that no additional staff capacity is required and there will be no financial impact to the CCG.
Treatment Room (TR) (‐7566, ‐14.1%) ‐ The treatment room overall positon has been impacted by underperformance in “other treatment room activities” (‐8465, ‐17.0%), with over performance in Non‐Serious Injury (+245, +26.0%), Tissue Viability (+117, +17.9%) and Ulcer and Vascular (+551, +48.3%). The main drivers are staffing and a high number of Did Not Attend (DNA’s).
In January, the CCG expects actions to be taken to increase capacity and performance. The CCG Executives will receive an implementation plan and a communication and engagement plan on 10th January 2018.
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Contract & Information Quality & Performance Other ‐ Executive Summary Other ‐ Executive Summary Month 7 Month 7
BMI Beardwood + BMI Gisburne Park ‐ Total costs are below plan ‐£207K (‐6.2%). Ambulance Response Programme – As previously reported, due to the • BMI Beardwood: ‐£233K (‐7.6%) Ambulance Response Programme which was implemented within NWAS on 7th • BMI Gisburne Park: +£26K (+9.1%) August 2017, incident classification and response measures have fundamentally changed. This means that any reports which were based on Reds/Greens or Elective Inpatient Care (EL + DC) position at month 7 shows activity +97 spells above plan measuring 8/19 minute response times are no longer possible to produce. At the (+4.7%) but with costs ‐£110K below plan (‐4.6%). General Surgery, Trauma & NWAS Contract and Commissioning Group in August 2017, it was agreed that Orthopaedics and Gynaecology are the key specialties which have underperformed: there would be a grace period of three months to allow completion of the • Trauma & orthopaedics ‐£61K (‐5.7%) [‐30 spells, ‐7.6%] Ambulance Response Standards consultation. • General Surgery ‐£41K (‐15.1%) [‐54 spells, ‐15.0%] • Gynaecology ‐£31K (‐30.9%) [‐38 spells, ‐31.9%] Referral to Treatment 18 weeks (Incomplete) – The referral to treatment (RTT) Pain Management is below plan in terms of cost, but above plan in terms of activity: incomplete pathway was not achieved for BwD CCG in October 2017, with • Pain management ‐£30K (‐5.1%) [+94 spells, +11.5%] performance at 91.33% (91.27% YTD), which is a slight improvement on the September 2017 performance of 91.18% (91.26% YTD). Patient flow to Only Gastroenterology and Ophthalmology have over performed to a notable degree: Lancashire Teaching Hospitals (LTHTr) continues to impact on the CCG position • Gastroenterology +£27K (+202.7%) [+64 spells, +207.5%] with 160 patients waiting over 18 weeks (a decrease from 214 in the previous • Urology +£19K (+72.3%) [+43 spells, +116.6%] month). The main pressure is in Neurology, where there are 70 patients with a • Ophthalmology +£12K (+8.9%) [+30 spells, +15.7%] wait over 18 weeks. The Trust has a recovery plan that is being closely monitored by Greater Preston CCG as host commissioner. Outpatient Care position at month 6, shows below plan attendances/procedures ‐325 (‐4.2%) with costs ‐£78K (‐11.0%). The cost disparity is due to below plan First Attendances Cancer ‐ Patients receiving 1st definitive treatment for cancer within 2 months and Procedures, with less costly Outpatient Follow‐ups being above plan. (62 days) – For BwD CCG, there was underperformance against the 62 day • Outpatient First Attendance ‐£44K (‐12.4%) [‐229 attendances, ‐10.7%] referral to first treatment standard in October 2017 with performance at 84.44% • Outpatient Procedure ‐£41K (‐28.1%) [‐310 procedures, ‐26.8%] against an 85% target. YTD the target is not being met with performance at • Outpatient Follow‐Up Attendance +£13K (+3.8%) [+223 attendances, +3.9%] 84.55%. There were 7 breaches leading to the underperformance. The Specialties which are under performing compared to plan are as follows:‐ • Trauma & orthopaedics ‐£24K (‐10.4%) [‐279 attendances/procedures, ‐11.0%] • ENT ‐£22K (‐18.4%) [‐219 attendances/procedures, ‐17.1%] • Spinal surgery service ‐£14K (‐38.1%) [‐70 attendances/procedures, ‐26.6%] • Ophthalmology ‐£14K (‐23.6%) [‐148 attendances/procedures, ‐23.3%] • General surgery ‐£12K (‐12.0%) [‐201 attendances/procedures, ‐19.5%] • Urology ‐£9K (‐17.0%) [‐16 spells/attendances/procedures, ‐4.1%]
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Appendix 1
East Lancashire Hospitals NHS Trust: BwD CCG Contract 1st April 2017 – 31st October
Blackburn with Darwen Year to Date CCG's position at EAST LANCASHIRE Activity Activity Activity % Cost Cost Cost % HOSPITALS NHS TRUST Plan Actual Variance Variance Plan Actual Variance Variance
A&E (including MIU) 34,124 32,497 ‐1,627 ‐4.8% £4.092M £3.907M ‐£186K ‐4.5%
Elective 9,021 8,972 ‐49 ‐0.5% £8.661M £8.735M £73K 0.8% (Ordinary + Daycases)
Excess Bed Days (Elective) 451 304 ‐147 ‐32.7% £118K £76K ‐£43K ‐36.2%
Non Elective 9,956 10,097 141 1.4% £15.952M £16.782M £829K 5.2%
Excess Bed Days 4,484 2,740 ‐1,744 ‐38.9% £1.079M £674K ‐£404K ‐37.5% (Non Elective)
Non Elective Non‐ 1,641 1,524 ‐117 ‐7.1% £3.457M £3.254M ‐£203K ‐5.9% Emergency
Excess Bed Days (Non 386 127 ‐259 ‐67.1% £99K £38K ‐£61K ‐61.6% Elective Non Emergency)
Outpatient First Attends 20,077 18,879 ‐1,198 ‐6.0% £4.554M £4.204M ‐£350K ‐7.7%
Outpatient Follow‐up 41,534 42,372 838 2.0% £1.529M £1.583M £54K 3.6% Attends
Outpatient Procedure – 5,361 5,662 301 5.6% £736K £760K £24K 3.2% New
Outpatient Procedure – 10,599 10,784 185 1.7% £1.191M £1.230M £40K 3.3% Review
Total £41.468M £41.242M ‐£227K ‐0.5%
Contract Residual Balance £739K £0 ‐£739K ‐100.0%
Other £18.238M £19.795M £1557K 8.5%
Grand Total £60.445M £61.037M £591K 1.0%
Tables Based upon Version 2 of the Contract Monitoring Pivot, updated at 08/12/2017
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Appendix 2
All Providers: BwD CCG Contract 1st April 2017 – 31st October
Blackburn with Darwen Year to Date CCG's position at ALL HOSPITAL Activity Activity Activity % Cost Cost Cost % PROVIDERS Plan Actual Variance Variance Plan Actual Variance Variance
A&E (including MIU) 35,331 33,863 ‐1,468 ‐4.2% £4.248M £4.078M ‐£169K ‐4.0%
Elective 12,921 12,935 14 0.1% £13.223M £13.213M ‐£9K ‐0.1% (Ordinary + Daycases)
Excess Bed Days (Elective) 647 647 0 ‐0.1% £166K £164K ‐£2K ‐1.4%
Non Elective 10,391 10,585 194 1.9% £16.842M £17.775M £933K 5.5%
Excess Bed Days 4,624 2,961 ‐1,663 ‐36.0% £1.116M £729K ‐£387K ‐34.7% (Non Elective)
Non Elective Non‐ 1,739 1,617 ‐122 ‐7.0% £3.752M £3.490M ‐£262K ‐7.0% Emergency
Excess Bed Days (Non 402 129 ‐273 ‐67.9% £103K £39K ‐£65K ‐62.5% Elective Non Emergency)
Outpatient First Attends 25,422 24,047 ‐1,375 ‐5.4% £5.473M £5.087M ‐£386K ‐7.0%
Outpatient Follow‐up 55,613 56,848 1,235 2.2% £2.593M £2.677M £84K 3.2% Attends
Outpatient Procedure – 5,572 5,948 376 6.7% £772K £805K £33K 4.3% New
Outpatient Procedure – 11,164 11,573 409 3.7% £1.273M £1.342M £69K 5.4% Review
Outpatient Procedure – 1,278 986 ‐292 ‐22.8% £163K £126K ‐£37K ‐22.6% Unspecified
Total £49.723M £49.526M ‐£197K ‐0.4%
Contract Residual Balance £634K £0 ‐£634K ‐100.0%
Other £20.120M £21.605M £1.485M 7.4%
Grand Total £70.477M £71.131M £654K 0.9%
Tables Based upon Version 2 of the Contract Monitoring Pivot, updated at 08/12/2017
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Appendix 3
GP Referrals > +5% (above) Within 5% versus < ‐5% (below) ‐1.6% versus 16/17 versus 2016‐17 2016‐17 versus 2016‐17
Number of Referrals Referrals per Working Day GP GP 2016‐17 2017‐18 Specialty Variance Variance Variance Referrals Referrals (149 (147 Quantity % % 2016‐17 2017‐18 days) days) Cardiology 900 884 -16 -1.8% 6.0 6.0 -0.4% Community Paediatrics 1 229 265 36 15.7% 1.5 1.8 17.3% Dermatology 1280 1081 -199 -15.5% 8.6 7.4 -14.4% E.N.T. 1460 1294 -166 -11.4% 9.8 8.8 -10.2% Gynaecology 1307 1303 -4 -0.3% 8.8 8.9 1.1% Medical Specialties 1614 1831 217 13.4% 10.8 12.5 15.0% General Medicine 115 137 22 19.1% 0.8 0.9 20.8% Diabetic Medicine 66 35 -31 -47.0% 0.4 0.2 -46.2% Elderly Medicine 81 57 -24 -29.6% 0.5 0.4 -28.7% Gastroenterology 953 1142 189 19.8% 6.4 7.8 21.5% Respiratory Medicine 399 460 61 15.3% 2.7 3.1 16.9% Oncology 196 172 -24 -12.2% 1.3 1.2 -11.1% Ophthalmology 1583 1753 170 10.7% 10.6 11.9 12.2% Other Specialty group 2 425 395 -30 -7.1% 2.9 2.7 -5.8% Paediatrics 3 707 644 -63 -8.9% 4.7 4.4 -7.7% Pain Management group 4 138 145 7 5.1% 0.9 1.0 6.5% Rheumatology 312 264 -48 -15.4% 2.1 1.8 -14.2% Surgical Specialties 2546 2421 -125 -4.9% 17.1 16.5 -3.6% Breast Surgery 854 840 -14 -1.6% 5.7 5.7 -0.3% General Surgery 1375 1328 -47 -3.4% 9.2 9.0 -2.1% Vascular Surgery 317 253 -64 -20.2% 2.1 1.7 -19.1% Trauma & Orthopaedics 1352 1228 -124 -9.2% 9.1 8.4 -7.9% Urology 917 848 -69 -7.5% 6.2 5.8 -6.3% Grand Total 14966 14528 -438 -2.9% 100.4 98.8 -1.6%
1 Community Paediatrics and Community Paediatric Neurodevelopmental Service
2 A&E, Cardiothoracic Surgery, Child & Adolescent Psychiatry, Clinical Genetics, Critical Care Medicine, Clinical Haematology, Endocrinology, Medical Oncology, Neonatology, Palliative Medicine, Radiotherapy, Rehabilitation
3 Paediatrics, Paediatric Surgery, Paediatric Cardiology, Paediatric Nephrology and Paediatric Respiratory Medicine
4 Pain Management and Anaesthetics
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Other Referrals > +5% (above) Within 5% versus < ‐5% (below) ‐2.6% versus 16/17 versus 2016‐17 2016‐17 versus 2016‐17
Number of Referrals Referrals per Working Day GP GP 2016‐17 2017‐18 Specialty Variance Variance Variance Referrals Referrals (149 (147 Quantity % % 2016‐17 2017‐18 days) days) Cardiology 511 583 72 14.1% 3.4 4.0 15.6% Community Paediatrics 1 619 516 -103 -16.6% 4.2 3.5 -15.5% Dermatology 173 158 -15 -8.7% 1.2 1.1 -7.4% E.N.T. 830 753 -77 -9.3% 5.6 5.1 -8.0% Gynaecology 654 661 7 1.1% 4.4 4.5 2.4% Medical Specialties 1848 1645 -203 -11.0% 12.4 11.2 -9.8% General Medicine 152 145 -7 -4.6% 1.0 1.0 -3.3% Diabetic Medicine 148 245 97 65.5% 1.0 1.7 67.8% Elderly Medicine 44 47 3 6.8% 0.3 0.3 8.3% Gastroenterology 273 338 65 23.8% 1.8 2.3 25.5% Respiratory Medicine 1231 870 -361 -29.3% 8.3 5.9 -28.4% Oncology 322 325 3 0.9% 2.2 2.2 2.3% Ophthalmology 1631 1517 -114 -7.0% 10.9 10.3 -5.7% Other Specialty group 2 1266 1275 9 0.7% 8.5 8.7 2.1% Paediatrics 3 521 606 85 16.3% 3.5 4.1 17.9% Pain Management group 4 177 171 -6 -3.4% 1.2 1.2 -2.1% Rheumatology 221 223 2 0.9% 1.5 1.5 2.3% Surgical Specialties 970 1018 48 4.9% 6.5 6.9 6.4% Breast Surgery 227 253 26 11.5% 1.5 1.7 13.0% General Surgery 553 591 38 6.9% 3.7 4.0 8.3% Vascular Surgery 190 174 -16 -8.4% 1.3 1.2 -7.2% Trauma & Orthopaedics 3092 2761 -331 -10.7% 20.8 18.8 -9.5% Urology 373 480 107 28.7% 2.5 3.3 30.4% Grand Total 13208 12692 -516 -3.9% 88.6 86.3 -2.6%
Number of Referrals Referrals per Working Day Referral Type Variance 2016‐17 2017‐18 2016‐17 2017‐18 Variance % % (149 days) (147 days) 1 GP 14966 14528 ‐2.9% 100.4 98.8 -1.6% Non‐GP Professional 2 8518 7875 ‐7.5% 57.2 53.6 -6.3% Other 3 4690 4817 2.7% 31.5 32.8 4.1% Total 28174 27220 ‐3.4% 189.1 185.2 -2.1%
1 From GP 2 From non‐GP professional (e.g. Consultant, Nurse Specialist, Other Practitioner 3 From non‐GP other (e.g. Following A&E Attendance or Emergency Admission, Self, Ex Private Patient)
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Appendix 4
LCFT Community Contract ‐ LCFT: Service Line Activity Against Plan – October 2017
Year to date ‐ Activity Full Year ‐ Activity Year‐on‐Year Comparison (Planned Activity) Service Line Plan Actual Variance Var % Status^ Plan Forecast 16/17 17/18 Variance Var % Adult Learning Disabilities 2973 1,220 ‐1,753 ‐59.0% 5509 2081 1,826 1,220 ‐606 ‐33.2% Adult Speech and Language Therapy No Plan 20 N/A No Plan 34 Children's Learning Disabilities 599 923 324 54.1% 1039 1574 584 923 339 58.0% Children's Nursing No Plan 33 N/A No Plan 56 Children's Speech & Language 4031 3,932 ‐99 ‐2.5% 6703 6706 3,265 3,932 667 20.4% Children's Occupational Therapy 961 913 ‐48 ‐5.0% 1553 1300 944 913 ‐31 ‐3.4% Children's Physiotherapy No Plan 68 N/A No Plan 116 Chronic Fatigue Syndrome No Plan 0 N/A No Plan 0 Community Matrons No plan 25 N/A No plan 43 Community Neurological Service No plan 34 N/A No plan 58 Community Stroke Service 3508 2,934 ‐574 ‐16.4% 6083 5004 3,995 2,934 ‐1,061 ‐26.6% Dermatology 3081 2,809 ‐272 ‐8.8% 5251 4791 3,376 2,809 ‐567 ‐16.8% DESMOND (Completed Courses) 206 167 ‐39 ‐18.9% 349 285 not known 167 N/A N/A Diabetes Specialist Nursing Service 3337 2,436 ‐901 ‐27.0% 5752 4155 2,743 2,436 ‐307 ‐11.2% District Nursing 51991 56,716 4,725 9.1% 88966 96735 58,241 56,716 ‐1,525 ‐2.6% District Nursing (Out of Hours) 3823 5,642 1,819 47.6% 6543 9623 4,891 5,642 751 15.4% District Nursing (inc. Out of Hours) 55814 62,358 6,544 11.7% 95509 106358 63,132 62,358 ‐774 ‐1.2% Falls Team No plan 18 N/A No plan 31 Heart Failure Service No plan 2 N/A No plan 3 Intermediate Care ACS 7493 6,875 ‐618 ‐8.2% 12787 11726 5,978 6,875 897 15.0%
Under Plan Close to Plan Above Plan ^ Status = change in variance to plan (year to date M7 to M6) Reporting Tolerances <‐10% >‐10% to <+10% >+10% % Variance Widened % Variance Narrowed
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Year to date ‐ Activity Full Year ‐ Activity Year‐on‐Year Comparison (Planned Activity) Service Line Plan Actual Variance Var % Status^ Plan Forecast 16/17 17/18 Variance Var % Intensive Home Support 19057 19233 176 0.9% 32234 32804 2,997 19,233 16,236 541.7% Community IV Service BwD 1771 664 ‐1,107 ‐62.5% 2862 1133 679 664 ‐15 ‐2.2% Complex Case Management 3018 2,992 ‐26 ‐0.9% 4809 5103 2,316 2,992 676 29.2% COPD 3717 4,245 528 14.2% 6626 7240 3,625 4,245 620 17.1% Rapid Assessment Team 10551 11,332 781 7.4% 17937 19328 8,751 11,332 2,581 29.5% Nutrition & Dietetics No plan 9 N/A No plan 15 Oxygen Service 2230 2,260 30 1.3% 3868 3855 4,246 2,260 ‐1,986 ‐46.8% Podiatry 12202 11,803 ‐399 ‐3.3% 20334 20131 13,187 11,803 ‐1,384 ‐10.5% Pulmonary Rehabilitation 3456 4,355 899 26.0% 6012 7428 5,221 4,355 ‐866 ‐16.6% Treatment Rooms 53818 46252 ‐7,566 ‐14.1% 88192 78888 50,060 46,252 ‐3,808 ‐7.6% Treatment Room 49861 41,396 ‐8,465 ‐17.0% 81645 70605 45,949 41,396 ‐4,553 ‐9.9% Ear Care (Treatment Room) 487 473 ‐14 ‐2.9% 861 807 552 473 ‐79 ‐14.3% Healthy Legs (Treatment Room) 733 733 0 0.0% 1110 1250 628 733 105 16.7% Minor Injury (Treatment Room) 943 1,188 245 26.0% 1496 2026 1,341 1,188 ‐153 ‐11.4% Ulcer & Vascular (Treatment Room) 1140 1,691 551 48.3% 1948 2884 1,273 1,691 418 32.8% Tissue Viability (Treatment Room) 654 771 117 17.9% 1132 1315 938 771 ‐167 ‐17.8% Grand Total ‐ Activity with Plans 172766 168319 ‐4,447 ‐2.6% 291175 287086 161554 168152 6,598 4.1%
Under Plan Close to Plan Above Plan ^ Status = change in variance to plan (year to date M7 to M6) Reporting Tolerances <‐10% >‐10% to <+10% >+10% % Variance Widened % Variance Narrowed
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Appendix 5
Inpatient Waiting List
Inpatient and Daycase Waiting List Source : ELHT Performance Report
East Lancashire Hospitals Current Month – September 2017 Previous Month ‐ August 2017 0‐<6 6‐<13 13‐<20 20 + Grand 0‐<6 6‐<13 13‐<20 20 + Grand Specialty Variance %age +/‐ Weeks Weeks Weeks Weeks Total Weeks Weeks Weeks Weeks Total General Surgery 553 135 55 21 764 561 138 59 29 787 ‐23 ‐2.9% Urology 290 104 77 51 522 266 121 97 43 527 ‐5 ‐0.9% Breast Care 49 16 7 0 72 59 20 2 0 81 ‐9 ‐11.1% Vascular Surgery 108 35 1 2 146 118 15 1 4 138 8 5.8% Orthopaedics 593 316 154 89 1152 542 334 186 99 1161 ‐9 ‐0.8% ENT 216 105 62 15 398 200 107 50 37 394 4 1.0% Ophthalmology 433 193 64 32 722 447 210 67 32 756 ‐34 ‐4.5% Oral Surgery / Maxillo Facial 409 178 85 81 753 300 204 132 88 724 29 4.0% Dermatology 0 0 0 0 0 0 0 0 0 0 0 N/A Medical Oncology 2 0 0 0 2 0 0 0 0 0 2 N/A Clinical Oncology 0 0 0 0 0 2 0 0 0 2 ‐2 ‐100.0% Surgical Division 2653 1082 505 291 4531 2495 1149 594 332 4570 ‐39 ‐0.9% General Medicine 845 13 2 11 871 661 17 2 11 691 180 26.0% Rehabilitation 0 0 0 0 0 0 0 0 0 0 0 N/A Cardiology 166 52 12 6 236 138 38 17 9 202 34 16.8% Thoracic Medicine 13 0 0 3 16 13 0 2 1 16 0 0.0% Nephrology 0 0 0 4 4 0 0 0 4 4 0 0.0% Medical Division 1024 65 14 24 1127 812 55 21 25 913 214 23.4% Gynaecology 227 25 3 0 255 230 46 4 0 280 ‐25 ‐8.9% Family Care Division 227 25 3 0 255 230 46 4 0 280 ‐25 ‐8.9% Interventional Radiology 0 0 0 0 0 0 0 0 0 0 0 N/A Pain Management 8 18 2 1 29 30 5 2 1 38 ‐9 ‐23.7% Rheumatology 32 9 4 4 49 60 8 2 4 74 ‐25 ‐33.8% Haematology 0 0 0 0 0 1 0 0 0 1 ‐1 ‐100.0% Diagnostic & Clinical Support 40 27 6 5 78 91 13 4 5 113 ‐35 ‐31.0%
Grand Total 3944 1199 528 320 5991 3628 1263 623 362 5876 115 2.0%
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LCFT MH quality measures currently underperforming against target Appendix 6
Threshold Apr May June July Aug Sep Oct 2017/18 Ref Indicator Level 2017/18 17 17 17 17 17 17 17 YTD
Trust 98.53% 97.13% 97.54% 94.63% 97.21% 99.46% 97.87% 97.44% CPA: 7 day follow up from psychiatric E.B.S.3 95% inpatient care BwD 100% 94.74% 100% 90.91% 94.74% 100% 100% 96.62%
NQR_1 Duty of Candour 0 Trust 0 0 0 0 2 1 0 3
Ethnicity coding 90% Trust
IAPT: Prevalence – Q1 3.75% Q2 3.96% Trust 3.87% 3.95% 1.34% 9.16% Q3 4.05% Notional Q3 Monthly 1.35% LQR_6 Notional YTD 9.06%
NB performance against notional targets are displayed as lightly shaded and are intended as an BwD 3.72% 3.85% 1.09% 8.66% indicator of current performance only. *Data is under review as detailed on page 21.
Trust 11% 7% 0% 10% 12% 16% 9.5% 9.42% Early Intervention Psychosis: seen within 2 E.H.4 50% weeks BwD 16.7% ADHD (Adult): seen within 18 weeks – new N/A Trust 46% 39% 36% 22.7% 20.9% 34.7% 36.7% patients LQR_1 ADHD (Adult): seen within 18 weeks – N/A Trust 94% 84% 85% CAMHS Transitions
Trust 47.02% 52.09% 70.37% 79.75% 80.40% 79.60% 78.15% 68.22% LQR_5 MAS: seen within 6 weeks 70%
BwD 16.67% 18.97% 84.48% 92.68% 97.78% 95.83% 89.19% 67.21%
Unscheduled Care: Trust 51.64% 45.88% 46.04% 40.75% 39.44% 42.31% 45.42% 44.56% LQR_8 MHLT assessment within 1 hour of referral N/A
from ED BwD 53.41% 57.00% 55.56% 41.84% 26.58% 41.54% 39.33% 45.79%
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Threshold Apr May June July Aug Sep Oct 2017/18 Ref Indicator Level 2017/18 17 17 17 17 17 17 17 YTD
Unscheduled Care: Trust MLHT Assessment within 24 hours from N/A Expected from Q2 ELHT ward referral site
Unscheduled Care: Trust 229 286 300 384 348 333 343 2223 All 4 hour breaches where psychiatric N/A ELHT assessment was requested 70 69 59 80 67 45 34 424 site Unscheduled Care: Trust 67 79 99 116 129 109 104 703 4 hour breaches where psychiatric N/A assessment ELHT 22 30 38 50 63 25 23 251 was requested within 2 hours site
Unscheduled Care: Trust 3 10 29 13 17 8 6 86 12 hour breaches where psychiatric N/A ELHT assessment was requested 1 1 12 8 8 1 2 33 site
OAPs Out Area of Placements (average) 0 Trust 23.48 25.52 25.67 24.23 23.68 26.17 24.58 24.76
KEY RED Under performance GREEN Achieving AMBER Under Review
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Appendix 7 ELHT quality measures currently underperforming against target
Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Ref Indicator 17/18 17 17 17 17 17 17 17 17 17 18 18 18 Referral to E.B.3 Treatment 92.42% 92.53% 92.39% 92.03% 92.01% 91.07% 90.79% 91.90% (Incomplete)
E.B.5 A&E 4 Hour * 95% 82.72% 84.39% 84.73% 79.95% 89.20% 89.20% 87.51% 85.40% Cancelled E.B.S.2 0 1 1 1 0 0 2 1 7 Operations E.B.S.4 52 week wait 0 1 0 1 2 0 0 1 5
E.B.S.5 Trolley wait 0 1 5 12 7 7 1 2 35
Cancer 31 day E.B.9 94% 95.7% 100% 95.5% 97.9% 92.9% 97.9% 99.7% subsequent Ambulance E.B.S.7a Handover 0 351 332 349 446 269 361 346 2454 >30min Ambulance E.B.S.7b Handover 0 85 45 29 106 30 67 115 477 >60min Missed E.B.S.7 handover 0 161 169 123 166 124 181 257 1181 stamps Clostridium E.A.S.5 28 2 4 3 2 5 2 3 21 Difficile
Never Events 0 2 1 2 5
*KEY RED Under performance GREEN Achieving AMBER Under Review
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Appendix 8 LCFT Community quality measures currently underperforming against target
Apr May Jun Jul Aug Sep Oct Indicator Target 17 17 17 17 17 17 17 Referral to treatment (RTT) Incomplete (BwD CCG) 84.9% 91.7% 95.6% 96.1% 99.4% 99.6% 100% Adult Learning Disability Service 100% 100% 100% 100% 100% 100% 100% Adult Speech and Language Therapy ‐ 100% 100% 100% 100% 0% ‐ Children's Occupational Therapy 100% 100% 100% 100% 95.7% 100% 100% Children’s Physiotherapy 100% 100% ‐ ‐ ‐ ‐ ‐ Children's Speech & Language Therapy 70.2% 81.8% 90.2% 90.9% 98.5% 99.3% 100% Community Respiratory Service 100% 100% ‐ ‐ ‐ 100% ‐ Community Stroke Service 100% 100% 100% 100% 100% 100% ‐ Continence Service 92% 100% 100% ‐ ‐ ‐ ‐ ‐ Domiciliary Physiotherapy ‐ ‐ ‐ ‐ ‐ 100% 100% Falls Team 100% 100% 0% ‐ ‐ ‐ ‐ Intermediate Care 100% 100% 100% 100% 100% 100% 100% Nutrition & Dietetics ‐ 100% 100% 100% 100% ‐ 100% Podiatry 100% 100% 100% 100% 100% 100% 100% Pulmonary Rehabilitation 100% 100% 100% 100% 100% 100% 100% Rapid Assessment Team 100% 100% 100% 100% 100% 100% 100% Rheumatology ‐ 100% ‐ ‐ ‐ ‐ ‐ Community Stroke Rehabilitation Measures (BwD CCG) Patients assessed with 72 hours of referral 95% Q1: 96.0% Q2: 100% Due Q3 FIM/FAM: increase in at least 1 domain at point 95% Q1: 97.0% Q2: 100% Due Q3 of discharge Mood screen: patients receiving a mood and 95% Q1: 100% Q2: 100% Due Q3 anxiety screen Goal setting: with written goals in place 95% Q1: 100% Q2: 100% Due Q3 PROM: improvements in more than one 95% Q1: 100% Q2: 100% Due Q3 domain
KEY RED Under performance GREEN Achieving AMBER Under Review
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NHS Constitution Appendix 9
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Year to Oct 2017 Metric Level Period Target Date Position Position
NHS Constitution support measures
HCAI
24: Number of C.Difficile infections CCG YTD 23 27 27
Activity Measures
Referral to Treatment (RTT) & Diagnostics
2015: Number of Endoscopy Diagnostic Tests/Procedures CCG YTD 3,013 3,013
2018: Number of Completed Admitted RTT Pathways CCG YTD 5,552 4,857 4,857
2016: Number of Diagnostic Tests/Procedures (excluding Endoscopy) CCG YTD 27,262 27,262
2019: Number of Completed Non‐Admitted RTT Pathways CCG YTD 18,430 17,538 17,538
Other performance measures
EMSA
1067: Mixed sex accommodation breaches ‐ All Providers CCG Oct 2017‐18 0 0 0
Referral to Treatment (RTT) & Diagnostics
1839: Referral to Treatment RTT ‐ No of Incomplete Pathways Waiting >52 weeks CCG Oct 2017‐18 0 0 0
Episode of Psychosis
2099: First episode of psychosis within two weeks of referral CCG Oct 2017‐18 50.00% 16.67% 64.58%
Increasing Access to Psychological Therapies (IAPT) Prevalence
Numbers of patients entered treatment for IAPT services (all providers) as a percentage YTD CCG 7.00% 7.70% 7.70% of estimated Prevalence (Aug 2017‐18)
Increasing Access to Psychological Therapies (IAPT) Waiting Times
E.H.1: Six week starters as a percentage of Finished course of treatment (all providers) CCG Aug 2017‐18 75.00% 83.33% 82.52%
E.H.2: Eighteen week starters as a percentage of Finished course of treatment (all CCG Aug 2017‐18 95.00% 95.83% 96.70% providers)
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GOVERNING BODY MEETING
EAT WELL MOVE MORE SHAPE UP STRATEGY: YEAR 1 UPDATE Date of Meeting 17th January 2018 Agenda Item 11
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor N outcomes and inequalities To work collaboratively to create safe, high quality health care services N To maintain financial balance and improve efficiency and productivity N To deliver a step change in the NHS preventing ill health and supporting people to live Y healthier lives To maintain and improve performance against core standards and statutory requirements N To commission improved out of hospital care N CCG High Impact Changes Delivering high quality Primary Care at scale and improving access N Self-Care and Early Intervention Y Enhanced and Integrated Primary Care and Better Care Fund N Access to Re-ablement and Intermediate Care N Improved hospital discharge and reduced length of stay N Community based ambulatory care for specific conditions N Access to high quality Urgent and Emergency Care N Scheduled Care N Quality N GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 2
Clinical Lead: Dominic Harrison
Senior Lead Manager Kenneth Barnsley Finance Manager Equality Impact and Risk Assessment Y completed: Patient and Public Engagement completed: Y Financial Implications N Risk Identified N Report authorised by Senior Manager: Y
Decision Recommendations The Governing Body is requested to:
1. To note the contents of the report; 2. To note the progress made to date and the key issues impacting on effective delivery of the action plan; 3. To note the priorities for Year 2 of the delivery of the Eat Well Move More Shape Up Strategy.
Governing Body Meeting Page 2 of 2
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
WEDNESDAY 17th JANUARY 2018
EAT WELL MOVE MORE SHAPE UP STRATEGY: YEAR 1 UPDATE
1. Purpose
1.1 The purpose of the report is to update the Governing Body on the progress made against the Eat Well Move More Shape Up strategic action plan during the first year of delivery and highlight key issues impacting on effective delivery of the action plan in year two.
2. Introduction
2.1 Physical inactivity and obesity are major public health problems due to their association with serious chronic diseases and the costs to both the individuals and society as a whole. Levels of participation in physical activity nationally are currently very low in both children and adults. Nationally, over two thirds of the adult population are overweight or obese and data from the National Child Measurement Programme (NCMP) shows that 1 in 10 4-5 year olds and 1 in 4 10-11 year olds are obese.
2.2 Healthy life expectancy in Blackburn with Darwen (BwD) is significantly lower than the national average and the amount of years lived with a long term condition and disability is increasing resulting in a poor quality of life in later years. The economic cost of obesity and physical inactivity is significant and with the increasing pressure on the health and social care system, prevention must be a priority.
2.3 Obesity is a complex, but largely preventable condition which has serious, far reaching physical, psychological and social consequences that affects virtually all age and socioeconomic groups although some groups are affected more than others. Obesity impairs a person’s wellbeing, quality of life and ability to earn. Society has radically altered over the last five decades with major changes in work patterns, transport, food production and food sales. The pace of the technological revolution is outstripping human evolution and for an increasing number of people weight gain is inevitable and largely involuntary and could be described as a consequence of a modern lifestyle.
2.4 Being physically active has benefits for mental health, quality of life and wellbeing and maintaining independent living in older age. Being active plays a key role in brain development in early childhood and is good for longer-term educational attainment.
Page 1 of 30
Increased energy levels boost workplace productivity and reduce sickness absence. An active population can even reduce levels of crime and antisocial behaviour. Physical activity can help to play a role in reducing health and social inequalities and as a result of its wide reaching impact has been described as the ‘best buy’ in public health.
2.5 Local partners and stakeholders are committed to reducing the incidence of obesity and increasing physical activity levels in BwD. Public Health has provided the strategic leadership and co-ordination, and has a key role in leading the delivery of the Eat Well Move More Shape Up strategy to ensure senior level, multiagency ownership and co- ordinated local action. The three year strategy (2017-20) adopts a life course approach, aligned to the three Health and Wellbeing life stages of start well, live well and age well.
2.6 The purpose of the BwD Eat Well Move More Shape Up Strategy is to provide a framework for action to reduce levels of obesity and increase physical activity levels. It intends to draw upon local experience and knowledge, dedicated health and social care workforce within the borough, a network of passionate volunteers and community groups and research evidence to improve the health and wellbeing of the residents of the Borough.
2.7 The three overall local strategic objectives are:
• To improve access to healthy, affordable and sustainable food • To increase physical activity levels • To increase the number of children and adults of a healthy weight
3. Key Issues
3.1 Tackling obesity requires a whole systems approach from all partners and stakeholders. Taking a population approach through policy change and development will have the greatest impact on obesity and not focussing on service delivery to a small number of people.
3.2 The ongoing cut in funding from central government to the Council and Clinical Commissioning Group (CCG) has led to reduced capacity to support the strategy. Whilst there has been widespread support for the strategy from senior leaders within both organisations, full engagement in supporting the steering group meetings and in the delivery of the action plan has not been a priority.
3.3 Lack of understanding of the wider determinants affecting obesity means there is a tendency to focus on one issue as the root cause e.g. hot food takeaways, rather than looking at the whole system and mechanism involved e.g. poverty. Supporting the drive to ensure healthy weight is included in all policies is part of the Local Authority Declaration on Healthy Weight which was signed in April 2017 by both the Council and CCG. This intention to tackle unhealthy weight will require further awareness of the complexities of obesity and how some of the issues can be tackled locally. Further work needs to be done to raise awareness of both the strategy and the Healthy Weight Declaration for both elected members and senior managers across the statutory organisations to address this.
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4. Key Progress
4.1 During the development of the strategic action plan new partnerships have been forged and a strong sense of working more closely to share resource and in preventing the duplication of delivery. Regular sub group meetings and a shared online platform to share information is supporting improved communication between organisations and progress towards meaningful outcomes.
4.2 Having an action plan with oversight for food, physical activity and healthy weight has ensured a cross cutting action plan with some partners working across all agendas to ensure a holistic approach is taken in policy and service development. Recognising the impact of each agenda on the other should see a more effective and sustainable approach in delivery of the action plan.
4.3 All the partners involved in the delivery of the strategy share a sense of passion and pride in serving BwD and its residents and share the common goals of improving health and wellbeing and helping to reducing the burden on local health care system and, in doing so, protecting precious resources.
5. Health Settings Action Plan
5.1 A health setting action plan was developed alongside the main action plan which identifies the support required from the CCG, East Lancashire Hospitals Trust (ELHT) and Lancashire Care Foundation Trust (LCFT) to enable the strategic vision to be met. Priority actions for Year 1 and an update against those actions are detailed in Appendix A. Other significant areas of progress in Year 1 which can be found in further detail in the draft Year 1 Annual Report (Appendix B) include: • Roll out of Primary School food policy to all BwD Primary Schools supported by LCFT. • ELHT’s Baby Friendly Team achieved Gold status from UNICEF and the Local Authority signed up to becoming a Breastfeeding Friendly Borough with a launch planned in June 2018. • ELHT’s nutrition and catering team were successful in achieving the health and wellbeing CQUIN and have increased healthy options available for staff, patients and visitors in Royal Blackburn Hospital.
5.2 Priority areas for action in Year 2 include those identified for Year 1 and also include the following new priorities for action • Early Years food and physical activity guidance in development in partnership with ELHT for use by nurseries and childminders in BwD. • Secondary School food policy to be developed in partnership with the Amplify project via BwD Healthwatch and supported into schools by the LCFT Healthy Child Programme team. • Development of a Food Poverty action plan and a Food Charter for BwD with support from Sustain’s Food Power programme. • Focus on dental health in early years with support from LCFT Healthy Child Programme team and BwD Council Children’s Centres to tackle poor dental health statistics in the Borough. • ELHT to complete their Healthy Weight Declaration and encourage other organisations to develop their own Declaration. There are significant opportunities for progress around developing the Primary Care workforce and embedding physical activity and healthy weight in all activities as part of the Sport England Place Pilot. Other opportunities include BwD’s designation as a
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National Lottery funded Food Power Borough with funding to support the development of a Food Poverty action plan
6. Conclusion
6.1 There has been significant progress against the action plan this year, as can be seen in the Year 1 Annual Report (Appendix B), but with the acknowledgement that there is still much to do to have a significant impact on the population. There is also acknowledgement that any significant impact on the high level indicators from delivery of the action plan may take many years to come to fruition.
6.2 In engaging with all partners and stakeholders, including council and health leaders, Community, Voluntary and Faith sector organisations, the wider public sector, private business, and local communities themselves; the strategy demonstrates a joint commitment to work together to have prevention as a priority in all that we do. This strategic approach that will enable us to make a significant difference to the health and wellbeing of the residents of Blackburn with Darwen.
6.3 The CCG has a key role to play to ensure the continued successful delivery of the Eat Well Move More Shape Up action plan with local partners and commissioned service providers, which will contribute to improved health and wellbeing outcomes for local residents and patients.
6.4 The final Year 1 report of the Eat Well Move More Shape Up Strategy will be presented to the Health and Wellbeing Board on 6th March 2017, for information.
7. Recommendations
The Governing Body is requested to:
7.1 To note the contents of the report;
7.2 To note the progress made to date and the key issues impacting on effective delivery of the action plan;
7.3 To note the priorities for Year 2 of the delivery of the Eat Well Move More Shape Up Strategy.
Beth Wolfenden Public Health Development Manager On behalf of Dominic Harrison, Director of Public Health 5th January 2018
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 Appendix A Update against Year 1 priorities
Year 1 Priority Update Ensuring senior leadership • The CCG is currently represented by the Service representation on the steering Transformation Manager for Children and Young group People which is a joint funded post between CCG and Council. Attendance is dictated by priorities but there is no other colleague identified to attend in her absence. • Executive GP and Clinical Lead Dr John Randall has sight of notes of steering group meetings and advises from a clinical perspective when contacted by email but is unable to attend meetings due to his clinical commitments. • Regular senior leadership representation would ensure effective communication of development, priorities and key issues and is critical to the success of the strategy. Developing food policies in the • Development of workplace food policies/guidance CCG and Health Centres / and support to implement these is being planned Primary Care buildings and GP for Year 2/3. This will include vending and Surgeries to include vending catering guidance for use across all organisations and procurement to support healthy weight.
Developing food growing • ELHT have identified a site for food growing and opportunities on sites for both this will be developed during Yr 2 with learning staff and patients used to support other health settings to consider developing their own food growing sites or supporting other existing or planned sites across the Borough. Promoting CCG and Primary • Work will begin on this priority in Yr 2 with the LGS Care staff as role models for Prevention at Scale pilot and the Sport England patients and embedding Making Place Pilot. This will support a culture change in Every Contact Count across the the workforce to support promotion of healthy workforce lifestyles to patients. • Around 60 Practice Nurses and Healthcare Assistants attended a Public Health England peer to peer promoting physical activity session. More will be planned to support the initiatives above. Further embed the Integrated • As per action above – the LGA and Sport England Wellbeing Service into all Pilot will enable more focussed work on this. relevant referral pathways promoting physical activity as medicine, as part of wider social prescribing
Review of the Tier 2 and Tier 3 • Ongoing – waiting for information to analyse from Weight Management pathways CCG re Tier 3 referrals including numbers, to ensure evidence based outcomes etc. Unable to progress until this practice in line with NICE information is available. Guidelines and Public Health England’s, soon to be released, blueprint for weight management programmes
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 Appendix B Eat Well Move More Shape Up Year 1 Report
N.B. DRAFT version still in the process of being completed – completion due by end of January 2018.
Eat Well Move More Shape Up Strategy 2017‐2020: Year 1 Update
Eat Well Move More Shape Up Strategy Vision: ‘For everyone in Blackburn with Darwen to move more, eat well and maintain a healthy weight’ Overview/Background
In February 2017 Blackburn with Darwen Borough Council (BwDBC) adopted the Eat Well Move More Shape Up strategy as a framework to improve the health and wellbeing of residents across the Borough. Blackburn with Darwen (BwD) has some of the most challenging health statistics in the country with increasing burden on the local healthcare system and economy.
The strategy is an all age, three year multi‐agency plan to tackle inactivity, improve access to healthy and sustainable food and to increase the number of people with a healthy weight. Whilst one of the overarching aims of the strategy to reduce unhealthy weight across the population may take a number of years to manifest there are a number of achievements that can be celebrated in this first year of delivery. This report aims to showcase and celebrate the excellent work taking place by all the partners involved in the delivery of the aims and objectives of the action plan.
What has worked well?
During the development of the strategic action plan new partnerships have been forged and a strong sense of working more closely to share resource and in preventing the duplication of delivery. Regular sub group meetings and a shared online platform to share information is supporting improved communication between organisations and progress towards meaningful outcomes.
Having an action plan with oversight for food, physical activity and healthy weight has ensured a cross cutting action plan with some partners working across all agendas to ensure a holistic approach is taken in policy and service development. Recognising the impact of each agenda on the other should see a more effective and sustainable approach in delivery of the action plan.
All the partners involved in the delivery of the strategy share a sense of passion and pride in serving BwD and its residents and share the common goals of improving health and wellbeing and helping to reducing the burden on local health care system and in doing so protect precious resources.
What have the challenges been?
Tackling obesity requires a whole systems approach from all partners and stakeholders. Taking a population approach through policy change and development will have the greatest impact on obesity and not focussing on service delivery to a small number of people. The ongoing cut in funding from central government has led to the need for local authorities to generate income
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 through other means. Competing priorities between income generation and health have, on occasion, gone against the aims and objectives of the strategy.
Lack of understanding of the wider determinants affecting obesity means there is a tendency to focus on one issue as the root cause e.g. hot food takeaways, rather than looking at the whole system and mechanism involved e.g. poverty. Supporting the drive to ensure healthy weight is included in all policies is part of the Local Authority Declaration on Healthy Weight which was signed in April 2017 along with the Blackburn with Darwen Clinical Commissioning Group (BwDCCG) and this intention to tackle unhealthy weight will require further awareness of the complexities of obesity and how some of the issues can be tackled locally. Further work will be done to raise awareness of both the strategy and the Healthy Weight Declaration for both elected members and senior managers across the statutory organisations to address this.
What did you say you wanted to see?
Prioritising action to be taken during year one has been a challenge when taking into consideration the size of the action plan and the current resource available to implement change. The work plan has developed in line with the consultation which took place and also considering the evidence base for what works. The development has also been dictated by current resources available including funding and capacity within services and also encouraging services to work together who may not have been connected before.
Extensive public and stakeholder consultation took place from which has informed the development of the strategic action plan. The have been a number of developments that have been directed by the feedback from the public, service users and stakeholders that have been highlighted here but will be discussed in more detail in the body of the report and other including:
Eat Well • Improving access to healthy options in public places – the Royal Blackburn Hospital have been working towards the CQUIN for healthier food for staff, visitors and patients. • School food policies & influencing catering in schools – a primary school food policy has been developed and is now being rolled out. Move More • Improved cycle paths – the Weavers Wheel is now completed and ready to launch in March 2018. • Mile a day in Primary Schools – supported training for staff to deliver the Daily Mile in schools has been delivered with more planned in 2018. • More Tai Chi classes for older adults – ….more staff have been trained to deliver Tai Chi and Ballet. These sessions focus on strength and balance which is evidence based exercise to reduce falls – Amy to confirm new classes • Effective and sustainable use of the Pupil PE and Sport premium – Primary schools PE conference has been delivered at Ewood Park to support this. Lancashire Sport Partnership has provided funding for Lancashire County Council’s PE advisor to support BwD schools which require further input to develop their action plans to ensure they are robust and sustainable. Shape Up • Wider range of activities in parks and open spaces with more organised family activities – Toddle Trails have been mapped out in Witton and Bold Venture Parks with monthly themed led walks and free family activities were delivered at Witton during the school holidays in 2017. A number of led walks, led runs and cycles and mass participation events have been supported by the National Charities Partnership providing more opportunities to be physically active. 7
Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 • A weight management programme for men – a 12 week FitFans programme has been piloted at Blackburn Rovers Football Club with Blackburn Rovers Community Trust (BRCT) and the Council’s Health and Wellbeing team. The programme has been formally evaluated by Lancaster University • Development of a Maternal pathway – a developing partnership between Blackburn Birthing Centre and the Council’s Health & Wellbeing team has seen some exciting sessions being piloted and embedded in service delivery including a weekly Active Bumps class and weight management drop ins attached to ante natal clinics. • Better buy in to the healthy weight agenda from Clinical Commissioning Group and Council – The Council and CCG signed the Local Authority Declaration on Healthy Weight in April 2017 ‐ the first of kind in the country. This demonstrates a strategic level commitment to tackling unhealthy weight in the Borough is a significant step in working to ensure healthy weight in all policies. Other • Settings based approach to health improvement – during this year the strategic partners are working with schools and colleges, the Royal Blackburn Hospital, GP practices and Workplaces to support behaviour change. The settings approach will continue in 2018 by embedding and developing on current partnerships along with developing a local blueprint for working with faith settings to improve health and wellbeing.
What we did this year ‐ Achievements during 2017
Eat Well
1 Promote healthy and sustainable food choices for all • A Primary School Food Policy and Toolkit has been developed by the Nutritional Advisor at East Lancashire Hospitals Trust (ELHT) and Public Health which has been through a consultation process with the Eat Well Sub Group, Head Teacher’s, Governing bodies, pupils and the Healthy Child Programme team. The policy is now being rolled out into schools via the Schools Catering Manager and the School Nurses. During the roll out, schools are also receiving their National Child Measurement Programme data and details around encouraging daily activity in schools via the Daily Mile and Youth Sport Trust 30:30 programme which is supported by the Move More Network. It is hoped that this joined up approach with School Nurses, School Catering Manager, School Games Organiser, BRCT visiting schools and giving the same information and messages more schools will adopt the policy and look to increase physical activity levels throughout the school day thus supporting the Shape Up action plan alongside the Eat Well and Move more agenda. • The BwDBC School Catering Manager supports 32 primary schools across the Borough with food provision across the school day. As part of this support 95% of schools have reduced sugar intake by having at least one sugar free day per week and some schools have increased this to two days a week.
2 Tackle food poverty and diet related ill‐health across the life course • The Baby Friendly team at ELHT have supported maternity services to achieve full UNICEF reaccreditation in April 2017 and progress to the UNICEF GOLD ‘achieving sustainability award’ in June 2018 – being the first UK service to achieve this . An action plan is now in place (Appendix….) to develop the sustainability of breastfeeding across the Borough which is supported by the Local Authority Declaration on Healthy Weight. • ELHT have also successfully achieved compliance with NHS England’s CQUIN scheme indicator ‘1b. Healthy food for NHS staff, visitors and patients’. This has included: a) The banning or price promotions on sugary drinks and foods high in fat, sugar and salt;
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 b) The banning of advertisement on NHS premises of sugary drinks and foods high in fat, sugar and salt; c) The banning of sugary drinks and foods high in fat, sugar and salt from checkouts; and d) Ensuring that healthy options are available at any point including for those staff working night shifts. To increase the availability of healthy options, outside of CQUIN, the Trust developed and ratified its own Food & Nutrient Standards. These standards have become fundamental to menu development for in‐house services, specific to non‐patient foods. • Recipe 4 Health – info to come • In October this year the BwD Food Alliance was formed with 30 service and organisations engaged to date. The BwD Food Alliance is a movement which will aim to address food poverty and the sustainability of food in BwD. In December the Alliance was successful in a bid for financial support from the Big Lottery via Sustain’s Food Power programme to develop a Food Poverty action plan for the Borough. Work had already begun to bring together stakeholders who support the food poverty agenda and a programme of activities to develop the plan will take place during 2018. This funding will allow dedicated time for the development of the action plan and will also enable learning across a network of food alliances, facilitated by Church Action on Poverty, from across the country to share good practice. • Over the summer of 2017, Kat Zaman from Kingdom Outreach coordinated the Summer Lunchbox Campaign which was supported by BwD Council’s Children’s Centres and also many volunteers including the Schools Catering Manager and some of the catering managers from local schools. Kat was passionate about supporting children and families over the summer holidays and was committed to bringing volunteers, public sector and businesses together to organise a summer lunch box scheme. The children centres provided the venues and the organisation along with the marketing and promotion, particularly to our most vulnerable families. The food was delivered to the children centres each day. Staff members were available every day over lunch to support families and provide summer fun activities. In total 16,886 lunches were distributed over the summer holidays. Families who engaged with the programme reported that their child’s learning and behaviour had improved, they had met new friends, it was one less thing to worry about over summer and children had sat at a table and got into a routine. Further outcomes included: o Six families identified for positive parenting programme and four for chatter chums. o One family who had child with additional needs and staff provided her with the support she was requesting. o Recruitment of 10 volunteers for the Children’s Centres There were also benefits for the volunteers who worked every morning to prepare the sandwiches. One volunteer at the beginning of the holidays felt isolated and lacked confidence in herself. At the end of the six weeks she was leading the sandwich making process and has had two job interviews. She reports that “she feels a different person”. Another volunteer in her eighties came every Tuesday to butter the bread and reported that it has given her “purpose”. Press and social media links to the programme can be seen below: • https://www.youtube.com/watch?v=pnWkMGD83O0 • http://www.lancashiretelegraph.co.uk/news/blackburn/15437213.Summer_scheme_to_pl ug_the____holiday_hunger____gap/ • http://theshuttle.org.uk/innovative‐scheme‐to‐tackle‐holiday‐hunger/
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018
• A5 Planning application restriction – info to come
3 Build community food knowledge, skills and resources • In 2017 Blackburn Youth Zone began to deliver the Jamie Oliver Ministry of Food cooking programme to cohorts of young people who access the centre. The programme looks at health and safety and food hygiene, theoretical sessions on health and nutrition and also includes practical cooking sessions from scratch. All the young people who participated showed an increase in how confident they felt being able to cook a simple recipe from scratch. Over half showed an increase in confidence in cooking more complex recipes. Over half also showed change in their eating habits (eating more fruit and vegetables, snacking less, cooking healthier more often). Further courses are planned to take place as part of Blackburn Youth Zone’s commitment to the Eat Well strategy. • Case study ‐ Edgeworth primary school
4 Promote a vibrant diverse local food economy • Work on this objective will begin in Year 2 of the strategy. 5 Transform catering and food procurement • 32 local schools are being supported to work to the School Food Plan by BwD Schools catering manager. This plan is about good food and happiness. It is about the pleasures of growing, cooking and eating proper food. It is also about improving the academic performance of our children and the health of our nation. • Recipe 4 Health awards achieved in schools, nurseries, care homes hospital – waiting for info • Royal Blackburn Teaching Hospital (RBTH) has achieved the Soil Association’s Food for Life Bronze Award. To gain the award compliance with the Government Buying Standards for Food and Catering Services is a prerequisite. 6 Reduce waste and the ecological footprint of the food system • The Royal Blackburn Hospital and a number of primary schools have introduced ‘Meat Free Mondays’ helping to reduce the ecological footprint locally. Roe Lee primary school hosted a Quorn taster session with catering managers invited to attend from all Blackburn schools. This was well received and catering managers received Quorn cook books to enhance their culinary repertoire. Two schools have also held Quorn taster days leading to Quorn being featured regularly on the menu. • Primary schools supported by BwD Schools Catering are reducing food waste by implementing pre ordering systems. Food waste has now been substantially reduced both on the plate and at the serving counter at a number of schools, particularly at Meadowhead Infants and Cedars Infants where this had been an issue previously.
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 • Highlighting the success of a joined up approach through the strategy sub groups! ELHT linked up with BwD Schools Catering to use a surplus of short dated breakfast items which were brought in for a hospital promotion. At very short notice the Schools Catering Manager was able to collect, deliver and use the surplus items – fruit pots, yogurts and muesli in 12 Blackburn school’s breakfast clubs ‐ much to the delight of their pupils.
Move More
1. Active society: creating a social movement where physical activity is a priority for everyone • In September a new ante natal exercise class ‘Active Bumps’ started at the Blackburn Birthing Centre led by the Council’s Healthwise team with support from a Midwife. The sessions include the opportunity to have regular contact with a midwife and time for mums to meet each other and chat over a cup of tea after the session. • The Healthwise team are delivering taster early years physical activity sessions for childminders and nurseries across the year to include indoor and outdoor play. The sessions support the childcare providers in developing their physical activity repertoire and ensuring the babies and children in their care have a range of activity opportunities to try. … Childminders attended the session at Witton Park in September with further sessions planned in 2018. • No of school games competitions – including number of children participating – info requested • In July 2017 eight schools participated in a free continuing professional development event for Primary School teachers to support the development and delivery of the Daily Mile in schools across BwD. The session was delivered by Lancashire Sports Partnership, BRCT and School Games Organiser in July 2017. A further session is planned for February 2018 to enable further roll out of the programme. A mapping exercise is currently taking place to see which schools are actively delivering the Daily Mile. • A half day Primary PE and School Sports conference was held by the School Games Organiser on 24th May 2017. The conference was organised to encourage schools to be inclusive in PE and school sport including competitions and to inform schools about the legal implications of using external coaching companies who are delivering activities in schools via the PE and Schools Sport Premium. …. Schools attended the event and a further conference is being planned in 2018 to address the wider issues of health and wellbeing through sport and physical activity. Lancashire Sports Partnership is facilitating support for BwD schools via the Lancashire County Council PE advisor to support the development of PE and Schools Sports Premium funding action plans to ensure effective and sustainable use of the increased premium. • BwD Council has been working with the National Charities Partnership to encourage the use of free outdoor space for physical activity, motivating women and families to engage in activity, get moving through active transport and improve signposting to local activity opportunities. Activities have included running and walking groups, toddler trails and mass participation events in local parks. The 3 year partnership, which has come to an end in 2017 has left a legacy for BwD of: o 9 newly mapped walking routes, o 23 trained volunteer walk leaders, o Year round walking programme with 1,000 unique participants • RoSPA – BwD Age UK to update • Pennine Lancashire has been chosen as a Sport England Place Pilot area to work on a bold new approach to build healthier, more active communities across England. The four year funding from National Lottery will be used to create innovative partnerships that make it easier for people in these communities to access sport and physical activity. Pennine Lancashire’s priority group will be almost 40,000 people with depression or anxiety and stress. The pilot will be looking to understand the things that lie behind physical inactivity 11
Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 and develop project and programmes to really support people to develop an active life in an active community with active family and friends. The focus will be on people with poor mental health but also the communities they live in, the places they go, the way they get around and the people they meet. Sport England have produced an animation to illustrate how they hope the funding will impact on physical activity levels nationally in the coming years https://youtu.be/hPJW358im9I. • CSI programme –info to come https://www.youtube.com/watch?v=f1A5606K2_o • Sport England funded Olympic legacy Sportivate projects in BwD have engaged 275 people aged 11‐25 during 2017. Delivery Partners have included Blackburn Youth Zone, Unit 2 Get Fit, BwD Council, Darwen Running Group, BRCT, Cycle Roots and St Bedes High School. Activities have included gym and fitness, swimming, cycling, running, spinning, multi‐sport disability and Boogie Bounce. A total investment of £17,000 has been made which was facilitated by Lancashire Sport Partnership at a cost of £60 per person for a 6‐8 week programme. • Walking Sport BRCT Walking Football – email sent • A third Back to Netball was established this year at St Mary’s College with an average attendance of 12‐14 every week. As a result of this session two teams of predominantly South Asian ladies have been formed and are now playing regularly in the Blackburn Netball League. The other two Back to Netball sessions which are run in partnership with Inter Madrassah Organisation and re:fresh continue to be well attended with an average of 14 per session and continue to provide new teams for the established netball league. There are currently two Walking Netball sessions at Darwen Leisure Centre and Mellor Village Hall. Ladies who attend the Mellor session have are now trained to lead the session and continue to run the sessions themselves.
• BRCT schools work
2. Moving professionals: activating networks to create active healthy workplaces and make every contact count to promote physical activity • Around 60 Practice Nurses and Healthcare Assistants from across BwD attended a peer to peer training session around promoting physical activity as a means to manage health conditions training in July. The session was only the second to be delivered in the North West region. http://togetherahealthierfuture.org.uk/physical‐activity‐perfect‐medicine/. More peer to peer sessions are being planned for 2018 for a range of health professionals. 12
Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 • Links to local business network The Hive have been built this year. The Hive are keen to develop a ‘Health’ arm of the organisation. The Hive have committed to promoting physical activity through their channels as a means to addressing ill health and sickness absence in the workplace. The Hive have promoted the April Get Britain Standing day and are engaged with the January 2018 Active Workplace Challenge. • Leading by example as a champion for physical activity is the Executive Member for Health and Adult Social Care, Councillor Mustafa Desai, who encourage his friends and family to join him on his regular walks. Councillor Desai says ‘I believe in leading by example and my motive for posting pictures of beautiful places that I walk with my family and friends – places that are right on our doorstep – is to inspire each and every one of you to seize the opportunity to do the same’. Read more here: http://togetherahealthierfuture.org.uk/new‐blog‐i‐love‐walking/.
3. Active environments: creating the right spaces for safe and enjoyable physical activity • Department for Transport funding for the BwD Connect was confirmed earlier this year and a three year delivery plan is now in place. Developments to date include: o ...downloads of the Blackburn Cycling app o Weavers Wheel – bespoke booklet has been designed to support the official launch in March 2018, o cycle training and maintenance • During 2017 the Healthy Travel to School programme has reached 2,855 children in nine schools. During a three month programme of work with Belmont School there was 9% reduction in car journeys to schools and a similar increase in parents using the Park and Stride option leading to a significant reduction in congestion and pollution around the school. During Healthy Travel to School week Belmont School also achieved 100% of pupils
participating in active travel to school – the first ever in the Borough.
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018
• A member of the Planning team attended a North West Physical Activity & Healthy Weight forum in October. This sharing of learning around the impact of planning on the health and wellbeing of communities through regional events brings together professionals from Public Health and Planning to strengthen the outcomes that can be achieved through working together more closely. Info required ‐ How new developments will support the Move More agenda?
4. Moving at scale: maximising the potential of the existing assets and build on existing evidence base on what works to make us active • A local strategic physical activity network has been reinstated to strengthen partnerships and co‐ordinate activity opportunities across the borough across the life course. The Move More Network has a wide range of partners who meet quarterly and links digitally via the KHub platform to share updates and good practice. • Blackburn college tackling Inactivity project SE funding – leading places, mile route, ‐ info requested • The re:fresh physical activity volunteer programme is in its third year and it’s thriving. This year has seen an increase in volunteers recruited; an increase in the number of people engaged with and an increase in the number of external organisations that know about the programme. There are 61 active volunteers out of over 100 on the database with 190 group activity sessions being delivered by volunteers, representing a significant contribution to the health and wellbeing of the community. 23 volunteers lead regular sessions and 24 volunteers have received formal qualifications through the re:fresh volunteer programme. • BwDBC and BRCT have entered into a partnership to strengthen sports development opportunities within BwD through the alignment of strategic planning and activity delivery, ensuring that available resources are maximised to increase participation and improve health and wellbeing. The partnership will seek to develop a new sports offer to schools which will be led by BRCT under the new title of the ‘School Sports Partnership – Powered by Blackburn Rovers Community Trust’. The partnership will strengthen existing links between both organisations and provide opportunities to explore and develop new ways of working together to benefit resident of BwD. Shape Up
1. Transforming the environment we live in
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 • In April the Council signed the Local Authority Declaration on Healthy Weight which has also been signed by BwDCCG. The joint Declaration is the first of its kind in the country and signifies the commitment of the senior health and local authority leaders in tackling unhealthy weight in the Borough. The Declaration includes 14 standard themes for all Declarations and a further 10 local commitments which are being managed through the Eat Well Move More Shape Up action plan. The full Declaration can be viewed here (http://www.blackburn.gov.uk/Lists/DownloadableDocuments/Healthy‐Weight‐ Declaration‐Blackburn.pdf)
• The Public Health department have been leading a whole council health and wellbeing review across all council departments to creating a healthier borough. The review recognises that all departments including public health, planning, transport, procurement, licensing and environmental health have a role to play in ensuring healthy weight is embedded in all policies. Improved partnership work across the council departments and with external organisations is being encouraged and monitored by newly developed service level agreements which reflect the ambitions of both the Strategy and Declaration.
2. Making healthier choices easier by educating and empowering individuals and communities • A range of strategy partners support national initiatives within primary schools these include Walk to School week, National School Sports week and Change 4 Life clubs. Detail of no of clubs, NSS activities to add from SGO
3. Giving all children the best start and tackling the generational issue of healthy weight in families • In November the Council’s Executive Board signed up to become a Breastfeeding Friendly Borough. This is a local commitment in the recently adopted Local Authority Declaration on Healthy Weight which aims to raise awareness of the importance of breastfeeding for all babies and to help mothers feel more confident, comfortable and happier to feed anywhere in the borough. Some achievements against the Breastfeeding Friendly action plan to date are: o Community commitment / background developed – for both staff and families o Work to engage eating places underway – 70 places currently signed up
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 o All primary schools have curriculum packs that include breastfeeding messages. All primary schools are breastfeeding welcome (no school opted out) o Senior school / colleges invited to accept a teaching session from the Baby Friendly Team – 178 students taught in 2017 o Work place employer e‐packs developed to help employers welcome and support breastfeeding / expressing mothers on their return to work. Working with The Hive to achieve this. o Nursery breastfeeding friendly packs developed and being distributed since June 2017. To date 24 pledges have been received. o The Baby Friendly Team are currently distributing pharmacy packs out – including information about breastfeeding and breastfeeding welcoming stickers. o GP packs developed– these are being distributed by the health visiting GP liaison staff. o Work has started with local hairdressers and beauty places to encourage awareness and breastfeeding welcome. 23 have signed up to date. o Work has also started with local leisure facilities. 4 places signed up to date. o Official launch for ‘breastfeeding friendly borough’ planned in breastfeeding month ‐ June 2018
• Early Years PhD – emailed Daisy for update • HENRY is a unique, evidence based, intervention to support parents and carers give their child a healthy, happy start in life and tackle childhood obesity. During 2016‐17 three programmes were delivered to 28 attendees and reaching 13 children aged 0‐5 years. As a result of attending the programme all attendees reported improved emotional wellbeing and healthy eating habits and increased physical activity levels. 79% of the families who started the HENRY programme completed in full. Read the full HENRY 2016‐17 Report here. • The Healthy Child programme team continue to have coverage of over 98% of Reception and Year 6 pupils across BwD for the National Child Measurement Programme (NCMP). This coverage includes ‘non‐NCMP’ schools – or private schools. This coverage continues to some of the best nationally and ensures a large amount of quality data is available for analysis and comparison.
4. Ensuring holistic and integrated evidence based support for individuals with weight related conditions – either under or overweight • BRCT Fit Fans – Ilyas to provide update/possible case study • The Council’s Health & Wellbeing team have been developing a relationship with midwives at Blackburn Birthing Centre to support a maternal healthy weight pathway to include physical activity and food and nutrition support for mums to be. In developing an innovative approach to address unhealthy weight in mums to be in a non‐judgmental environment, weight awareness drop in sessions are being provided whilst ante natal appointments are taking place in Children’s Centres. The team are also starting to deliver low level ante/post‐natal walks and cooking sessions for mums to be and new mums to support healthy introduction to solid foods along with healthy eating for mums and their families.
What happens next…what are the opportunities in Year 2?
The strategic action remains a fluid plan into which all partners input. This enables a full reflection of the ongoing work and the potential developments due to new funding and service developments.
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 An overview of work which has already begun in each strand along with work that is being planned can be seen below.
Eat Well
• A Secondary School food policy will be developed by pupils for pupils with support from Amplify at BwD Healthwatch. • Development of a Food Poverty action plan with support from the National Lottery funded Food Power programme. This will also include the development of a Food Charter for BwD.
Move More
• Blackburn Rovers FC has been selected to run the Eurofit pilot programme which begins in February 2018. Blackburn Rovers join Leicester City and four other clubs from across Europe to test the new programme which uses football clubs to engage fans in increasing physical activity. The programme will be formally evaluated by the University of Glasgow. • Pennine Lancashire’s Place Pilot will begin in 2018. The Sport England funded four year programme will be developed with partners from across Pennine Lancashire and will be led by BwDBC. This opportunity will target those with low to moderate mental health conditions who would benefit from being physically active but who also have a greater number of barriers to accessing opportunities to become more active. • Youth Sport Trust’s My Personal Best and Athlete Mentoring programmes will be rolled out into Secondary schools across BwD during 2018. These programmes use physical activity and sporting role models to engage with young people. My Personal Best supports the development life skills, leadership and employability skills in young people. Athlete mentor visits uses elite athletes as a vehicle to transform the aspirations of young people. Using the power of world class athletes can help to tackle declining emotional wellbeing and resilience in young people and improve behaviour and attitudes to raise attainment across the curriculum. • BwD Connect will be delivering the following activities: o Bike Active beginners cycling programme in partnership with British Cycling, o Further development of the Blackburn Cycling app to include motivational features, route feedback and information on local led rides, o Weavers Wheel launch March 2018, o Tackling inactivity in colleges – cycle training and maintenance for students • European Social Fund funded project More Positive Together, led by Lancashire Sport Partnership, is using sport and physical activity as a tool to increase confidence and improve work prospects for unemployed people living in social housing across BwD. Newground are supporting the delivery of the project
Shape Up
• ELHT are following the lead of the Council and CCG by signing their own Healthy Weight Declaration. The signing of the Declaration by a key partner in the Together a Healthier Future transformation programme further demonstrates a joint approach to tackling unhealthy weight across Pennine Lancashire. • A local Early Years Food and Physical Activity guidance is being developed for use by nurseries and childminders to support healthy weight in pre‐school children. The guidance will include links to all relevant national guidance and local service information to serve as an easy reference document which can be reviewed an updated annually. • As part of the Local Authority Declaration on Healthy Weight guidance for vending and catering will be developed for BwD. This guidance will initially be supported into all BwDBC
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 and BwDCCG vending and catering arrangements with a view to all partners adopting them in their own organisations. • A Primary care based multi‐disciplinary pilot weight management programme will be delivered at Oakenhurst Medical Practice. Delivered by Practice staff and supported by the BwDBC Health & Wellbeing team, the programme will test new ways of working to deliver an effective weight management programme. • There will be a call out to all partner organisations and beyond to develop and commit to their own healthy weight declaration or charter to support the overarching Declaration signed by BwDBC and BwDCCG.
Social Movement for Health
• Leading Places 2 pilot with Blackburn College, BwDBC and Lancaster University will use social movement for health to address physical inactivity with a focus on young people. Rather than reach for expensive clinical solutions the programme will support and empower individuals and communities by enabling healthier choices and so champion inclusive economic growth. To simultaneously develop solutions and grow the movement, a ‘Healthy Social Movement’ is proposed to deliver : • An Environment that empowers people to make physical activity and healthy eating the easy choice. • An Innovation Summit to develop and pilot new interventions to cut across health, education & policy. • An Assembly of local‐level consortiums to mobilise people and coordinate local efforts • The Local Government Association are providing support for a Prevention at Scale pilot in BwD. The programme will empower Health Professionals who conduct NHS Health Checks to refer to the Wellbeing Service to increase physical activity. A primary aim of the pilot will be to change the culture of the workforce to promote physical activity in the workplace and improve professionals participation in and belief in the benefits of physical activity from a personal perspective with the ultimate aim of increasing onward referral and an increase in physical activity for patients.
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Bringing the Achievements in Year 1 to Life ‐ Case studies from partners
Turton & Edgworth Primary School Healthy Eating – awaiting info & photos from Suzanne
East Lancashire Hospitals Trust ‐ Food for Life Award Royal Blackburn Teaching Hospital has earned national nutrition recognition for serving fresh and healthy meals for patient and staff food on its site.
The Bronze Food for Life Served Here award was presented to the Trust’s catering team by the UK's leading food and farming charity and organic certification body, the Soil Association.
The award recognises restaurants and caterers who serve fresh food which is free from controversial additives and better for animal welfare, and includes a rigorous on‐site inspection.
The team at Royal Blackburn have achieved this accolade for serving fresh meals that meet nutritional guidelines for both staff and patients at their onsite restaurant and café.
“Getting the Served Here award demonstrates our department’s progressive approach to catering,” said Zac Rayson, Nutritional Advisor at East Lancashire Hospitals Trust.
“It has never been clearer for our service users that our foods are freshly prepared, using local and sustainably sourced produce and that we strive to support the health and wellbeing of our staff, visitors and patients.”
Staff, patients and visitors can now be assured that meals served at the restaurant are produced with fresh ingredients, all the meat achieves UK animal welfare standards, dishes contain only free‐ range eggs, no undesirable additives or trans‐fats are used and staff and visitors can easily be told where the food comes from, with much of it being sourced locally from the region using NHS accredited suppliers.
The Trust is already thinking about the future and how they can continue to improve standards.
“For us, the bronze status we are awarded with today is just a starting point and our next goal will be to achieve the award at our other hospitals,” said Tim Radcliff, Catering Manager at the Trust.
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Elizabeth Testani from the Soil Association presenting the Bronze Food for Life Served Here award to the catering team at Royal Blackburn Teaching Hospital.
National Charities Partnership and BwDBC Health & Wellbeing Team – Witton Park Event July 2017
Engage & Motivate
Blackburn’s Witton Park Family Fun Festival
On Saturday 12th July the National Charity Partnership prevention team and 5 Tesco Colleagues attended Blackburn’s Witton Park Family Fun Festival. The NCP teamed up with re:fresh Blackburn County Borough Council to offer a range of physical activity taster sessions as well as to launch the opening of Witton Parks new walking route funded by the NCP for the 800 local residents who attended the event.
It was a great day, despite the not so lovely weather (raincoats and wellies were a necessity),
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 but it didn’t appear to put off the residents as they got stuck in with the huge amount that was on offer. The NCP stand was offering the public a chance to win a free goodie bag – complete with branded items including water bottles and Frisbees – by taking part in our pedometer challenge, with the aim of getting participants to use the newly launched walking routes in the park. 381 people were handed a pedometer, with 276 returning to the NCP stand to collect their free prize. 536,090 steps were accounted for throughout the whole challenge, with the average per person completing around 2000 steps. The participants were also given information about the NCP, the 8 week challenge and how they can get more involved with their free local walking schemes in Blackburn.
There are three main walking routes to choose from, each with options to make it longer or shorter so that they are suitable for all age ranges and all fitness levels. They range from a one mile flat route suitable for pushchairs and wheelchair users to a more challenging four and a half mile route, with each one having a distinctly different feel with attractions to spot along the way. At the festival 775 people took part in one of the 3 walking routes.
As well as the launch of the walking routes, there was a range of physical activity taster sessions that ranged from a climbing wall, sack races, clubacise (complete with glow sticks), a BMX bike track and a stationary rowing challenge, of which 656 people took part in one of the above activities.
“This pedometer is great! I’m going Overall, the launch of the walking routes was a huge success and we to use it every day!’ look forward to seeing them be used for the rest of 2017!
BwD Inspire in partnership with Challenge through Sport Initiative – Old Skool Sports Day & Winter Olympics. BwD Inspire integrated treatment prevention and recovery service hosted an ‘Old Skool’ sports day in partnership with Lancashire Sport Partnership’s Challenge through Sport Initiative in July at Witton Park Arena.
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The teams consisted of services and service users of vulnerable adult’s services in BwD and the surrounding areas. This was a great opportunity for individuals to connect with each other and to link in to the many services available in BwD along with promoting healthy lifestyle choices and physical activity. It was also an opportunity for service users to connect with each other and the staff who deliver these interventions, in a relaxed, fun environment. …. people took part in the afternoon and after such positive feedback from the event a Winter Olympics event was planned!
Photos from the Winter Olympics Event December 2017
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Lancashire Sport Partnership Sportivate Funding – BwDBC Children’s Services Swimming Project
The swimming project was managed by the Adolescent Support Team which is part of Blackburn with Darwen Borough Council children's Services. This team works with young people who are on 'the edge of care' or who are in care. All young people have a Social Worker and under either 'Child Protection Plans', 'Child in Need Plans' or are 'Looked After'. About 50 young people currently access the service. It had been identified that approximately 12 young people who accessed the service were 'non‐swimmers' and lacked the confidence and financial means to access mainstream swimming lessons. The service had access to a qualified swimming instructor. Following a successful Sportivate bid, the service hired a local authority pool for 16 weeks and delivered two blocks of lessons. After the sessions, all young people were supported to obtain the local leisure pass (the 'Beez Card') so they were able to access leisure services independently and at a subsidised rate.
Case study:
Young person X was subject to a Child Protection Plan when he started accessing the swimming lessons, after relocating to the area because of domestic violence. X was from a large family and did not have the financial means to access private swimming lessons. As the young person was in his mid‐teens, he felt self‐conscious going to a swimming pool with his friends as he could not swim. X felt comfortable accessing the lessons through ASU as he was comfortable with both the staff and peers, and no one else would be accessing the pool. Young person X developed both swimming technique and water confidence quickly and learnt to swim after the first block of lessons, and then accessed the second block as a mentor / role model. X was given a local leisure card and felt confident accessing the local authority swimming pools independently after the sessions. Young person X and his family received other support from a range of professionals and their case was closed to Social Care.
Identified improved outcomes for the group: • Improved health / fitness through taking part in exercise • Social skills / accessing mainstream services • Challenging perceived personal limitations / going outside personal comfort zone • Supporting peers / giving encouragement • Sense of personal achievement / increased self‐ confidence • Learning of a new skill • Gaining an awareness of young people with cultural differences / ability levels (Social 23
Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 model of disability) • Increased personal safety around water
Our Lady of Perpetual Succour Roman Catholic Primary School ‐ Daily Mile
Info to come
Baby Friendly Team Gold Award The team have supported maternity services to achieve full UNICEF reaccreditation in April 2017 and progress to the UNICEF GOLD ‘achieving sustainability award’ in June 2018 – being the first UK service to achieve this. We are now in our 20th year of working closely with UNICEF BFI. ACHIEVING SUSTAINABILITY – ‘GOLD’ AWARD
It was with true excitement and wonder that we explored the new UNICEF UK BFI ‘achieving sustainability’ standards, considering what more we could do to invest in the further protection of the core BFI standards achieved and how we could continue to progress. ELHT maternity services have long been ambassadors for the BFI standards and invested well over the time period in staff education and support for families. This has been evidenced at all reassessments. Staff feel very proud to work in a Baby Friendly environment. It gives them very clear, consistent evidenced based standards. We support student midwives so we feel they are having optimal experiences in relation to infant feeding and relationship building – protecting our future midwives.
The GOLD themes:
Leadership: We introduced our new BFI Guardian, a consultant obstetrician with Trust Executive responsibilities who also had experienced our BFI journey and holds a passion for BFI standards / evidence based practice. This role has proved invaluable in communicating ‘upwards’ with our ‘GOLD’ reporting and also supporting wider Trust opportunities to make a difference. We developed a ‘BFI GOLD’ leadership team to help review and support the project long term. This group includes our Guardian, Head of Midwifery, Infant Feeding Lead, Matrons and our senior infant feeding team. The manager training was delivered to the GOLD team and all the band 7 midwifery managers.
Monitoring: A ‘BFI data dashboard’ was designed, which is simply a spreadsheet that allows us to examine lots of data in one place, ‘rag’ rate it each month and agree progression interventions. Data such as breastfeeding rates, mode of delivery, skin contact rates, supplementation rates, hours of peer support on the ward, readmission rates, 6 week rates etc. Our six monthly readmission reports have also helped us take a closer look at which mothers are readmitted and why. Ongoing internal BFI audits also help us monitor care provided.
Culture: Anonymized staff surveys were sent to all staff to assess how staff feel about the culture of kindness for staff and families. We also have twice yearly ‘BFI roadshows’ to formally spend time listening to staff in every area on how they feel about the BFI standards, the challenges, the strengths and ideas for progression. The culture of the service is highly important. In our very busy NHS staff need and should feel valued – so we thought carefully how we could enhance this in addition to a verbal ‘thank‐you’. Emails, thank you cards, employee of the month and star of the year are some of the ways we hope to celebrate great care. Happy valued staff equals happy families – no matter how busy the environment is. Staff education is integral to culture. We have tried to be creative on education outside of the new starter two‐day course and annual updates by developing 24
Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 ‘BFI‐bitesize’ emails fortnightly. We are also fortunate to have a service user website / social media that we can utilise for feedback. At audits we also ask ‘is there anything else you would like to feedback’, ‘were the staff kind?’, ‘how can we do better?’. Paying attention to friends and family cards also helps give indicators of how families feel.
Progression: Progression is what you do over and above the core BFI standards to improve experiences for families and breastfeeding rates. For our submission we included several progression projects including antenatal colostrum harvesting, removal of formula milk in postnatal areas, introducing more peer support and reducing weight loss readmission. Going forward we are supporting: • More antenatal expressing by introducing this for mothers being induced • A team of breastfeeding champions Trust‐wide to support staff returning from maternity leave • BFI ‘clinical experts’ for the postnatal ward.
In the long term, BFI GOLD Achieving Sustainability standards and regular validations by the UNICEF team will most certainly help us to maintain our standards and keep moving forwards, being vigilant to data / audit changes and embracing progression plans. Improved reporting and monitoring mechanisms will ensure optimal internal scrutiny and suggestions, which we have welcomed. The importance of the BFI standards are understood and well respected in our service and we would completely urge other services to do this. The future of infant feeding / relationships for families is worth this investment – it is absolutely paramount that we embed this across the UK.
One mother wrote this to us in a thank you card: “Those first few days were terrifying but your kind words and personal perspective gave me real hope and positivity. Throughout the past few months you've shown us support and kindness beyond measure and we are eternally grateful. Thank you so much for supporting our breast feeding journey. There have been so many times when it would have been easy to give up hope, but you helped us to take a tenacious approach and gave us self‐belief. Breastfeeding my daughter is something I'm incredibly proud to have achieved and we simply couldn’t have done it without you.”
We are extremely proud of all our staff and our GOLD leadership team for being the first service to achieve this award. Our trust and respect for each other and the families we serve has made this possible.
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Appendix A Eat Well Move Shape Up Strategy Information
Strategy http://www.blackburn.gov.uk/Public%20health%20docs/Eat‐Well‐Move‐More‐Shape‐ Up.pdf
Action Plan http://www.blackburn.gov.uk/Public%20health%20docs/Eat‐Well‐Move‐More‐Shape‐ Up‐Strategy%20Action%20Plan.pdf
Local Authority Declaration on Healthy Weight http://www.blackburn.gov.uk/Lists/DownloadableDocuments/Healthy‐Weight‐Declaration‐ Blackburn.pdf
Strategy Plan on a Page
Eat Well Move More Shape Up Plan on a P
Governance Structure
Eat Well Move More Shape up Governance
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Appendix B Breastfeeding Friendly Borough Action Plan
Feeding future Feeding future generations_BwD_ 20generations_BwD_ 20
ELHT BABY FRIENDLY TEAM ACTION PLAN – PROGRESSING TO BREASTFEEDING FRIENDLY BOROUGH *SEE BWD HEALTHY WEIGHT DECLARATION
Key Actions Key Deliverables Progress Organisation/ Timescale Indicators Lead COMMUNICATION Briefing meetings Meetings to B Wolfenden with : with identified timescale S Henry • 1.8.17 • PH teams – groups with Beth extended senior Wolfenden • 1.8.17 leads • 14.8.17 • LCC – Pennine • 14.8.17 approach • Counsellor Desai • 15.8.17 • Elected members / • 8.9.17 PH consultants • Counsellor Bateman • CCG
EXECUTIVE BOARD Report completion B Wolfenden End August DECISION Report S Henry 17
FEEDING FUTURE Document produced S Henry GENERATIONS – consultation Information Document comments welcomed for form above gourds / • Parents service users (via BF • Public groups / volunteers ) MAINTAIN BFI As per BFI leads Audit results S Henry Annual ACCREDITATION action plans and D Butler internal Education of the audit calendar / audit benefits of education curriculum submission breastfeeding for mum April 2018 and baby along with External wider society and how assessment best to support a early 2019 breastfeeding mum. Challenge the ‘bottle feeding’ culture amongst young mums and those from lower socio economic backgrounds by utilising a mother centred /
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Draft v1.0 Eat Well Move More Shape Up Annual Report February 2018 motivational conversation approach during pregnancy
Key Actions Key Deliverables / Progress Organisation/ Timescale Lead BREASTFEEDING Ask local families – via breastfeeding S Henry March 2018 WELCOMING TOWN groups and volunteers D Butler
Areas to target outstanding • GPs – lots of work completed –all practises as part of BFI work. Meeting with CCG GP partners 12.9.17 to agree ongoing education / welcoming plans • Dentists • Employers ‐employer pack launched in 2016 via Work Well Team • Hairdressers / nail bars • Witton Park • Playcentres ie. Funtazia, happy daze • Wellibobs • Leisure centres – new one in BBurn – visited Darwen LC in past • Blackburn visitor centre • Ewood park • Museums • Maryvale‐DB • Everybody centre‐DB • Foyer‐DB • Hollin street – completed 1.8.17 • Dentists • Council buildings o libraries o courts o Duke Street –reception completed by R Moreton June 2017 • Transport o Buses‐Manager Transdev buses BwD Shaun Walmsley has briefed staff to ensure BF welcomed on buses. Can’t place welcome stickers on buses – CEO not agreeing. o Rail / station • Pharmacies
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• Vue / leisure • Restaurants – Nandos – 132 eatery etc • Cafes – Lots of work completed in town centre areas ‐ Environment team helping to support this – Denise Andrews. Costa coffee • Hospital / ELHT – breastfeeding welcome messages, posters have gone out to all ELHT teams via the matron forum in 2016 and 2017 • Schools / Colleges • Nurseries – new pack launched during breastfeeding week 2017 – w/c 26.6.17
LAUNCH PLANS Signage to be in place Date – national breastfeeding week (Lancashire LIFP have agreed to use w/c 25/6/18) ‘Launch Event’
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GOVERNING BODY MEETING GORNIN
REVIEW OF REGISTER OF INTERESTS
Date of Meeting 17TH JANUARY 2018 Agenda Item 12
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity X To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements 9 To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access X Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund X Access to Re-ablement and Intermediate Care X Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions X Access to high quality Urgent and Emergency Care X Scheduled Care X Quality √ G BODGOVERNING BODY MEETING
Page 1 of 3
Clinical Lead: N/A
Senior Lead Manager Mrs Claire Moir Finance Manager Mr Roger Parr Equality Impact and Risk Assessment This report is for information only completed: Patient and Public Engagement completed: This report is for information only Financial Implications This report is for information only Risk Identified This report is for information only Report authorised by Senior Manager: Mr Iain Fletcher
Y Decision Recommendations The Governing Body is requested to note the content of the report.
Page 2 of 3
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
17TH JANUARY 2018
REVIEW OF REGISTER OF INTERESTS
1. Introduction
The purpose of this briefing is to provide the Governing Body with an update on its Register of Interests.
Following new guidance from NHS England and subsequent revision to the CCG’s Conflicts of Interest Policy, the CCG’s Registers of Interests have been reviewed to ensure compliance with the new guidance.
2. Governing Body Register
There have been changes to the register since the last review as follows:
• Dr Chris Clayton has been removed from the register following his departure from the CCG. • Dr John Randall has amended his declaration to reflect that he is no longer a Medical Officer at Priory Hospital and his General Practice no longer hosts the Roe Lee Ultrasound Service. • Dr Preeti Shukla has amended her declaration to include that she is the national General Practitioner (GP) British International Doctors Association Chair, a blog writer, the Deputy Policy Lead, British Medical Association, a Federation GP for the Spoke Hub and an Out of Hours GP for East Lancashire Medical Services. She has also declared friends and colleagues working as GPs, Consultants, Health Care Assistants, Nurses, Allied Health Professionals at East Lancashire CCG, Blackburn with Darwen CCG, East Lancashire Hospitals NHS Trust (ELHT), Beardwood Hospital and other hospitals in other areas via social media contacts.
The updated register (attached as Appendix 1) was presented to the CCG’s Audit Committee on 28th November 2017 and has been published on the CCG’s website in line with statutory requirements.
3. Recommendation
The Governing Body is requested to note the content of the report.
Mr Iain Fletcher Head of Corporate Business 5th January 2018
Page 3 of 3 REGISTER OF INTERESTS NHS BLACKBURN WITH DARWEN (BwD) CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY - NOVEMBER 2017 Name and position within, or Type of Interest Description of Interest (including for indirect interests, Dates Interest Relates Actions to be taken to mitigate risk (to relationship with, the CCG details of the relationship with the person who has the From and To be agreed with Line Manager or a interest) Senior CCG Manager) Dr Adam Black (General Financial GP Partner for Cornerstone Practice 2008 Present As per CCG Conflicts of Interest (CoI) Practitioner (GP) Executive Policy Member) Director of Cornerstone Healthcare Community Integrated Care 2009 Present As per CCG CoI Policy (CIC) Out of Hours (OOHs) sessional GP for East Lancashire Medical 2008 Present As per CCG CoI Policy Services (ELMS) Non-Financial Professional Director of Cornerstone Healthcare Charity 2010 Present As per CCG CoI Policy
Indirect Wife is Speech and Language Therapist for 'Speak Easy' 2014 Present As per CCG CoI Policy Charity Mr Graham Burgess (Chair) Indirect Chair of Torus Social Housing Company, Warrington and St 2014 Present Indirect so no action Helens Professor Dominic Harrison Indirect Partner is a Lancashire County Councillor 2011 Present As per CCG CoI Policy (Director of Public Health, BwD Borough Council) Mr Paul Hinnigan (Lay Member - Financial Director of Beardwood Business Services Limited 2012 Present No longer trading Governance) Director of Northlands Consultancy Services Limited 2016 Present Health Consultancy. Projects discussed with BwD CCG Chair in advance to ensure no conflict. Indirect Wife is Deputy Chief Finance Officer at East Lancashire CCG 2013 Present Interest Declared Dr Nigel Horsfield (Lay Member) Non-Financial Professional Friends and former colleagues work at East Lancashire 1981 2010 As per CCG CoI Policy and Personal Hospitals NHS Trust (ELHT), Beardwood Hospital and Gisburne Park Hospital Miss Claire Jackson (Director of Financial Seconded from role jointly funded through the Local Authority 2017 2018 Indirect so no action Commissioning Operations) and CCG
Indirect Friendships with colleagues at Blackburn with Darwen Borough Indirect so no action Council and Trafford CCG Dr Geraint Jones (Lay Member - Non-Financial Professional Friends and former colleagues work at ELHT, Beardwood 1987 2016 As per CCG CoI Policy Secondary Care Doctor (Retired)) and Personal Hospital and Gisburne Park Hospital
Dr Penny Morris (GP Executive Financial GP Partner Darwen Healthcare (DHC). Dr M Ninan (Partner at TBC Present As per CCG CoI Policy Member) DHC) is GPwSI in Cardiology, BwD Community Anticoagulation Service is run by DHC. (Personal) Non-Financial Personal Medical Advisor to the W M and BW Lloyd Trust (Charity) in 2016 Present As per CCG CoI Policy Darwen. Indirect Son is employed by G2 speech who provide speech recognition TBC Present As per CCG CoI Policy software and workflow management systems to NHS organisations Mr Roger Parr (Deputy Chief Non-Financial Professional Father is Chair of East Lancashire Hospice and Governor at 2014 Present As per CCG CoI Policy Executive/Chief Finance Officer) ELHT ) Public Sector Director of East Lancashire Building Partnership 2013 Present As per CCG CoI Policy
Indirect Close relationship (Partner) with Director of Performance at 2015 Present As per CCG CoI Policy Blackpool CCG. Dr Zaki Patel (GP Executive Financial GP at Umar Medical Centre (salaried). 2016 Present As per CCG CoI Policy Member) Sessional work for ELHT 2017 Present As per CCG CoI Policy Sessional work for ELMS 2016 Present As per CCG CoI Policy Sessional work for Local Primary Care 2017 Present As per CCG CoI Policy Dr John Randall (GP Executive Financial GP at Oakenhurst Medical Practice 1992 Present As per CCG CoI Policy Member) GP Partner, Dr Ali, within my practice receives financial TBC Present As per CCG CoI Policy remuneration for conducting Phase 3 trials for Merck; Sanofi; Novonordisk; AstraZenica. I am a member of the Local Blackburn GP Federation TBC Present As per CCG CoI Policy I am a member of the OOHs Service, ELMS TBC Present As per CCG CoI Policy Indirect My wife is Executive Chief Nurse at Trafford CCG TBC Present As per CCG CoI Policy Dr Malcolm Ridgway (Clinical Financial Wife, Diane Ridgway , is Chief Executive Officer, ELMS, 2009 2018 Exclusion from any discussions regarding Director of Primary Care and Pennine Lancashire GP OOHs Provider ELMS. Quality) Son in Law, James Bibby, works for ELMS 2009 2018 Exclusion from any discussions regarding ELMS. Seconded to NHS England two days per week as a Primary 2016 2018 Exclusion from decisions that might Care Senior Responsible Officer benefit the CCG. Indirect Daughter, Jennifer Ridgway, works as a Practice Nurse in 2014 Present Exclusion from any relevant discussion. Burnley Daughter, Rebecca Bibby, works for a Pharma Company 2012 Present Exclusion from any relevant discussion. supplying unlicensed drugs to hospitals. Dr Preeti Shukla (GP Executive Financial Salaried GP at Primrose Bank Medical Centre 2011 Present As per CCG CoI Policy Member) Locum GP in Blackburn and East Lancashire area 2011 Present As per CCG CoI Policy Director AADI ADITI Limited (private company) 2012 Present As per CCG CoI Policy Local Medical Committee Member 2016 Present As per CCG CoI Policy British Medical Association sessional Sub-Committee Member 2016 Present As per CCG CoI Policy
Non-Financial Professional GP Survival England Representative 2016 Present As per CCG CoI Policy British International Doctors Association Executive Member 2016 Present As per CCG CoI Policy Blackburn Financial National GP British International Doctors Association Chair 2017 Present As per CCG CoI Policy Blog writer 2016 Present As per CCG CoI Policy Deputy Policy Lead, British Medical Association 2017 Present As per CCG CoI Policy Federation GP for the Spoke Hub 2017 Present As per CCG CoI Policy OOHs sessional GP for ELMS 2017 Present As per CCG CoI Policy Non-Financial Professional Friends and colleagues working as GPs, Consultants, Health 2011 Present As per CCG CoI Policy and Personal Care Assistants, Nurses, Allied Health Professionals at East Lancashire CCG, Blackburn with Darwen CCG, ELHT, Beardwood Hospital and other hospitals and other areas via social media contacts. Mrs Janet Thomas (Associate Non-Financial Professional Friends and former colleagues at Lancashire Care NHS 2000 2017 As per CCG CoI Policy Director of Quality and and Personal Foundation Trust and ELHT Commissioning)
GOVERNING BODY MEETING
SUB-COMMITTEES AND GROUPS’ MINUTES
Date of Meeting 17th January 2018 Agenda Item 13
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor X outcomes and inequalities To work collaboratively to create safe, high quality health care services X To maintain financial balance and improve efficiency and productivity X To deliver a step change in the NHS preventing ill health and supporting people to live X healthier lives To maintain and improve performance against core standards and statutory requirements √ To commission improved out of hospital care X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access X Self-Care and Early Intervention X Enhanced and Integrated Primary Care and Better Care Fund X Access to Re-ablement and Intermediate Care X Improved hospital discharge and reduced length of stay X Community based ambulatory care for specific conditions X Access to high quality Urgent and Emergency Care X Scheduled Care X Quality √
Clinical Lead: N/A
Senior Lead Manager Mr Iain Fletcher Finance Manager N/A Equality Impact and Risk Assessment Report for information only completed: Patient and Public Engagement completed: Report for information only Financial Implications Report for information only GOVERNING BODGOVERNING BODY MEETING
Risk Identified Report for information only Report authorised by Senior Manager: Mr Iain Fletcher
Decision Recommendations The Governing Body is requested to receive and note the content of the report.
Y
Governing Body Meeting Page 2 of 3
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
17th JANUARY 2018
SUB-COMMITTEES AND GROUPS’ MINUTES
1. Introduction
This report presents the minutes of the Governing Body Sub-Committees and Groups for receipt and note by members.
The minutes inform members of delegated and key decisions taken and provide information regarding items of particular interest or potential risk.
2. Sub-Committees and Groups
2.1 Primary Care Co-Commissioning Committee
The ratified minutes of the meeting held on 19th July 2017 are attached as Appendix 1.
2.2 Commissioning Business Group
The ratified minutes of the meetings held on 11th October and 15th November 2017 are attached as Appendices 2 and 3.
2.3 Pennine Lancashire Quality Committee
The ratified minutes of the meetings held on 27th September, 25th October and 22nd November 2017 are attached as Appendices 4, 5 and 6.
2.4 Audit Committee
The ratified minutes of the Audit Committee held on 22nd August 2017 are attached as Appendix 7.
3. Recommendation
The Governing Body is requested to receive and note the content of the report.
Iain Fletcher Head of Corporate Business 5th January 2018
Governing Body Meeting Page 3 of 3
CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Primary Care Commissioning Committee (PCCC) held on Tuesday 19th September 2017 at 12.30 – 2.00 p.m. in Meeting Room 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG
PRESENT: Dr Nigel Horsfield Lay Member (Chair) Mr Roger Parr Deputy Chief Executive/Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Mr Paul Hinnigan Lay Member - Governance Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Dr Preeti Shukla General Practitioner (GP) Executive
IN ATTENDANCE: Mr Peter Sellars Primary Care Transformation Lead Mrs Anne Greenwood Service Transformation Manager Mrs Sarah Danson Primary Care Contracts Manager, NHS England Lancashire Mr Stephen Toulmin Head of Strategic Partnerships, Cumbria and Lancashire Local Medical Committee Mrs Shirley Goodhew Public Health Specialist, Blackburn with Darwen (BwD) Borough Council (BC) (representing the Public Health Team) Mrs Jolene Gregory Director, Local Primary Care (Item 13 only) Dr Mohammed Umer Chair and Clinical Lead for Access, Local Primary Care (Item 13 only) Dr Amar Ali Clinical Lead for Quality, Local Primary Care (Item 13 only) Mrs Pauline Milligan Governing Body Secretary (Minutes)
Min No: 1. Chair’s Welcome
The Chair welcomed everyone to the meeting and explained that he was leading the meeting in the absence of Mr Graham Burgess, CCG Chair.
He gave a short briefing with regards to the content of the agenda and members introduced themselves.
2. Apologies for Absence and Confirmation of Quoracy
Apologies for absence were received in respect of:
Mr Graham Burgess, CCG Chair; Miss Claire Jackson, Director of Commissioning (Operations); Mrs Janet Thomas, Executive Nurse/Associate Director of Quality and Commissioning; Dr Stephen Gunn, GP Educational Lead.
The meeting was confirmed as quorate.
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3. Declarations of Interest
The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG.
He asked members if they would like to declare any Conflicts of Interest (CoI) relating to items on the agenda.
Declarations declared by members of the PCCC are listed in the CCG’s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/
Mr Paul Hinnigan declared a non-financial personal CoI in Item 11 – Application to Close Limefield Branch Surgery, due to the fact that he was a patient registered with that GP Practice.
It was agreed that, due to the nature of the conflict, Mr Hinnigan could remain in the meeting and take part in the discussions.
Dr Preeti Shukla declared a financial CoI in Item 13 - Outcomes Enhanced Services Transformation (QOEST) Progress Update, as she was a Locum GP providing out of hours sessions for Local Primary Care (LPC).
It was agreed that, due to the nature of the conflict, Dr Shukla could remain in the meeting and take part in the discussions.
The Chair reminded those present that if, during the course of discussion, a CoI became apparent, it should be declared at that point.
4. Questions from the Public
No questions had been received from members of the public.
5. Draft Minutes of the Meeting Held on 18th July 2017
The minutes of the previous meeting were reviewed and accepted as an accurate record.
Mr Stephen Toulmin stated that the minutes referred to the Local Medical ‘Council’ but should read Local Medical ‘Committee’. It was agreed that the minutes would be amended.
RESOLVED That, following the above correction being made in line with discussions, the Minutes of the Meeting held on 18th July 2017 were approved as an accurate record.
6. Action Matrix / Matters Arising
The action matrix was reviewed and the following was noted.
Item 7 – 18th July 2017 – Primary Care (PC) Update Mr Peter Sellars confirmed that the satellite surgery at Barbara Castle Way Health Centre was not being progressed.
7. Primary Care Update Report
Mr Sellars presented the Primary Care Update, which brought to the attention of members national and local PC news and information and highlighted key points.
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He confirmed that Local Primary Care (LPC) were attending the meeting later on the agenda to provide an update on the Quality and Outcomes Enhanced Services Transformation (QOEST) Scheme and Key Performance Indicator (KPI) measures within the plan.
In relation to the Estates and Technology Transformation Fund (ETTF), it had been confirmed that the CCG would receive funding for the West Locality to progress the scheme. As yet, however, there had been no formal confirmation from NHS England.
Mr Sellars confirmed that all the GP Practices in BwD had signed up to be part of the development of the PC Network within their neighbourhoods and districts. The completed documentation had been sent to NHS England.
Mr Sellars referred to Limefield Surgery which was in initial discussions with NHS England to consolidate the practice on one site and also to potentially partner with the Redlam practice.
He confirmed that some work had been undertaken in relation to the retirement of GPs over the next 5 years. There were potentially approximately 26 GPs who may retire over that period. Some of the GPs may stay in practice under the Retention Scheme. He explained that the CCG was also part of NHS England’s International GP Recruitment Programme.
Members noted that there would be an e-Referral Service in place across Lancashire and South Cumbria from 1st October 2018 and all referrals from GP Practices to Consultant-led first out-patient appointments would be done electronically.
Questions and answers followed.
ACTION: Following a request by Mr Roger Parr in relation to PC at scale, it was agreed that it would useful for the PCCC to receive details of how the funding was being spent. Dr Malcolm Ridgway/Mr Peter Sellars to action.
RESOLVED: That the PCCC received the report and noted the items as detailed.
7.1 PC Work Plan
The Work Plan was presented for information.
There were no questions.
RESOLVED: That the PCCC noted the content of the Work Plan.
8. Alternative Provider Medical Services (APMS) Contracts
Dr Ridgway introduced the report and reminded members of the background to the issue which had been discussed at the last meeting.
There were two APMS GP Practices which had come to the end of their contracts. A procurement process had been undertaken which had resulted in a contract not being awarded due to a lack of interest and the single bid being non-compliant.
Dr Ridgway reminded members that, following discussions on a number of options at the last meeting, the PCCC had considered either a direct award of the combined contracts to a suitable provider, or to disperse one or both lists. Ultimately, it had been agreed to proceed via a direct award; however the CCG would consider all the various options involved in the process of a direct award to ensure value for money.
Dr Ridgway explained that, after seeking further advice, NHS England had confirmed that the
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best process would be for the CCG to undertake a further procurement with an altered specification to facilitate the development of larger, more productive and sustainable practices in line with the CCG’s PC Strategy. He explained that the options, which were aligned with the CCG’s strategic intent, were to be re-considered.
Dr Ridgway outlined the options which were:
1. Disperse one or both lists; 2. Extend current arrangements; 3. Re-procure Bentham Road and disperse the Waterside list (Waterside on its own is not viable); 4. Direct Award of the combined contracts to a suitable provider (Single Tender Action); 5. Combine both practice lists and procure as a single practice to operate out of one or both sites (reviewing the previous tender).
The PCCC were requested to support Option 5 and agree to progress the procurement as described.
Questions and answers followed.
Members considered the options and discussed the best process to ensure a successful procurement for the benefit of the patients within the timescales.
RESOLVED: That the PCCC:
i. received and considered the report; ii. agreed to approve Option 5 in the report, subject to the timescales being adhered to; iii. agreed to progress the procurement as described.
9. Proposed Practice Opening Times
Mr Sellars presented the report which set out the request from the 3 practices operated by Dr Gupta to change their opening times to comply with access requirements; both from a GP contract perspective and also to comply with local requirements via the QOEST scheme.
The current opening times were:
• Springfield – 8-6.30pm Mon/Tue/Thur/Fri. Wed 8-1pm. Lunchtime closing 1-2pm; • Pringle Street – 8-6.30pm Mon/Wed/Thur/Fri. Tue 8-1pm. On Tuesdays an additional extended hour between 7am and 8am is provided by the Direct Enhanced Service (DES); • Feniscowles – Mon/Tues/Wed/Fri 8-6.30pm; Thur 8-1pm. Lunchtime closing 1-2pm On Mondays an additional extended 1.5 hours between 6.30pm and 8pm is provided by the Direct Enhanced Service (DES).
The proposed new times were:
• Springfield – 8-6.30pm Mon-Fri; • Pringle Street – 8-6.30pm Mon/Wed/Thur/Fri. Tue 8-1pm; • Feniscowles – 9-5pm Mon/Wed/Fri. Lunchtime closing 1-2pm.
Mr Sellars explained that the CCG’s view was that half-day closing should no longer be allowed in main surgeries, except in exceptional circumstances.
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He continued that the practice would operate one telephone system so that patients could access any site via a single telephone call and one EMIS computer system so that patient records were available in full at any of the three sites.
A consultation with patients, via the Patient Participation Group (PPG), had taken place and the group were in agreement with the proposal.
Mr Sellars concluded that the CCG Chair had already approved the proposal (in order for the practices to commence future planning) and it was being brought to the meeting for final ratification from the Committee.
Questions and answers followed.
Members discussed how the proposal aligned with the CCG’s PC Strategy and the nature of the contracts which were involved. It was noted that the practice had now withdrawn from providing the extended hours DES with effect from 30th September 2017.
ACTION: Dr Ridgway agreed to review the current contracts to suggest they merge.
RESOLVED: That the PCCC agreed to ratify the Chair’s Action to enable the practice to change to the proposed new opening hours from 1st October 2017; subject to a recommendation to the practice to work towards a merger.
10. Practice Merger
Dr Ridgway declared a non-financial personal CoI in this item, as a patient of the Montague Practice. It was agreed that, due to the nature of the conflict, Dr Ridgway could remain in the meeting and take part in discussions.
Mrs Sarah Danson presented the application which had been received from Roe Lee Surgery and the Montague Practice. The practices had applied to terminate one of the P codes and to merge the contracts; working towards a timescale of 1st October 2017.
Mrs Danson explained that Roe Lee Surgery was previously on a Personal Medical Services (PMS) Contract and had exercised its right to terminate that contract. The application presented was the next step in terms of merging the practices’ contracts. The practices were considering economies of scale in terms of staff, etc. There were no plans to change the core opening hours at both sites; however, there were plans to introduce extended opening times during the week at one of the sites.
Mrs Danson outlined the benefits to patients and members noted that a patient consultation had taken place via Roe Lee Surgery’s PPG. Patient engagement had been developed and conducted with both surgeries. She added that, to date, there had been no comments.
Mrs Danson confirmed that there no financial implications, as both practices held General Medical Services (GMS) contracts, which allowed for the merger of the two contracts and clinical systems.
Questions and answers followed.
ACTION: Following an enquiry from Mr Roger Parr, Mrs Danson agreed to check the status of the contracts and if the request had already been approved.
RESOLVED: That the PCCC approved the termination of contract P81607 which would enable both practices to operate under one GMS contract P81704. 11. Application to Close Limefield Branch Surgery
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Mr Hinnigan declared a non-financial personal CoI in Item 11 – Application to Close Limefield Branch Surgery as a patient registered with that GP Practice.
It had been agreed that, due to the nature of the conflict, Mr Hinnigan could remain in the meeting and take part in the discussions.
Mrs Danson presented the application from Limefield Surgery to close its Branch Surgery at Cherry Tree Surgery with effect from 1st October 2017.
Mrs Danson explained that the practice currently held a GMS contract with two partners, Dr Hereward Brown and Dr Katherine Burn. Dr Burn had submitted documentation to resign from the practice. This would leave Dr Brown as the sole contract holder with a list size of 4,160 patients.
Mrs Danson drew members’ attention to the opening hours for the main practice site, the patient consultation required (Appendix A) and a copy of the letter which had been sent to patients regarding the proposal (Appendix B). She confirmed that the CCG had also written to the local Member of Parliament and other local practices for comments and views.
Questions and answers followed.
ACTION: Following discussion regarding the consultation process, Dr Ridgway agreed to check that the consultation had been completed. It was further agreed that a report would come back to the next meeting which would record that the CCG had completed the required process to be followed (as set out in Appendix A).
RESOLVED: That the PCCC approved the closure of the branch surgery, Cherry Tree Surgery; subject to the completion of a satisfactory consultation with patients and local stakeholders.
12. QOEST Scheme Assurance Delivery Programme
Mr Sellars presented the update for information.
There were no questions.
RESOLVED: That the PCCC noted the content of the update.
13. QOEST Scheme Progress Update
Members of LPC attended for this item.
Dr Preeti Shukla had declared a financial CoI in this item as a Locum GP providing out of hours sessions for LPC.
It had been agreed that, due to the nature of the conflict, Dr Shukla could remain in the meeting and take part in the discussions.
Mrs Jolene Gregory provided a presentation to update members on the current position in relation to the QOEST Scheme.
Mrs Gregory reminded members of the objectives of the QOEST Scheme and gave an overview of the progress in each of the three key areas:
• Sustainability; • Access;
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• Quality.
Mrs Gregory highlighted key issues within the scheme and explained the actions and solutions. She outlined the short and expected long term benefits of QOEST.
Questions and answers followed.
Dr Ridgway commended LPC for its work with the Practices and the way in which it has helped and supported them to work together.
The Chair thanked them for the presentation and they left the meeting.
RESOLVED: That the PCCC noted the content of the update.
14. Enhanced QOEST Scheme
Mrs Anne Greenwood presented a proposal to enhance the Primary Care QOEST Scheme.
Mrs Greenwood explained the background to the proposal to enhance and support the QOEST Scheme; particularly in relation to improving the quality of referrals into secondary care. She outlined how the changes would be delivered and supported to meet increasing secondary care demand and enabling more patients to be provided with out of hospital care.
A toolkit would be designed which would be made up of a number of components that would, for example, enable a process of peer review of referrals to monitor quality; patient decision aids and shared decision making; standard referral proformas and the development of internal professional standards based on locality and practice benchmarking of data.
Mrs Greenwood explained the anticipated benefits of all the above tools which would help support the improvement of quality in referrals and patient access.
Dr Ridgway provided further background information about cost savings and how any savings would be re-invested in the neighbourhoods in ways to improve patient care.
Questions and answers followed.
Members discussed the impact of the proposal and if it would mean an increase in GP Practices’ workload.
Mr Hinnigan enquired about the potential risks and referred to section 7 (page 9) which indicated that there should be an accompanying Risk Register.
Mrs Greenwood tabled a copy of the Referral Quality Improvement Scheme Risk Register (Appendix 5). Members considered the potential risks to the scheme which had been identified. Dr Ridgway provided assurance in relation to the potential financial incentives involved; in that there would be no direct financial gain for GP Practices.
RESOLVED: That the PCCC approved the enhanced referral quality component of the QOEST described as outlined in the report.
15. Primary Care Commissioning Activity Report
The Chair highlighted the activity report, which was presented for information.
There were no questions.
RESOLVED: That the PCCC noted the content of the report.
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16. Primary Care Financial Summary
Mr Parr presented the Primary Care Financial Summary for month 4 for the information of members.
There were no questions.
RESOLVED: That the PCCC noted the contents of the Financial Summary and the overall position at the end of July 2017, noting the risks.
17. Any Other Business
No further business was discussed.
18. Date and Time of Next Meeting
The next meeting was scheduled for Tuesday 21st November 2017 at 12.30 - 2.00 p.m. in Meeting Room 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG.
The Chair thanked everyone for their attendance and input and stated that the meeting would now move into Part 2.
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CLINICAL COMMISSIONING GROUP (CCG)
Minutes of the Commissioning Business Group (CBG) Meeting held on Wednesday 11th October 2017 1.30 – 3.30 p.m. in Room G10 & 11, Innovation House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
Present Dr John Randall General Practitioner (GP) Executive Member (Chair) Dr Zaki Patel GP Executive Member Dr Malcolm Ridgway Clinical Director for Quality and Primary Care Dr Penny Morris GP Executive Member Dr Geraint Jones Secondary Care Doctor (Retired) Dr Adam Black GP Executive Member Dr Preeti Shukla GP Executive Member Mr Paul Hinnigan Lay Member (Governance) Miss Claire Jackson Director of Commissioning Operations Mr Roger Parr Deputy Chief Executive/Chief Finance Officer In Mr Neil Holt Head of Commissioning Performance Attendance Mrs Julie Kenyon Senior Operating Officer Ms Elizabeth Fleming Head of Urgent Care Ms Jacquie Allan Executive Support Mr Kenneth Barnsley (On behalf of Public Health Karen Cassidy) Mrs Joy Arrandale Head of Mental Health and Learning Disabilities Dr Rakesh Sharma Mental Health Lead GP Apologies Mrs Janet Thomas Executive Nurse, Associate Director Quality and Commissioning Mrs Karen Cassidy Public Health Specialist (Live Well)
Item Action 10/17/01 Apologies for Absence
Noted as above
10/17/02 Declarations of Interest and Confirmation of Quoracy
The meeting was confirmed as quorate.
The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of Blackburn with Darwen (BwD) Clinical Commissioning Group (CCG). Info
He also informed members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.
Dr Preeti Shukla declared a new conflict, as she is now employed by East Lancashire Medical Services. She has completed the relevant paper work for the governance records.
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Item Action 10/17/03 Minutes of the Previous Meeting – 13th September 2017
It was noted that on page 4 of the previous minutes a Deep Vein Thrombosis was referred to when this should have read Cellulitis. With the action to change this completed, the Minutes of the last Meeting were reviewed and agreed as a true record.
RESOLVED: That the Minutes of the Meeting held on 13th September 2017 were agreed as an accurate record.
10/17/04 Matters Arising - Action Matrix
The action matrix was reviewed:
05/17/10 – Improving Access to Psychological Therapies (IAPT) is on the October agenda 04/17/13 – Sexual Health is scheduled for April 2018 07/17/05 – Acute Visiting Service is scheduled for January 2018 09/17/06 - Out of Hours, GP Advice and Clinical Navigation Hub Contract Review is scheduled for November 2017 09/17/07 – Intensive Home Support Service – Intravenous Antibiotics Service – this is in progress 09/17/09 – Joint Committee – ongoing 09/17/10 – Urgent Treatment Centre Review is scheduled for December Declaration of Any Other Business 10/17/05 Dr Penny Morris asked if Safeguarding Training could be added to the agenda For Decision 10/17/06 Respiratory Assessment Unit and Home Non-Invasive Ventilation Service Business Case
Mrs Elizabeth Fleming presented a paper and explained that she was representing both in her CCG role and in her seconded role to East Lancashire Hospital Trust (ELHT). The paper had already been to several meetings including CMET, PL A&EDB and ELHT Operational Delivery Board where the clinical aspects had been debated. The request of the members was to agree the financial and funding flows.
ELHTs medium term vision is to form an integrated acute medical unit which would include a medical triage function, a Clinical Decision Unit, acute medical beds with stays of up to 72 hours and Ambulatory Emergency Care.
A business case for the development of a Respiratory Assessment Unit 7 days per week (14.5 hours per day) and Home NIV service had been reviewed by the ELHT Executive Team and PL A&E Delivery Board and Finance Directors in Pennine Lancashire, and Mrs Elizabeth Fleming, Miss Claire Jackson and Mr Roger Parr have been involved in the discussions and debate.
Home NIV and RAU in 2017/18 will be funded through the use of non-recurrent contingency funding from East Lancashire CCG and it is anticipated that the benefits of the Home NIV and RAU will be assessed in order to inform recurrent funding solutions. The RAU and Home NIV service will need to run for a year in order for a full evaluation but there will be an interim evaluation Page 2 of 6
before the financial year end.
The members were asked to support the paper, which was followed by a full and frank discussion.
Mr Paul Hinnigan asked why the paper was only being presented at a late stage, which could present issues within BwD CCG governance. Mrs Elizabeth Fleming confirmed that from a Pennine Lancashire perspective senior executive management from within BwD had been present at other Board Meetings including the PL A & E Delivery Board. If the paper was requesting additional resource or funding then it would have come earlier for agreement. As funding for 2017/18 and the proposed recurrent funding is within the current resilience funding envelope, this is under the governance of the AEDB. Unfortunately the current structure within Pennine Lancashire does not support a single decision making process, which necessitated the understanding of the order of the forums for the paper.
Admission tariffs were debated with all in agreement that this should be revisited when agreeing new contracts. It was agreed that lessons would be learnt and that going forward papers of this nature would be brought to the CBG for discussion following a review of the evidence.
The CBG members were in agreement that in principle they would support this paper on the proviso that it was funded on a recurrent basis from resilience funding and the CCG would not be asked for any additional funding.
RESOLVED: The CBG members supported the paper Item Action 10/17/07 Improving Access to Psychological Therapies
Dr Rakesh Sharma and Mrs Joy Arrandale presented a paper to the members of CBG asking for a decision to be made on the recommendations presented to the Collaborative Commissioning Board on the 12th September 2017.
The funding is to meet the performance targets for IAPT set out in the Five Year Forward View, by using the Long Term Conditions pilot services within Lancashire.
The five recommendations are:
• Confirm that funding for the trainee posts for 2018/19 will be met from baseline allocations as set out in "Implementing the Five Year Forward View" and in line with the figures presented above.
• Agree to receive an evaluation report for wave 1 in Autumn 2017 and full evaluation for waves 1 and 2 in Autumn 2018 which will inform the recurrent funding position of the service (subject to satisfactory evaluation findings) for 2019/20 onwards.
• Agree to the creation of a system wide task and finish group to agree a common system and set of processes that will report via respective contracting routes and the Mental Health STP steering group.
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• Agree to the cessation or review of any planned or current procurement activity in respect of IAPT, pending agreement of an STP wide commissioning framework.
• Receive an update on proposed commissioning models post current contract end (2018/19) with regard to the potential development of a Lancashire wide alliance model.
Dr Adam Black asked if this had to be allocated solely to Lancashire Care Foundation Trust (LCFT), and it was explained that this is predominantly a core service which is hard to commission from smaller organisations.
LCFT are looking to sub contract from Third Sector providers and there is a task and finish group which is looking at the best models going forward.
The IAPT money currently in the system is delivering 15% prevalence which needs to increase to 25% by 2020.
In relation to the figures in table one, Miss Claire Jackson confirmed that she would investigate the anomaly in the 2015/16 figures and report back to Mr Paul Hinnigan.
Previously the IAPT figures had not been reported through the Governing Body, but these are now tracked through the CSU. Mr Roger Parr asked for some assurance on the pilots and it was agreed that an evaluation would be presented at the November CBG.
Action 10/17/07 Dr Geraint Jones asked why there was such as difference in cost between CCGs and their suppliers. In agreeing to the recommendations, this would form a Lancashire wide alliance model through the STP from 2019.
RESOLVED: The CBG members supported the paper.
ACTION: An evaluation on the pilots to be presented at the November CBG
10/17/08 Pennine Lancashire Transformation Programme – initial feedback
Miss Clare Jackson presented a slide set on the Pennine Lancashire Health, Care and Wellbeing Transformation programme. This involved setting the scene and detail on how proposals are being developed. The topics discussed were:
• Case for change • Our principles and commitments - For all of us to live a long and healthy life. Any extra help and support we need will be easy to find, high quality and shaped around our individual needs • Outcomes • Priorities • Place based prevention • New model of care • Living happy • Joined up care and support Page 4 of 6
• The future
Following the discussion it was requested that Dominic Harrison attend the next CBG to do a presentation on the Place Based Prevention Framework.
Comments from the table included:
• “The word happiness does not appear enough” • “Equity before equality” It was felt that the word equality should be removed from the heading, as this could give the view that we do not value equality.
The draft copy of the slides will be distributed to the members and any feedback should be forwarded to Mr Roger Parr.
Dr Penny Morris left the meeting.
This is a significant change that has to be implemented as part of the 5 year forward view and regular updates will be taken through CBG.
ACTION: A draft copy of the slides to be distributed to the members and feedback forwarded to Mr Roger Parr
ACTION: Dominic Harrison to attend the next CBG to do a presentation on the Place Based Prevention Framework Standing Item 10/17/09 Right Care Update/Quality, Innovation, Productivity and Prevention (QIPP)
Mr Neil Holt presented the current position on Right Care/QIPP.
The 2018/19 QIPP position was discussed, with a number of schemes already identified to contribute towards the delivery of a circa £5million target. Further work needs to be done to identify additional opportunities to close the gap.
Going forward there will be additional pressure on prescribing, which has been identified as a national problem and NHS England are currently gathering information, although at present the CCG are not aware of what the outcome may be.
RESOLVED: That the CBG noted the content of the update.
For Information 10/17/10 Investments Schedule
The investment schedule was presented for information.
RESOLVED: That the CBG noted the content of the schedule. 10/17/13 East Lancashire Medicines Management Board Minutes
The minutes of the EL Health Economy Medicines Management Board on 19th July 2017 were presented for information.
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RESOLVED: That the CBG noted the content of the minutes.
10/17/14 Any Other Business
Dr Penny Morris raised mandatory training as a corporate risk. A number of CBG members have not completed their IG training, specifically their Safeguarding for adults and children.
It was confirmed that if a GP had completed the training at their surgery, if they submitted the paperwork to the CCG this would be acceptable. It was suggested that future mandatory training could be completed during a GB Development Session.
The training needs to be completed by 13th October 2017.
ACTION: All outstanding safeguarding training must be completed by Friday 13th October 2017.
ACTION: Miss Claire Jackson is to provide an overview of statutory safeguarding requirements for governing bodies. 10/17/15 Date and Time of Next Meeting
The next meeting was scheduled for Wednesday 15th November 2017 at 1 pm Info in Room G10 and G11, Innovation Centre.
The Chair thanked everyone for their attendance and the meeting closed.
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BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP (CCG)
Minutes of the Commissioning Business Group (CBG) Meeting held on Wednesday 15th November 2017 1.00 p.m. – 3.30 p.m. in Room G10, Innovation House, Evolution Park, Haslingden Road, Blackburn BB1 2FD
Present Dr John Randall General Practitioner (GP) Executive Member (Chair) Dr Zaki Patel GP Executive Member Dr Malcolm Ridgway Clinical Director for Quality and Primary Care Dr Geraint Jones Secondary Care Doctor (Retired) Dr Adam Black GP Executive Member Dr Preeti Shukla GP Executive Member Mr Paul Hinnigan Lay Member (Governance) Miss Claire Jackson Director of Commissioning Operations Mrs Janet Thomas Executive Nurse, Associate Director Quality and Commissioning Mr Roger Parr Deputy Chief Executive/Chief Finance Officer In Mr Kenneth Barnsley Public Health Representative Attendance Mr Neil Holt Head of Commissioning Performance Ms Jacquie Allan Executive Support (Minutes) Apologies Dr Penny Morris GP Executive Member
Item Action 11/17/01 Apologies for Absence
Apologies were received from Dr Penny Morris
11/17/02 Declarations of Interest and Confirmation of Quoracy
The meeting was confirmed as quorate.
The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of Blackburn with Darwen (BwD) Clinical Commissioning Group (CCG). Info
He also informed members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.
11/17/03 Minutes of the Previous Meeting – 11th October 2017
It was noted that on page 3 in the fourth paragraph agenda item 10/17/06, that more emphasis needed to be added regarding the timing of papers being taken through CBG. With the action to change this completed, the Minutes of the last Meeting were reviewed and agreed as a true record.
RESOLVED: That the Minutes of the Meeting held on 11th October 2017 were agreed as an accurate record.
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Item Action 11/17/04 Matters Arising - Action Matrix
The action matrix was reviewed:
04/17/13 – Sexual Health update is scheduled for April 2018 07/17/05 – Acute Visiting Service review is scheduled for January 2018 09/17/06 - Out of Hours, GP Advice and Clinical Navigation Hub Service Specification is scheduled for December 2017 09/17/09 – Joint Committee – Ms Claire Jackson is to meet with Mrs Jackie Hanson and provide verbal feedback at December 09/17/10 – Urgent Treatment Centre Review is scheduled for December 2017 10/17/07 - Improving Access to Psychological Therapies Long Term Conditions is scheduled for December 2017
11/17/05 Declaration of Any Other Business • CBG change of date proposal • Executive GP Representation on the Pennine Lancashire Care Professionals Board
For Decision 11/17/06 Enhanced Quality and Outcomes Enhanced Services Transformation Scheme Briefing Paper
Dr Adam Black presented the paper highlighting that there has been an average annual growth of GP outpatient referrals to secondary care in Blackburn with Darwen of 3%.
In September 2017 the Quality Improvement Scheme was implemented in order to support the increase quality of referrals. In Blackburn with Darwen there were already a number of initiatives developed to support demand management including pathways to alternative community services and a policy in place to support the compliance with Procedures of Limited Clinical Value (PLCV). These complimentary approaches are supporting the reduction of referrals and improving the patient choice and demand management approaches advocated by NHS England.
The paper highlights the reduction in PLCV referrals over the past 12 months which has achieved CCG efficiencies. The paper provided an overview of the recent Quality Improvement Scheme and related plans to manage and monitor any impact of the scheme from both a referral and first outpatient appointment trend perspective.
There will be a focus at the forthcoming Protected Learning Event on reviewing referrals to ENT and Gynaecology where there is high first patient attendance and high cost. The Scheduled Care Team have developed a supportive GP tool kit containing information relating to: • Shared decision making • Procedures of Limited Clinical Value • Alternative community services and pathways • Advice and guidance
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Blackburn with Darwen CCG is evidencing a downward trend and associated cost reductions over the past 12 months and will continue to work to reduce this further. We are able to currently provide a positive position with regards to secondary care referrals, first out-patient attendances, and compliance with Procedures of Limited Clinical Value and associated cost reductions following the implementation of various schemes.
The CBG members agreed that a better understanding of outlier services was required and it was agreed that shared decisions with patients was a good way to close a consultation.
The figures and graphs quoted in the paper were discussed in detail and Mr Roger Parr was asked to confirm the (blank) lines in the graph pictured on page seven, point 3.3.
Dr Adam Black asked the CBG Members to support the paper.
RESOLVED: The CBG Members supported the paper
ACTION: Mr Roger Parr was asked to confirm the (blank) lines in the graph pictured on page seven, point 3.3.
ACTION: A planning update and evaluation to be presented at CBG in March 2018
11/17/07 VCSE Health and Wellbeing Grant Fund bid
Mr Kenneth Barnsley presented a PowerPoint, together with a paper providing CBG members with information regarding a proposal to bid for up to £300K grant funding from the Voluntary, Community and Social Enterprise (VCSE) Health and Wellbeing Fund from the Department of Health. The grant will support Social Prescribing in the New Model of Care development. This is a joint bid for Pennine Lancashire and will require match funding from the CCGs commencing in April 2019
The proposal outlined the definition of social prescribing as “Enabling healthcare professionals to refer patients to a link worker, to co-design a nonclinical social prescription to improve their health and wellbeing”.
Social prescribing is most suitable for people who are lonely or isolated, have long term health conditions and need support to self-manage, have mild mental health issues or have wider social issues.
It was recognised that the proposal would provide additional capacity to support development of the community connector roles, clinicians and social support. The financial risk for subsequent years will be shared between BwD and ELCCG.
The paper had been discussed at CMET in November, and had received a positive response. (The main issue was that the practising GPs have been supporting social prescribing and the question was asked; of why do we now need additional money?)
Page 3 of 6
Miss Claire Jackson suggested that the development would need to align to the Voluntary Sector contracts already funded through the Better Care Fund. The social prescribing development could support a review of existing capacity and activity to inform future commissioning of these schemes from April 2019.
A report had been previously circulated to the Healthier Lancashire and South Cumbria Finance Investment Group (FIG) regarding this proposal. The bid had the support of Partnership Leaders’ Forum and Care Professionals Board and the Finance and Investment Group is was asked to support the bid, which they did. BPR CVS is putting the bid together on behalf of Pennine Lancashire and is due for submission by 21 November 2017.
It was commented that bid would bring the benefit of additional income into the economy and support the direction of travel, but clarity is needed with regard to the matched funding requirement from year two onwards.
The action required from the FIG was to approach each organisation is to consider targeting existing resources to support this rather than new investment.
CBG members were supportive of the bid, and agreed to approve in principle, but they required clarity of the non-recurrent commitment and the position in year 2 if the BwD CCG did not want to continue.
RESOLVED: CBG supported and approved the bid with the caveats noted.
For Discussion 11/17/08 Placed Based Prevention Framework
Kenneth Barnsley presented a PowerPoint outlining the Pennine Lancashire Place Based Prevention Framework 2017-2020, including the 5 principles and 10 actions identified in Creating Healthy Communities, for information.
The vision being “For everyone to have a healthy life that is lived for as long as possible in their own home and community; free from disease and free from dependence on health and social care services”.
The presentation has been received at many different forums, including the Care Professional Board and System Leaders Board and has been approved, and is now part of the Pennine Lancashire LDP plan.
A number of questions were raised regarding how developments outlined within the framework would be funded which would be an ongoing challenge. It was recognised that there were a number of low cost/no cost developments which could be progressed and needed to be prioritised.
RESOLVED: CBG supported the Framework
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Standing Item 11/17/09 Right Care Update/Quality, Innovation, Productivity and Prevention (QIPP)
Mr Neil Holt presented the current position on Right Care/QIPP.
The 2017/18 QIPP position was discussed, with £7m banked against a target of £8.6m. Further work is ongoing to identify additional opportunities to close the gap. An initial plan for 2018/19 has been developed and shared with Governing Body finance sub group members.
The contractual position is on plan and currently mirroring Lancashire Teaching Hospital and Blackpool Teach Hospitals.
We are waiting for the September Data, and Quarter two position to look at the patterns and trends with the additional pressure on prescribing to do a comparative analysis.
A North of England Event is taking place on 30th November 2017 which should provide further learning from other areas regarding successful QIPP delivery.
RESOLVED: That the CBG noted the content of the update.
11/17/10 Investments Schedule
The investment schedule was presented for information.
RESOLVED: That the CBG noted the content of the schedule. 11/17/11 East Lancashire Medicines Management Board Minutes
The minutes of the East Lancashire Health Economy Medicines Management Board were presented for information.
RESOLVED: That the CBG noted the content of the minutes. 11/17/12 Any Other Business
CBG change of date proposal CBG were asked to consider meeting on the third Wednesday of the month, rather than the second. This would enable the utilisation of shared learning from CMET prior to GB meetings.
ACTION: The CBG members were in agreement. Ms Jacquie Allan to confirm dates for 2018 onwards.
Executive GP Representation on the Pennine Lancashire Care Professionals Board BwD CCG had received a request from Dr Phil Huxley, Chair of the Pennine Lancashire Care Professionals Board, for a clinical representative from BwD to attend the Board meetings. The CBG members discussed the options and it was agreed that Dr Zaki Patel would attend this meeting.
ACTION: Ms Jacquie Allan to confirm that Dr Zaki Patel will attend the meetings, and circulate all future dates.
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For Info 11/17/13 Date and Time of Next Meeting
The next meeting was scheduled for Wednesday 13th December 2017 at 1 pm Info in Room G10, Innovation Centre.
The Chair thanked everyone for their attendance and the meeting closed.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
PENNINE LANCASHIRE QUALITY COMMITTEE Minutes of the meeting held on 27 September 2017
PRESENT: Michelle Pilling Lay Advisor: Quality and Patient Engagement, ELCCG – Chair Jackie Hanson Director of Quality and Chief Nurse, ELCCG Dr Nigel Horsfield Lay Member, BwDCCG Geraint Jones Secondary Care Doctor (retired), BwDCCG Kathryn Lord Associate Director of Quality and Nursing, ELCCG Claire Moir Governance, Assurance and Delivery Manager, BwDCCG Dr M Ridgway Director of Quality and Performance, BwDCCG Lisa Rogan Associate Director of Research, Medicines and Clinical Effectiveness, ELCCG Debbie Ross Head of Safeguarding, Pennine Lancashire CCGs Dr Zeenat Sykes GP Representative, Rossendale Locality, ELCCG Dr Paul Taylor Secondary Care Consultant, Non-Executive Director, ELCCG Janet Thomas Executive Nurse and Associate Director of Quality & Commissioning, BwDCCG Collette Walsh Head of Commissioning, Integrated and Community Service, ELCCG
In Attendance: Deryn Ashby Executive Assistant, ELCCG – minutes Victoria Ainscough Specialist Safeguarding Practitioner (Children), Pennine Lancashire CCGs Simon Bradley Quality and Performance Manager, M&LCSU Kim Ciraolo Quality and Performance Manager, M&LCSU Michael Connell Quality and Performance Specialist, M&LCSU Gifford Kerr Consultant in Public Health, BwD Borough Council Caroline Marshall Locality Lead, Quality and Performance, M&LCSU
Attended for Specific Items: Julie Cross Specialist Safeguarding Practitioner, Lancashire Youth Offending Team Vanessa Morris Infection Prevention & Control Lead Nurse, Pennine Lancashire CCGs Kelly Taylor Commissioning Lead – Maternity, Children and Families, Pennine Lancashire CCGs
REF: ACTION 17.211 Welcome & Chair’s Update
The Chair opened theRATIFIED Pennine Lancashire Quality Committee and welcomed all attendees.
17.212 Apologies
Apologies were received from: Kerry Galloway, Dr Stephen Gunn,
C Walsh has attended to represent S Martin.
17.213 Declarations of Interest
There were no Declarations of Interest declared.
The meeting was not quorate so the recommendations from the meeting will be circulated for virtual approval by members.
Page 1 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.214 Minutes of the Meeting Held On 23 August 2017
Some amendments were offered for the meeting held on 23 August 2017.
Title Page The meeting was held on 23 August 2017, not 28 August 2017.
17.191: Pennine Lancashire Risk Management Update In the last paragraph it was confirmed that this should read as C Moir, not C Marshall.
17.194: Pennine Lancashire Quality and Performance Report – Month 03 Under “Out of Area Treatments” it should read that this was the position in June 2017, not April 2017. Under “Attention Deficit Hyperactivity Disorder” the last sentence “S Clarke was concerned about the vacancy rate, noting that this would have a negative impact on the service delivery” was not relevant to the subject and can be removed.
With the above amendments, the minutes were formally ratified.
17.215 Action Matrix
17.129: CQC Review of Health Services for Children Looked After and Safeguarding in Lancashire: Action Plan Update D Ross clarified that the action was more in relation to the Looked after Children Initial Health Assessments issue. It was confirmed that the situation has progressed and there is a more streamlined process with requests from the Local Authority going directly to ELHT. There had been some requests from BwD LA that were not sent to ELHT, but it was found this was following a reduction in back office function, which has now been resolved. An action plan is in place for these cases and this will be scrutinised as part of the Ofsted inspection for BwD Local Authority. A dashboard has been received from ELHT to manage the backlog of assessments, but this shall remain on the risk register for both organisations until there is consistent reporting received from ELHT. This action can be closed. RATIFIED 17.145.1: Presentation: Complaints Service D Ross confirmed that she has attempted to make contact with D Brewin, and that she is awaiting a response. K Lord agreed to discuss at the Complaints Teleconference on Thursday 28 September 2017 to try and establish a dialogue.
17.168: Provider Quality Accounts There have been no NHS deaths in 2 years, although there have been private oncology patients that have passed away. BMI are linking with ELHT for joint working around this area. This action can be closed.
17.172: Cancer Update: GP Making a Cancer Referral 14-Day Rule Further guidance is awaited. This is being monitored through the Cancer Tactical Group. This action can be closed, and an update will be brought when available.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.173.2: Home of Choice Policy S Bradley confirmed that the information is now included as part of the Pennine Lancashire Quality Report. The Chair asked whether data could be included about the number of patients discharged to care homes. S Bradley agreed to see if this was possible.
17.191.1: Pennine Lancashire Risk Management Update It was confirmed that both organisations are working closely on joint risks. This action can be closed.
17.191.2: Pennine Lancashire Risk Management Update This action has been completed.
17.193: CONFIDENTIAL: Domestic Homicide Review: Final Report and Action Plan This report has been presented at the BwD Safeguarding Adults Board who will monitor the action plan and feedback to NHS England accordingly. This action can be closed.
17.199.1: Pennine Lancashire Safeguarding Dashboard The discussion has been held. This action can be closed.
17.199.2: Pennine Lancashire Safeguarding Dashboard The IG self-assessment has since been received from the CSU and is currently being reviewed. This action can be closed and an update brought to committee, if needed.
17.216 Matters Arising
The Chair advised that she had recently attended an AQUA event on Hospital Standardised Mortality Ratios (HSMR). She agreed to circulate the slides after the meeting, as they were informative and noted that the event was very beneficial in understanding a complex area of reporting.
Pennine Lancashire Research and Clinical Effectiveness Committee ToR RATIFIED L Rogan reminded members that she had taken an action from this committee to develop a Pennine Lancashire Research and Clinical Effectiveness Committee, to serve as a sub-group of the Pennine Lancashire Quality Committee. The Terms of Reference have been developed and circulated to the Local Authority and Senior Clinicians across Pennine Lancashire and should be available for discussion at the November Quality Committee. The first meeting of the Research and Clinical Effectiveness Committee is scheduled for October 2017 where the Research Innovation and Clinical Effectiveness Strategy will be discussed.
G Kerrr queried the membership noting that it was not clear which roles were across both CCGs. Dr N Horsfield requested to see a list of organisations involved and asked if both sides of Pennine Lancashire are signed up to this committee. L Rogan confirmed this to be the case, and also advised that the intention was to have a joint venture with the best representation at the meeting. The Chair advised that it would provide more clarity by capturing the roles across Pennine Lancashire.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
ACTION: L Rogan to update the Terms of Reference to reflect the member organisations
Dr G Jones queried how this new committee would relate to the Local Research Ethics Committee. L Rogan advised that this new committee would not be replacing the LREC, but would aim to obtain oversight across the health economy for the research that is taking place. The Research and Effectiveness Strategy will also provide oversight into the different groups and functions
The Chair observed that Blackburn with Darwen Public Health are working closely with Lancaster University, and asked how this committee would link with this. L Rogan clarified that Lancaster University is part of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC), which is one of the organisations associated with this new committee. J Hanson advised that both CCGs had been aware of elements of research, but had not been systematically accessing this information. The new committee was to try and obtain a system-wide approach and ensure that both organisations are sighted on new innovation and research.
Dr G Jones queried whether the Chairman of LREC had been contacted, and Dr N Horsfield cautioned duplication with parallel meetings. J Hanson clarified that this new committee was not an ethics committee, but would provide an interface to the LREC. Dr P Taylor observed that this new committee would need clear focus to ensure it is effective, particularly when it involves so many different parties.
ACTION: L Rogan to make contact with the LREC chair regarding the establishment of this new committee
There was discussion about utilising information and functions available, most notably to ensure a robust exit strategy on commissioned services, and some of the necessary evaluations can be undertaken through these other partner organisations. C Walsh noted that this committee would provide live information at a time when the pace of change is fast. The CCGs would need to be involved in research at the early stages to improve understanding for commissioning services.
17.217 Presentation: Youth OffendingRATIFIED Team
D Ross introduced J Cross from the Lancashire Youth Offending Team (LYOT)to offer insight into the how the safeguarding resource is used in the community, and how this contributes to the CCG objective of reducing hospital admissions. Over the last 2 or 3 years the mental health support within East Lancashire through LYOT has been acknowledged with the model being shared across Lancashire.
The service supports 10-18 year-olds and covers 1-2% of the teenage population. Young people can have complex issues, particularly those living in deprived areas who are more likely to find themselves in custody. The focus of the LYOT is to try and prevent these young people from going into custody.
J Cross noted that offending behaviour in youths can stem from a number of issues, such as drug or alcohol issues, mental health or domestic abuse. These can result in poor emotional development and social outcomes. Young people are more likely to commit offences when they do not have good emotional regulation; they experience high levels of violence and distress and often exhibit low self-esteem. Page 4 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
J Thomas entered the meeting
These young people can be socially isolated and often have undiagnosed learning or communication difficulties. Committing crime is often the only thing they can do to feel in control.
Dr M Ridgway entered the meeting
The main issues experienced are unresolved emotional distress. The young people do not recognise risk-taking behaviour and cannot hypothesise situations; 60% use cannabis on a regular basis; 60-70% smoke; they often have complex conditions, such as ADHD, asthma and common limb problems through failure to take medical advice. Social Services do not remove them from their homes as they are teenagers and felt to be able to take care of selves. With experience and adult mentorship they can improve their emotional responses.
Young people do not visit health services on their own unless something is really wrong. Youths seen by the YOT are asked about their health as they are reluctant to volunteer information. Standard healthcare services are not accessible to young people for a number of reasons, and there can be cultural issues to overcome such as men not wanting to talk about their health needs. There are advantages to addressing health within youth offending, which can empower young people and make a difference in the long term. J Cross provided examples of how the team have intervened and helped young people.
The Chair queried how many young people are currently being supported; J Cross advised that the team supports approximately 110 young people in East Lancashire at present. These young people are referred in via the court or police. Dr G Jones queried whether there was an option for a pre-YOT service to identify young people at risk of offending and try to help them from preventing offending behaviour from developing. J Cross explained that the police work with young people and their families when they are first identified as being at risk of offending, particularly the siblings of offenders. She added that Safeguarding, the School Nursing Team work to try and embed this work within school nursing services to identify vulnerable people at risk of offending. There are concerns that the supportRATIFIED is removed when the young people reach 18-years, and there are considerations to extend CAMHS, including YOT, to 21-years but this has not progressed to date. Collaborative work is undertaken with probation services for those approaching 18-years.
Dr P Taylor acknowledged the hard work that YOT do with offenders, noting that these youths often come from chaotic households, and queried how much time is spent working with the individual and how much is spent with the family. J Cross advised that there is a multi-agency partnership in place, including Social Workers within the team as well as liaison with the police, probation and Children’s Social Care. The YOT worker and Social Worker will go out to the home to work with parents, as many will not come to health assessments or into school to meet with teachers.
D Ross informed members that J Cross has been in post 8-years, and the model has been exemplified as good practice to the extent that J Cross has been seconded by the Youth Justice Board, which is recognition of her hard work. J Cross added that she had developed 2-page health assessment tool to use when having a conversation and engaging with the young person. The Health Intervention Plan is then developed and Page 5 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
agreed with the young person, and shared with the GP, School Nurse and Social Worker. This tool has been published on the Youth Justice website.
The Chair acknowledged the good work, noting that this complex group of young people can often slip through the net. She asked what is being commissioned around low to medium support for young people, as there are many reports from GPs and schools about young people with difficulties that are struggling to access help. She added that more focus needs to be on prevention to avoid these issues developing. K Taylor advised that there is progress in this area, particularly around the wellbeing agenda. A workshop is scheduled for Pennine Lancashire to focus on emotional health and wellbeing, and map this against the THRIVE model; this would then be shared with schools and GPs. She agreed to provide a comprehensive summary on this to a future committee
ACTION: A summary around Emotional Wellbeing for Children and Young People to be presented to a future committee
Dr Z Sykes raised a concern that many referrals are returned from the East Lancashire Child and Adolescent Services for reasons such as low-level mental health problems, therefore not suitable for the service. In addition there is a long wait for community paediatricians so families are turning to third sector agencies. She stated that angry young people need support early on to prevent problems developing further. K Taylor advised that she is leading a workstream on care for vulnerable young people is commissioning a behavioural support service to support people with challenging behaviours before a formal diagnosis is in place. This should help prevent escalation of behaviours during this time.
C Walsh queried whether the work on the health of offenders is being reflected in the youth offending rates. J Cross confirmed this is the case, advising that a dashboard has been developed to show this. She added that there are other social impacts not related to health that also need to be addressed to further improve outcomes.
The Chair thanked J Cross for her presentation and the work she has been undertaken.
J Cross exited the meeting. RATIFIED
17.218 Presentation: Tier 4 CAMHS Update
K Taylor attended to provide an update on the Tier 4 CAMHS Service, which has been a concern for some time and is a shared risk on the Risk Registers. This is a service commissioned by NHS England providing care for children and young people with severe or complex mental health disorders that cannot be met by Tier 3 services. As part of the National Mental Health Service Review programme, NHS England are looking at a re-distribution of Tier 4 beds across country. This is being nationally co- ordinated, but regionally planned and driven.
There is a national focus on Tier 4 services following a report by Panorama that highlighted people were travelling across the country to visit patients admitted to Tier 4 beds. In 2014 NHS England committed to opening 50 new beds, which was increased in March 2017 to 150–180 new beds across the country to reduce travel distances. NHS England have published a Tier 4 Service Specification, which CCGs have contributed to, as part of this national review. This is a nationally phased programme, which will Page 6 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group start with introducing additional beds in the South of the country before reducing the number of beds in the North. The aim is to prevent young people from the South blocking beds because they are placed out of area, and to provide sufficient beds in each location. K Lord noted that young people are being left to sit in hospital wards, which are not equipped to manage their needs. It was noted that NHS England have not stated how many out of area placements are currently utilising the Tier 4 beds in East Lancashire. K Taylor explained that NHS England are considering a whole-system change to prevent young people escalating to that level. The Chair was concerned about the proposal to reduce beds in the north where there are high levels of deprivation. D Ross added that there have been a number of unaccompanied asylum seekers accessing beds but are not necessarily under NHS England’s responsibility.
There have been a number of cases where young people needed Tier 4 beds and had to wait, often in excess of 31 days. The local CAMHS services are in dispute with NHS England, asking that they pay for Tier 4 services that had to be delivered in Tier 3 due to lack of available beds. C Marshall stated that there are unintended consequences to this situation, such as closing a whole bay to manage an individual which put additional pressures on the Trust. The overall situation is now better, although there was 1 case that waited 50 days for a specialist bed.
K Taylor informed members that LCFT have combined 2 separate units so that there is now a single 18-bedded unit at The Cove, Heysham. The national procurement has started for beds across country, and provided an opportunity for collaborative commissioning with NHS England. The team are recommending that this remains on the risk register for both organisations, but that the score is matched across Pennine Lancashire.
The Chair clarified that the reduction in Tier 4 beds in the North of England would not happen until the bed number has been increased in the South of England. She asked what assurances there are from NHS England that there will be no beds lost until all additional beds in the south have been opened. K Taylor advised that this is the plan that NHS England have provided. Dr G Kerr queried the number of beds available per head of population once the target number of beds has been achieved.
J Hanson was concerned that there is no clarity on the comparative position from NHS England. Concerns wereRATIFIED being escalated, and things are starting to change. She noted that the rating of the risk can be considered and reduced, but the team need to ensure they continue to monitor the situation.
ACTION: K Taylor to feedback the concerns to NHS England and seek assurance that the reduction of Tier 4 beds in the North will not take place until additional beds in the South have been introduced, and to clarify the number of beds currently available per head of population and the projected number.
There was discussion about how the reduction in resources to prevent deterioration of mental health had let to more cases of crisis appearing in secondary service, usually without being known to any service and escalating to crisis and presenting at A&E. The Chair asked if there was any support that could be offered from Public Health to target prevention initiatives.
ACTION: Dr G Kerr and K Taylor to meet and discuss prevention strategies outside of the meeting Page 7 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
J Thomas queried the support in place for families and carers that travel to The Cove to visit patients. K Taylor agreed to confirm the arrangements.
ACTION: K Taylor to ascertain the support available to families and carers travelling to The Cove
The Chair thanked K Taylor for her presentation, noting that progress was being made.
K Taylor exited the meeting.
17.219 Presentation: Rossendale NWAS Scheme
Dr Z Sykes presented a summary of the Rossendale NWAS Scheme. She explained that this had originally been piloted in Pendle but did not work as planned, so Rossendale were asked to trial it. The pilot involved utilising a Community Paramedic as a first responder.
There has been an increase in ambulance calls since 1997, with concerns about the NWAS response times for Rossendale, Pendle and Ribblesdale. Rossendale has 2 full- time and 1 part-time ambulances assigned to them serving a population of 69 thousand, although they are not always in that area. This pilot is funded by NWAS and is aiming to work with patients and the community to provide safe care closer to home, drive improvement, reduce 999 calls and reduce unplanned admissions.
The community responder spends 50% of his time working on projects within the community, working with frequent 999 callers and their GP practices to identify any underlying issues. The patients are also linked with the INT service for full support. The responder is also working with nursing homes to implement a triage tool, encourage flu vaccines, and provide training for day and night staff. J Hanson noted that this work is being rolled out through the Vanguard work as well. Dr Z Sykes advised that there is Year 6 CPR training in schools, as well as providing health training and promotions in mosques to encourage members of the BME population. The responder is also visiting high-risk people identified through the Transforming Lives panel to support and enable better self-management.RATIFIED There have been a number of public awareness campaigns, including a BME Women’s Group, and ‘Make the Right Call’ public awareness of local health provision. He has developed relationships with primary care and is conducting joint home visits with GPs for vulnerable patients to try and identify those that need ambulances earlier in the day so that they can be seen and treated. NWAS has indicated an intention to have 12 community paramedics across the North West, and will continue to fund the service in Rossendale.
The public have funded the purchase of a defibrillator at Edenfield, and the responder will work with them to decide where to place this and how to use it.
Dr M Ridgway observed that there needs to be a systemic answer to the issues, rather than ‘patching’ problems as they arise. The Chair noted that this pilot had been developed specifically to deal with the issue of response times in an area where performance is low. It has worked well in Rossendale, although it didn’t progress in Pendle. Dr G Kerr observed that there was a presentation from Fleetwood at a transformation programme meeting that had shown this kind of service had transformed the practice; Dr Z Sykes explained that this funding was from NHS England and that this Page 8 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
role had not completed any acute work, so was a slightly different pilot. Dr G Kerr queried whether the responder rotates through the NWAS system to prevent them from becoming isolated. He noted that there are many demands on a limited resource of paramedics.
The Chair thanked Dr Z Sykes for her presentation, noting how positive the impact had been.
17.220 CONFIDENTIAL DISCUSSIONS – Provider Updates
S Clarke and C Marshall presented this item; the paper was tabled for reference. The content of this item is for committee members and attendees only, and is not for wider distribution.
The confidential minutes of this part of the meeting will be circulated under separate cover.
Members received and acknowledged this report.
17.221 Pennine Lancashire Quality and Performance Report – Month 04
S Bradley and M Connell attended to present the key points from the Pennine Lancashire Quality and Performance Report for Month 04. Full details are available within the report.
Mixed-Gender Accommodation There was 1 mixed-gender accommodation breach for ELCCG in July 2017 at Pennine Acute Hospitals Trust. Members were notified that there have been a further 2 breaches in August 2017. A contract query has been raised with Bury CCG.
C-Diff There were 5 cases of C-Diff identified for BwDCCG, and 3 cases identified for ELCCG. Both organisations are above trajectory with numbers rising across all organisations with no themes and trendsRATIFIED identified as yet. All pre- and post-48-hours cases are reviewed.
E-Coli In July 2017 there were 36 E-Coli cases identified within the population of East Lancashire, and 7 cases in Blackburn with Darwen. A concern has been raised by LMC regarding the collation of E-Coli data by GPs. This has been shared with LCC to provide a response, as it is a nationally mandated process. V Morris advised that an action plan cannot be developed until the data collection is complete. In the interim, there continues to be promotion of best practice. Public Health have identified that the most vulnerable to E-Coli are older people that live alone, without social or family support. The Chair suggested linking with Housing Associations to support multi-agency working.
MRSA In July 2017 there was 1 case of MRSA identified for BwDCCG, although it was reported that there were issues with the patient’s compliance to treatment that contributed to the case. Page 9 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
Quality Premium ELCCG are currently meeting 2 out of the 3 NHS Constitution measures, and BwDCCG is meeting 1 out of 3. The constitution Measure for ambulance response times is subject to change, although further guidance is awaited from NHS England.
52 week There were 9 patients reported with a wait over 52-weeks in July 2017 for ELCCG. 8 patients were identified as under Care UK for Ophthalmology, but this is felt to be a data error; C are UK have been asked to comment, as no long waiters have appeared on previous reports. The remaining patient is a complex case at ELHT; this patient was admitted for treatment on 07 August 2017.
ELHT
A&E There was underperformance against the 4-hour A&E target in July 2017 for both CCGs. The Trust must achieve the 90% target by the end of September 2017, and 95% by end of March 2018.
The Chair acknowledged the inclusion of discharge rates within the report and queried whether it was possible to identify the number of patients in care homes that are re- admitted within 30-days of discharge.
ACTION: S Bradley to try to obtain data on re-admission rates within 30-days for discharges to care homes
RTT Incomplete There was underperformance against the RTT incomplete standard in July 2017 for BwDCCG. Performance at Lancashire Teaching Hospitals is having the most significant impact on the position for both CCGs, and CSRCCG have been asked for an update on progress. It was noted that more recent data is showing that ELHT are also starting to struggle with the 18-week target for Maxillo-facial, which is commissioned through Specialised Commissioning. RATIFIED Cancer: 2-week referral This target was not met for BwDCCG in July 2017. It was noted that the main reason was found to be patients choosing to initiate a delay for reasons such as holidays. This is being reviewed by the Cancer Tactical Group to identify any themes or trends. Dr M Ridgway was concerned about the target, observing that the IT system was not yet working to support the pathway.
Ambulance Calls There has been underperformance for both CCGs against all 3 ambulance targets
Mandatory Training The Chair queried ELHT’s Information Governance Training, as it is showing red on the dashboard S Bradley advised that the target is 95% completion by March 2018, but this was raised at the last Quality Contract Meeting. ELHT will be identifying those staff that have not yet completed training and encouraging compliance.
Page 10 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
LCFT Out of Area Treatments There was an average of 24 Out of Area Treatments in April 2017 against a target of 0 and a tolerance threshold of 9-13. There has been an increase in PICU placement, and there is a review on patients with treatment-resistant disorders to try and treat them in the community and not refer to beds in the future.
IAPT Recovery The 50% Recovery Target was met for both CCGs in July 2017.
IAPT Prevalence Members were advised that BwDCCG did not achieve this target in July 2017, although it was explained that this was due to the decision of BwD Borough Council to withdraw funding in 2016/17.
CQC LCFT has received a data request from LCFT. It is anticipated that they will receive an unannounced visit in 6-8 weeks, where the focus will be on the well-led element of the inspection.
Airedale NHS Trust The CQC report for Airedale has been released, and shows that the Trust requires improvement in 2 areas: Safe and Well-led. The other domains were not inspected this time. During the inspection 5 breaches were found; 3 were identical to breaches identified in the 2016 inspection. Although there is recognition of progress since the last inspection, there are 17 ‘must do’ items, although this is less than the previous inspection. There are also 26 ‘should do’ items, which is also less than the previous inspection. The action plan is under development and will be shared when available.
ACTION: J Hanson to confirm with AWCCG colleagues the QI process and membership
Members acknowledged the report RATIFIED Dr G Kerr exited the meeting
17.222 Pennine Lancashire Serious Incident Review Group Recommendations
L Wilkinson presented the paper to the committee.
ELCCG In August 2017, 21 reports were reviewed. Of these, 16 were approved for closure, 3 were returned to the provider and 2 required a CCG action.
BwDCCG In August 2017, 11 reports were reviewed. Of these, 1 was approved for closure and 10 were returned to the provider.
During this period, a total of 7 extension requests were submitted by ELHT; 5 were made before the deadline, and 2 were received after the deadline. Page 11 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
There have been 5 extension requests submitted by LCFT; 3 were received before the deadline, and 2 were received after the deadline.
Communication has been received from Chorley. South Ribble and Greater Preston CCGs requesting that no LCFT Mental Health incidents, involving their patients, are closed until the incident has been through their SIRG process. This may affect the timeframe of reviewing reports within 20 days of submission, as the CSR&GPCCG Closure Panel currently takes place monthly. There are plans to change this to fortnightly, which would bring it in line with local process.
Three Rapid Review reports from ELHT, were received after the 72-hour timeframe. This was discussed with ELHT, who advised it was due to operational pressures within the Risk and Safety Team. LCFT submitted 6 Rapid Review reports outside the 72-hour deadline, and 1 report is still awaited; the timely submission on these reviews will be discussed with them.
ELCCG has 56 StEIS incidents open at present and BwDCCG has 46 incidents open at present.
C Marshall cautioned members that future reports will reflect that a number of LCFT action plans have been rejected as they do not contain enough detail. This has been recognised by LCFT, and they have undertaken some focussed work with the Mental Health Network to try and improve the position. The investigation is now undertaken by a central hub team as an internal independent investigation, and the action plan is completed by the Mental Health Network; this does create a slight delay to the report.
The Chair queried the spike in the number of incidents. C Marshall advised that no themes or trends have been identified, but an increase often occurs in Summer months due to annual leave. C Walsh queried whether the commissioning lead is made aware of any incidents. C Marshall confirmed that this should be the case, but agreed to ensure there is better links with the commissioning lead. She noted that commissioners have an open invitation to attend the fortnightly incident panel meeting, should they wish to attend.
ACTION: C MarshallRATIFIED to ensure that increases in the number of incidents, or any themes and trends, are notified to the relevant commissioning lead
J Hanson commented that reviewing 33 RCAs in a month is hard work for the team involved and commended the team for their commitment to review them.
The Committee formerly received the report for information.
Page 12 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.223 Pennine Lancashire Risk Management Update
Across Pennine Lancashire there are 6 risks which are included on the Risk Registers for both CCGs. These are: 95% Accident and Emergency 4-Hour Standard 62-Day Cancer Target
Ambulance Performance
Initial Health Assessments for Looked after Children Performance Against Financial Targets Lack of In-Patient Beds for Children and Young People with Mental Health Issues (Tier 4 beds)
For BwDCCG there is 1 NHS Constitution risk, and 4 Quality / Safety risks. No new risks have been added and no risks recommended for closure since the last report.
There was no update available for the ELCCG Risk Register.
C Moir advised that the issues for the Tier 4 Bed risk were discussed earlier in the agenda, so did not need repeating. The situation continues to be monitored.
There is increased scrutiny on A&E performance and the actions to be undertaken. This has been included as an item on the next committee agenda to enable members to go through the issues and gain assurance. The A&E Delivery Board have accountability for this.
C Moir requested the narrative for the 18-week RTT performance in preparation for the BwDCCG Assurance Meeting with NHS England.
ACTION: S Bradley to send the 18-week RTT narrative to C Moir
J Hanson informed members that there had been discussion at the Governing Body meeting about the risks around nursing home beds. She asked C Moir to liaise with R Catlow and consider including this as a shared risk for Pennine Lancashire.
ACTION: C Moir andRATIFIED R Catlow to liaise and discuss a new PL risk for nursing home beds
Full details of the risks are available within the report and on the Corporate Risk Registers
Members acknowledged the report and the updates to the Risk Register, and approved the recommendations.
17.224 Pennine Lancashire Court of Protection Prioritisation
D Ross presented this report. She summarised that public authorities have statutory duties under the Mental Capacity Act 2005 to protect people who may lack capacity to make decisions for themselves. This includes people who may be under a Deprivation of Liberty order. Since March 2014, following a Supreme Court ruling known as the Cheshire West ruling, there has been a significant increase in the number of people
Page 13 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group who come under the remit of Deprivation of Liberty legislation and applications to the Court of Protection for DoLS have increased dramatically.
Nationally it is recognised that there are significant ongoing resource implications for the Court of Protection. CQC inspectors are focussing on DoLS in community settings, and urging providers to refer people that may be deprived.
The commissioning body, be that LA or CCG, is responsible for making the application to the Court of Protection; there is a financial risk by failing to make an application as damages can attract a claim worth tens of thousands. It is estimated that 3150 people in Lancashire require an annual Court of Protection DoL application, on an annual basis, to meet the Cheshire West Acid Test, although this does not take into account individuals waiting for a social care review not any increase in demand.
In light of competing demands with limited resources, and recognition that not every case will go through the Court of Protection process immediately, the Pennine Lancashire Safeguarding Team are proposing utilisation of a Court of Protection Prioritisation Tool to ensure that the most pressing cases are identified and progressed quickly. In addition the paper proposed that an urgent move, if it is an individual’s best interest, is not delayed until the Court of Protection DoL order is in place. This tool has been agreed and implemented by Lancashire County Council and approved by the Lancashire Safeguarding Adults Board.
Utilisation of this tool will still result in the CCG holding some level of risk around commissioning packages of care that are not compliant with the Mental Health Act 2005. However, it provides a robust risk decision process.
Members were assured that concerns have been raised about the backlog of Court of Protection DoL applications, and that this prioritisation tool formalises the approach, which has already been adopted, into a process to support the prioritisation of applications. This has been reviewed at the IPA board, which is attended by representatives of both CCGs. J Thomas queried whether the tool had been approved at the BwD Safeguarding Adults Board, as it has been debated and agreed at the Lancashire Safeguarding Adults Board already. It was noted that P Chapman is the Pennine Lancashire CCG representative for both board meetings but D Ross agreed to verify that this is the case.RATIFIED
ACTION: D Ross to confirm that the prioritisation tool has been presented to the BwD Safeguarding Adults Board for approval
Dr M Ridgway queried whether the extent of the problem has been escalated to central government. D Ross confirmed that this is a national problem, and J Hanson assured members that this has been escalated in regional and national forums.
The members present supported the adoption of the tool, although this needs to be confirmed as the meeting was not quorate.
ACTION: D Ashby to send committee members the recommendation for approval for formal ratification
Members received the report and noted the concerns raised.
Page 14 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.225 Quality Contract Meeting Minutes August 2017: BMI, ELHT, LCFT, MCFT Quality Contract Meeting Minutes July 2017: LCFT
These were distributed prior to today’s meeting for information, including a set of minutes from July 2017 that were omitted from the circulation. No comments were raised.
Members acknowledged the minutes.
17.226 ELCCG Risk Management and Information Governance Minutes: August 2017
These were distributed prior to today’s meeting for information. No comments were raised.
Members acknowledged the minutes.
17.227 ELMS Out of Hours Contract Minutes – August 2017
These were distributed prior to today’s meeting for information. No comments were raised.
Members acknowledged the minutes.
17.228 Cancer Tactical Meeting: August 2017 and summary for July 2017
These were distributed prior to today’s meeting for information. No comments were raised.
Members acknowledged the minutes and summary.
17.229 Lancashire Safeguarding Boards Annual Report 2016/17 RATIFIED These were distributed prior to today’s meeting for information. No comments were raised.
Members acknowledged the minutes.
17.230 Any Other Business
It was confirmed that this is M Connell’s last meeting as he has a new role at the CSU. He was thanked for his time with the committee and the Chair wished him well for the future, on behalf of all members.
Page 15 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.231 Items for the Risk Register
C Moir to liaise with R Catlow to consider including nursing home beds as a shared risk for Pennine Lancashire
17.232 Date & Time of Next Meeting
The next meeting has been scheduled for Wednesday 25 October 2017 in Meeting Room 1, Walshaw House.
The deadline for papers is 5pm on Monday 16 October 2017.
The meeting closed at 16:00
RATIFIED
Page 16 of 16 Minutes Approved by the Chair: 09/10/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
PENNINE LANCASHIRE QUALITY COMMITTEE Minutes of the meeting held on 25 October 2017
PRESENT: Michelle Pilling Lay Advisor: Quality and Patient Engagement, ELCCG – Chair Jackie Hanson Director of Quality and Chief Nurse, ELCCG Dr Nigel Horsfield Lay Member, BwDCCG Geraint Jones Secondary Care Doctor (retired), BwDCCG Kathryn Lord Associate Director of Quality and Nursing, ELCCG Claire Moir Governance, Assurance and Delivery Manager, BwDCCG Dr M Ridgway Director of Quality and Performance, BwDCCG Lisa Rogan Associate Director of Research, Medicines and Clinical Effectiveness, ELCCG Debbie Ross Head of Safeguarding, Pennine Lancashire CCGs Dr Ash Misra GP Representative, Burnley Locality, ELCCG Ryan Catlow Compliance and Resilience Manager Dr Stephen Gunn GP Representative, Blackburn with Darwen CCG Judith Johnstone Head of Clinical Commissioning
In Attendance: Jacquie Allan Executive Assistant, BwDCCG – minutes Victoria Ainscough Specialist Safeguarding Practitioner (Children), Pennine Lancashire CCGs Simon Bradley Quality and Performance Manager, MLCSU Kim Ciraolo Quality and Performance Manager, MLCSU Caroline Marshall Locality Lead, Quality and Performance, MLCSU Robert Nicholson-Kershaw Safeguarding Adults and Mental Capacity Act Practitioner
Attended for Specific Items: Vanessa Morris Infection Prevention & Control Lead Nurse, Pennine Lancashire CCGs Alex Walker Programme Director for Urgent Care Catherine Wright Primary Care Quality Lead
REF: ACTION 17.233 Welcome & Chair’s Update
The Chair opened the Pennine Lancashire Quality Committee and welcomed all attendees. RATIFIED
17.234 Apologies
Apologies were received from: Susan Clarke; Dr Asif Garda, Kirsty Hollis, Dr Gifford Kerr, Sharon Martin, Dr Richard Robinson, Dr Paul Taylor, Dr John Randall
Judith Johnston has attended to represent Sharon Martin.
17.235 Declarations of Interest
Dr Malcolm Ridgway declared a conflict in item 17.250, as he has relatives in employment at East Lancashire Medical Services, who operate an out of hours service. The conflict did not make it necessary for him to leave the meeting when the discussion took place.
Page 1 of 11 Minutes Approved by the Chair: 03/11/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.236 Minutes of the Meeting Held On 27 September 2017
No amendments were offered for the meeting held on 27 September 2017.
17.224: Pennine Lancashire Court of Protection Prioritisation The recommendations from the meeting held on 27 September 2017 were circulated for approval to members, as the meeting was not quorate. Approval to ratify the recommendations was received from members, and the recommendations were formally ratified and received by the committee.
The minutes were formally ratified, and the recommendations from the September committee relating to the Pennine Lancashire Court of Protection Prioritisation were formally ratified.
17.237 Action Matrix
17.145.1: Presentation: Complaints Service It was confirmed that there was no policy for children under 18, complaints and the standard policy would apply. This action was closed.
17.168: Provider Quality Accounts There have been no NHS deaths in 2 years, although there have been private oncology patients that have passed away. BMI are linking with ELHT for joint working around this area. This action was closed.
17.173.2: Home of Choice Policy Information was included around admissions/discharges and re-admissions on the Quality and Performance Report. This action was closed.
17.216.1: Matters Arising: PL Research and Clinical Effectiveness Committee ToR The first meeting has been held and the ToR has been updated. This action was closed.
17.216.2: Matters Arising: PL Research and Clinical Effectiveness Committee ToR This is now a single committeeRATIFIED including ELHT, local authorities and PHE. It was noted that the members were knowledgeable about the system. A research strategy is to be conveyed for information at the November 2017 PLQC. This action was closed.
17.217: Presentation: Youth Offending Team This action will need to be reviewed by the new Commissioning Lead for Maternity, Children and Families, in Pennine Lancashire when in post. This action was closed.
17.218.1: Presentation: Tier 4 CAMHS Update The committee members had received a copy of the email which has raised more questions. Royal College guidance had been used by Specom. J Hanson to discuss with Colette Walsh and a full brief to be taken back to the committee in February 2018.
17.218.2: Presentation: Tier 4 CAMHS Update Dr G Kerr and K Taylor were to meet to discuss prevention strategies. K Taylor leaves her position on the 26th October 2017, and this needs to be followed up before then and reported back at the November 2017 PLQC.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.220.1: CONFIDENTIAL DISCUSSIONS – Provider Updates These are reported separately through the ORG and the Crisis Concordat. At a meeting with H Curtis it was confirmed that the same approach for 12 hour breaches is being used with S136 breaches in Pennine and Central Lancs. This action was closed.
17.220.2: CONFIDENTIAL DISCUSSIONS – Provider Updates It was confirmed that there had been a spike in S136 cases over the last three months. There is a team fully sighted on this, with the providers working with us. This action was closed.
17.220.3: CONFIDENTIAL DISCUSSIONS – Provider Updates This action has been completed and closed.
17.221.1: Pennine Lancashire Quality and Performance Report – Month 04 This data has been collected and discussions held. This action was closed.
17.221.2: Pennine Lancashire Quality and Performance Report – Month 04 J Hanson has spoken to the Chief Officer at AWCCG regarding the Q1 process and C Marshall will attend the Airedale Hospital Quality Meeting. This action was closed.
17.222: Pennine Lancashire Serious Incident Review Group Recommendations C Marshall is ensuring that the commissioning leads are advised of any increases in the number of incidents, themes and trends and is liaising with J Arrandale frequently. This action was closed.
17.223.1: Pennine Lancashire Risk Management Update S Bradley sent the 18 week RTT narrative to C Moir. This action was closed.
17.223.2: Pennine Lancashire Risk Management Update C Moir and R Catlow have drafted a new PL risk for nursing home beds, which will be taken to the November 2017 PLQC.
17.224.1: Pennine Lancashire Court of Protection Prioritisation An update will be taken to the November 2017 PLQC.
17.224.2: Pennine LancashireRATIFIED Court of Protection Prioritisation This was formally approved. This action was closed.
17.238 Matters Arising
There were no matters arising.
17.239 A&E Position Update
A Walker attended to present members with the current position in relation to the performance of A&E services across Pennine Lancashire, and to apprise them of the plans in place to improve the service and the overall system.
It was noted that the A&E performance has remained challenging throughout 2017/18, with the system rarely achieving the 95% target for seeing and treating or discharging patients. A recovery plan was requested from NHS England and NHS Improvement in Page 3 of 11 Minutes Approved by the Chair: 03/11/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
July 2017, and ELHT and the CCG have developed a combined system-wide recovery plan that is designed to improve the A&E performance position so that it achieved 90% of the target by the end of September 2017, and the 95% target by March 2018.
The purpose of the report was to outline to members the progress to date to implement the improvement schemes. To date the A&E Delivery Board has had positive feedback from NHS England and NHS Improvement regarding the 4-hour recovery plan and the performance of the system has shown some positive signs of improvement. The system had achieved 89.20%, narrowly missing the 90% performance target.
The recovery plan concentrated on 9 priority areas, with the focus being the flow of patients and elements of discharges. At present we are currently holding our target position instead of increasing, but this could be down to reduce consultant capacity and workforce issues. It was commented that there are further additional schemes in place which will bring us back on plan for March 2018.
The A&E Delivery Board is sighted on all of the plans, with NHSE joining the daily calls. The positive relationships across all agencies were noted.
ELHT with ELCCG monitor the situation on a daily basis and both boards are sighted on the position. Whilst aware that this may be a difficult winter period, and there has been significant winter planning we have to continue to concentrate on putting patient safety first and implementing sustainable plans accelerated for winter.
A query was raised about preparedness for an increase in paediatric attendances. Front end performance has improved around minors.
The committee queried the resilience of the system, recruitment and retention and discussed the health and wellbeing of both patients and system staff. It was felt crucial that all staff were supported and that proactive patient engagement took place, not only through the friends and family scheme.
Members asked about what plans were in place for the first week of January. It was confirmed that a plan was in place that more planning had taken place than in previous years. RATIFIED Members were asked to receive the paper and acknowledge the partnership working that has taken place to support the recovery plan.
The Chair acknowledged the pressures in the system and is mindful of the scrutiny afforded to the A & E position. A Walker was asked to be more explicit regarding staff on the plan on the page, adding further detail to the escalation and system resilience.
Members acknowledged the report and progress.
17.240 CONFIDENTIAL DISCUSSIONS – Provider Updates
K Lord and P Chapman presented this item; the paper was tabled for reference. The content of this item is for committee members and attendees only, and is not for wider distribution.
Page 4 of 11 Minutes Approved by the Chair: 03/11/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
The confidential minutes of this part of the meeting will be circulated under separate cover.
Members received and acknowledged this report.
14.10 Vanessa Morris joined the meeting 14.15 Dr Malcolm Ridgeway joined the meeting
17.241 Pennine Lancashire Quality and Performance Report – Month 05
S Bradley and K Ciraolo attended to present the key points from the Pennine Lancashire Quality and Performance Report for Month 05. Full details are available within the report.
Mixed-Gender Accommodation For EL CCG, there were 2 x mixed sex accommodation breaches in August 2017; these breaches were attributed to LTHT. The MLCSU Contracts Management Team has raised a contract query with Greater Preston CCG; requesting details of the breach, lessons learned and actions in place to prevent re-occurrence. A further update was requested in the Month 6 report.
C-Diff There were 3 cases of C-Diff identified for BwDCCG, and 4 cases identified for ELCCG. Both organisations are above trajectory with numbers rising across all organisations with no themes and trends identified as yet. All pre- and post-48-hours cases are reviewed.
E-Coli In August 2017 there were 27 E-Coli cases identified within the population of East Lancashire, and 15 cases in Blackburn with Darwen. From July 2017 comprehensive data on each E-Coli case is being collated from all providers and a local reduction plan for Pennine Lancashire is being developed in collaboration with LCC, ELHT, LCFT and the CCGs.
MRSA RATIFIED In August 2017 there was 1 case of MRSA identified for ELCCG. This case has gone to arbitration for assignment to “third party” as the patient was a temporary resident at Southend Hospital in the South of England at the time. The BwD CCG case from July 2017 was assigned to Lancashire Teaching Hospital by NHS England arbitration panel. The need to improve the transfer of patient records was discussed.
Quality Premium ELCCG are currently meeting 2 out of the 3 NHS constitution measures, and BwDCCG is meeting 1 out of 3. The constitution measure for ambulance response times has been removed due to the changes recently published by NHS England.
RTT Incomplete There was underperformance against the RTT incomplete standard in August 2017 for BwDCCG. Patient flow to LTH continues to impact on the CCG position; there are medical vacancies within neurology that is creating the main pressure on performance.
Page 5 of 11 Minutes Approved by the Chair: 03/11/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
ELHT
A&E There was underperformance against the 4-hour A&E target in August 2017 for both CCGs, with the Trust achieving 89.20% against a 90% target at the end of September 2017. The Trust must achieve 95% by end of March 2018.
Cancer: 2-week referral This target was not met for either CCG in August 2017, which appears to be caused by patients initiating delays. The Cancer Team are working with GP practices and emphasising the patients the importance of attending at the earliest opportunity. Both CCGs are experiencing continued pressure and an audit is currently taking place on referral forms.
Cancer: 31 day subsequent treatment (Surgery) The 31 day target was not met at BwD CCG in August 2017, with performance at 88.89% against a target of 94%. Year to date the target is being met at 95.24%.
This was noted as being one patient.
Cancer 62 day 1st definitive treatment The target was not met at BwD CCG in August 2017. The delay was attributed to capacity, there are 2 additional locums being recruited. The year to date the target is being met at 85.29%.
The cancer pathways are being focused on with a view to streamlining.
Ambulance Calls Due to the new Ambulance Response Programme, implemented by NHS England in August 2017, it has been agreed at the Contract and Commissioning Group that existing outputs would be frozen for 3 months to enable a refresh of the reporting mechanisms.
LCFT Out of Area TreatmentsRATIFIED There was an average of 24 Out of Area Treatments in August 2017 against a target of 0 and a tolerance threshold of 9-13.
IAPT Prevalence A query has been raised with LCFT due to inconsistencies with the calculation formulas. The data within the report has been calculated by BwD, but remains unverified until LCFT have completed their data review.
MAS The backlog has been cleared due to additional capacity and there has been a performance increase at Trust level.
Unscheduled Care Due to no data being submitted, this will be updated in the Month 6 report.
Members acknowledged the report
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.242 Pennine Lancashire Serious Incident Review Group Recommendations
C Marshall presented the paper to the committee.
ELCCG In August 2017, 11 reports were reviewed. Of these, 9 were approved for closure, and 2 were returned to the provider.
BwDCCG In August 2017, 8 reports were reviewed. Of these, 4 were approved for closure and 4 were returned to the provider. The action plans although very comprehensive need to be more outcomes focused.
During this period, a total of 12 extension requests were submitted by ELHT; 9 were made before the deadline, and 3 were received after the deadline.
There have been 8 extension requests submitted by LCFT; 2 were received before the deadline, and 6 were received after the deadline.
The late submission of extension requests has been raised with both organisations.
One of the six Rapid Review reports from ELHT was received after the 72-hour timeframe. This was discussed with ELHT, who advised it was due to operational pressures within the Risk and Safety Team, but indicated that this position was due to improve following successful recruitment to the team. LCFT submitted One of the eight Rapid Review reports outside the 72-hour deadline; the timely submission on these reviews will be discussed with them at the next Quality and Performance meeting.
ELCCG has 50 StEIS incidents open at present and BwDCCG has 47 incidents open at present.
To ensure shared learning, both CCGs do announced walk-arounds triangulated with complaints received and review all action plans in place.
The Committee formerly received the report for information. RATIFIED
17.243 Pennine Lancashire Primary Care Quality Update
C Wright attended to present the bi-monthly Primary Care Quality Assurance update. Full details are available within the report.
There are five practices that have changed provider or registration and are therefore awaiting CQC inspection, and one practice in BwD is awaiting the first inspection. Three practices have been inspected and are awaiting publication of their report. CQC are in the process of changing the inspection system so that practices will be required to submit an annual ‘Provider Information Collection’ report; this will be operational from April 2018.
The Pennine Lancashire GP Practice Dashboard has been refreshed, but there are no changes to the lowest performing practices. These are being supported through the monthly GP Quality Group.
Page 7 of 11 Minutes Approved by the Chair: 03/11/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
The Primary Care Complaints Q1 Report 2017/18 has been published. East Lancashire practices received 16 complaints and Blackburn with Darwen practices received 5. The complaints report has been vastly improved by NHS England over the last 6 months, with a more comprehensive list of complaint subjects. The CCG has made further recommendations to NHS England to refine the report further.
Blackburn with Darwen has implemented GPTeamNet, which is an online tool that allows information sharing and supports practices with CQC compliance. East Lancashire is currently undertaking an appraisal of the system.
C Wright was requested to contact D Rogers regarding media communication. Blackpool CCG has recently published CQC figures, which are lower than BwD CCG. We should promote our successes.
ACTION: C Wright to contact D Rogers regarding media communication.
Members received and acknowledged the report.
17.244 Pennine Lancashire Risk Management Update
C Moir and R Catlow presented the risk management up date. Across Pennine Lancashire there are 6 risks which are included on the Risk Registers for both CCGs. These are: 95% Accident and Emergency 4-Hour Standard 62-Day Cancer Target
Ambulance Performance
Initial Health Assessments for Looked after Children Performance Against Financial Targets Lack of In-Patient Beds for Children and Young People with Mental Health Issues (Tier 4 beds)
An update on Initial Health Assessments for looked after children will be included in the next report RATIFIED In addition to the above there are a number of similar risks in relation to workforce/system capacity, diagnostic capacity and the quality of care provided to patients. Workforce was discussed as the collection of information and recording is different for both organisations and C Moir and R Catlow were assigned to align the risk.
Both C Moir and R Catlow noted that this will be a beneficial exercise for both organisations.
Within Blackburn with Darwen CCG there are currently 9 operational risks and 6 strategic risks held on the register. No new risks have been added and no risks recommended for closure since the last report. The 18 week risk has not changed, but this will be updated in the Month 6 report.
For ELCCG there are 15 open risks, with 3 rated as “extreme”. All have been reviewed and action plans are in place. No new risks have been added since the last report, and 2 risks were removed at the Risk Management Meeting in October 2017.
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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
Full details of the risks are available within the report and on the Corporate Risk Registers
Members acknowledged the report and the updates to the Risk Registers, and approved the recommendations.
17.245 Pennine Lancashire IPA / CHC Update
J Johnston presented this report to committee to update on the progress and current risks in relation to Individual Patient Activity for the Pennine Lancashire CCGs. Full details are available within the report.
The Department of Health is undertaking a review of the national framework which will be published at the end of 2017 with implementation from 1 April 2018.
The implementation of the new IPA database within MLCSU has had some impact on the forecasting of financial commitments. The CCGs’ Finance Teams continue to seek assurance from MLCSU that the database reflects the actual position.
MLCSU have indicated that there are 362 CHC reviews outstanding for ELCCG and 94 reviews outstanding for BwD. This is a reduction on figures previously reported. They have confirmed that they will find additional resource to clear the backlog.
BwD CCG received a letter from the Equality and Human Rights Commission on the 24th October 2017, challenging the legality of the policy. They have been given 21 days to reply and are in the process of reviewing this in detail, with a view to acquiring legal advice if required. At this point ELCCG have not received any notification.
Previously Unassessed Period of Care (PuPOC) The CSU is continuing to manage the process by responding to the disputes against decisions received. As at 30 September 2017 38 disputes have been received relating to Blackburn with Darwen cases and 76 disputes have been received relating to East Lancashire cases. RATIFIED Transforming Care Members were asked to note that the projected discharge for an EL patient was adjusted due to difficulties in recruiting carers to the package. The case has been referred to the Lancashire procurement framework to try and mitigate any further delay.
LeDeR There have been 2 additional referrals for LeDeR review since the last report to committee. The learning from reviews will be shared with the Lancashire and South Cumbria LeDeR Steering Group and the Quality Surveillance Group.
The Chair thanked J Johnston for her update.
Members received the report and noted the concerns raised.
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17.246 ELCCG IG Policy and Handbook
R Catlow presented the ELCCG Information Governance Policy, which has been reviewed by the CCG’s IG Leads and Senior Management Teams.
The ELCCG IG Team have requested that the review of the IG Handbook is amended to March 2018, so that it is reviewed in preparation for the implementation of the General Data Protection Regulation (GDPR) on 25 May 2018.
Members ratified the ELCCG IG Policy and the review date of the IG Handbook
17.247 Pennine Lancashire Policy for Managing Back Pain – Spinal Injections
A Greenwood attended to present the revised policy following publication of NICE Guidance in November 2016 and July 2017. The updated policy has been developed with Lead Clinicians from both CCGs and MSK clinicians. It represents the local position on the management and treatment by promoting the most effective forms of care for back pain and sciatica.
The Policy is for the Assessment and Management of Back Pain in Adults over the age of 16 but excludes cancer, infection, and inflammatory disease or trauma patients.
It was noted that the CCGs must be mindful that complaints from patients may increase due to this change in Policy. A Greenwood advised that this had been run in shadow form in BwD CCG and to date no complaints had been received.
MR commended A Greenwood and the team on their work.
Members acknowledged the report and ratified the amended policy.
17.248 Quality Contract Meeting Minutes September 2017: BMI, ELHT, LCFT,
These were distributed prior to the meeting for information. No comments were raised. RATIFIED Members acknowledged the minutes.
17.249 Cancer Tactical Meeting: September 2017
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes and summary.
17.250 Any Other Business
‘Flu On the 13th October 2017, a directive was given that ‘flu vaccinations should be offered to all residents and staff in care homes. The system is still waiting for further information on how this is to be provided.
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A discussion then took place on the resilience in place for an outbreak of ‘flu in a care home. PHE will be notified if two or more people from a single residence are diagnosed with flu. A same day process of swabbing the patients will take place and if required, Tamiflu will be provided from a central stock being held at LTH. PHE guidance will be exercised regarding the supply of Tamiflu.
It was agreed that care homes should take responsibility to inform PHE as within one residency there will be various GPs that may not treat the same patients, and therefore the care home staff will be able to identify an outbreak and take the necessary actions.
Action: Dr M Ridgway asked if L Rogan could confirm if OOH providers are linked in.
J Newman will be asked to attend the next PLQC meeting with a ‘Flu update and assurance of the process in place from PHE.
17.251 Items for the Risk Register
There were no additional items to be added to the risk register.
17.252 Date & Time of Next Meeting
The next meeting has been scheduled for Wednesday 22 November 2017 in Meeting Room 1, Walshaw House.
Both M Pilling and J Hanson sent their apologies for the next meeting. It was agreed that Dr G Jones would Chair.
The deadline for papers is 5pm on Monday 13 November 2017.
The meeting closed at 15.45 hours RATIFIED
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PENNINE LANCASHIRE QUALITY COMMITTEE Minutes of the meeting held on 22 November 2017
PRESENT: Geraint Jones Secondary Care Doctor (retired), BwDCCG – Chair Kirsty Hollis Chief Finance Officer, ELCCG Dr Nigel Horsfield Lay Member, BwDCCG Kathryn Lord Associate Director of Quality and Nursing, ELCCG Dr Ash Misra GP Representative, Burnley Locality, ELCCG Claire Moir Governance, Assurance and Delivery Manager, BwDCCG Lisa Rogan Associate Director of Research, Medicines and Clinical Effectiveness, ELCCG Dr Zeenat Sykes GP Representative, Rossendale Locality, ELCCG Dr Paul Taylor Secondary Care Consultant, Non-Exec Director, ELCCG Janet Thomas Associate Director of Quality and Commissioning, BwDCCG Collette Walsh Head of Commissioning, Integrated Community Services, ELCCG
In Attendance: Ridwaan Ahmed Clinical Director for Quality and Performance, BwDCCG Deryn Ashby Executive Assistant, ELCCG – minutes Simon Bradley Quality and Performance Manager, MLCSU Kim Ciraolo Quality and Performance Manager, MLCSU Kerry Galloway Healthwatch Lancashire Caroline Marshall Locality Lead, Quality and Performance, MLCSU
Attended for Specific Items: Vanessa Morris Infection Prevention & Control Lead Nurse, Pennine Lancashire CCGs Jennifer Mulloy Equality and Inclusion Business Partner, MLCSU Jason Newman Head of Performance and Delivery, ELCCG Anita Watson Lead Nurse, Infection Prevention and Control, LCC
REF: ACTION 17.253 Welcome & Chair’s Update
The Chair opened the Pennine Lancashire Quality Committee and welcomed all attendees. RATIFIED
17.254 Apologies
Apologies were received from: Ryan Catlow, Jackie Hanson, J Johnston, Dr Gifford Kerr, Sharon Martin, Michelle Pilling, Dr M Ridgway, Dr Richard Robinson, D Ross
C Walsh has attended to represent Sharon Martin.
17.255 Declarations of Interest
None declared
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17.256 Minutes of the Meeting Held On 27 September 2017
Some amendments were offered for the meeting held on 25 October 2017.
17.237: Action Matrix 17.221.2: Pennine Lancashire Quality and Performance Report – Month 04 This item should refer to the Airedale Hospital Quality Meeting, and not Quality Improvement Board.
17.242: Pennine Lancashire Serious Incident Review Group Recommendations C Marshall presented this agenda item, not L Wilkinson.
With the above amendments, the minutes were formally ratified.
17.257 Action Matrix
17.218.1: Presentation: Tier 4 CAMHS Update This is currently under discussion with a view to receiving a presentation from Specialised Commissioning in the New Year. This item can be closed.
17.218.1: Presentation: Tier 4 CAMHS Update Discussions have been held. This item is to be kept open until the CAMHS update from Spec Comm.
17.223.2: Pennine Lancashire Risk Management Update C Moir and R Catlow have drafted a new PL risk for nursing home beds, which will be presented to the next Risk Meeting in December 2017. This item can be closed.
17.224.1: Pennine Lancashire Court of Protection Prioritisation A confirmation that this action has been completed will be available at the next committee.
17.243: Pennine Lancashire Primary Care Quality Update This action has been completed and the information is being disseminated to practices via the locality newsletters.RATIFIED
17.250.1: Any Other Business: ‘Flu A Standard Operating Procedure is being developed is in development for accessing antivirals in localised outbreaks.
17.250.2: Any Other Business: ‘Flu J Newman is in attendance today with an update. This action can be closed.
17.258 Matters Arising
There were no matters arising.
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17.259 CONFIDENTIAL DISCUSSIONS – Provider Updates
K Lord and S Clarke presented this item; the paper was tabled for reference. The content of this item is for committee members and attendees only, and is not for wider distribution.
The confidential minutes of this part of the meeting will be circulated under separate cover.
Members received and acknowledged this report.
17.260 Pennine Lancashire Quality and Performance Report – Month 06
S Bradley and K Ciraolo attended to present the key points from the Pennine Lancashire Quality and Performance Report for Month 06. Full details are available within the report.
Mixed-Gender Accommodation In relation to the mixed-gender accommodation breaches reported in the August 2017 report, a review paper is due to be presented to the GPCCG Governing Body meeting in November 2017. After this, GPCCG will provide an update to all affected CCGs.
C-Diff There were 3 cases of C-Diff identified for BwDCCG, and 4 cases identified for ELCCG. Both organisations are above trajectory with numbers rising across all organisations with no themes and trends identified as yet.
E-Coli In September 2017 there were 24 E-Coli cases identified within the population of East Lancashire, and 11 cases in Blackburn with Darwen. LCC, ELHT, LCFT and CCGs have worked together to develop a Pennine Lancashire E- Coli Reduction aim to reduce the number of gram-negative BSI across the health economy.
Quality Premium RATIFIED ELCCG are currently meeting 2 out of the 3 NHS constitution measures, and BwDCCG is meeting 1 out of 3. The constitution measure for ambulance response times has been removed due to the changes recently published by NHS England.
RTT Incomplete There was underperformance against the RTT incomplete standard in September 2017 for both CCGs; year to date ELCCG Is meeting the RTT target but BwDCCG is not. The RTT performance at LTH is impacting on BwD, although they have advised that NHS England have lowered the target for them. This is being discussed with NHS England. All soft intelligence and complaints regarding the neurology service is being sent to CSRCCG for monitoring. Concerns have been expressed about Maxillofacial referrals sent to ELHT; it has been reported that these are being held by the Referral Management Centre, which would affect the RTT performance. This has been escalated for discussion with Specialised Commissioning.
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ELHT
A&E There was underperformance against the 4-hour A&E target in September 2017 for both CCGs, with the Trust achieving 89.20% against a 90% target at the end of September 2017. The Trust must achieve 95% by end of March 2018. The overall position has since deteriorated, although this will be reflected on future reports, with the Trust citing staffing issues as the reason. It was observed that the position would not recover until the staffing improves. Members were advised that ELHT will be opening a ‘Winter Room’ to support the department, and that the Trust needs to understand the staffing issues and how to sustain improvements when they occur. There was also discussion about patients presenting with Mental Health needs that are not previously known to services, as these people should be accessing services when their problems develop before they reach crisis. It was noted that providers are identifying regular attenders to see if they would benefit from an alternative wrap around service, with care plans, to support them and reduce their attendances at A&E.
Cancer: 2-week referral This target was met for BwDCCG in September 2017, although the Q2 target was not met. It has been reported that this is due to patient-initiated delays.
Cancer: 31 day subsequent treatment (Surgery) The 31 day target was not met at ELCCG in September 2017.
Cancer 62 day 1st definitive treatment The target was not met at BwDCCG in September 2017. Pathway-specific action plans are being developed and implemented.
Ambulance Calls Due to the new Ambulance Response Programme, implemented by NHS England in August 2017, it has been agreed at the Contract and Commissioning Group that existing outputs would be frozen for 3 months to enable a refresh of the reporting mechanisms.
LCFT Care Programme ApproachRATIFIED The target for 95% of patients on Care Programme Approach (CPA) to be followed up within 7 days of discharge was met at Trust level in September. The target was also met for all CCGs in month; however the quarter 2 target was not met for Chorley and South Ribble CCG at 94.59%. This was a result of the 2 x July 2017 breaches.
Duty of Candour There were 2 incidents reported in September 2017 where written Duty of Candour was not served within the 10-day timescale. One was for an incident at HMP Liverpool which is commissioned by Spec Comm and one of these was delayed due to the family. The CCG are working to understand the reasons behind this decision.
IAPT Prevalence Data has been refreshed and re-submitted by LCFT which demonstrates no major impact on achievement. This indicator is reconciled on quarter 4 achievement and is on track with the year to date position.
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Early Intervention Psychosis The data reported in the Pennine Lancashire Quality Report is currently under scrutiny by the Trust. Data discrepancies were noted between the reports submitted to Commissioners and the Trusts Quality and Performance Report. Validation is underway and an update and recovery plan is awaited.
ADHD The quarter 2 submission was not received. This has been chased with the Trust.
MAS The target for 70% of patients to be assessed by the Memory Assessment Service (MAS) within 6 weeks was met at Trust level in September 2017, with performance at 79.6%. However this was not achieved for Chorley and South Ribble CCG, at 14.63% and Greater Preston CCG, at 9.09%.
Unscheduled Care Reporting against the target for the Mental Health Liaison Team to carry out assessment within 24 hours for ward referrals was expected from Q2. An update has been received and is under review.
Out of Area Treatments There was an average of 26 Out of Area Treatments in September 2017 against a target of 0 and a tolerance threshold of 11-21.
Members acknowledged the report
J Thomas and Dr A Misra entered the meeting
17.261 Pennine Lancashire Serious Incident Review Group Recommendations
C Marshall presented the paper to the committee.
ELCCG In November 2017, 13 reports were reviewed. Of these, 10 were approved for closure, and 3 were returned to theRATIFIED provider.
BwDCCG In November 2017, 15 reports were reviewed. Of these, 6 were approved for closure and 9 were returned to the provider, as they had submitted weak action plans with no substance to support the recommendations.
During this period, a total of 5 extension requests were submitted by ELHT; 2 were made before the deadline, and 3 were received after the deadline.
ELHT submitted 1 Rapid Review outside of the 72-hour timeframe, although this is expected to improve following successful recruitment to the team.
LCFT submitted 5 Rapid Reviews outside of the 72-hour timeframe. This was discussed with them and felt to be due to internal processes. This is being debated and monitored.
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There have been 5 extension requests submitted by LCFT; 5 were received before the deadline, and 0 were received after the deadline. Members were warned that there will be an increase in extension requests due to staff vacancies and illness within the team at LCFT, although this is being monitored.
ELCCG has 40 StEIS incidents open at present and BwDCCG has 47 incidents open at present.
The Committee formerly received the report for information.
17.262 Pennine Lancashire 2017/18 CQUIN Q2 Update
2017/2018 CQUIN Reconciliation has taken place for Q2 for ELCCG and BwDCCG hosted contracts.
BMI Evidence has been submitted by BMI for the 2 CQUIN indicators; 1 has been partially reconciled and 1 has been fully reconciled. It has been recommended that the partially reconciled CQUIN receives partial payment of the CQUIN.
ELHT Evidence has been submitted by ELHT. Of the 6 indicators: 1 does not have any Q2 milestones; 4 have been fully reconciled; and 1 is not yet reconciled due to a datalag. Members were cautioned that there is a risk that the Q3 data will not be available as ELHT are changing provider for their data service. This is being monitored by the CCG, and ELHT are confident that they will be able to send the data through.
LCFT Evidence has been submitted by LCFT. Of the 5 Q2 CQUIN indicators: 1 did not have any Q2 indicators; 2 have been fully reconciled, 1.has been partially reconciled; 1 is awaiting further information.
MCFT Additional information for a Q1 indicator is still awaited and has been requested again. A partial submission has beenRATIFIED received for the Q2 indicators. Of the 4 CQUIN indicators: 1 did not have any Q2 milestones; 1 has been fully reconciled; and 3 are awaiting further information. There was debate about how much time should be offered before the CCG determines a CQUIN indicator has not been met due to non-submission of data. It was acknowledged that there has been inconsistent submission of data by MCFT, and this has been discussed with them. Members were assured that a paper will be brought to committee if MCFT continue with inconsistent data submissions.
IAPT Consortium Evidence has been submitted for the Q2 indicator and will be discussed at the Contract Review Meeting on 04 December 2017.
About Health Evidence has been submitted for the Q1 milestones, which have now been fully reconciled. Evidence has not yet been received for the Q2 milestones.
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Age UK Evidence has been submitted for the Q2 indicator, and this has been reconciled.
Members were asked to support the recommendations relating to release the newly reconciled Quarter 1 monies, as specified, and the identified Quarter 2 payments.
Members acknowledged the report and approved the recommendations for payment of CQUIN monies as outlined in the report
17.263 Lancashire IPC Update: 2017/18 Q2
A Watson attended to present the Lancashire County Council Health Care Associated Infection Report for Q2 2017/18 across the Lancashire footprint.
MRSA During Q2 there were 4 cases of MRSA in Lancashire. One of these was an ELCCG resident and one was a BwDCCG resident. There has been discussion regarding whether the BwDCCG resident should be referred for LeDER review as well.
Clostridium Difficile During Q2 there were 110 cases of C-Diff meaning that 5 out of the 7 Lancashire CCGs have breached the cumulative objective for this illness. The number of cases is increasing, but this could be through the increased use of antibiotics to manage illnesses such as Sepsis; this is an unfortunate side-effect of appropriate antibiotic treatment. V Morris added that it depends on the strain of C-Diff circulating, as cases in the community will be milder than those in hospitals. There remains a 17% mortality rate from C-Diff. It was requested that future reports detail the number of mild, moderate and severe cases and for the IPC team to undertake further analysis on the impact.
ACTION: Future IPC reports to detail the number of mild, moderate and severe C-Diff cases, and to include further analysis on the impact of these different levels on patients.
E-Coli RATIFIED During Q2 there were 327 cases of E-Coli across Lancashire. All Lancashire CCGs are breaching the cumulative trajectory for this infection. As each case is investigated it is hoped that themes for improvement work streams will be identified.
Care Homes During Q2, there have been 23 care homes supported to manage norovirus outbreaks. The Care Homes IPC Champions meetings focussed on “Back to Basics” during this quarter.
Future Plans A Watson advised that is continued focus on the Sepsis Strategy for care homes. The Care Home IPC Champions will be focussing on influenza during Q3 as well
The Chair thanked A Watson for her report.
Members acknowledged the report and the progress made in this area.
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17.264 Pennine Lancashire E-Coli Update
V Morris presented the Lancashire-wide E-Coli Reduction / Action Plan for information, with a request that members approve the action plan specifically pertaining to Pennine Lancashire. All organisations meet on a monthly basis to review the action plans collectively, but are responsible for their own actions.
There was discussion about the data, as much of this has come from Sentinel whilst more up-to-date data collection takes place. However, early indications are that the new data is reflecting the Sentinel data. The aim is to reduce the rise in infections whilst acknowledging that there is an increase in the number of resistant strains of E-Coli.
J Thomas queried the CCG response around education and support for GPs. V Morris assured the group that all actions are aimed at Pennine Lancashire, although there have been some workshops undertaken as part of the East Lancashire CCG Medicines Management Work Programme. This will be discussed with the BwD Medicines Management team to ensure equity across both CCGs.
Nursing homes are receiving training through the telehealth scheme, and LCC is supporting BwD LA to provide support to care homes in BwD.
Dr Z Sykes queried whether more training is needed for District Nurses around swabs to try and reduce the number of lab results being sent. V Morris agreed to feed this back to LCFT as part of their action plan. The Chair noted that this needs to be undertaken across Pennine Lancashire to help to manage these resistant strains.
V Morris was thanked for her report.
Members acknowledged the report and approved the Pennine Lancashire Action Plan
17.265 Pennine Lancashire Risk Management Update
C Moir presented the risk management update. Across Pennine Lancashire there are 6 risks which are included on the Risk Registers for both CCGs. These are: 95% Accident and EmergencyRATIFIED 4-Hour Standard 62-Day Cancer Target
Ambulance Performance
Initial Health Assessments for Looked after Children Performance Against Financial Targets Lack of In-Patient Beds for Children and Young People with Mental Health Issues (Tier 4 beds)
S Clarke informed members that the risk pertaining to the “Initial Health Assessment for Looked after Children” were being worked through, and that is was made more complex by the fact that different Local Authorities were involved who were experiencing different issues. There are also issues with the provider.
There was discussion about the BwD risk pertaining to “Workforce”. It was noted that this covered a range of specialities across BwD, but the similar risk for EL specifically focussed on the GP workforce. There was debate about aligning this, if possible, across
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Pennine Lancashire. Dr Z Sykes emphasised that practices that are performing badly are often affected by insufficient practice workforce.
There was concern raised regarding the “18-week RTT” risk for BwDCCG. Feedback has been requested from NHS England as performance in this area is being reduced by LTH, who have indicated that they have a lower target agreed with NHS England. This needs to be further discussed.
The SEND inspection has been completed and the results are awaited from OfSted and CQC. The recommendations will impact on the risks for children for both CCGs.
A new risk is due to be entered on the Risk Registers pertaining to the reduction in care home beds.
The Chair queried the process for resolving these action plans. C Moir advised that the risk owners provide updates with action plans to underpin the risks. The assurance is gained by looking at performance reports and SI Reviews.
No new risks have been added since the last report, and no risks have been recommended for closure.
Full details of the risks are available within the report and on the Corporate Risk Registers
Members acknowledged the report and the updates to the Risk Registers, and approved the recommendations.
17.266 Pennine Lancashire Equality and Inclusion Update: 2017/18 Q2
J Mulloy attended to present the Equality and Inclusion Q2 report for Pennine Lancashire.
She advised members that EDS grading took place for both CCGs around “Inclusive Leadership”. Both CCGs are achieving in this area, but identified different issues. This is currently being analysed and will be fed back to both CCGs. RATIFIED There was discussion about Equality Impact Assessments and the work done by the Equality and Inclusion Team to support the CCGs. There was discussion about the Pan- Lancashire policies for procedures of limited clinical value. There is a 12-week engagement and consultation process through the communication teams. C Walsh queried the design of the questions for the engagement, emphasising the need to use standardised questions so as to not appear leading.
ACTION: J Mulloy to check the questions utilised in the engagement and consultation process for PLCV and ensure they are not leading.
The Chair thanked J Mulloy for her update, noting the vast work being undertaken in this area.
Members acknowledged this report.
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17.267 ELCCG Influenza Programme Planning and Delivery
J Newman attended to provide an update about the preparations for seasonal ‘flu across Pennine Lancashire.
Vaccinations for ‘flu are monitored, although uptake is voluntary and not mandated. There are campaigns in place to try and improve public engagement with the vaccine. L Rogan queried whether the data included vaccines provided in community pharmacies. J Newman advised that this is being collected, but more formal data is being sought. V Morris added that a letter has been issued by Public Health England regarding the ‘flu vaccination for Care Home staff.
A Watson advised that LCC cannot always attend the ‘flu meetings, but will endeavour to send an update. J Newman acknowledged that the notes will reflect any update received.
Members noted that concern has been expressed by ethnic minorities about the nasal spray vaccine for children as this is not halal, therefore uptake has been poorer than anticipated. J Thomas advised that BwDCCG had arranged visits to local mosques to discuss the importance of the ‘flu vaccine with religious leaders and encourage uptake of the vaccine.
The Chair thanked all for their participation in this discussion.
Members acknowledged the report.
17.268 Pennine Lancashire Complaint, MP Letters and PALS Report, 2017/18 Q2
K Lord presented this report to provide a 2017/18 Q2 update on the complaints, MP Letters and PALS enquiries received across Pennine Lancashire.
The report detailed that ELCCG had received 19 complaints in Q2, and BwDCCG had received 11; this is a reduction for ELCCG and an increase for BwD compared to the previous quarter.
During this period, both RATIFIEDCCGs have also received 1 compliment.
The report detailed an analysis on the reasons for the complaints, MP letters and PALS contact to identify themes and trends. There were no new cases referred to the Parliamentary Health Service Ombudsman during this time.
It was noted that a large proportion of complaints have been received in relation to CHC, and the complaints team now have a dedicated member of staff to manage these queries. In addition, the commissioning team liaise with the complaints team around complaints, and standardised letters have been developed for issues that are anticipated in order to expedite the response times.
Members noted that broader trend analysis would be beneficial, but the Chair credited the team for their improved response times to queries. K Lord stated that the SitRep and weekly phone calls with the team have supported this improvement, and that the initial contact with the complainant has helped to improve the process.
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There was discussion regarding the satisfaction surveys, as it was not clear in the report which complaints had received the 24 surveys that were posted out. It was confirmed that these were sent to the closed complaints, but it was felt that this could be better reflected within the report to provide context. It was also noted that greater context is needed with the comparative data to enable members to understand performance compared to other areas.
Members acknowledged the report
17.269 Pennine Lancashire Safeguarding Annual Report
S Clarke presented the Pennine Lancashire Annual Safeguarding Report for 2016/17. The report outlines how both CCGs are meeting their statutory requirements and responses to local challenges across the health economy.
The key achievements were outlined within the report, such as the Safeguarding and MCA Champion Model within the Care Home Sector and Primary Care across the Pennine Lancashire Footprint
There has been ongoing work to develop the Safeguarding Team model and implement this for Pennine Lancashire. This incorporates statutory functions and skill mix as a component within the team, which now includes a nurse from a Learning Disability background, health visitors, school nurses and social workers. There are also designated doctors and medics from acute settings and the community. The aim is to ensure this is an adaptable service.
One of the most significant barriers experiences is the governance arrangements within two separate CCGs, which have retained their different reporting structures despite moving towards joint working. An Exec lead within each CCG is still required to meet statutory obligations, and the complexities are challenging.
Another barrier is that the Pennine Lancashire area is one of high deprivation, with a large number of domestic abuse and drug misuse incidents. There have been a number of Serious Case Reviews and Domestic Homicide Reviews, particularly in BwD, which have been labour-intensiveRATIFIED and identified some lessons learned. Expanding agenda within SG.
The Chair acknowledged that this was a comprehensive report, and queried the issues with the individual governing bodies. It was noted that one issue is the need to complete separate report templates to present the same agenda item, although there are other issues. These will be discussed with their Exec Leads outside of this meeting.
C Walsh observed that there are links to commissioning as many issues can follow a child through their lives, and there is a need for early intervention commissioning to stop things developing. This will be discussed with commissioners to try and overcome this issue.
There was discussion regarding referrals for Serious Case Review and Domestic Homicide Reviews. It was noted that the data reflects the referrals per 100 of population, and that percentage numbers and rates would be needed to make a comparative assessment.
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K Lord commended the team for this report despite the vacancies they have recently experienced within the team.
K Galloway exited the meeting.
Members acknowledged the report.
17.270 CCG Acute Kidney Injury Quarterly Report, 2017/18 Q1
L Rogan presented the CCG Acute Injury Quarterly Report. This has been presented to members as part of the Think Kidneys national programme. A key aspect of this work was the development of a new AKI warning stage test result, using an algorithm implemented in Pathology Labs Reporting Systems. An audit of primary and secondary care has been undertaken and identified that the Calderdale and Preston labs are listed as not reporting data to the national UK Renal Registry and it has been recommended that this is raised formally through Quality Review Meetings and contracting processes to the relevant lead CCG.
ACTION: L Rogan to share the lab reporting issues with C Marshall to go through the contracting processes
The report recommends that support is requested from AQuA and to include this AKI reporting as part of the Quality Framework for 2018/19 to determine patient outcomes.
Dr Z Sykes was concerned that formal AKI training has not been offered to GPs, although she acknowledged that she had seen a 10-15 minute talk on nephrology as part of another training event. She advised that Bolton have been requesting ITU consultants to give talks and provide cards to GPs and pharmacies for them to share with patients.
ACTION: Dr Z Sykes to try and obtain a sample of the AKI cards from Bolton
J Thomas queried whether the reporting included BwD patients to reflect the Pennine Lancashire overview. It was noted that the central lab at ELHT has signed up for this AKI reporting system, so the surrounding labs need to sign up as well to provide a more complete picture. It wasRATIFIED requested whether the data could be broken down to show the EL and BwD residents.
ACTION: L Rogan to ascertain with Think Kidneys whether the reporting data can be broken down into CCG areas
Dr N Horsfield enquired about the processes to show the effect of prevention and early detection to manage Acute Kidney Injuries. L Rogan advised that the Eclipse system highlights red alerts, or high risks, to practices. In addition, AKI is one of the care bundles for ELHT, so they will receive regular updates. V Morris noted that LCC are also working with care homes around hydration.
Members were happy to support the proposal for AQUA to be involved, although this needs to be discussed with them to ensure there is no datalag on future reports.
Members acknowledged the report and approved the recommendations.
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17.271 Safe Management of NHS Prescriptions in GP Practices
L Rogan informed members that this process has been developed following a serious incident at a practice where some prescriptions were found to be missing. The practice immediately alerted the police, NHS England and NHS Protect. It has been recognised that there is no protocol in place, and the CCG has developed this to help practices identify safe and secure management of prescriptions. It was noted that this remains under the responsibility of NHS England, as they hold the Primary Care contract, and that this should be included within the conversations around the Memorandum of Understanding between NHS England and the CCG, which will clearly outline the roles and responsibilities of each organisation.
Dr Z Sykes observed that this protocol would be beneficial to practices, and provided an example of a patient that had stolen a computer prescription and presented this, hand written, at a pharmacy. She advised that it was reported to NHS England and the police but no action was taken.
The protocol was agreed in principle, but would need to form part of the wider discussions regarding the MoU with NHS England.
ACTION: L Rogan and C Walsh to meet and discuss this protocol as part of the MoU with NHS England, and to provide an update to committee in due course
Members acknowledged the report and agreed in principle, although it needs further discussion with NHS England in the first instance.
17.272 PL Research, Innovation and Clinical Effectiveness Strategy
L Rogan presented this strategy, which outlines the Pennine Lancashire objectives for research and development over the next 5 years.
This was presented and discussed at the first Research, Innovation and Clinical Effectiveness group, where the focus was on utilising existing resources and partnership working to maximise clinicalRATIFIED research.
Dr A Misra observed that this presented an opportunity for Primary Care research and to develop the model accordingly. C Walsh concurred, noting that pilots and evaluations could be introduced.
Members received the strategy.
17.273 Quality Contract Meeting Minutes October 2017: BMI, ELHT, LCFT
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes.
Page 13 of 14 Minutes Approved by the Chair: /12/2017
NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group
17.274 ELCCG Risk Management and Information Governance Group Draft Minutes – October 2017
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes.
17.275 Cancer Tactical Meeting: October 2017
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes and summary.
17.276 PL Research and Innovation and Clinical Effectiveness Committee – October 2017
These were distributed prior to the meeting for information. No comments were raised.
Members acknowledged the minutes.
17.277 Any Other Business
None raised.
17.278 Items for the Risk Register
There were no additional items to be added to the risk register.
12.279 Date & Time of Next Meeting
The next meeting has been scheduled for Wednesday 20 DecemberRATIFIED 2017 in Meeting Room 1, Walshaw House.
The deadline for papers is 5pm on Monday 11 December 2017.
The meeting closed at 15:50 hours
Page 14 of 14 Minutes Approved by the Chair: /12/2017
CLINICAL COMMISSIONING GROUP (CCG)
Minutes of the Audit Committee Meeting held on 22nd August 2017 at 1 p.m. in the Board Room, Fusion House Evolution Park, Haslingden Road, Blackburn, BB1 2FD
PRESENT: Mr Paul Hinnigan Lay Member – Governance (Chair) Dr Nigel Horsfield Lay Member Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Dr John Randall General Practitioner (GP) Executive Member
IN ATTENDANCE: Mr Roger Parr Chief Finance Officer Mr Chris Whittingham Manager – Assurance, Grant Thornton UK LLP. Mrs Sharon Brock Local Anti-Fraud Specialist, Mersey Internal Audit Agency (MIAA) Mrs Liz Squires Senior Audit Manager, MIAA (representing Mrs Lisa Warner) Mrs Pauline Milligan Corporate Support Officer (minutes)
Min No Item Action By 17.052 Chair’s Welcome
The Chair welcomed everyone to the meeting of the Clinical Commissioning Group’s (CCG’s) Audit Committee (AC). 17.053 Apologies for Absence and Confirmation of Quoracy
Apologies were received in respect of Mrs Karen Murray, Director – Assurance, Grant Thornton UK LLP; Mrs Lisa Warner, Senior Internal Audit Manager, MIAA and Mrs Claire Moir, Governance, Assurance and Delivery Manager.
The meeting was confirmed as quorate. 17.054 Declarations of Interest
The Chair invited members to declare any interests they may have in relation to items on the agenda.
No declarations of interest were made.
Declarations declared by CCG staff are listed in the CCG’s Registers of Interests. The Registers are available, either via the Secretary to the Governing Body (GB), or on the CCG website via the following link:
http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/
The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting.
17.055 Minutes of the Meeting held on 25th May 2017
The minutes of the meeting held on 25th May 2017 were reviewed and agreed as an accurate record.
RESOLVED: That the minutes of the meeting held on 25th May 2017 were approved as an accurate record.
17.056 Matters Arising/Action Matrix
The Action Matrix was reviewed and the following actions were noted:
Minute 17.009.4/17.0027 – Assurance Framework Benchmarking Report The Chair reported that Mrs Moir had sent him an email regarding the MIAA detailed review of the CCG’s Governing Body Assurance Framework (GBAF). The report had rated the CCG as ‘green’, with no areas identified for improvement; however Mrs Moir planned to improve the ‘gaps/actions on controls’ and associated action plans. The GBAF was due for review at the next meeting of the GB.
Minute 17.009.5 (iii)/17.039 – Primary Care Quality Assignment Report 2016/17 Mr Roger Parr confirmed that the dashboard had been produced and discussed at the Primary Care Co-commissioning Committee.
Minute 17.028 – Risk Management Report Mr Parr agreed to pick up with Mrs Moir the action in relation to her Roger Parr/ agreement to make enquiries regarding the action to reduce risk ID Claire Moir 2014/12 to the target risk rating.
Minute 17.030.1 – Internal Audit Progress Report Mrs Liz Squires reported that MIAA had met with Dr Malcolm Ridgway, Clinical Director for Primary Care and Quality and Mr Peter Sellars, Primary Care Transformation Lead and confirmed, through provision and discussion of documentation, that the recommendations in the report had been completed.
Minute 17.048.1 – Audit Findings Report Mr Parr reported that, in relation to offsite information technology access, he planned to get advice and make recommendations through the Information Governance Steering Group. 17.057 Risk Management Report
In the absence of Mrs Moir, Mr Parr presented the Risk Management Report, which provided the AC with an updated on the management of risks held on the full Corporate Risk Register (CRR) for May – August 2017 and highlighted key points:
• Strategic Risk Management – Corporate Objectives
At its meeting on 7th June 2017, the GB had reviewed the CCG’s Corporate Objectives for 2017/18 with no changes to risk ratings.
• Operational Risk Management
Mr Parr reported that the CCG had been doing some joint work with East Lancashire CCG to align the CCGs’ CRRs as much as possible. There were a few risks which were common to both CRRs but had different ratings. Further work was underway to discuss and agree ratings.
• Corporate Risk Review: May – August 2017
There were ten operational risks and six strategic risks held on
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the register. Members noted the risks which had been reviewed during the period with no movement in risk rating.
The following risks were added to the CRR during the reporting period:
o Ability of diagnostic provision to support the 14 day cancer diagnosis (12); o Lack of oncology provision across the Lancashire footprint including Pennine Lancashire (12).
Mr Parr explained that, as reported earlier, a review of jointly held risks was underway and there was a proposal going to the Pennine Lancashire Quality Committee (PLQC) to reduce the following risk ratings:
o 2016/04: Failure to achieve cancer targets if activity increases as anticipated (reduce from “16” to “12”). o 2013/05: Performance against the Accident and Emergency (A&E) 4 hour target (reduce from “20” to “16”).
At its meeting on 24th May, PLQC had approved the closure of the following risk:
o 2014/12: Increased safeguarding and quality demands in the system having direct impact on established safeguarding adult capacity within CCG.
Questions and answers followed.
Members discuss the reasons for and potential implications in reducing risk 2013/05.
ACTION: The Chair requested that Dr Nigel Horsfield inform the PLQC that Blackburn with Darwen’s AC had expressed its surprise Nigel at the proposal to reduce the risk rating of risk 2013/05 in light of Horsfield performance against the target.
RESOLVED: That the AC noted the content of the report.
17.058 Annual Governance Statement 2017/18 Progress Report
In the absence of Mrs Moir, Mr Parr presented the Annual Governance Statement (AGS) 2017/18 Progress Report, which provided an update on the work to develop the CCG’s AGS for 2017/18.
Mr Parr drew members’ attention to Appendix 1, which detailed progress made in quarter 1 and highlighted key elements.
Four significant risks had been identified:
• Clinical workforce capacity; • Managing demand and activity; • A&E performance; • CCG Financial Recovery Plan.
Questions and answers followed.
RESOLVED: That the AC noted the content of the report.
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17.059 Draft AC Annual Report
The Chair presented the draft AC Annual Report, which would be presented to the GB for information.
The Chair requested views and comments prior to submission to the GB.
Questions and answers followed.
ACTION: It was agreed that the following comments would be actioned: • That the membership section would be amended to note that Mrs Anne Asher was only a member of the AC for part of the year; • That the report would include a reference to the re- Roger Parr appointment of the CCG’s External Auditors; • That the Internal Audit section would be amended to ‘Internal Audit and Anti-Fraud’; • That the Internal Audit section would be amended to include the term ‘Director of Internal Audit’, rather than ‘Chief Internal Auditor’.
RESOLVED: That, following the above amendments being made in line with discussions, the AC approved the content of the report.
17.060 External Audit
Mr Chris Whittingham presented items on behalf of External Audit.
17.060.1 Annual Audit Letter 2016/17
Mr Whittingham presented the letter and informed members that it formally concluded the work to audit the CCG’s financial statements for the year end 2016/17.
Mr Whittingham stated that the content of the letter largely reflected the results of the Audit Findings Report which was presented to the last meeting.
Mr Whittingham drew out key elements of the report.
Questions and answers followed.
ACTION: Following comments from the Chair, Mr Whittingham Chris agreed to amend an error on page 10 of the letter and reword the Whittingham second paragraph to reflect the correct tense.
Members discussed the reporting of the CCG’s financial position and how it would be perceived by members of the public.
ACTION: It was agreed that the public reporting of the CCG’s Pauline financial position would be discussed further at the next meeting. Milligan Mrs Pauline Milligan to add to the agenda.
RESOLVED: That, following the above amendments being made in line with discussions, the AC approved the content of the letter for presentation to the GB for information. 17.061 Internal Audit
In the absence of Mrs Lisa Warner, Mrs Squires presented a suite of
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documents on behalf of Internal Audit.
17.061.1 Progress Report
Mrs Squires presented the progress report, which provided an update to the AC in respect of the assurances, key issues and progress against the Internal Audit Plan 2017/18 and highlighted key elements:
• A&E Delivery Board Report issued – significant assurance; • Delivery of 2017/18 Audit Plan commenced: o There were three reviews at a draft stage: Governing Body Reporting; Risk Management; Stakeholder Engagement.
Mrs Squires stated that Mrs Warner would provide an update on progress of the above and the contents of the ‘Follow Up’ section (page 5) at the next meeting.
Mrs Squires drew members’ attention to the ‘Work in Progress’ section (page 7) and it was noted that there were currently no changes to the Audit Plan.
Members noted the overview of ‘Output Delivery’ (Appendix B2) and Appendix C1 which indicated that there were no critical or high priority recommendations to bring to the attention of the AC.
Questions and answers followed.
Mrs Squires confirmed that, at this stage, delivery of the Audit Plan was on track and Mrs Warner would inform the Chief Finance Officer of any changes if necessary.
RESOLVED: That the AC noted the content of the report.
17.061.2 Insight Assurance Framework Benchmarking Report
Mrs Squires presented the above for information.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.061.3 Insight Update
Mrs Squires presented the above for information.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.061.4 Annual Review of the Effectiveness of Internal Audit
The Chair presented the questionnaire, which had been used last year to review the effectiveness of Internal Audit; when it had been agreed that the review would be undertaken on an annual basis.
ACTION: Mrs Milligan to email the questionnaire out to members Pauline for completion and the results would be brought to the next Milligan meeting.
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There were no questions.
RESOLVED: That the AC noted the process.
17.062 Anti-Fraud
Mrs Brock presented items on behalf of Anti-Fraud.
17.062.1 Progress Report
Mrs Brock presented the first progress report of the year, which covered the period April – August 2017 and highlighted key elements:
Mrs Brock drew members’ attention to the reporting dashboard (page 2) and explained the items which were marked ‘red’ – items for attention:
• Prevent and Deter – National Fraud Initiative (NFI) 2016; • Hold to Account – Closure of Investigations.
Mrs Brock highlighted items of interest (pages 4-6):
• Changes to NHS Protect; • Scam emails; • Smishing or SMS Phishing Fraud Alert; • The Sentinel Summer Newsletter; • Local Anti-Fraud Alerts;
• Timesheet Fraud;
• Bogus Boss Fraud;
• MIAA Recent Cases.
Members noted the details of current investigation activity (page 6).
Questions and answers followed.
Members discussed how Primary Care could be made more aware of fraud and scam email alerts.
RESOLVED: That the AC noted the content of the report.
17.062.2 The Sentinel
Mrs Brock presented the report for information.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.062.3 Recent Fraud Cases
Mrs Brock presented the report for information.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.062.4 Timesheet Fraud
Mrs Brock presented the report for information.
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There were no questions.
RESOLVED: That the AC noted the content of the report.
17.062.5 Bogus Boss Fraud
Mrs Brock presented the report for information.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.063 Losses and Special Payments
Mr Parr presented the Losses and Special Payments Report for 1st April – 30th June 2017.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.064 Waivers and Standing Orders
Mr Parr presented the Waivers and Standing Orders report for the period 1st April – 30th June 2017.
There were no questions.
RESOLVED: That the AC noted the content of the report.
17.065 Corporate Registers
Mr Parr presented the Corporate Registers Report, which provided an update on the registers held by the CCG and details of any exceptions.
Mr Parr highlighted changes to the GB and staff registers and new entries on the Procurement Register.
The Chair highlighted that his entry in the Register of Interests incorrectly included a declaration relating to the Clinical Chief Officer.
Questions and answers followed.
ACTION: Mrs Milligan to remove the duplicate entry for the Clinical Pauline Chief Officer and the AC Chair on the GB Register. Milligan
RESOLVED: That the AC noted the content of the report.
17.066 Quality, Innovation, Productivity and Prevention (QIPP) Report
Mr Parr presented the QIPP update report.
Mr Parr reported that in 2017/18 the CCG’s QIPP target was £8.6m; in order to meet NHS business rules. As at 31st July, the CCG had identified and banked annual savings of £6.2m.
Mr Parr reminded members that in 2016/17 the CCG delivered just over £5m for the whole year; therefore this year’s savings were already greater than the whole of the last financial year.
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Mr Parr explained that some of the hard work that had taken place last year, had created a firm foundation for this year and the final quarter of last year had demonstrated an improvement in performance which had carried over into this year.
The CCG had identified and implemented schemes which should release £7.7m by the end of the financial year; with a further £2.1m of schemes under review.
Mr Parr continued that, despite the improved position at this stage, there were still some risks to be managed. The QIPP target relating to prescribing schemes was challenging at £3.4m and every effort was being made to fully achieve the target.
Mr Parr explained that the CCG continued to monitor QIPP on a weekly basis.
Questions and answers followed.
RESOLVED: That the AC noted the content of the report. 17.067 Audit Committee Work Plan 2017/18
The Chair introduced the AC Work Plan 2017/18 and invited any comments on the content.
There were no comments.
RESOLVED: That the AC noted the content of the Work Plan 2017/18. 17.068 Pennine Lancashire Quality Committee (PLQC)
The Chair introduced the minutes, presented for information, and invited Dr Geraint Jones and Dr Horsfield to highlight any areas of concern.
Dr Jones and Dr Horsfield agreed that the Committee was working quite well. There had been a presentation on Stroke Services at the last meeting and it was planned that there would be a more detailed presentation at a future meeting.
17.068.1 Minutes of the Meeting held on 26th April 2017 17.068.2 Minutes of the Meeting held on 24th May 2017
There were no other issues to be raised from the minutes.
RESOLVED: That the AC noted the content of the minutes. 17.069 Primary Care Co-commissioning Committee (PCCC)
17.069.1 Minutes of the Meeting held on 31st May 2017
The Chair introduced the minutes of the meeting held on 31st May 2017, presented for information.
There were no questions.
RESOLVED: That the AC noted the content of the minutes.
17.070 Any Other Business
Accountable Officer Mr Parr reported that it had been announced that the CCG’s Clinical
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Chief Officer (CCO) (Accountable Officer (AO)) had been appointed to a new post in Derbyshire, which would commence on 1st October.
The CCG’s Chair had been liaising with NHS England and the Pennine Lancashire System Leaders in relation to the process for appointing a new CCO. The CCG was bound by the terms of its Constitution in appointing an AO and it was hoped that an interim solution would be in place prior to the CCO’s departure to ensure there would not be a gap in service. The Constitution stated that the CCG must have an elected General Practitioner as its AO.
Questions and answers followed.
RESOLVED: That the AC noted the content of the update.
17.071 Date and Time of Next Meeting
It was agreed that the next meeting would be scheduled for November; avoiding the school half-term holidays.
ACTION: Mrs Milligan to arrange. Pauline Milligan The Chair thanked everyone for their attendance and input and the meeting closed.
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GOVERNING BODY MEETING
JOINT COMMITTEE OF CLINICAL COMMISSIONING GROUPS
Date of Meeting 17TH JANUARY 2018 Agenda Item 14
CCG Corporate Objectives
Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING
Governing Body Meeting Page 1 of 2
Clinical Lead: N/A
Senior Lead Manager N/A Finance Manager N/A Equality Impact and Risk Assessment Report for information only completed: Patient and Public Engagement completed: Report for information only Financial Implications Report for information only Risk Identified Report for information only Report authorised by Senior Manager: Mr Roger Parr Y
Decision Recommendations The Governing Body is requested to note the agenda for the January meeting and the minutes of the last meeting for information.
Governing Body Meeting Page 2 of 2
Lancashire and South Cumbria Joint Committee of CCGs Thursday 11th January 2018 13:00 – 15:00 Venue: Tanhouse Community Enterprise, Ennerdale, Tanhouse, Skelmersdale, WN8 6AN Agenda Agenda Timings Item Owner Action Format Item Standing Items
1. 5 mins Welcome and Introductions Phil Watson Information Verbal Apologies Phil Watson Information Verbal Declarations of Interest Phil Watson Information Verbal 2. 5 mins Minutes from the last meeting Phil Watson Information Paper held on 2nd November 2017 Action Matrix Review Phil Watson Information Paper 3. 5 mins Any other business declared Phil Watson Information Verbal For Discussion/Recommendations
4.1 40 mins A New Commissioning Andrew For Paper Framework For Lancashire & Bennett Approval South Cumbria
4.2 Mental Health Commissioning Debbie For Paper Development Mobilisation and Nixon Approval Next Steps
(There are a number of related technical papers supporting both these reports running to nearly 450 pages. Should any Committee member wish to receive copies, please contact the office on 01253 951630) 5. 20 mins Specialist Neuro Rehabilitation Carl For Paper Implementing a New Model of Ashworth Approval Care 6. 20 mins Commissioning Policies: Hilary For Paper • Complementary and Fordham Approval Alternative Therapies • Facial Nerve Rehab 7. 5 mins Any Other Business Phil Watson Verbal Formal meeting closed – continue with Questions from the Public
8. 10 mins Questions and Answers All Discussion Verbal For information only
9. The next JCCCG Meeting will be held on:- Phil Watson Information Information Thursday 1st March 2018 Venue to be confirmed Apologies should be sent to Susan Hesketh [email protected] or dial 01253 951490 Details of Venue – Directions and parking attached
By Road Tanhouse Community Centre is at the far end of Ennerdale, a turning off Tanhouse Road, Skelmersdale. The car park in front of the centre is for centre users and is free. Our post code for your satnav is WN8 6AN Accessibility We are a single storey building with double doors at the entrance and into the main hall. The entrance is up a very slight slope from the car park but is step-free. We have a disabled toilet. Public Transport Preston Bus 3A travels along Tanhouse Road and stops near the other end of Ennerdale. It runs approximately hourly Mondays to Saturdays, Burscough - Parbold - Newburgh - Skelmersdale - Upholland - Appley Bridge. Timetable at www.prestonbus.co.uk Other more frequent buses to/from Wigan, Ormskirk and Southport stop at the Upholland Labour Club approximately a 5-minute walk away. Timetable from Arriva Rail: Wigan Northwestern and Wallgate stations are approximately 15 minutes away by taxi. Direct trains to/from Southport, Manchester, Preston, Warrington, Liverpool, St Helens
Joint Committee of the Clinical Commissioning Groups (JCCCGs)
Minutes of the Joint Committee of the Clinical Commissioning Groups held on Thursday 2nd November 2017, 1pm – 3pm at Moor Lane Mills, Lecture Theatre, Lancaster
Chair Phil Watson (PW) Independent Chair JCCCGs Attended Voting Alex Gaw Chair Morecambe Bay CCG Attended Members Andrew Bennett Chief Officer Morecambe Bay CCG Apologies Penny Morris Chief Clinical Officer Blackburn with Darwen CCG Apologies (One vote Sumantra Mukerji Chair Greater Preston CCG Apologies per CCG) Doug Soper Lay Member West Lancashire CCG Apologies Susan Fairhead GP Member Blackpool CCG Attended Geoffrey O’Donoghue Lay Member Chorley South Ribble CCG Apologies Gora Bangi Chair Chorley South Ribble CCG Apologies Graham Burgess Chair Blackburn with Darwen CCG Attended Mark Youlton Chief Officer East Lancashire CCG Attended
Tony Naughton Chief Clinical Officer Fylde and Wyre CCG Attended
Mary Dowling Chair Fylde and Wyre CCG Attended
Paul Kingan Chief Finance Officer West Lancashire CCG Attended
Phil Huxley Chair East Lancashire CCG Attended Debbie Corcoran Lay Member for Patient Greater Preston CCG Apologies & Public Involvement Roy Fisher Chair Blackpool CCG Attended Roger Parr Chief Finance Officer Blackburn with Darwen CCG Attended Denis Gizzi Chief Officer Greater Preston and Chorley and Attended South Ribble CCG In Dr Amanda Doyle STP Lead Healthier Lancs & South Cumbria Apologies attendance Andrew Bibby Director for Specialised NHS England Attended Services Andy Curran Medical Director Healthier Lancs & South Cumbria Apologies Carl Ashworth Service Director Healthier Lancs & South Cumbria Apologies Gary Hall Chief Executive Officer Chorley Council Apologies Gary Raphael Finance Director Healthier Lancs & South Cumbria Attended Jane Cass Acting Director of NHS England Attended Operations Lawrence Conway Chief Executive Officer South Lakeland District Council Attended Sir Bill Taylor Chair Healthwatch Attended Neil Greaves Communications and Healthier Lancs & South Cumbria Attended Engagement Manager Clive Unitt Lay Member Morecambe Bay CCG Apologies Dave Tillary Representative West Lancashire Borough Council Attended Dean Langton Representative Pendle Borough Council Apologies Debbie Nixon SRO Mental Health Healthier Lancs & South Cumbria Attended Neil Jack Chief Executive Blackpool Council Apologies Sakthi Karunanithi Director of Public Health Lancashire County Council Apologies Katherine Fairclough Chief Executive Officer Cumbria County Council Attended David Bonson Chief Operating Officer Blackpool CCG Attended Harry Catherall Chief Executive Officer Blackburn with Darwen Council Attended Steve Thompson Director of Resources Blackpool Council Attended Vanessa Wilson Divisional Manager East Lancs Hospital Trust Attended Charmaine McElroy Business Manager to Healthier Lancs & South Cumbria Attended Amanda Doyle Lucy Atkinson Communications and Healthier Lancs & South Cumbria Attended Engagement Officer
______Joint Committee Clinical Commissioning Group Page 1 of 9
ACTION 1 Welcome and Introductions Information
The Chair welcomed the members of the Committee to the formal meeting. He explained the status of the meeting and that the Committee had invited members of the public to a drop-in session prior to the meeting commencing, in order to give them the opportunity to ask questions in advance. He added that there would still be an option to ask questions after the meeting had finished.
The Chair welcomed Denis Gizzi, Chief Officer for Greater Preston and Chorley and South Ribble CCG to the meeting. 2 Apologies and Quoracy Information
Apologies were received from: Dr Amanda Doyle, Debbie Corcoran, Geoffrey O’Donoghue, Gora Bangi, Sumantra Mukerji, Sakthi Karunanithi, Dean Langton, Gary Hall, Andy Curran and Neil Jack.
The Chair approved Denis Gizzi as the formal representative from Greater Preston and Chorley and South Ribble CCG to make the meeting quorate.
RESOLVED: The Chair noted the apologies and declared the meeting quorate 3 Declarations of Interest Information
The Chair requested that the members declare any interests relating to items on the agenda. The Chair reminded those present that if, during the course of the discussion, a conflict of interest subsequently became apparent, it should be declared at that point.
RESOLVED: No declarations of interests declared 4 Minutes from previous meetings for ratification Agreement
The Chair explained that the outstanding issues with the minutes from 6th July 2017 and 2nd March 2017 had now been rectified. The Chair thanked Mary Dowling for her contribution in resolving the outstanding issues.
• 7th September 2017 – Minutes approved with no amendments • 6th July 2017 - Minutes approved with no amendments • 2nd March 2017 – Minutes approved with no amendments
Revised Joint Committee of CCGs Terms of Reference
The Chair explained that the Terms of Reference had been refreshed to bring them in line with the current environment, with the outstanding comments provided by Phil Huxley and Mary Dowling incorporated. The Chair reminded members that the Terms of Reference will be reviewed again towards the end of the financial year and following the outcome of the STP Gateway Review, the roles and Terms of Reference for other associated groups will also be reviewed. The Chair commented that he is hoping that we can now use the revised Joint Committee Terms of Reference as a springboard for the Joint Committee to move forward. Mary Dowling commented that the revised Terms of Reference are as good as they can be at this stage and she paid tribute to Charmaine McElroy and other colleagues for their work on them.
ACTION: The revised Terms of Reference were agreed ______Joint Committee Clinical Commissioning Group Page 2 of 9
5 Action Matrix Review Information
The Chair explained that we had undertaken a refresh of the action matrix and the following points were discussed:
• Evaluation and Hurdle Criteria – This has been removed from the matrix as an action for the Joint Committee and work is progressing on this via the Care Professionals Board. • Integrated Diagnostics – This has also been removed from the action matrix, as the work around this is being picked up via the Provider Group, as part of the work around the Carter Review. Mary Dowling queried whether there will be any commissioning issues in relation to this that would still require intervention from the Joint Committee. Gary Raphael responded to clarify that this work will have significant links with primary care and the intention is for the Provider Group to lead on developing the work, then when a decision will be required from commissioners, this will come back to the Joint Committee at the appropriate time. • Mental Health – The Chair explained that work is ongoing on this, linked to the commissioning development work. This will be brought back to the Joint Committee at the appropriate time. Harry Catherall commented that it is critical that we involve broader agencies such as the police in our work on mental health service development. Members of the Committee agreed with this.
6 Any Other Business Declared: Information
The Chair asked the members of the Committee if they had any other business they wished to declare for discussion at the end of the meeting.
RESOLVED: No other business was declared
The Chair added that there would also be an opportunity for the public to ask questions at the end of the formal meeting.
7 Local Maternity Services (LMS) Plan Support
The Chair invited Vanessa Wilson, Divisional Manager at East Lancashire Hospitals Trust, to commence her presentation.
Vanessa Wilson explained that the purpose of the presentation today is to apprise the Joint Committee of CCGs of the ongoing work across Lancashire and South Cumbria (L&SC), with regards to Maternity Services, in line with national strategy and expectations. She explained that she is seeking support from the Committee today on the high level plan, which is summarised within the slides presented today.
In 2015, Simon Stevens commissioned Better Births, a Five Year Forward View for Maternity Care. The key task is to deliver the expectations within Better Births across L&SC by the end of 2020/2021. The key elements are to improve maternity services in the following areas:
• Improving choice and personalisation • Improving safety of services • NHS Personal Maternity Care Budget • Continuity of Care • Working with Strategic Clinical Networks
______Joint Committee Clinical Commissioning Group Page 3 of 9
• Development of Maternity Voices • Partnerships
Vanessa Wilson explained that the demographics are challenging and there are significant workforce challenges around this agenda, with complex interdependencies that need to be considered that affect the flow of patients between hospitals.
An LMS Board has been created, which is coterminous with STP geography. This is a key requirement outlined within Better Births. She explained that the governance structure surrounding LMS is complex and there are significant links with other areas of health and social care services that need to be considered.
The LMS plan had been submitted to regional colleagues on 22nd October 2017, in line with national timescales. Vanessa Wilson indicated that there will not be national feedback on this; the regional teams will provide assurance to national colleagues on the robustness of the plan.
Vanessa Wilson explained that she has not shared the detailed plan with members today, as it is in excel format with a significant number of lines of tasks. However, she indicated that she is happy to share this with members if felt necessary.
She went on to explain that the plan does not sign us up to a way of changing services radically, it is a vehicle to implement the requirements outlined within Better Births and reduce variation and inequalities going forward.
A Project Manager and Communications and Engagement Officer will be appointed to support the workstream.
Workstream Chairs are already in place from constituent organisations and they are undertaking these roles in addition to their day job.
The Chair thanked Vanessa Wilson for her presentation and invited questions from members.
Graham Burgess asked regarding the timescales of the project. Vanessa Wilson explained that over the next 6 months, by the end of March 2018, baseline mapping will be undertaken and completed.
Vanessa Wilson also offered to produce a condensed version of the plan, Vanessa indicating the key tasks and timescales and agreed to share with members. Wilson
Phil Huxley commented on the governance structure for the project and asked how patients are involved. Vanessa Wilson confirmed that there are patient voices on the LMS Board and other opportunities for engagement. It was acknowledged that we need to connect with people rather than just services.
Harry Catherall went on to say that in Blackburn with Darwen he was surprised by how many young new families in the area do not really know about the support services out there. It was acknowledged that we need to ensure that we connect to our communities. Vanessa Wilson stated that there are plans to address this by establishing community hubs focused on local communities.
Mary Dowling asked whether the workforce elements of the programme will be worked through on a L&SC basis, or whether it will be influenced nationally. Vanessa Wilson responded to say that there is a workforce planning tool that is ______Joint Committee Clinical Commissioning Group Page 4 of 9
used for maternity workforce modelling, which is quite limited and does not take account of the broader pregnancy journey, where other services from different parts of the system can add value. She acknowledged that there are opportunities to bring together the relevant sections of the woman’s care pathway, to improve the whole journey.
Sir Bill Taylor reflected on a personal experience and asked what mechanisms there are in place for patients to feedback on their experience and suggest improvements. Vanessa indicated that there are opportunities for patients to talk about and review their experiences and the service welcomes this as part of continuous learning.
Paul Kingan asked whether there are any specific issues for West Lancashire to be aware of in relation to this work. Vanessa Wilson agreed to link-in with Paul Kingan outside of the meeting to discuss further.
ACTION: The Joint Committee agreed to support this plan. 8 Transforming Care Decision
The Chair invited Debbie Nixon to commence her presentation.
Debbie Nixon stated that it is important to note that the boundary changed in April 2017 when the Morecambe Bay footprint changed.
She explained that the Transforming Care Programme is aimed at moving away from hospital care, to more community orientated provision and we will be working with the lead commissioner as the programme progresses. We have a legacy agreement in place and we were charged with being ambitious in reviewing the model for L&SC, to develop a strategic plan and establish a Task and Finish Group to work up the model of care and develop options for public consultation by March 2020, when the legacy agreement will end and the new model of care will be in place.
Paul Kingan queried the groups of people that are on the Operational Delivery Network. Debbie Nixon explained that the governance around the programme is very complex, but national guidance is prescriptive and the governance is in line with this. She added that Lancashire Care Foundation Trust is in a position to lead the Operational Delivery Network, which will bring together the providers in the North West, not just providers of Learning Disabilities services, including primary care and mental health.
Debbie Nixon stated that this does not mean that we lose a grip on this on a L&SC basis. It is an opportunity for greater collaboration, to enable some of the workforce challenges and other complex areas to be effectively managed and worked through.
Harry Catherall commented that Blackburn with Darwen Council provide a number of services to people with Learning Disabilities. He stated that it is critical that we properly understand the financial assumptions around Calderstones, as it will be difficult to facilitate faster discharges when the funding arrangements are not clear. He stressed the importance of urgently reviewing this issue.
Graham Burgess welcomed sight on the timeline for delivery and felt this was really useful for the Committee. He queried the Lancashire housing providers and local pools, asking why the commissioning functions where listed in phase 2 rather than phase 1. Debbie Nixon explained that there are colleagues that are leading on the housing strategy elements, in terms of the full financial ______Joint Committee Clinical Commissioning Group Page 5 of 9
arrangements.
She went on to explain that the first iteration of the strategic plan aspired to having a single STP pooled budget, but this was not supported locally and so an alternative way forward was suggested by the national team. The recommendation from national colleagues was that we have to get our pools in place, or we will not get the funding flows right. The initial thoughts are that pooling in unitary areas would make most sense, as this has been most successful in other areas. Debbie Nixon explained that this will be the starting point and work will progress on assessing the benefits of this, to enable additional pools to be formulated. She went on to explain that a wider strategic case for change needs to be developed and this will require the support of the Joint Committee at the appropriate time.
Mary Dowling raised a query regarding the timeline for the signoff of the plan. Debbie The timeline within the paper states November 2017 and she asked for clarity Nixon around this. Debbie Nixon apologised for the confusion and clarified that this should read that November 2017, the Joint Committee receives this update and not the actual plan. She agreed that she would amend this timeline and recirculate the paper to members.
Roy Fisher also raised a query regarding the timeline around the technical appraisal of the clinical model. He asked that when the initial outcomes from the technical appraisal are collated, whether this should be brought back to the Joint Committee for discussion.
Debbie Nixon explained that both the Mental Health and Learning Disabilities commissioning cases for change are being developed as part of the ongoing work around commissioning development and this will be brought back to the Joint Committee at the appropriate time.
ACTION: Subject to amendments to the timeline within the paper, the Joint Committee agreed to support this proposal
9 Urgent and Emergency Care/Core 24 Support
The Chair invited David Bonson to commence this item.
David Bonson explained that A+ E departments across Lancashire and South Cumbria are seeing a high number of mental health patients in crisis, which is not the best place for them to be treated for their mental health needs. He explained that there are two funding streams available to improve services for mental health patients in crisis, by putting provision in place as an alternative to A+E.
L&SC had been successful in a recent bid submitted to secure Core 24 services, which is 24 hours a day/7 days a week support for mental health patients in crisis situations. He stated that an application was made to access the funding earlier this year to implement this service now, to ensure that mental health patients are seen in the right place at the right time in the most appropriate setting according to their needs.
Plans are already in place to put services into A+ E departments, so that mental health patients presenting in crisis will be seen by the appropriate service to meet their needs. David Bonson stated that there will be specialist mental health triage and support in place within A+E departments and an access line which will be manned by mental health professionals, so that patients can access quick advice and support. The access line will be operational from 5th December 2017. ______Joint Committee Clinical Commissioning Group Page 6 of 9
David Bonson explained that there is some urgent care funding for developing services at Furness General Hospital.
He went on to explain that there will be a gap in funding next year and CCGs will need to pick this up earlier than expected to ensure that the service developments are maintained. This is expected to come from CCG allocations.
Denis Gizzi queried the purpose of reducing unnecessary admissions to A+ E departments and asked whether we should be striving for zero waits. Debbie Nixon explained that the ideal state is that we have far fewer attendances at A+E, by deflecting patients to an appropriate alternative, however patients are still turning up at A+E departments and we are doing our best to deter people and deflect, but mental health patients are a complex cohort of people who have both mental and physical problems and we cannot aspire to zero waits, but we can do everything we can to reduce them by ensuring appropriate alternative provision.
Phil Huxley stated that careful thought and planning would need to be undertaken regarding the workforce to support redirecting people to other services, in that they need to be appropriately skilled and robust enough to cope with demand. He also asked why CCGs should draw down funds to support this, rather than using it elsewhere. Debbie Nixon responded to reiterate that we are required to deliver a very prescriptive Mental Health Five Year Forward View. We do not have a choice in this and the draw down of funding to support this work will enable us to deliver improvements in this area much quicker and this is not a choice locally. She went on to explain that Consultant Psychiatrists will be appointed and in addition to Core 24 delivery they will have a wider role.
Alex Gaw raised concerns over funding for Morecambe Bay. Debbie Nixon confirmed that Morecambe Bay is not expected to draw down the money for South Cumbria as it was based on the footprint before the boundary change. This issue has been signalled to the national team regarding the boundary change.
Mark Youlton asked whether we are responding to the immediate funding available for this, or whether are we trying to transform care to seek improvements in this area. Gary Raphael responded to reiterate that within the Five Year Forward View there are a number of priorities and must do’s that we need to achieve and that we do not have a choice about the model of care that we need to deliver. He went on to clarify that national colleagues have agreed to provide non-recurring money to deliver this in a certain number of health economies. We have to do this anyway, but we have the opportunity to do this faster with support from the centre around this.
Gary Raphael stated that he is doing some wider work on CCG allocations and other funding sources, working with Chief Finance Officers, to help colleagues understand all of the different funding elements and streams.
Debbie Nixon responded stating that she was concerned that Core 24 is being considered by some Committee members as something that we may not want. She explained that this has been evaluated nationally and has had significant impact in other areas and it is considered as something that needs to be implemented faster to see the greatest impact.
Mark Youlton stated that he understands all of this, but we also need to tackle mental health at source, such as in schools, social media etc. Gary Raphael stated he agreed with this and explained that we are taking all opportunities available regarding national funding to accelerate service developments, but it was acknowledged that there are some more significant strategic issues such as ______Joint Committee Clinical Commissioning Group Page 7 of 9
this that need to be progressed as a priority.
The Chair explained that as a system we have not yet got into a position where we can avoid dealing with the urgent issues now, but we do need to look at long term solutions and tackle things at source. We are being told that we have to get on with this and do it next year, so we are taking every opportunity in terms of funding available, to accelerate this work.
Debbie Nixon explained that she and Sakthi Karunanithi are doing a lot of work Sakthi around prevention. It was suggested that it would be worthwhile for Sakthi Karunanithi/ Karunanithi to do a presentation to the Joint Committee at an appropriate future Debbie date, to talk about the ongoing prevention work. Nixon
ACTION: The Joint Committee agreed to support this proposal.
10 Capital and estates pipeline Support
The Chair invited Gary Raphael to commence this item.
Gary Raphael explained that the purpose of this report and update today to the Joint Committee is to ensure that members are aware that the L&SC Sustainability and Transformation Partnership (STP) is developing an estates and capital strategy, in line with national expectations and requirements, to enable us to access national capital funding streams. Gary Raphael stated that without a clear and robust strategy in place, we cannot progress in this area and money will not come down to the Partnership. He stated that the ask of the Joint Committee today is to ensure members are apprised of the issues around this and he is seeking support from the Committee to progress. He added that the timescales are tight for developing and submitting this strategy, the deadline is the end of November 2017. He went on to explain that the STP will need to agree to relevant schemes and plans, which will be in line with the overall L&SC strategy, in order to allocate funds appropriately. He stated that there is a L&SC Capital and Estates Workshop taking place on 3rd November 2017, to progress development around this.
Harry Catherall commented that he strongly supports this initiative, but added that the One Public Estate Programme needs to be considered in this process, as they will be able to offer valuable resource and support to strengthen the strategy. Gary Raphael acknowledged this.
Sir Bill Taylor asked whether lease vehicles have been considered as part of this work. Gary Raphael responded to say that currently this area has not been considered, but this may be one of the issues raised at the workshop tomorrow.
Mary Dowling asked Gary Raphael what he requires from members of the Committee to help produce this strategy within the required timescale. He responded to say that the workshop tomorrow will be a critical stage in its development and that he requires the Joint Committee to support the proposal to develop this.
Phil Huxley asked whether IT will be included within the strategy. Gary Raphael confirmed it will be and that we need a clear picture on the assets we have got across the system, to enable us to determine what we need to improve going forward.
Mark Youlton stated that he strongly supports this. He commented that it is also ______Joint Committee Clinical Commissioning Group Page 8 of 9
worth having a discussion with Lancashire County Council around buildings, we need a consistent approach in the use of buildings.
ACTION: The Joint Committee agreed to support this proposal.
The next JCCCG Meeting will be held on: 11th January 2018, 1.00pm – 3.00pm – venue to be confirmed
The Chair thanked the Committee members and members of the public for their attendance and closed the meeting prior to taking questions from members of the public.
Topics discussed through the Public Questions:
Core 24 – recruitment of staff Public consultation/co-production – when this will happen Transforming Care – longer term funding for such services. Clarity on this. Engagement with business community crime services
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