Meeting Pack

Governing Body Part 1 Meeting

3 March 2021 09:30 – 12:00pm

http://www.swlondonccg.nhs.uk/ 1 of 134

Agenda NHS South West London Governing Body Meeting - Part 1 Meeting 03 March 2021 09:30 – 12:00 Microsoft Teams Meeting due to Coronavirus COVID-19

No. Timing Item Lead Action Enclosure

1. 09:30 Welcome, Introductions and Apologies Chair Information Declarations of Interest All members and attendees may have interests relating to their roles. These interests should be declared in the 2. 09:35 register of interests. While these general All Information Enc 01 interests do not need to be individually declared at meetings, interests over and above these where they are relevant to the topic under discussion should be declared.

Minutes of the last meeting dated 04 Enc 02 3. 09:40 All Approval November 2020 & Matters arising

Andrew Information 4. 09:50 Chair & Accountable Officer reports Murray/ Enc 03 Sarah Blow

Covid update Matthew Information Enc 04 10.00 5. Kershaw • Covid vaccination

Committee Updates & reports Paul Gallagher • Audit Committee

David Smith • Finance Committee

James Murray • SWL CCG Finance report

Susan Gibbin • Primary Care Commissioning Information Enc 05 10.20 Committee & 6. (a – f) discussion

Pippa Barber • Quality, Performance Oversight

Committee Jonathan

Bates • Performance report

David Smith • Remuneration Committee (no update)

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Richmond & Kingston IAPT contract Tonia 10:45 Enc 06 7. proposals Michaelides Approval

Update on Kingston & Richmond Tonia 8. 11:00 Information Enc 07 community provider collaboration Michaelides 9. 11.15 Board Assurance Framework Ben Luscombe Discussion Enc 08 For 10. 11:30 IG annual report Ben Luscombe information Enc 09 only

Public Questions – By email Members of the public are invited to ask Andrew Information 11:45 11. questions, in advance by email, of the Murray Committee relating to the business being conducted today.

12. 11.55 Any Other Business

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3 of 134 NHS SOUTH WEST LONDON CLINICAL COMMISSIONING GROUP REGISTER OF DECLARED INTERESTS

Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial 1 2 1 Parchmore Partnership Partner 3 2 Haling Park Medical Practice Partner 3 Croydon GP Collaborative Parchmore Partnership and Haling Park Medical Practice are shareholders 4 National NHS Pathways Governance Group (Royal College General Practitioners) Chairman 4 5 South London Faculty Board, Royal College of General Practitioners Member 6 NHS England (London) - Pan London Integrated Urgent Care Governance Group 1 - 2 Roles and responsibilities held Chairman 6 within member practices 7 London Urgent and Emergency Care Clinical Leadership Group Member National NHS Pathways Programme Board (NHS England/Health & Social Care Information 8 3 Shareholding Centre) Member 7 8 Health Education England South London GP Trainer 10 Elected GP Lead Croydon Borough 9 Russell School Trust (Royal Russell School) Governor 11 5 4 - 8 position of authority held in the Declared Discuss where Agnelo Fernandes Governing Body Member Y 10 Community Phlebotomy Service field of health and social care present relevant with the Conflict Audit Committee Member 11 Parchmore Partnership provides premises for this service Community Anti- 12 of Interest Guardian Coagulation Service Parchmore Partnership provides premises for this service to 13 CICAS from October 2019 12 Community Minor Surgery Service Parchmore Partnership provides premises 14 8 - 17- Other 13 Community Diabetes Service - Bromley Healthcare Parchmore Partnership provide 9 the premises for this service 14 Guy's, King's and St Thomas's Medical School Parchmore Partnership Medical 15 Learner Centre 15 Dr ABC First Aid Training Company Wife-owner. Provides training for 16 schools/nurseries and some GP practices (there is no link to the CCG or contracting) 16 Connect Physiotherapy ( NHS) Parchmore partnership provides the premises for 17 this service 17 Circumcision CentreParchmore Partnership provide the premises for this service

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2 3 Present 1. GP Partner in The Nelson Medical Practice (Practice is a member of the Merton GP Federation) SWLCCG Chair 1. April 2015 Present 2. Chair of Executive Management Team at Nelson. Chair of the Governing Body June 2017 3.Trustee of Health and Hope UK (charity supporting workers in Myanmar). Andrew Murray Remuneration Committee attendee Y 2. April 2015 Adherence to COI policy 4. Regular attendee of Raynes Park Community Church, which is a member of 3. April 2015 Merton Citizens, a community movement whose campaign areas include mental health services for children and young people. 4. Personal

Governing Body Attendee Asiya Yunus Y Sessional GP, The Hurley Group 1 Jan-19 Present Adherence to COI policy London Wide LMC Representative

4 of 134 Page 1 of 7 Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial Chief of Staff Governing Body Attendee Ben Luscombe N Nil return Audit Committee Attendee Remuneration Committee Attendee 1.Declaration only. Not 1. 14 September To date an employee in a position 1. Employed by Richmond CVS. A Voluntary Sector Charitable Company which 2010 1 of influence in Charity. acts as an Voluntary Sector Infrastructure Organisation and receives Local Not a CCG decision Authority and CCG contracts and grants from bodies within the SW London maker. CCG area. To date 2. Declaration only. Governing Body non voting attendee 2. October 2015 Company is not currently invited to specified committee and 2. Minority shareholder in wife’s private limited company ‘Life in Balance Ltd’ active in SW London. Not board meetings in public as a nominee which provides massage and reflexology services and has had spot contracts a CCG decision maker, Bruno Meekings of Voluntary Sector Infrastructure Y with West London CCG. 3. Declaration only. CML Organisations within the SW London To date CIC is not currently active CCG area 3. Wife is a Director of ‘Community Massage London Community Interest 3. January 2018 in SW London. Not a Company’ (CML CIC) An asset locked CIC which promotes and delivers 2 CCG decision maker. complimentary therapies in NW London 4. Declaration only. H+F 3 CCG has defined 4. Lay Governing Body Member for Patient and Public Involvement (PPI) 4 operating area.. Not a Hammersmith and Fulham CCG (H+F CCG) To date SW London CCG 4. November 2019 decision maker. Director of Communications and Engagement Charlotte Gawne SMT Member N Nil return Patient and Public Reference Group Member 1. Director of Public Health, LBM In this role potential / perceived conflict of interest re any decision about future 1. Feb 2016 1. Not being a member of of St Helier’s Hospital. 1 the CIC, being excluded 2. Partner is owner of ZG publishing (publishes the magazine: “Outdoor Director of Public Health (Merton) 2. Feb 2011 from any decision making Swimmer”). Dagmar Zeuner Governing Body Attendee Y on the future of St Helier, 3. Honorary senior lecturer at the London School of Hygiene and Tropical 3. Apr 2006 which includes circulation Medicine. 2 of related unpublished 4. Research advisor (occasional) for University of London/Institute of Child 3 4. Apr 2010 papers. Health.

Governing Body Deputy Chair Lay Member Finance 1. Director - D Smith Partnership Ltd 1 1. Jan 2018 Finance Committee Chair 2. Senior Adviser - Newton Europe 2 2. Jan 2018 David Smith Audit Committee Member Y 3. Trustee - Active Oxfordshire Adherence to COI policy 3. Jan 2018 Remuneration Committee Member 4. Independent Chair of the Joint Committee for the NHS 111 and Clinical 3 4. Feb 2019 Assessment Service Procurement: Kent, Medway and Sussex 4

Elected GP Lead Sutton Borough 1. Mulgrave Road Surgery 1 1. GP Principal Present Declared discuss where Governing Body Member Dino Padhanani Y 2. Sutton GP Services (Sutton Federation) 2 2. GP Practice is a Member Present relevant with the Conflicts Audit Committee Member 3. Clinical Director Central Sutton Primary Care Network 3 3. Clinical Director Present of Interest Guardian

5 of 134 Page 2 of 7 Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial 1 Nursing and Midwifery Council (Associate Council Member 2 days Chief Nurse and Director of Quality 1. Nursing and Midwifery Council (Aassociate Council Member 2 days a month) a month) Governing Body Member 1. 8.12.20 1. Ongoing Ensure Board dates do Gloria Rowland y 2. Care Embassy Consultancy & training Ltd - Director 1 2. Care Embassy Consultancy & Quality & Performance Oversight 2 2. 21.01.17 2. Ongoing not conflict Director training Ltd Committee Member Director (Husband owns the Company) Executive Director health,Croydon 1. Trustee of National Charity for people with Learning Disabilities and Mental Guy van Dichele Council Y Health United Response Trustee Present Adherence to COI policy Governing Body Attendee 2. Member of ADASS professional body

6 of 134 Page 3 of 7 Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial Locality Executive Director Merton and I am not present at Wandsworth specific discussions James Blythe Governing Body Attendee Y 1. Spouse is an employee of Kingston Hospital from Oct 2019. 1 Oct-19 Present relating to the relevant Finance Committee Member service. Senior Management Team Member Chief Finance Officer Finance Committee Member Audit Committee Member 1. MPL Ltd. (Director) 1 1. 30/09/03 James Murray Y Adherence to COI policy 2. Provek Ltd (Associate Director) 2 2. 30/09/03

Executive Director Systems Planning Performance and Delivery Governing Body Attendee SMT Member Spouse provides primary care Highlighted potential 1. Spouse provides primary care consultancy and interim support to a range of Jonathan Bates Quality & Performance Oversight Y 1 consultancy and interim support to a Autumn 2020 ongoing conflict to the organisations. Committee Member range of organisations. Accountable Officer Primary Care Commissioning Committee Member

1. Chief Executive Surrey and Sussex LMCs Present 1 2008 2. Salaried GP, Farnham Road Surgery Present 2 2005 Governing Body Attendee 3. GPC representative: Surrey and Croydon constituency Present 3 2009 Julius Parker Surrey and Sussex LMCs Y 4. GPC Policy Lead: Contracts and Regulation Present Adherence to COI policy 4 2019 Representative 5. Fitness to Practice Tribunalist, Medical Practitionery Tribunal Service Present 5 2011 6. Medical Director East Berkshire Primary Care Out of Hours Service which Present 6 2004 includes Richnond Executive Director Strategy and Transformation Governing Body Attendee Karen Broughton N Nil return SMT Member Primary Care Commissioning Committee Member Secondary Care Consultant Governing Body Member Quality & Performance Oversight Committee Member 1. Daughter Consultant Obstetrics & Gynaecology Imperial Healthcare Trust 1 Declared Discuss where Finance Committee Member 1 April 2020 Les Ross Y 2. Son in law Consultant Urologist Surrey and Sussex Healthcare Trust 2 relevant with the Conflict Primary Care Commissioning 3. Grandson autistic resides in Merton 3 of Interest Guardian Committee Member Audit Committee Member

Liz Meerabeau Healthwatch Representative N Nil return Locality Executive Director Sutton I would recuse myself from Governing Body Attendee any SWL CCG GB agenda Lucie Waters Y 1. Spouse is a senior manager at Laing O’Rourke, Engineering 1 2007 Present Quality & Performance Oversight item related to any bid for Committee Member work from Laing O Rourke

7 of 134 Page 4 of 7 Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial Locality Executive Director Merton and My substantive NHS role is MD of To be excluded from any Wandsworth NEL CSU who provide services to conversations/decision Mark Creelman Governing Body Attendee Y 1. North East London Commissioning Support Unit (NEL CSU) 1 2017 both CCG and GP and other about commissioning Finance Committee Member provider organisations in SWL from the CSU Senior Management Team Member Placed Based Leader for Health Croydon Declared Discuss where Chief Executive Croydon Health Chief Executive Croydon Health Matthew Kershaw Y 1. Chief Executive Croydon Health Services NHS Trust 1 19-Oct-19 Present relevant with the Conflict Services NHS Trust Services NHS Trust of Interest Guardian Governing Body Attendee

8 of 134 Page 5 of 7 Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial

1. Partner at Groves Medical Centre 2. Director 424 Medical Ltd (Practice Management Support Group) 3. Wife is Director PIBNPOB Ltd 3. Elected GP Lead Kingston Borough 4. Member of Kingston General Practice Chambers Ltd Governing Body Member Naz Jivani 5. Groves Medical Contract for Shockwave therapy 1. Governing Body Vice Chair Y 2. 4. Practice 6. Co-Chair Kingston Health and Wellbeing Board 6. Finance Committee Member 5. Practice 7. Board member NHS Clinical Commissioners 7. 8. MSK GP with a Special Interest working at KHFT and Molesey Hosiptal 8. 9. Trustee Kingston CCG Charitable Funds 9. 10. KHFT Remuneration Committee and Councillor of Governors 10

Elected Governing Body Member Wandsworth Borough 1. Managing Partner Brocklebank Group Practice and St Paul's Cottage 1. Practices hold PMS/GMS 1. 1996 Governing Body Member Surgery. 1 contracts. 2. 2004 Governing Body Vice Chair 2. Clinical Lead for Cardio Vascular Disease, WCCG. Dr Nicola Jones holds no director Nicola Jones Quality & Performance Oversight Y Adherence to COI policy 3. Managing Partner - The Haider Practice (GMS) post and has no specific Committee Member 2 4. My practices are part of Battersea Healthcare (BHCIC). 3 responsibilities within BHCIC other 4. 2018 Primary Care Commissioning 5. Member of Brocklebank Primary Care Network than those of other member GPs. 5. July 2019 Committee Attendee

Elected Governing Body Member Richmond Borough Governing Body Member 1. GP Partner at Essex House (Richmond) 1 Declared Discuss where 1997 ongoing Patrick Gibson Quality & Performance Oversight Y 2. Practice is a member of Richmond GP Alliance (provider federation of GPs) 2 relevant with the Conflict 2014 ongoing Committee Member of Interest Guardian

Lay Member for Audit and Conflicts of Interest Guardian Governing Body Member Audit Committee Chair Present Paul Gallagher Y 1. PJ Gallagher Consulting Limited - Director 1 Owner 01-Sep-16 Adherence to COI policy Finance Committee Member Remuneration Committee Member

1. Declared - no services Independent Nurse provided in SWL Governing Body Member 2. Declared - no services Chair of the Quality & Performance 1. Director THF Health Ltd 1 1.2016 Present provided in SWL Pippa Barber Oversight Committee Y 2. Non Executive Director Kent Community Health NHS FT 2 2.2016 Present 3. Declared - diiscuss Member of Finance Committee 3. Trusteee Demeiza Childrens Hospice 3 3.2018 Present where relevant with the Conflict of Interest Guardian

9 of 134 Page 6 of 7 Do you Current position (s) held in the CCG have any i.e. Governing Body member; interests Declared Interest Action taken to mitigate Name Nature of Interest From To Committee member; Member to (Name of the organisation and nature of business) risk practice; CCG employee or other declare? Interest Indirect Interest

(Y or N) Non-Financial Financial Interest Financial professional Interest professional Non-Financial Personal Personal Non-Financial Accountable Officer Governing Body Member Audit Committee Member Sarah Blow N Nil return

Lay Member Patient Public and Engagement Governing Body Member Chair of Primary Care Commissioning 1. Bourne Education Trust 1 1. Trustee/Director Susan Gibbin Y Adherence to COI policy Committee 2..St Mary's Primary School, Oxted 2 2. Chair of Governors Quality & Performance Oversight Committee Member Remuneration Committee Member Locality Executive Director Richmond and Kingston Tonia Michaelides Governing Body Attendee N Nil return Quality & Performance Oversight Committee Member

1. GP Principal - Stonecot Surgery (Practice is a member of Merton GP Federation) 2. GP Trainer 3. GP Appraiser 4. F2Y Supervisor 5 5. Wife is Medicines Optimisation lead in Sutton CCG. 6. Senior Lecturer in Physician Associate Education- SGUL 1 7. Teaching at St Georges University of London since Sept. 2008) -My former students work at many hospitals including St Georges, St Helier’s, Epsom, Kingston and Croydon. 8. Over the last 20 years have held numerous discussions with various practices and clinicians regarding closer working, shared guidelines and templates, exploring joint appointments, shared buildings etc. Elected GP Lead Merton Borough 6 Vasa 9. Primary care practitioner St Georges Accident and Emergency department 7. 2008 Governing Body Member Y 7 Adherence to COI policy Gnanapragasam 1997-2013. 9. 1997 9. 2013 Finance Committee Member 10. Partner- Dr Scott and partners, Sutton - skill mix and long term conditions. 11. Have met with a few of the neighbouring practices to discuss the impact of Morden regeneration and also discussed skill mix - currently employ physician Associates. We discussed the possibility of joint appointment of a clinical pharmacists across our practices. 12. Have met with a few peers to discuss primary care at scale and primary 9 care Home. 13. Board member of Morden PCN. 14, Clinical supervisor, educational supervisor to a doctor working under GMC conditions. 15 15. A Partner at my practice is the clinical lead of Merton learning hub 16 16. A Partner at my practice is joint CD of our PCN 17 17. A doctor at my practice works for the federation, diabetes QI team.

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MINUTES South West London Clinical Commissioning Group GOVERNING BODY PART 1 Wednesday 4 November 2020 Meeting took Place by Microsoft Teams due to Coronavirus COVID-19

Chair: Dr Andrew Murray

Members: Dr. Andrew Murray SWL CCG Clinical Chair Dr. Naz Jivani Kingston, elected GP Borough Lead Dr. Nicola Jones Wandsworth, elected GP Borough Lead Dr. Dino Pardhanani Sutton, elected GP Borough Lead Dr. Agnelo Fernandes Croydon, elected GP Borough Lead Dr. Patrick Gibson Richmond, elected GP Borough Lead Dr. Vasa Gnanapragasam Merton, elected GP Borough Lead

Lay Members David Smith SWL CCG, Deputy Chair & Lay member Finance Paul Gallagher Lay Member, Audit Chair Susan Gibbin Lay Member, Public & Patient Engagement

Independent Members Pippa Barber Registered Nurse Dr. Les Ross Secondary Care Doctor

Executive Members Sarah Blow SWL CCG Accountable Officer James Murray SWL Chief Finance Officer

Attendee Role Mark Creelman Locality Executive Director, Wandsworth & Merton Tonia Michaelides Locality Executive Director, Kingston & Richmond Lucie Waters Deputy Executive Director, Sutton Matthew Kershaw Place Based Leader, Croydon Karen Broughton Executive Director of Strategy and Transformation Jonathan Bates SWL CCG Director of System Planning, Performance and Delivery Charlotte Gawne Executive Director of Communications & Engagement Ben Luscombe Chief of Staff, SWL CCG Yvonne Hylton SWL CCG Committee Officer (Minutes)

Local Medical Councils Asiya Yunus London Wide LMC

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Local Authority Representatives Dagmar Zeuner Director Merton Public Health Guy van Dichelle Director of Adult Social Care Ian Dodds Director of Children’s Services Voluntary Sector Representative Bruno Meekings Voluntary Sector representative

HealthWatch Representative Liz Meerabeau Kingston, Chair

HealthWatch Observers Dave Curtis Merton, Head Mike Derry Richmond, Chief Officer Pete Flavell Sutton, Chief Executive Office Stephen Hickey Wandsworth, Chair Edwina Morris Croydon, Chair

Apologies Julius Parker Chief Executive, Surrey, and Sussex LMC

No. AGENDA ITEM Action by 1 Welcome and Apologies

The Chair welcomed the members, attendees and observers to the meeting advising that the meeting was being broadcasted live and that there would be an opportunity for people to ask questions during the broadcast, which depending on the time allowed, would be responded to either in or after the meeting.

The Chair welcomed Dr Dino Pardhanani, newly elected GP Borough Lead for Sutton, Mark Creelman, recently appointed interim Locality Executive Director for Merton and Wandsworth and Ian Dodds, Director of Children’s Services who were all attending their first meeting of the Governing Body.

Apologies were received from Julius Parker, Chief Executive, Surrey and Sussex Local Medical Committee.

With no further apologies the meeting was quorate.

2 Declarations of Interest

Conflicts of Interest Register

The register was APPROVED as a full and accurate record of all declared interests.

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3. Minutes of the meeting and matters arising from the Governing Body Part 1 meeting held on the 2 September 2020.

The minutes were APPROVED without amendment.

The action log was reviewed, and all actions were completed.

There were no outstanding matters arising.

4 Chair and Accountable Officer Reports

Chair’s report

The Chair highlighted key points from his written report, particularly that, since his report was published Dr Agnelo Fernandes had been re-elected as GP Borough Lead for Croydon.

Secondly, the Chair wanted to emphasise that, as we move into a further peak in the pandemic that the NHS, and in particular General Practice, was open for business. The Chair noted that it was important to encourage people with non- Covid related concerns to continue to seek support and treatment from the NHS.

Lastly, and not in his written report, the Chair informed the Governing Body that, last night, the Secretary of State for Health and Care (The Rt Hon Matt Hancock, MP) had accepted the recommendation from the Independent Reconfiguration Panel that the Improving Healthcare Together Programme should continue. The Secretary of State’s acceptance meant that the programme, which would see the investment of £500M to build a new Specialist Emergency Care Hospital in Sutton and investment in the Epsom and St Helier hospital sites, can proceed to the original timetable with the aim for the new hospital to open in 2025. The Chair confirmed that, as members would be aware, that all those involved have committed to ensuring the three hospitals meet the needs of local people. As part of this, the organisations have commissioned the King’s Fund to carry out a deprivation review for East Merton and North Sutton looking at bus routes from Merton and further into Surrey and car parking on all three sites for staff, visitors, and patients. The CCG will continue to meet with the Trust, who will develop the business case.

Accountable Officer Report Sarah Blow (SB) highlighted two items from her written report. Firstly, the appointment of SWL CCG/ICS Chief Nurse and Director of Quality, Gloria Rowland. Gloria is currently the Director of Midwifery at Barts NHS Trust and joins SWL at the beginning of January 2021.

Secondly, the work taking place across SWL in preparation for the Covid-19 vaccination which could be available from as early as December. However, exact timings and quantities of the vaccine are not known. Tonia Michaelides and Matthew Kershaw are leading the work and would be happy to answer any questions.

The following questions and comments were received from members and attendees:

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Susan Gibbin (SG) asked if the second Covid wave would have an impact on the recovery of planned care.

The Chair responded that whilst a second wave was not in the original planning guidance, SWL had factored this into the plans and there is now significant work taking place to maintain planned activity.

Matthew Kershaw (MK), from the perspective of an Acute Provider CEO, gave an overview of some of the work taking place in Croydon to ensure planned care continued. MK noted that, each hospital in SWL had taken a similar but local approach and hospitals were working collectively to sustain planned care for the SWL population.

Bruno Meekings (BM) asked that, if a mass Covid vaccination programme started in December, would there be enough time to absorb and apply the learning from the Flu vaccination programme. TM noted that there was absolutely some learning that could be shared but that the vaccine had very different characteristics and the programmes would substantially differ.

Charlotte Gawne (CG) updated the meeting on the communication strategy relating to the vaccination programme.

MK noted that, while communication is a priority, there were two other key priorities. Firstly, workforce; to ensure there is the capacity to deliver the vaccine and, secondly, logistics; both the site locations and how they are supported.

The Chair thanked everyone for their contribution to the discussion.

The Governing Body NOTED the Chair and Accountable Officer reports.

5 SWL Mental Health & Learning Disability Update

5.1 Tonia Michaelides (TM) introduced the item and talked through the presentation which provides an outline of the work and future planning to support Mental Health and Learning Disability services in SWL.

The Borough Chair’s reports were included in the meeting pack and outlined the work that was taking place within each area.

The Chair thanked TM and the Borough Chairs and said it was clear from the presentations that there is a substantial amount of work taking place both at a SWL and borough level to support these services.

The following questions and comments were received from members and attendees:

In response to a question from Les Ross (LR), Pippa Barber (PB) noted that learning from the Learning Disability Mortality Reviews (LDMR) was discussed both at the SWL Performance Recovery Workstream and with the Directors of Quality. This work would also be reported through the Quality and Performance Oversight Group (QPOC).

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PB then asked if the boroughs had oversight of the new Learning Disability and ASD host commissioning arrangements. TM was able to confirm that the work had been completed at a SWL level and all boroughs were aware of the Providers within their boundaries.

In response to a question from SG highlighting the importance of carers in the process, TM noted that all boroughs have a Carers Strategy and SWL works with the boroughs to ensure their strategies reflect the support which is available.

DP asked whether the CCG was assured that, in the move to digital by default, there was the capacity to see patients who may not have access to digital or would benefit from being seeing face to face. TM noted that, finding the right balance was important and that it was important we support both patients and our staff so that they feel comfortable to support people both digitally and face to face where this is appropriate.

In response to a question from DZ asking whether regular COVID testing would be taking place for those working in SEND schools, TM noted that there were plans for mass testing such as the pilot which is starting in Liverpool.

BM asked two questions, firstly we are hearing that some voluntary sector organisations who are supporting carers and people with low level mental health conditions (not SMIs) are in extreme difficulty and may not survive and asked if there is the capacity in the community to accommodate the kinds of shifts in the levels of community support we are now seeing; and secondly in relation to Learning Disabilities does the CCG feel that the level of integration of the CCG planning and Local Authority Planning is sufficient.

In response to the first question from BM, TM said that the role of the Voluntary Sector in supporting people in the community was very important and agreed to work with BM to look at how the CCG could work with and support organisations who are struggling given the current demands.

Responding to the second question, TM said that the level of integration varies across SWL, but Sutton is a very good example of good integration and the learning from Sutton can be shared with other Boroughs.

The Chair thanked TM for a very good paper and the members for their contribution to the discussion.

The Governing body NOTED the SWL Mental Health and Learning Disability Updates and NOTED the Borough Chair’s updates.

6 Committee Chair’s Reports, Finance Report and Performance Report

6.1 A Chair’s report from each of the Committees of the SWL CCG was presented for note by the Governing Body. The report from the Finance and Quality, Oversight and Performance Committees were accompanied by the SWL CCG Finance Report and SWL CCG Performance Report. Each of the Chairs highlighted some key point for the meeting attention.

SWL CCG Finance Report Month 6

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James Murray (JM) presented the report which provided an overview of the position at Month 6. JM also provided a verbal update on the new financial regime from Month 7.

DZ asked whether, when we talk about the ‘SWL system’ this refers to NHS Finance or includes the Local Authority. JM responded by saying that the focus has been on NHS Finance but where the work overlaps, for example Continuing Healthcare and Discharges the two areas are considered.

SWL Performance report Month 5

Jonathan Bates (JB) presented the Month 5 Performance Report.

DS asked, if going forward, the performance report could include a written summary of these areas which describes issues, risks and actions being taken by the CCG to improve performance.

MK highlighted to the Governing Body that, in response to a CQC inspection in Croydon related to mental health care in the emergency department, the Trust had developed a detailed action plan.

In response to a question from LM regarding patient involvement during the current pandemic, Charlotte Gawne (CG) outlined that engagement during this time was challenging but the Communications Team had worked hard with Healthwatch colleagues to understand the experience of patients and as essential changes were made for the health and safety of staff and patients

The Governing Body NOTED the Chair’s updates and Committee reports

7 Planning Update – Response to Phase 3 Letter

7.1 JB presented the paper which sets out the plans to meet the requirements of the Phase 3 letter to restore and recover services for patients within SWL to pre-Covid levels.

The Chair thanked JB for a well written and informative report.

The Governing Body NOTED the report

8 SWL Flu Vaccination Programme 2020/21

TM presented and talked through item, updating the Governing Body on both 8.1 the approach to and delivery of the 2020/21 SWL Flu Vaccination Programme.

BM asked if Voluntary Sector sub-contractors doing equivalent roles to the NHS are seen as a vaccination priority. In response to a question from BM, TM said that the definition of priority staff who would be entitled to a vaccination, was set nationally and did not include the Voluntary Sector but agreed to raise this.

AF commented that, while the overall take-up of the vaccination across SWL is good, in areas of Croydon with a large BAME population the take-up is worse. To prevent a further widening of inequalities, as a system, we should

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consider how we engage with our communities. CG noted that this was something the communications and engagement teams were already working on.

The Governing Body NOTED the update

9 NHS 111 First proof of concept

9.1 MK presented the paper providing an update on the delivery of NHS First programme across SWL.

JB noted the current challenges with the SWL 111 provider, the fact this had been flagged to NHSE and that we were working hard to manage and mitigate these issues.

The Governing Body NOTED the update

10 Board Assurance Framework (BAF)

10.1 Ben Luscombe (BL) introduced the SWL CCG Board Assurance Framework.

In response to a question on the process for capturing Borough level risks BL outlined that, now the SWL Risk Register is established, the next step is to work with the borough teams to identify risks and whether they sit at a Borough or SWL level. Following this, BL said he would discuss with SB and KB how we ensure that we have the right balance between the CCG and ICS risk register.

The Chair noted that this is a work in progress and will continue to evolve and thanked BL for the update.

The GB NOTED the report.

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11 Mental Health Complex Care Business Case

11.1 TM introduced the business case which was being brought to the Governing Body, in order to ratify the recommendation of the CCG’s Finance Committee and the subsequent Chair’s Action taken to approve the Mental Health Complex Care Business Case.

DS noted that the business case had been reviewed in detail by the Finance Committee who agreed that the proposal to move financial responsibility to the SWL Partnership provides the opportunity to improve services and reduce costs. It was on this basis that the Finance Committee is recommending that the Governing Body approves the business case.

The Governing Body RATIFIED the Chair’s action on the recommendation of the Finance Committee to approve the Mental Health Complex Care Business Case.

12 Questions from Members of the Public: Members of the public are invited to ask questions relating to the business on the agenda

12.1 The following question had been received in advance of the meeting from Tony Burton, Secretary, Mitcham Cricket Green Community & Heritage.

‘Please will you confirm whether it remains your intention to open the repurposed Wilson Hospital in Mitcham by the end of 2022 or otherwise confirm a revised date?

Please will you confirm when a planning application for the repurposed Wilson Hospital in Mitcham is scheduled to be submitted and what prior engagement with local organisations and the community is planned before this occurs?’

Dr Gnanapragasam (VG), elected GP Lead for Merton, responded by saying that the health and wellbeing hub planned for Mitcham and surrounding communities remains a key priority for SWL CCG and for Merton.

VG confirmed that the CCG has spent a number of years designing the model and agreeing the services to be included in order to best meet the needs of the population in the local area. The facility will provide adult mental health services in modern, accessible surroundings; a children’s centre, including mental health services for children and young people, and community-based wellbeing services both on site, and via improved signposting which will support people to manage their health and wellbeing outside of a clinical setting. The engagement work to-date, working with a number of stakeholders across health and care has informed these requirements, along with information from public health about ensuring future service provision meets the needs of the local population.

The hub will also promote the use of green and health spaces to improve wellbeing and combat loneliness and isolation via community and neighbourhood gardening schemes.

The CCG is currently exploring options for delivery and will be in a position to share the outcomes in spring 2021. The facility will not be ready to open as

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previously estimated in 2022, but the CCG will share the revised timeline and new estimated date at the earliest opportunity.

There are no plans to submit a planning application at present. The CCG will follow due process in terms of information sharing, engagement, and consulting with relevant stakeholders as appropriate, leading up to any planning application.

In the interim, additional investment has been made in refurbishing space in the Wilson Hospital and grounds for use by community organisations. This is part of our joint commitment to promoting wellbeing and social prescribing services in Mitcham.

The CCG expects to be able to provide more information about this in the coming weeks.

13 Any Other Business

13.1 NHS Media briefing

SB noted that whilst the Governing Body had been meeting, a media briefing had been released by Sir Simon Stevens (Chief Executive of the NHS) and Professor Stephen Powis (National Medical Director) announcing that, from midnight, tonight the NHS is in a Level 4 incident.

13.2 Date of next meeting

The next meeting of the Governing Body Part 1 will take place on Wednesday, 13th January 2021 from 9.30 am to 12.00 noon.

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NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday 3 March 2021

Document Title Chair and Accountable Officers Report Lead Director Sarah Blow, Accountable Officer, SWL CCG (Name and Role) Clinical Sponsor Andrew Murray, Chair, SWL CCG (Name and Role) Author(s) Ben Luscombe, Chief of Staff, SWL CCG (Name and Role) Agenda Item No. 4 Attachment No. 03

Purpose Approve Discuss Note  (Tick as Required) Executive Summary

The report highlights items of interest to members of the Governing Body and the Public which are not discussed in detail in the rest of the agenda.

Background:

At each public Governing Body meeting the Clinical Chair and Accountable Officer will provide a brief verbal and written update regarding matters of interest to members of the Governing Body and members of the Public.

Purpose:

The report is meant for information to keep members of the Governing Body and Public up-to-date with key issues.

Reason for Governing Body Consideration:

To keep the Governing Body updated on key developments not covered in other substantive agenda items.

Key Issues:

1. ICS White Paper 2. System Pressures Update

Conflicts of Interest: None Mitigations: N/A

20 of 134 Page 1 of 2

Recommendation: The Governing Body is asked to:

Note the contents of the report.

Corporate Objectives Overall delivery of the CCG’s objectives. This document will impact on the following CCG Objectives:

Risks N/A This document links to the following CCG risks: Mitigations N/A Actions taken to reduce any risks identified:

Financial/Resource/ N/A QIPP Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Click here to Enter any enter a date. Committees/ Groups at which Click here to this document has enter a date. been previously Click here to considered: enter a date. Supporting Documents None

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South West London Clinical Commissioning Group Governing Body – Paper for part 1 meeting in public

Chair and Accountable Officers Report

Introduction

1. The following report highlights items of interest to members of the Governing Body and the public which are not discussed in detail in the rest of the agenda.

Items to note from the Chair

2. None to note this month.

Update from the Accountable Officer

ICS White Paper

3. The government published the ‘Integration and Innovation: working together to improve health and social care for all' white paper on Thursday 11 February, outlining proposals to bring NHS and social care closer together: Integration and Innovation: working together to improve health and social care for all.

4. The paper includes proposals to make integrated care the default, reduce legal bureaucracy, and better support social care, public health and the NHS, with a sharp focus on improving care and tackling health inequalities through measures to address obesity, oral health and patient choice.

5. We are pleased to see that this paper supports the key principles that we established when we formed the South West London Health and Care Partnership and believe this will help us build on the progress we have already made to improve the health and care we provide for our communities.

System Pressures Update

6. In SWL, the second wave of Covid has resulted in far more patients in hospital than the first peak. Pressure on the hospital wards is now easing slightly and very slowly reducing in intensive care.

7. The usual pressures on the NHS in winter are present with non-Covid pressures building. In addition, there will be patients whose condition is now urgent as a result of delaying accessing care. SWL can be rightly proud of the response – we have managed to support critical care patients from elsewhere in London and further afield. The hospitals have helped each other, with the support of LAS, when experiencing

1

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pressures as diverse as limited oxygen supplies to second wave pressures hitting different boroughs at different times.

8. SWL has also managed to keep the most urgent planned and cancer surgery going, even in the most difficult weeks of January; this did not happen in such a well coordinated way during the first wave. The primary care and community response has also been very impressive – new services such as virtual wards, pulse oximetry services, weekend hubs in primary care and the bed bureau to match community bed capacity to need – all established in a matter of days thanks to incredible efforts of so many.

9. Responding to the second wave has been hard for all staff. We are putting plans in place to allow staff a proper break and secure access to the support they need after nearly a year of dealing with immense challenges. This support needs to be carefully thought through and tailored to individual needs and includes input from local mental health providers.

2

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NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title COVID19 Vaccination Programme Update Lead Director Matthew Kershaw - Chief Executive and Place Based Leader for (Name and Role) Health Croydon Health Services/ Tonia Michaelides, Locality Executive Director Kingston and Richmond

SROs SWL COVID19 Vaccination Programme Clinical Sponsor (Name and Role) Author(s) Tonia Michaelides, Locality Executive Director Kingston and (Name and Role) Richmond

Agenda Item No. 5 Attachment No. 04

Purpose Approve Discuss Note  (Tick as Required) Executive Summary

This paper provides a summary of the approach to the roll out of the national COVID19 vaccination programme across south west London (SWL).

The ambition is to offer the vaccine to every adult who lives in SWL together with those who work locally in key or essential services. With the requirement for everyone receiving the vaccine to have two doses we have modelled that 1.7 million vaccines will need to be administrated across SWL.

The first nationally set milestone for the programme was that all eligible care homes were visited by 24th January 2021 and first doses of the vaccine by offered to residents and staff. This milestone was achieved with over 80% of residents received their first dose.

The next nationally set milestone was that by the 14th February 2021 people within priority cohorts 1-4 as set by the Joint Committee on Vaccinations and Immunisations (JCVI) were to be offered their first dose - this milestone was met in SWL. We were also set targets for the number of doses to be delivered by this date and exceeded both these targets. First dose target was 262,371 and we delivered 266,924 and the all-dose target was 275, 787 and we delivered 280,482.

Detailed planning to support the roll out of the vaccine has been underway for several months, building on the expertise and strong track record the local NHS has already in delivering immunisations like the annual flu vaccination programme. We are now modelling for phase 1b of the programme – that everyone in cohorts 5-9 are offered their first dose by the end of April 2021. Alongside this we are also modelling the 2nd

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doses that are now beginning to be delivered to those who received their first dose in early December.

People will continue to be invited to book an appointment for their first dose in priority cohort order. The priority cohorts are still set nationally by the JCVI.

Background:

The government asked the NHS to be ready to deliver the first COVID19 vaccinations from December 2020 using the Pfizer vaccine. In south west London this began with two hospital hubs which opened on 8th December. More vaccination sites (PCN, Hospital Hubs, Vaccination Centres and Community Pharmacy sites) opened across south west London during the during December 2020- February 2021 with the final tranche of sites anticipated to be opening in March 2021.

Purpose:

The purpose of the paper is to give an update on the delivery of south west London’s COVID19 Vaccination Programme. Key Issues:

The SWL COVID19 Vaccination Board meets weekly and reviews the issues impacting on the roll out of the vaccine programme and agrees actions to mitigate against them. Key Issues include – logistics; tech and data and workforce

Conflicts of Interest:

No conflicts of interest have been identified Mitigations:

Not Applicable

Recommendation: The Governing Body are asked to note the content of the report

Corporate Objectives To commission high quality health care services that are This document will impact on accessible, timely, provide good treatment and achieve the following CCG Objectives: good patient outcomes

Risks The SWL COVID19 programme has an established risk This document links to the register which is reviewed weekly at the programme board following CCG risks: meeting Failure to roll out the COVID19 vaccine is

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recorded as a risk on the CCG’s risk register. The main risks identified are:

• Successful delivery of the vaccine in the situation of increasing number of COVID19 cases • Delays in vaccine supply and other consumables and kit • Low rates of vaccination take-up in high-risk population groups • Workforce available to deliver the vaccine. • Tech and data Mitigations Mitigations to reduce these risks are discussed at the Actions taken to reduce any weekly SWL COVID19 Vaccination Programme Board risks identified:

Financial/Resource/ Central funding has been allocated to support the delivery QIPP Implications of the COVID19 vaccination programme across local systems.

Croydon Hospital has been identified as the SWL lead provider for the programme. The financial governance arrangements for the SWL COVID19 vaccination program follow Croydon Health Service’s SFIs

Has an Equality Impact A draft EIA has been completed Assessment (EIA) been completed? Are there any known No specific implications for equalities have been identified. implications for A range of actions have been identified to ensure that we equalities? If so, what maximise uptake of the flu vaccination across our BAME are the mitigations? population and are summarised on page 6 of the paper

Patient and Public A range of material has been produced nationally that we Engagement and are sharing with our local communities and staff groups. Communication We have conducted a survey with staff to identify any barriers to staff from taking up the vaccine.

We will also use the Insight work completed as part of the roll out of the flu communications and engagement plan which has given us detailed information around access for the high-risk groups

Previous Committee/Group Name: Date Outcome: Committees/ Discussed:

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Groups Click here to Enter any enter a date. Committees/ Click here to Groups at which this document has enter a date. been previously Click here to considered: enter a date.

Supporting Documents

27 of 134 Page 4 of 4

COVID19 Vaccination Programme - Update

Matthew Kershaw/Tonia Michaelides 3rd March 2021

Bringing together Croydon, Kingston, Merton, Richmond,28 Suttonof 134 and Wandsworth 1 Contents

1. Position to date 2. Plans for the next six months 3. Workforce 4. Communications, Equity and Engagement 5. Risk and Issues

29 of 134 2 | 2 Position to date

• SWL met the target set for Phase 1a of the roll out of the COVID19 Vaccine Programme – all people in cohorts 1-4 offered a first dose of the vaccine by 14th February 2021 • Our target for first doses to be delivered by 14th February was 262,371 and we delivered 266,924 • Our target for all doses to be delivered by 14th February was 275,787 and we delivered 280,842 • These figures have been now been exceeded as shown in the next slides • We have written to the teams involved, thanking them for the work thus far and the importance of maintaining the momentum as we move into the next, bigger cohorts. • The percentage of people in all four priority cohorts is over 80% (detail given on slide 5) including the Clinical Extremely Vulnerable (CEV) cohort where we achieved 90%. For the percentage of people vaccinated we have consistently remained top in London for over 70s, 75s and over 80s • We are developing the next phase of the programme including, modelling, planning for second doses, staffing structures and ensuring we have alignment across the delivery arms. The focus of our modelling for the first dose is to ensure that we have sufficient capacity to ensure everyone in cohort 1-9 are able to receive their first dose by the end of April 2021. We are awaiting confirmation of the timescale post April for the whole population to be offered the vaccine. • The biggest challenge of this next phase will be ramping up our Vaccination Centres whilst maintaining appropriate capacity in Local Vaccination Centres (PCN) sites and determining the best approach for our Hospital Hub sites 30 of 134 3 1. Vaccination Services & Vaccinations

Data as of Monday 22nd February. Totals include first and second doses for all ages. Data shown reflect the sit at which the vaccinations were administered.

Over 325k vaccines delivered

315,020 first doses delivered. Target for 30th April is 639,837 first doses (to be confirmed) and includes cohorts 5 (65 years and over), 6a, 6b (16-64 year olds with underlying health conditions which put them at a higher risk of serious disease and mortality) 6c (unpaid carers), 7, 8 and 9 (the 50-64 year olds).

Second doses are in addition to this at circa 250k making a total of 890k vaccinations to be delivered by the end of April or a total of 609k vaccinations within the 11 week period This equates to an average run rate of 8,460 per day of which 4,844 should be first doses. 31 of 134 4 | 4 2. Cohorts 1-4 Receiving 1st Vaccination

Vaccination Cohort Week 13 to Total To Week 13 Population % Vaccinated First Dose by ONS Cohort date Vaccinated

Care Home Residents Local Figures (Nursing Home, Residential Home, Older Residents in LD&MH Homes) 5,603 5,603 6,257 89.5% 80+ 47,906 47,906 52,001 92.1% 70+ 79,564 79,564 85,792 92.8% Health and Social Care Workers 78,031 8,572 86,603 65+ 44,129 44,129 52,665 83.8%

Care Homes Percentage calculated using Capacity Tracker returns. This figure will differ from the one on Foundry as we have an increased our cohort size to account for older residents living in Mental Health and Learning Disability homes. There is a data discrepancy in the number of homes used for the national cohort and ones SW London are responsible for due to home location. The team working to ensure that all patients the SW London are responsible are vaccinated.

Health & Social Care workers – Numerator is a proxy measure based on all under 65s receiving a first vaccination (figure from Foundry) minus an estimate of those CEV patients. The CEV estimate is calculated using the cohort size multiplied by the percentage of Cohorts 1-4 vaccinated. However, the current proxy measures is becoming less valid as we move to younger cohorts. Therefore the accuracy of this figure will diminish sharply this week.

Work is on gong to estimate the coverage of under 65s at high32 and of moderate134 risk. 5 | 5 Where we are delivering the vaccine Delivery model overview - defined centrally by NHS England to ensure consistency in deployment across all regions. Each region has defined the mix and number of delivery models required based on local demographics.

Community vaccination centres Local vaccination services Hospital & trust hubs

High volumes, high throughput in a fixed Primary Care Led vaccination location for an extended period e.g. sports Delivered from NHS provider premises venues, conference venues • 25 across South West London in total of a defined number of hubs and further NHS trusts • Hawks Road, Kingston • Care home residents and staff – 100% of care homes for older people were visited by 24 January 2021, a total of 200 • Crystal Palace and Harlequins stadiums • Croydon University Hospital care homes across SWL. We continue to visit mental health • St. George's Hospital Epsom Downs racecourse • and learning disability homes. We are also now planning • Kingston Hospital visits back to all care homes to ensure residents and staff • Hounslow and Richmond Community Further vaccination centres going on line are offered the second dose. Healthcare Trust – (Teddington) throughout March 2021. • Epsom Hospital • Roving model by GPs and community service teams to take • St Helier Hospital the vaccine to those in the priority groups who are • South West London & St. George’s housebound. Mental Health trust • Royal Marsden Hospital Community Pharmacy • 4 community pharmacy sites are now delivering vaccine: 2 in Croydon , 33Kingston, of 134 and Wandsworth • Exploring options for additional pharmacy sites in SWL 6 | 6 Workforce

• Based on the workforce modelling for the SWL mass vaccination centres we need to recruit 823 staff for 20 PODS and we are on track to meet this target. • To date 270 staff have been fully cleared including completion of all checks and training. • To increase the number of staff ready to be deployed we have streamlined the recruitment and the training process and we are currently clearing 30 staff per day (150 per week). • The workforce requirements for PCN sites are being coordinated by the SWL Primary Care Provider Alliance, on behalf of GP Federations in SWL. • We have circa 2,600 volunteer stewards in the SWL area, we plan to deploy volunteers to both PCN and Mass vaccination sites via the Good Sam app. • Extensive staff engagement has been led by the SWL Communications and Engagement Team

34 of 134 7 Communications and Engagement to increase uptake Four ‘swim lanes’ of activity - supported by communications with staff, stakeholders & print/broadcast media

1. Community engagement – NHS led

- Work with voluntary sector to host community conversations to provide 2. Community partners & influencers – partner led latest evidence about the vaccine, hear local stories and gather insight. - Hold smaller focus groups to allow - Work with Local Authorities and PH 3. GP practice engagement – GP led for rich and ongoing dialogue teams strong local networks to host engagement - ‘Every contact counts’ – all NHS ‘3 approach offer’ to cohort - Work with key local influencers contacts should be empowered to patients: – 4. Social media (health and care professionals, faith have the vax ‘confident conversation’ 1. text message or letter, –tips and sign post to single source leaders, community champions, - Develop culturally relevant content of truth of swl website pharmacists) to lead and host 2. phone call from practice staff conversations for us, to build trust 3. phone call form GP featuring trusted community and provide confidence in the influencers (GPs/Nurses, faith vaccine. Clinically led engagement leaders, community champions) - Fund and support voluntary sector sessions with decliners / wider - This content used for paid-for to do outreach work in communities practice population targeted ads to people in low-uptake - Work with local partners and -Signpost to community sessions post codes – on digital devices, community influencers to share facts or community champions social media and other digital and respond to rumours / false - Work with practice link channels. information. workers/social prescribers to - Different languages & formats 35 haveof 134 121 conversations - Local radio and local BAME media - - Proactive and responsive posts on social media (Facebook & Next door) 8 Engagement focus on Croydon

36 of 134 9 Key challenges in delivering the programme

1. Sites where we are vaccinating

2. Vaccine supply

3. Reaching and informing communities with low uptake

4. Needing a flexible workforce

37 of 134 10

NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title Report from the Chair of the Audit Committee Lead Director Paul Gallagher, Lay Member, Finance Committee Chair (Name and Role) Clinical Sponsor N/A (Name and Role) Author(s) Neil McDowell, Director of Finance, SWL (Name and Role) Agenda Item No. 6 Attachment No. 05 (a)

Purpose Approve Discuss Note  (Tick as Required) Executive Summary The SWL CCG Audit Committee met on 12 January 2021. The meeting was conducted remotely due to COVID-19 and was quorate.

Key items discussed at the meeting included: - Primary Care rebate scheme - External audit update and approach to 20/21 accounts - Internal audit update - Local counter fraud update - Contract register update - Single tender waivers - SWL CCG risk management framework - Finance Committee update - Systems update – including ICS discussion

The committee is scheduled to meet again on 9 March 2021.

Reason for Governing Body Consideration: The Governing Body is provided with the key items discussed at the two recent Audit Committee meetings.

Key Issues: As noted above.

Conflicts of Interest: None Mitigations: N/A

Recommendation: The Governing Body is asked to note the key points discussed at the two recent Audit Committee meetings.

38 of 134 Page 1 of 2

Corporate Objectives To commission high quality health care services that are This document will impact on accessible, provide good treatment and achieve good patient the following CCG outcomes. Objectives:

Risks Failing to make appropriate preparations for such a report would This document links to the place the CCG at a reputational risk, initially, principally with its following CCG risks: auditors and authorising bodies such as NHSE/I.

Mitigations Report provided to the Governing Body in a timely manner Actions taken to reduce any risks identified:

Financial/Resource/ QIPP As per above and attached Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Enter any

Committees/ Groups at which this document has been previously considered:

Supporting Documents None

39 of 134 Page 2 of 2

NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title Report from the Chair of the Finance Committee Lead Director David Smith, Lay Member, Finance Committee Chair (Name and Role) Clinical Sponsor N/A (Name and Role) Author(s) James Murray, Chief Financial Officer (Name and Role) Neil McDowell, Director of Finance, SWL Agenda Item No. 6 Attachment No. 05 (b)

Purpose Approve Discuss Note  (Tick as Required) Executive Summary The SWL CCG Finance Committee met on 26 January 2021. The meeting was conducted remotely due to COVID-19 and was quorate.

Key items discussed: - M9 SWL CCG Finance report; including discussion around the 2022/2023 financial position. - Exceptional expenditure requests for COVID were ratified for extending primary care facilities in each borough. - The contract with Totally PLC (Vocare and SELOC) for NHS111 and Out of Hours has been extended from October 2020 until September 2021. - Discharge initiatives set up to facilitate patients discharge from hospital were reviewed and approved. - The GP IT service for Kingston single tender waiver was approved subject to further work and a recommendation to extend the contract until 2022 during which time the future direction of GPIT will be clearer.

An extraordinary SWL CCG Finance Committee also met on 4 February 2021. The meeting was conducted remotely due to COVID-19 and was quorate.

The following SWL CCG single tender waivers were considered and actioned as follows: - Camden and Islington NHS Foundation Trust- contract extension – APPROVED - Richmond East London Foundation Trust contract extension – deferred to February’s committee - CLCH- Haemoglobinopathy & HRAT – APPROVED subject to clarification following discussion - SWLStG – Emotional Wellbeing & MH services - APPROVED - Roundabout – CAMHS - APPROVED - Barnados (PATHS Programme) – APPROVED - PLACE2Be (Parity of Esteem) – APPROVED - Age UK Sutton – APPROVED - Community Anticoagulation Services – APPROVED - Intermediate Care beds - APPROVED - Sutton MH Foundation – APPROVED - Sutton Low Vision Clinic – APPROVED - Off the Record – APPROVED

40 of 134 Page 1 of 3

- Croydon Drop in – APPROVED - Hear Us Service – APPROVED - Alzheimer’s Society – APPROVED - Croydon Hearing Resource Centre – APPROVED - Stroke Association – Language support – APPROVED - MSI Reproductive Choices – APPROVED - Royal Hospital for Neurodisability’s – APPROVED - Cricket Green Service – APPROVED - Greenmead Special School – APPROVED

Reason for Governing Body Consideration: The Governing Body is provided with the key points discussed at the recent Finance Committee meetings.

Key Issues: As noted above.

Conflicts of Interest: None Mitigations: N/A

Recommendation: The Governing Body is asked to note the key points discussed at the recent Finance Committee meetings.

Corporate Objectives To commission high quality health care services that are This document will impact on accessible, provide good treatment and achieve good patient the following CCG outcomes. Objectives:

Risks Failing to make appropriate preparations for such a report would This document links to the place the CCG at a reputational risk, initially, principally with its following CCG risks: auditors and authorising bodies such as NHSE/I. Mitigations Report provided to the Governing Body in a timely manner Actions taken to reduce any risks identified:

Financial/Resource/ QIPP As per above and attached Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

41 of 134 Page 2 of 3

Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Enter any

Committees/ Groups at which this document has been previously considered:

Supporting Documents None

42 of 134 Page 3 of 3

NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title Month 10 Finance Report Lead Director James Murray SWL CFO (Name and Role) Clinical Sponsor (Name and Role) Author(s) Neil McDowell, Director of Finance, SWLCCG (Name and Role) Agenda Item No. 6 Attachment No. 05 (c)

Purpose Approve Discuss  Note  (Tick as Required) Executive Summary

This is the month 10 financial position for the CCG. The CCG has now received its fixed allocation for the second half of the year.

Background: The CCG is reporting on plan for the remainder of the year. All top ups for hospital discharge programme up to month 9 have been received and confirmed that the last top up from month 6 will be paid in month 11.

We have requested a further £10.4m of funding for the hospital discharge programme at month 10.

Key Issues: 1. The CCG is on plan to achieve its control total deficit (£0.2m) 2. The £0.5m of top up funding from month 6 has now been confirmed. 3. We require £10.4m of national funding to cover the costs from the hospital discharge programme.

Conflicts of Interest:

None

43 of 134 Page 1 of 2

Mitigations:

Recommendation: Governing Body to note the report

Corporate Objectives Meeting our performance and financial objectives: Make This document will impact on the best use of our resources to benefit our patients and the following CCG Objectives: communities.

Risks Outlined in the document This document links to the following CCG risks: Mitigations Non recurrent allocation from NHSEI Actions taken to reduce any risks identified: Financial/Resource/ Within the report QIPP Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations? Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Finance Committee Tuesday, 23 Noted Enter any February Committees/ 2021 Groups at which this document has Click here to been previously enter a date. considered: Click here to enter a date.

Supporting Documents One attachment

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SWL CCG Month 10 Finance Report & Covid Expenditure

James Murray , Chief Finance Officer & Neil McDowell, Director of Finance, SWL CCG

Bringing together Croydon, Kingston, Merton, Richmond,45 Suttonof 134 and Wandsworth 1 Contents

1. SWL CCG Scorecard

2. 20/21 Summary Financial Position

3. Borough level variance analysis

4. Key Headlines by Borough

5. Conclusion

6. Covid cost summary for month 10

7. Covid costs – breakdown by expenditure type

8. Appendix 2 – Financial Statements

46 of 134 2 SWL CCG Scorecard

Financial StrategyFebruary 2020 Financial Performance • Currently the financial strategy has been suspended until we receive the • The CCG has now to work within its fixed allocation for the second half of the year revised financial guidance for 2021/22. and deliver a £0.2m deficit control total. • Boroughs continue to be responsible for the budgets acknowledging the • No financial pressure from NHS providers due to the block payment approach limited scope due to Covid • Issues with month 11 non recurrent benefits remain although these have been • All contracts with NHS Providers have been agreed up to the end of the offset in the plan for SWL by the system growth reserve. Decision will be made year and the CCG has received resource to pay these over. post month 10 how this will be utilised across SWL. • The CCG has received its allocation for the remainder of the year and will • We have agreed how we will invest in mental health but it should be noted that we be expected to operate within that. This includes Covid expenditure. are seeing increased expenditure above plan for mental health placements • Current arrangements will cease at the end of the financial year and new although this will be risk shared with South London Partnership. financial framework expected to be announced as part of planning for • All the Borough teams have assumed the full 5% uplift for BCF. 2021/22 • Continuing healthcare expenditure is variable by Borough with some reporting • Revised financial plans was submitted at the end of October 2020. increased expenditure above the month 11 19/20 baseline however seen reduced • Planning has started for 21/22 with quarter 1 seen as a roll over from 20/21 run rate associated with second surge. and BAU planned for from quarter 2 to 4. • The new hospital discharge programme (scheme 2) came into force on 1 • However planning guidance not released so still a working assumption. September and the CCG is utilising this. Still unclear what impact this will have the CCG business as usual activity for CHC. • Prescribing remains above plan but appears to have stabilised in latter months albeit at a slightly higher run rate.

Financial Governance Financial Risk

• Internal audit plan has now been agreed and signed off by the SWL Audit • Financial risks were mitigated in the first 6 months but for the second 6 months we Committee and will be commencing in July 2020. have to live within our fixed budget. • Finance and Activity Committee comprising of Directors of Finance across • Opportunities to deliver a savings/transformation programme are going to be the system meets weekly and is used to agree system wide issues and set limited in this financial year although we did assume a level of efficiencies equating up working groups on areas such as the recovery and capital to 1% of the total non NHS expenditure in the second 6 months (circa £4.5m). • Board Assurance Framework was presented to the CCG Governing Body • We have set a small reserve for Covid expenditure in the second 6 months that we at its November 2020 meeting. have to live within (£3.5m). • Prescribing and continuing healthcare remain the 2 largest budget areas where we have the most significant risk along with mental health and learning disability placements. • Risks are now turning to 21/22 which CHC remains uncertain due to support received in 20/21 and how much the CCG will need to pick up from BAU.

47 of 134 3 2020/21 – Summary Financial Position at Month 10 • As at month 10 closedown the CCG had received all its top ups up to month 6 apart from £0.5m linked to hospices. However we have received confirmation this will be paid in month 11. Position reported below takes this into account. • Therefore reported position for CCG non Covid costs is in line with the submitted plan once this adjusted for (£0.2m deficit) • No change from previous months with mental health placements and prescribing being main areas of over performance with some offset around continuing healthcare. • The Covid costs below include the CCG (funded from reserve set aside) as well as HDP funds which can be claimed back nationally. • Total nationally claimed value is £10.4m with an estimate through to year end of £17.3m. Covid/HDP Budget Variance Allocation Covid/HDP Covid/HDP Covid/HDP M10 YTD Actual M10 M10 YTD Annual Variance Received Costs Variance Budget FY Costs (Full Variance YTD FOT Area £m YTD £m £m Budget £m FOT £m FOT £m £m (YTD) £m M10 £m £m year) £m FY £m Variance Variance

Acute £1124.16m £1124.67m (£0.51m) £1376.85m £1377.44m (£0.6m) £0.5m £0.5m £0.m £0.5m £0.84m (£0.34m) (£0.51m) (£0.94m) Mental Health £221.39m £221.27m £0.12m £268.52m £269.13m (£0.61m) £0.52m £0.5m £0.02m £0.52m £0.52m (£0.01m) £0.14m (£0.61m) Community £145.36m £145.41m (£0.04m) £174.97m £175.43m (£0.46m) £2.59m £3.38m (£0.79m) £2.59m £3.72m (£1.13m) (£0.83m) (£1.59m) Continuing HealthCare £118.91m £115.83m £3.08m £144.15m £140.66m £3.48m £41.61m £50.86m (£9.25m) £41.61m £57.87m (£16.26m) (£6.16m) (£12.78m) Local Primary Care £197.84m £197.25m £0.59m £237.37m £236.02m £1.35m £5.79m £6.02m (£0.23m) £5.79m £6.23m (£0.44m) £0.37m £0.91m Primary Care Co Commissioning £189.04m £189.96m (£0.92m) £226.69m £228.7m (£2.01m) £6.66m £6.66m £0.m £6.66m £6.66m £0.m (£0.92m) (£2.01m) Other Programme Services £87.32m £89.68m (£2.37m) £106.04m £106.32m (£0.27m) £3.46m £3.73m (£0.27m) £4.23m £4.48m (£0.25m) (£2.63m) (£0.52m) Service Development Funding £3.08m £3.08m £0.m £4.62m £4.62m £0.m £0.m £0.m £0.m £0.m £0.m £0.m £0.m £0.m Total CCG Commissioning Services £2087.11m £2087.15m (£0.04m) £2539.2m £2538.31m £0.89m £61.12m £71.63m (£10.51m) £61.89m £80.32m (£18.43m) (£10.55m) (£17.54m) Running Costs £25.24m £25.24m (£0.m) £29.89m £29.89m £0.m £0.m £0.m £0.m £0.m £0.m £0.m (£0.m) £0.m Total CCG Net Expenditure £2112.35m £2112.39m (£0.04m) £2569.09m £2568.2m £0.89m £61.12m £71.63m (£10.51m) £61.89m £80.32m (£18.43m) (£10.55m) (£17.54m) Covid claim M10/FOT (Estimate) £10.4m £17.32m

48 of 134 CCG Reported Position after Covid Claim (£0.15m) (£0.22m) 4 Borough Level Variance Analysis At Month 10 Croydon Kingston Merton Richmond Sutton Wandsworth SWL Grand Total Variance YTD Variance FOT Variance YTD Variance FOT Variance YTD Variance FOT Variance YTD Variance FOT Variance YTD Variance FOT Variance YTD Variance FOT Variance YTD Variance FOT Variance YTD Variance FOT Area £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Acute (£192k) (£316k) (£0k) (£0k) £20k £1k £2k £2k (£51k) (£61k) £19k £15k (£303k) (£239k) (£506k) (£597k) Mental Health £663k £231k (£410k) (£596k) (£4k) (£161k) (£185k) (£270k) (£237k) (£284k) (£477k) (£722k) £765k £1,195k £116k (£606k) Community (£634k) (£940k) £355k £575k £3k (£57k) £7k £10k (£87k) (£105k) (£229k) (£486k) (£0k) (£0k) (£586k) (£1,004k) Continuing HealthCare £1,774k £2,175k £124k (£94k) £202k £529k £313k (£153k) £167k £250k £1,007k £1,381k (£502k) (£603k) £3,084k £3,485k Local Primary Care (£306k) £57k (£82k) (£69k) (£1,187k) (£1,404k) £212k £317k (£232k) (£148k) (£1,229k) (£1,010k) £3,416k £3,608k £591k £1,351k Primary Care Co Commissioning (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£918k) (£2,008k) (£918k) (£2,008k) Other Programme Services £26k £14k (£274k) (£399k) £725k £707k (£181k) (£265k) £441k £348k £344k £349k (£3,448k) (£1,028k) (£2,365k) (£274k) OTHER £26k £14k (£274k) (£399k) £725k £707k (£181k) (£265k) £441k £348k £344k £349k (£3,296k) (£810k) (£2,213k) (£56k) SUSPENSE (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£152k) (£218k) (£152k) (£218k)

Total CCG Commissioning Services £1,330k £1,222k (£287k) (£584k) (£240k) (£386k) £168k (£358k) (£0k) £0k (£565k) (£472k) (£990k) £924k (£585k) £346k

Running Costs (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k) (£0k)

Total CCG Net Expenditure £1,330k £1,222k (£287k) (£584k) (£240k) (£386k) £168k (£358k) (£0k) £0k (£565k) (£472k) (£990k) £924k (£585k) £346k

Hospice Funding still to be settled £544k £544k

CCG Reported position to NHSE as per non ISFE £890k

• The variances above are against the plan we have set for months 7 to 12. The plans for the second half of the year are based on the first 6 months expenditure. • The values above excludes Covid costs (including those costs covered from the CCG reserve) and allocation. • We have added the hospice funding top up as a separate line and NHSE have stated that we should not report this as an adverse variance in our position until they have confirmed the final position. • We have now received confirmation this will be paid in month 11.

49 of 134 5 Key Headlines – By Borough (Page 1 of 2)

Croydon (FOT £2.2m improved position from month 9) • This position has moved significantly in month due to a few issues. There was a double count of expenditure related to prescribing that was reported at place as well as across SWL which resulted in a £1.2m swing. In addition there was an improved CHC position (£0.6m) and slippage of £0.4m on mental health schemes although should be noted that we are still within the MHIS overall. Kingston (FOT £10k worse than month 9) • This position has remained broadly in line with the previous months. There are a couple of areas of movement linked to an improved position on mental health linked to the SLP risk share but a deterioration in adult CHC partially mitigated with an improved children's CHC. Richmond (FOT £177k improvement from month 9) • Similar to Kingston an improved mental health position has been reflected due to SLP risk share and in addition children's CHC has also improved after releasing a prudent accrual made earlier in the year. Merton (FOT £6k worse than month 9) • Overall position is in line with last month although a few areas have moved in month. Mental health position has improved due mainly to the SLP risk share, adult CHC has also improved but this has been offset against primary care expenditure related to GP 5 year forward view funding.

50 of 134 6 Key Headlines – By Borough (Page 2 of 2)

Sutton • No change from previous month Wandsworth (FOT £184k improvement from month 9) • Risk share with SLP has improved this position on mental health placements similar to other Borough’s. There have also been improvements in the AQP and adult CHC expenditure. Within primary care there has been a deterioration in the prescribing expenditure due to the write back of charges for patients in RHND but has been partially offset by the referral management scheme now forecast to be much lower due to Covid. SWL (FOT £1.2m worse than month 9) • We have now shown the transformation funding that was difficult to unpick due to the complicated arrangements that the national team put in place as part of the financial regime for the second half of the year. This accounts for all of the movement at month 10 although there were a number of other movements which largely offset each other. • It should be noted that whilst we have identified the transformation funding we have also assumed that this will be spent. Work is continuing to identify the true position for year end however this approach is the most prudent. • We have also released the mental health reserve that was being accrued centrally should mental health underspend against the MHIS. As this is now expected to be met we have released this uncommitted funding.

51 of 134 7 Conclusion • Fixed allocations for the second half of the year increases our financial risk although at this stage we are confident that we will hit our targets

• Transformation funding has now been identified which we have accrued on the assumption it will be committed.

• We will need to maintain current levels of underspends to ensure that we achieve our balanced plan

• Decisions on how we utilise the system funding held by the CCG will be made post month 10.

• Risks still exist in relation to Covid expenditure although the forecast position is prudent.

• Note the position on delegated commissioning due to the non recurrent benefits in 19/20 understating the underlying recurrent position.

• The Finance Committee is asked to note this report and the risks within it.

52 of 134 8 20/21 SWL CCG Covid costs summary

• Month 10 YTD Covid revenue costs as reported to NHSEI £71.6m (£11.7m increase from M8). • This excludes £1.6m GPIT costs claimed via capital route (per NHSE guidance). • Increase in spend in M10 driven by Covid wave 2 surge costs (£2.4m) and national funding distributed to primary care to support capacity during the vaccine rollout (£4.0m).

Actual Place M1-10 (£k) Croydon 18,960 K&R 14,023 M&W 13,696 Sutton 10,831 SWL 15,688 SWL CCG total 73,197 Of which GPIT capital 1,567 Covid revenue cost 71,628

53 of 134 9 20/21 COVID expenditure breakdown - POD • Below is the Covid expenditure breakdown by point of delivery and Covid spend category as reported to NHSE/I. • From M6 there is a new category for the Hospital Discharge Programme (HDP) scheme 2. This covers costs associated with discharges after 31 August for up to 6 weeks.

54 of 134 10 20/21 COVID expenditure breakdown - phasing

• M10 spend of £11.7m, this compares to monthly average spend in M1-9 of £6.8m.

£k Apr May Jun Juy Aug Sept Oct Nov Dec Jan Total After care and support costs 41 19 66 188 105 124 26 26 1 296 891 Backfill for higher sickness absence 3 3 3 2 ------12 Bank holidays 750 407 ------1,157 Capital 585 983 ------1,569 Care homes 15 15 10 332 13 13 - - - - 398 Enhanced patient transport 271 271 271 ------813 Infection prevention training - - 87 21 ------109 Internal / exteral communication - 2 2 - 10 10 3 3 3 3 35 NHS 111 additional capacity 373 178 178 ------730 Nightingale running costs - 2 ------2 Other COVID 91 89 105 66 36 134 15 15 14 4,040 4,604 Remote management of patients 142 143 1,036 607 52 81 - - - - 2,061 Remote working non-patient activities 48 - - 60 60 - - - - - 168 Support stay at home model 1,247 844 697 1,065 570 666 71 407 - 36 1,609 7,139 HDP scheme 1 2,045 4,638 5,091 5,961 6,783 5,767 4,866 3,430 3,424 2,536 44,540 HDP scheme 2 - - - - - 763 1,410 1,722 1,547 2,891 8,333 Existing workforce additional shifts 19 47 28 12 5 5 3 3 4 - 126 Covid-19 related MH services - 1 ------1 PPE - locally procured - - - 91 - - - 12 - - 102 Segregation of patient pathways ------31 31 31 31 125 Additional capacity (exc. Care homes) ------127 127 Asylum seekers contingency service - - 55 of - 134 ------153 153 Total 5,630 7,644 7,574 8,404 7,634 7,562 6,425 5,649 4,988 11,686 73,197 11 Appendix 1 – Financial Statements

56 of 134 12 Statement of Financial Position – January 2021 JAN-21 DEC-20 De Intangible Assets 27,866 33,818 Property, Plant And Equipment 486,219 555,864 Non-current Assets Total 514,085 589,682 Cash And Cash Equivalents (2,571,371) 274,005 Current Trade And Other Receivables 177,934,226 193,192,087 Current Assets Total 175,362,855 193,466,091 Current Other Liabilities (40,165,426) (49,080,869) Current Trade And Other Payables (174,121,450) (165,481,923) Provisions 0 0 Current Liabilities Total (214,286,876) (214,562,792) Grand Total (38,409,936) (20,507,018)

JAN-21 DEC-20 General Fund 38,409,936 20,507,018 Financed by Taxpayers Equity: Total 38,409,936 20,507,018

• The Statement of Financial Position shows the YTD position as at Month 10 and compared to the previous month.

• The cash position ended negative in January. Movements on Receivables and Payables are explained in sections 10 and 11 of this report

57 of 134 13 Statement of Cash Flows December 2019

STATEMENT OF CASHFLOWS JAN-21 DEC-20 (Payments) for property, plant and equipment 69,646 69,646 (Payments) for intangible assets 5,952 5,952 (Increase)/decrease in trade and other receivables 15,257,861 (22,011,355) Increase/(decrease) in provisions 0 (1,774,289) Increase/(decrease) in trade and other payables (275,916) 14,537,705 Net operating costs for the financial year (240,727,890) (235,369,584) 1.Cash Flows from Operating Activities: Total (225,670,347) (244,541,924) Net parliamentary funding received 222,824,971 243,501,444 2.Cash Flows from Investing Activities Total 222,824,971 243,501,444 Grand Total (2,845,375) (1,040,481) Movement (2,845,375) (1,040,481) Opening Amount 274,005 1,314,485 Closing Amount (2,571,371) 274,005

• The statement reflects the total book cash outflow since 1st April 2020 with a negative cash balance of £2.6m reported in the SOFP.

58 of 134 14 Monthly Cash Profile Initial Monthly Comparison Cumulative Additional Total Draw Cumulative Bank Balance Cash drawdown Drawdown to straight Drawdown Target % December 2019Draw £000s * £000s Drawdown £000s month end £000s line forecast %

April 2020 165,600 154,198 319,798 319,798 116,468 13% £1,820 1.10%

May 2020 165,000 22,000 187,000 506,798 (16,331) 21% £273 0.17%

June 2020 180,900 8,300 189,200 695,998 (14,131) 29% £313 0.17%

July 2020 186,700 12,300 199,000 894,998 (4,331) 37% £498 0.27%

August 2020 182,100 10,700 192,800 1,087,798 (10,531) 45% £261 0.14%

September 2020 176,900 6,200 183,100 1,270,898 (20,231) 52% £1,268 0.72%

October 2020 185,200 - 185,200 1,456,098 (18,131) 60% £522 0.28%

November 2020 201,900 36,000 237,900 1,693,998 34,570 69% £1,320 0.65%

December 2020 228,540 - 228,540 1,922,538 25,210 79% £283 0.12%

January 2021 158,100 49,000 207,100 2,132,638 3,335 87% £471 0.30%

February 2021 197,700 14,500 212,200 2,344,838 8,435 96% 0.00%

March 2021 100,347 - 100,347 2,445,185 (103,418) 100% 0.00% The NHS England cash target was achieved in January with the month end cash balance being 0.30% of the initial drawdown of £158.1m, comfortably inside the NHS England target of 1.25% of cash drawn down for the month. The ACDR is based on the BSA Cash Report supplied by NHS England for January 2021. Having front loaded the cash impact with advanced block payments per NHSE guidance, the CSU is waiting on guidance for the impact on the cash in March 2021 in relation59 of 134to block payments. South West London CCG should not require additional cash because the March Block payments will be paid in February. We are anticipating further guidance for 21/22 Cash management. 15 Aged Debtors December 2019

Customer Account Total AR O/S Amt AR Ageing 1-30 AR Ageing 31-60 AR Ageing 61-90 AR Ageing 91 - AR Ageing 121- AR Ageing 181 + Group Amt Amt Amt 120 Amt 180 Amount Amount NHS 8,255,090.41 604,165.99 126,322.07 63,682.83 155,242.94 120,270.69 7,185,405.89 NON-NHS 11,275,514.22 5,047,792.53 2,433,956.28 2,210,541.37 50,973.86 35,869.40 1,496,380.78 UNALLOCATED -130,109.77 -8,868.25 -110,683.77 -3,060.94 -7,496.81 0.00 0.00 CASH Grand Total 19,400,494.86 5,643,090.27 2,449,594.58 2,271,163.26 198,719.99 156,140.09 8,681,786.67

• The total aged debt at end of January was £19.4m with £1.1m settled within the first seven working days of February The difference of £130k between the above table and aged debtor total in the Receivables table on the previous page refers to unallocated cash. The largest debtor is Royal Borough of Kingston upon Thames Council with £3.8m, followed by NHS England with £3.6m and £3.4m owed by London Borough of Sutton.

60 of 134 16 Better Payments Practice Code December 2019

Dec-20 Jan-21 NHS NON-NHS TOTAL NHS NON-NHS TOTAL • Under the Better Payments Practice Code NUMBERS FOR THE MONTH (BPPC), CCGs are expected to pay 95% of all Total number of invoices paid in the month 248 5,792 6,040 115 4,973 5,088 Number of invoices paid within target 244 5,730 5,974 115 4,865 4,980 creditors within 30 days of the receipt of

Numbers % for the month 98.39% 98.93% 98.91% 100.00% 97.83% 97.88% invoices. This is measured both in terms of

the total value of invoices and the number of VALUES FOR THE MONTH (£000s) Total value of invoices paid in the month 174,663 52,207 226,870 147,029 59,107 206,136 invoices by count. The BPPC percentage Value of invoices paid within target 174,655 51,528 226,183 147,029 57,264 204,293 achievement for South West London CCG in Value % for the month 100.00% 98.70% 99.70% 100.00% 96.88% 99.11% terms of number of invoices paid within target

is 97.88%. Cumulatively this stands at

CUMULATIVE NUMBERS TO THE MONTH 98.26%. NHS invoices have now recovered Total number of invoices paid YTD 6,194 47,976 54,170 6,309 52,949 59,258 Number of invoices paid within target 5,954 47,292 53,246 6,069 52,157 58,226 from the impact earlier in the financial year.

Numbers % Cumulative 96.13% 98.57% 98.29% 96.20% 98.50% 98.26% • GREEN = target of 95% met, RED = target not met CUMULATIVE VALUES TO THE MONTH (£000s) Total value of invoices paid YTD 1,433,011 479,654 1,912,665 1,580,040 538,761 2,118,801 Value of invoices paid within target 1,427,191 468,882 1,896,073 1,574,220 526,145 2,100,366

Value % Cumulative 99.59% 97.75% 99.13% 99.63% 97.66% 99.13%

61 of 134 17

NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title Chair’s Report: Primary Care Commissioning Committee Lead Director Susan Gibbin, Lay Member, Chair Primary Care Commissioning (Name and Role) Committee Clinical Sponsor Nicola Jones, Governing Body GP (Primary Care Portfolio) (Name and Role) Author(s) Andy McMylor, Director of Primary Care (Name and Role) Agenda Item No. 6 Attachment No. 05 (d)

Purpose Approve Discuss Note  (Tick as Required) Executive Summary

This report provides a summary of the key items discussed at the last Primary Care Commissioning Committee (PCCC) meeting held in public on 18 November 2020 as well as an extraordinary decision-making Primary Care Commissioning Committee on 14 December 2020 and a part 2 Primary Care Commissioning Committee which took place on 20 January 2021.

Due to the COVID-19 pandemic, all three meetings were held virtually on MS Teams

Meeting held on 18 November 2020 Primary Care resilience: Following a very helpful presentation, the Committee discussed the CCGs approach to current SWL workforce health and wellbeing and resilience concerns. The committee received insight into a number of key strands of work which included action to support: • Staff health and wellbeing. • Vulnerable practices and resilience. • General Practice staff development, recruitment and retention. • The work of SWL Training Hubs on delivery.

GP access survey results: The GP Patient Survey (GPPS) is an England-wide survey administered by Ipsos MORI on behalf of NHS England, which is sent randomly each year to approximately two million patients to gain feedback on their experiences of their GP practices.

The SWL achievement has been compared against the National average, the other London CCGs achievement, and previous year’s SWL achievement, from a sample of the following eight questions from the survey:

1. Overall experience of the GP surgery? 2. Ease of getting through to the GP surgery? 3. How satisfied are you with the general practice appointment times that are available to you? 4. Overall experience of making an appointment? 5. How long after your appointment did you wait to see or speak to the healthcare professional (15 mins or less)? 6. Did you have confidence and trust in the healthcare professional you saw or spoke to?

62 of 134 Page 1 of 3

7. In the past 12 months have you contacted an NHS service when you wanted to see a GP but your GP practice was closed? 8. How helpful do you find the receptionists at your GP practice?

The survey is sent in January 2020 asking patients to submit their response by March 2020. SWL CCG had the second highest response rate of 27%, compared to 33% for Havering CCG. The National response rate was 31.7%.

Overall, SWL CCG has achieved well for all eight questions in comparison to the other London CCGs. No contractual action has been identified, however; the committee were asked to consider a recommendation for further work to take place to help practices to improve achievement for the next survey. This included the following areas for action:

• Improving the experience in making an appointment • Appointment wait times • Ease of getting through by phone

The SWL Primary Care Team will support the Borough teams to work with individual practices to help identify any issues and develop action plans to improve achievement, in conjunction with any other concerns that may also have been identified.

The PCCC approved the recommendation and asked for feedback on actions taken and their impact.

Borough Primary Care Management Groups report: In addition to receiving reports from each borough PCMG meetings each Borough lead helpfully described the actions they were taking to respond to the SWL workforce resilience programme.

Urgent Decision-Making meeting 14 December 2020 An extraordinary decision-making Primary Care Commissioning Committee also took place on 14 December 2020 making a decision around change of control request regarding AT Medics LTD.

The Primary Care Commissioning Committee also met in private on 20 January 2021 Key agenda items included ratification of practice boundary change requests, AT Medics and proposed practice merger requests. The primary care COVID risk register was also discussed in detail and will be presented again at a future committee meeting in public.

Reason for Governing Body Consideration: The Governing Body is provided with the key points and recommendations from the recent Primary Care Commissioning Committee meeting for formal approval by the Governing Body.

Key Issues: Noted above.

Conflicts of Interest: The PCCC meeting has been convened with observance of the CCG’s Conflict of Interest Policy.

Mitigations: Members were asked to declare interests at the meeting.

63 of 134 Page 2 of 3

Recommendation: The Governing Body is asked to note the key points discussed and decision making at the recent Primary Care Commissioning Committee.

Corporate Objectives To commission high quality health care services that are This document will impact on accessible, provide good treatment and achieve good patient the following CCG outcomes Objectives: Risks No specific risks are raised in reporting from the Committee held This document links to the with its members. following CCG risks: Mitigations Conflicts of interest were managed as per policy. Actions taken to reduce any risks identified:

Financial/Resource/ QIPP No financial implications arise through the Committee Chair Implications reporting. Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations? Patient and Public The Committee is chaired by the Lay Member for Patient and Engagement and Public Involvement. Communication Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups

Supporting Documents None

64 of 134 Page 3 of 3

NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title Quality and Performance Oversight Committee Chairs Report Lead Director Pippa Barber, Independent Governing Body Nurse (Name and Role) Clinical Sponsor N/A (Name and Role) Author(s) Yvonne Hylton, Committee Officer (Name and Role) Agenda Item No. 6 Attachment No. 05 (e)

Purpose Approve Discuss Note  (Tick as Required) Executive Summary

The report provides a summary of the key items discussed at the Quality and Performance Oversight Committee meeting held on 10 February 2021. Due to the Covid-19 pandemic the meeting was held virtually on Teams.

The following items were reviewed and discussed:

SWL Performance Report (Month 8)

The report provided an overview of performance at Month 8 (November 2020).

The Committee were assured that all SWL all Trusts had worked together to support each other during the recent urgent and emergency care pressures as the prevalence of Covid-19 changed across SWL. To provide on-going assurance the Committee requested a further update on urgent and emergency care for the next meeting.

The Committee discussed the SWL 111 service performance and in particular the extra funding to provide more GP input into the service and noted the benefits of high levels of clinical validation in terms of the meetings people’s needs and improved outcomes for patients.

SWL Quality Report

Since the last meeting the Ockenden review into maternity services has been published. The Committee was assured that individual Trusts providing maternity services and the LMS will be taking immediate actions and drafting a response.

The Committee was asked to note an increase in the number of falls reporting during October, November and December and was assured this was subject to scrutiny at the local Quality Oversight meetings and Root Cause Analysis are being carried out and any actions and changes to practice will be added to the report.

65 of 134 Page 1 of 3

The Chair requested the outcomes of the work happening across SWL be presented in two months time to review where providers are sharing the learning. SPC charts should be used(where appropriate) in the report to clearly idendify normal standard variations.

The Committee sought and received assurance of how staff are being supported during this time.

SWL Covid-19 Update

The Committee noted a significant reduction in community prevalence and an improving capacity profile for acute and community beds is being seen across SWL.

In response to discussion on the focus on IPC the Committee requested an update including how IPC links to estates and other priorities and how themes and learning are being shared .

The Committee received assurance that all Care Home residents in SWL are being supported to have their Covid-19 vaccinations and surveillance of residents who subsequently test positive is being undertaken by the Local Authority. As part of the ongoing assurance of care homes the Committee requested an update including the actions being taken by the Local Authority where vaccinated care home residents test positive for the next meeting.

London Equality and Health Inequalities Impact Assessment (EHIA) – Covid- 19 Vaccination Programme

The briefing document was presented to provide assurance that the SWL Covid-19 programme board has carefully assessed and considered the EHIA regarding the implementation of the Cocid-19 vaccination programme and the recommendation and actions being taken. Good assurance was provided on the targeted approach in place across all Boroughs.

Serious Incident Q2 (2020/21) report

Following review and noting that some of the actions and recommendations from the Serious Incident Annual Report 2019/20 had not yet been completed the Committee requested a further update on progress against the recommendations in the next report.

SWL Quality Risk Register Qtly review

The Committee reviewed and discussed the report and requested that the date the risk is added and the target date for completion is included in the report to the Committee.

The Committee received assurance on work going on to support staff across the system. It was agreed the addition of this area on the risk register would be considered.

Conflicts of Interest: None

Mitigations: N/A

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Recommendation: The Governing Body is asked to note the key points discussed and decision making at the recent Quality and Performance Oversight Committee.

Corporate Objectives To commission high quality health care services that are This document will impact on accessible, provide good treatment and achieve good patient the following CCG Objectives: outcomes.

Risks Failing to make appropriate preparations for such a report would This document links to the Place the CCG at a reputational risk, initially, principally with its following CCG risks: auditors and authorising bodies such as NHSE/I. Mitigations Report provided to the Governing Body in a timely manner Actions taken to reduce any risks identified:

Financial/Resource/ As per above QIPP Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Enter any Committees/ Groups at which this document has been previously considered:

Supporting Documents None

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NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021 Document Title South West London Performance Report (Month 9) Lead Director Jonathan Bates, (Name and Role) Executive Director of System Planning, Performance and Delivery Clinical Sponsor (Name and Role) Author(s) David Peck, Gayathri Sivapalan, (Name and Role) Director of Planning Deputy Director of Performance Agenda Item No. 6 Attachment No. 05 (f)

Purpose Approve Discuss Note  (Tick as Required)

Executive Summary

Background:

The SWL Performance Report provides an overview of performance against both Constitutional Standards and other key metrics. This report focuses on CCG and ICS performance for December 2020 and January 2021 using the most recent nationally published data.

Purpose:

The SWL Performance Report provides Governing Body Members with a high level update on performance against Constitutional Standards and other key performance areas, as well as identifying key issues that may require additional focus and providing commentary on actions that are being undertaken to improve both quality and performance outcomes.

Key Issues:

Performance against the Constitutional Standards broadly evidences improvements across many areas following the impact of the onset of the pandemic, which can be demonstrated by the areas listed below.

Cancer • South West London ICS was the highest performing sector in London for both performance against the 2 Week Wait standard (96.8%) and the 62 Day Treatment (83.9%). • Both Bowel screening and Cervical screening services continue to manage their screening throughput, with backlogs caused by the initial COVID wave nearly cleared and plans are being developed to further increase screening uptake.

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IAPT (Psychological Therapy Services)

• IAPT services have returned to pre-COVID levels in the relation to the number of referrals received and the capacity of services provided. • Performance against the Access Rate is 4.95% (against a national threshold of 5.5%) and the Recovery Rate 54.5% (against a national threshold of 50%) demonstrates good performance under the circumstances.

Waiting Times and Waiting List

• South West London continues to be the highest performing sector within London for the percentage of patients treated within 18 weeks with a performance of 76.6%. • South West London also maintains its position of having the lowest numbers of patients waiting over 52 Weeks for treatment (1,798) compared to other sectors in London, despite this cohort seeing an increase over December. • Provisional data has shown a further deterioration of the overall waiting time position in SWL over January due to the increase in COVID inpatients and the reduction in elective activity. However, collaborative working across the sector is ensuring that patients with the highest clinical needs are still being treated.

Nonetheless, there are some areas of performance that are not doing so well.

Diagnostics

• South West London’s diagnostic performance remains challenging, where 73.6% of patients received a diagnostic within 6 Weeks. The performance at a London and National level were 78.4% and 70.6% respectively. • Whilst this position is driven by overall reductions in capacity, the Trust within SWL with the lowest performance is Kingston Hospital at 49.22%.

NHS 111

• NHS 111 performance continues to be challenged. The Provider showed a deterioration in performance for the Number of Calls Answered within 60 seconds with an achievement of 70.77% in December to a performance of 66.64% in January. However, SWL was the second-best performing ICS within London for this indicator, which reflects the current challenges faced by 111 services. • Significant staff sickness and self-isolation has also had a detrimental impact on performance over this period.

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Health Checks for Patients with a Serious Mental Illness (SMI)

• The percentage of patients with a SMI receiving a Health Check has reduced further to 23.6%, which is a reflection of the competing demands currently being experienced by primary care. Steps are being taken to embed the changes and improvements that are have arisen from a Task & Finish Group that was convened to look into the issue.

Conflicts of Interest:

No specific conflicts of interest are raised in respect of this paper

Mitigations:

In relation to the issues raised, the following mitigations have been put into place:

Diagnostics- The Diagnostics Board are actively monitoring diagnostic performance and a number of networks have been established to look at specific areas, such as Endoscopies. The ICS is undertaking a Demand and Capacity modelling exercise at all SWL Trusts with support from the NHSE Intensive Support Team as part of a London Regional project.

NHS 111- The Contract Performance Notice will continue to be robustly enforced and weekly assurance meetings will continue with the Provider. In addition, some activity is also scheduled to be transferred to LAS.

SMI Health Checks- Concerted efforts are being undertaken to mitigate against the impact of the second wave and to increase the number of SMI Health Checks that are undertaken.

Recommendation:

The Governing Body is asked to note the contents of this report.

Corporate Objectives Meeting performance objectives This document will impact on the following CCG Objectives:

Risks Performance has decreased in a number of key areas since This document links to the the onset of the pandemic, which has reduced access to following CCG risks: services and increased waiting times for patients

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Mitigations As described above, a number of mitigations have been out Actions taken to reduce any into place. risks identified:

Financial/Resource/ Recovering performance to pre-COVID levels may have QIPP Implications financial and resource implications.

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups None Click here to Enter any enter a date. Committees/ Groups at which Click here to this document has enter a date. been previously Click here to considered: enter a date.

Supporting Documents SWL Performance Report (Month 9)

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South West London Performance Highlight Report 20/21 Month 9 - December Published Date: 22nd February 2021

72 of 134 Contents

Heading Page Key Messages 3 ICS Benchmarking 4 A&E 5 NHS 111 8 Ambulance Handovers 9 Referral to Treatment 11 Diagnostics 14 Cancer 16 SMI Health Checks 18 LD Health Checks 19 IAPT (Psychological Therapies) 20 Dementia 22 Children & Young People 23 73 of 134 Headline Messages Urgent and Emergency Care The impact of the second wave of the pandemic has inevitably led to a reduction in A&E performance, whereby 79.0% of patients were seen within 4 hours in December. Nonetheless, SWL was the highest performing sector in London for Type 1 attendances. There has been a discernible impact across all Trusts as a result of implementing infection prevention and social distancing measures that, coupled with pressures arising from bed occupancy, has reduced patient flow and led to an increase in delays of patients being admitted and increased ambulance handover times. 111 performance was again challenged in January 2021, although Vocare (the 111 service Provider) was the best performing in London for the week ending 17th January. The ICS continues to work with Vocare to improve its resilience and support performance improvement.

Planned Care South West London continues to maintain its position as the best performing sector for the 18 Week Referral to Treatment standard and remains the sector with the lowest number of 52 Week Waiters. The impact of the second wave of COVID can be seen in the higher than expected growth of those patients waiting over 52 Weeks for treatment and also in the growth in the overall waiting list size. The impact of the second wave has led to reduced elective capacity, although procedures are still being undertaken for the most clinically urgent cases. In comparison to the first wave, there are more procedures taking place and much closer working with the Independent Sector to mitigate risk to patients.

Diagnostics Access South West London's diagnostic waiting list continues to be challenging. Whilst 72.7% of patients were receiving a diagnostic within 6 weeks of referral, the number of patients on the waiting list is significantly higher than in April 2020. However it should be noted that this is still less than pre-covid levels. The reduction in activity seen in the lead up to the holiday period and reduced capacity owing to the infection prevention measures put in place during the second COVID wave, continues to adversely influence performance. The modalities with the highest numbers of patients waiting over 6 weeks remain Echocardiography (n=2,657), Non-Obstetric Ultrasound (n=1,487) and Gastroscopy (n= 1,022). The Diagnostic Board is currently overseeing diagnostic recovery and are leading the implementation of a number of initiatives to improve the position, with early February data showing an improvement.

Cancer Access South West London ICS has maintained its position as the highest performing sector in London with regards to both the 2 Week Wait standard (96.8%) and the 62 Day Treatment standard (83.9%) in December. Despite the impact of the second wave, the ICS has been able to maintain its momentum on Cancer Screening with both Bowel and Cervical screening activity being undertaken at high levels.

Mental Health The focus on COVID vaccinations by primary care has impacted on the ICS' ability to deliver Health Checks for patients with Serious Mental Illness and those on the Learning Disability Register. The Access Rate for psychological therapies (IAPT) has reduced slightly to 4.95%, which has been driven, in part, by capacity issues at one of the main Providers in SWL. The Recovery Rate saw an improvement of nearly 6%, whereby 54.54% of patients recovered following therapy.

Updates to the Report The report now contains reporting on ambulance metrics and it also includes SPC charts.74 of 134 Highlight Constitutional Standards - Regional Benchmarking

RTT - Performance * ~ A&E - All Type Performance ^ Cancer - Two Week Wait

Oct-20 Nov-20 Dec-20 Nov-20 Dec-20 Jan-21 Oct-20 Nov-20 Dec-20 South West London 71.4% 76.2% 76.6% South West London 88.8% 82.7% 79.0% South West London 96.3% 96.3% 96.8% South East London 69.2% 73.0% 74.2% South East London 89.0% 81.5% 76.5% South East London 87.8% 91.1% 92.6% North East London 62.8% 67.0% 67.1% North East London 82.0% 75.6% 73.4% North East London 95.8% 95.7% 96.1% North Central London 65.9% 70.1% 71.0% North Central London 88.8% 81.1% 77.3% North Central London 81.3% 85.5% 89.1% North West London 71.3% 75.3% 75.1% North West London 91.4% 86.1% 81.6% North West London 94.9% 93.8% 95.1%

RTT - PTL * ~ A&E - Type 1 Performance ^ Cancer - 62 Day

Oct-20 Nov-20 Dec-20 Nov-20 Dec-20 Jan-21 Oct-20 Nov-20 Dec-20 South West London 112,040 111,106 112,331 South West London 86.5% 79.0% 74.3% South West London 80.4% 81.0% 83.9% South East London 131,951 130,839 134,330 South East London 81.3% 68.9% 61.8% South East London 68.8% 73.7% 72.9% North East London 84,369 82,486 82,393 North East London 72.1% 63.0% 59.8% North East London 80.7% 78.9% 83.7% North Central London 64,026 63,328 64,670 North Central London 85.5% 76.1% 72.5% North Central London 65.9% 76.3% 70.6% North West London 151,904 152,401 154,547 North West London 79.5% 67.2% 60.1% North West London 76.2% 78.0% 80.2%

RTT - 52 Week Waits * Diagnostics - Performance IAPT - Access Rate

Oct-20 Nov-20 Dec-20 Oct-20 Nov-20 Dec-20 Oct-20 Nov-20 Dec-20 South West London 1,653 1,623 1,798 South West London 72.0% 73.6% 72.7% South West London 5.0% 5.2% 5.0% South East London 5,423 5,380 5,606 South East London 69.8% 74.1% 73.2% South East London 5.0% Not yet published North East London 6,194 6,233 7,136 North East London 81.7% 81.4% 81.7% North East London 4.0% Not yet published North Central London 1,984 1,877 2,101 North Central London 85.0% 83.8% 88.0% North Central London 3.7% Not yet published North West London 4,365 4,107 4,163 North West London 76.5% 79.6% 76.0% North West London 4.6% Not yet published

Notes: * These figures (most notably NCL) are impacted by the current pause in RTT reporting at The Royal Free. ~ NEL providers are engaged in the Review of NHS Access Standards for RTT as such these figures are based on 3 of the 6 CCGs. ^ NWL providers are engaged in the Clinical Review of Standards for A&E, as such trial sites are excluded from75 these of 134 figures. A&E - Summary & Headlines (95% Threshold) Month 10 - January

SWL CCG Croydon Hospital Kingston Hospital Epsom & St. Helier St. George's Hospital

78.97% 79.13% 76.20% 77.54% 82.19% All Type Last Month: 82.69% Last Month: 81.83% Last Month: 79.57% Last Month: 84.22% Last Month: 84.64% Change: -3.72% Change: -2.7% Change: -3.37% Change: -6.69% Change: -2.45%

Type 1 74.31% 68.13% 67.53% 76.27% 81.65% Vs Last Month: -4.71% Vs Last Month: -4.66% Vs Last Month: -3.09% Vs Last Month: -7.25% Vs Last Month: -2.99%

Type 2/3 99.91% 100.00% 99.65% 100.00% N/A Vs Last Month: +0.04% Vs Last Month: +0% Vs Last Month: +0.07% Vs Last Month: +0% N/a

Commentary • South West London ICS was the highest performing ICS in London for the percentage of patients seen within 4 Hours at a Type 1 A&E department with an achievement of 74.3% in January, despite this being a decrease from previous months performance. All four of the SWL Trusts performed within the top 10 highest performing Type 1 A&E departments within London. SWL ICS was also the second highest performing sector in London for combined (Type 1 and 3) A&E performance (78.97%). • Attendancesat A&E departments at SWL Trusts decreased in Januarywith 35,876 attendances, which is a reduction from 41,717 attendances in December. This is also a significant reduction on the same period last year (61,598 attendances in January 2020). The numbers of attendances of both All Type and Type 1 declined between December and January, due to the national lockdown. However, the profile of people presenting in A&E is not the usual profile for this time of year, which would be mainly Flu, Stroke or falls, but has been replaced with a significant increase in presentations for other respiratory conditions. • The impact of implementing enhanced infection prevention and social distancing measures on the UEC pathways is envisaged to continue throughout winter; however, there has been a slow but steady increase in performance across all SWL Trusts so far in the first weeks of February. • CHS reported that 56 patients breached the 12-hour limit for admission post-decision to admit in ED, which was an increase from 38 patients reported in December. Two of these these were patients suffering from a Mental Health condition. Significant progress has been made in reducing the number of mental health breaches that relate to South London and Mausdley patients at CHS down to zero this month. • More detail on the impact of ambulance handover delays can be found in the new ambulance section of this report.

76 of 134 A&E - South West London ICS (95% Threshold) Month 10 - January

All Type All Type Performance All Type Attendance 100% 70,000 90% 78.97% 60,000 Last Month: 82.69% 80% Change: -3.72% 70% 50,000 60% 40,000 Type 1 50% 30,000 40% 74.31% 30% 20,000 20% Vs Last Month: -4.71% 10,000 10% Type 2/3 0% 0 99.91% Vs Last Month: +0.04% Type 1 Attendance & Performance Type 1 Admission & Conversion Rate 45,000 100% 12,000 35% 40,000 90% 10,000 30% 35,000 80% 25% 30,000 70% 8,000 60% 25,000 20% 50% 6,000 20,000 40% 15% 15,000 4,000 30% 10% 10,000 20% 2,000 5% 5,000 10% 0 0% 0 0% Jul-20 Jul-20 Jan-20 Jan-20 Jan-21 Jan-21 Jun-20 Jun-20 Oct-20 Oct-20 Feb-20 Apr-20 Feb-20 Apr-20 Sep-20 Sep-20 Dec-20 Dec-20 Aug-20 Aug-20 Nov-20 Nov-20 Mar-20 Mar-20 May-20 May-20

Type 1 Attendance Type 1 Performance Type 1 Admissions Type 1 Conversion Rate 77 of 134 A&E - South West London ICS (95% Threshold) Month 10 - January

All Type A&E All Type by Provider 78.97% 100% Last Month: 82.69% 95% Change: -3.72%

90% Type 1 85% 74.31% Vs Last Month: -4.71% 80%

Type 2/3 75%

70% 99.91% Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Vs Last Month: +0.04% CHS ESTH KHFT SGH

Commentary • In South West London, the main challenge to patient flow through hospitals has been the availability of appropriate beds since, with the increasing numbers of COVID patients being admitted, the infection prevention and distancing measures have restricted bed availability. This issue has been exacerbated by the increased Length of Stay (LOS) of patients with COVID in ICU and ward beds. There has also been an increase in readmission rates due to higher acuity of patients and discharges. • The number of long stay patients over 14 days has continued to fluctuate into February. As of Sunday 14 February 2021, there were 448 patients with a LOS over 14 days, of which 280 patients had a LOS over 21 days, which is in line with the position in mid-January. • SWL ICS has responded to these challenges by commissioning additional high intensity rehabilitation beds and reintroducing Continuing HealthCare (CHC) assessments and teams to support discharge. An additional new Temporary Alternative Discharge Destination (TADD) care home with 11 beds is now on stream from Thursday 4th February. This is an interim measure to support the transient arrangement before patients test negative and can return to their nursing home. The London Nightingale hospital beds can be accessed through the, recently established, SWL Bed Bureau and there is further potential for spot purchasing in neuro-rehabilitation and RHND beds. • At the recent A&E delivery board meeting, CHS reported that it continues to offer Booked Appointments as part of front door transformation work that has been taking place. The Trust is also working on sustaining patient flow and the discharge process, especially for patients who are medically fit. In terms of the wider transformation of MH services the Trust advised of a potential increase in demand coming, similar to that seen after the first COVID wave. 78 of 134 South West London 111 Performance Month 10 - January

Calls Offered Calls Answered in 60 Seconds - >95% Calls Abandoned After 30 Seconds - <5% 37,004 40,000 120% 90,000 60% Last Month: 42,992 35,000 100% 80,000 Change: -5,988 50% 30,000 70,000 80% Calls Answered in 60 Sec. 25,000 60,000 40% 50,000 20,000 60% 30% 40,000 66.64% 15,000 40% 30,000 20% Last Month: 70.77% 20,000 10,000 10% Change: -4.12% 20% 10,000 5,000 0 0% Calls Abandoned in 30 Sec. 0 0% Jul-20 Jan-20 Jan-21 Jun-20 Oct-20 Feb-20 Apr-20 Sep-20 Dec-20 Aug-20 Nov-20 Mar-20 May-20 Jul-20 Jan-20 Jan-21 Jun-20 Oct-20 Feb-20 Apr-20 Sep-20 Dec-20 Aug-20 Nov-20 Mar-20 5.13% May-20 SWL Calls answered Last Month: 6.04% SWL % Calls answered in 60 seconds SWL Calls Offered SWL % Calls Abandonded Change: -0.91% London % Calls answered in 60 seconds London % Calls Abandoned

Commentary • South West London was the second best performing ICS within London for the Percentage of Calls Answered Within 60 Seconds in January (66.64%). This reflects a comparative improvement, as SWL was the third highest performing in December. Moreover, Vocare was the highest performing 111 Provider within London during the week ending 17th January (75.43%) showing that, whilst this achievement is below the national threshold, Vocare is developing its resilience in continuing to provide the service during challenging circumstances. • There has been a higher than forecasted number of calls in January 2021 when compared to January 2020, in particular those with flu-like symptoms. Vocare have advised that the lower performance has been due to peaks in calls changing from in the mornings in December to afternoons and evenings in January. To deal with this change in call patterns, a 2-week surge management pilot has been implemented in February. The outcome of this pilot will be used to better inform future demand and capacity planning. Further to this, Commissioners agreed some additional funding for more GPs to support the increase in calls requiring clinical input. There has been a noticeable improvement in February data so far since these changes were implemented. • Vocare’s performance for the Call Abandonment Rate (5.13%) was an improvement from last month’s position (6.04%) and was better than the national average (5.17%). Performance improved further during the last two weeks of the month, where the abandonment rate averaged 1% - 2%. • Plans to transfer 16% of calls from Vocare to LAS in January have been put on hold until March 2021 due to LAS staffing pressures. Further meetings with LAS have been held to agree an approach to work collaboratively with Vocare in transferring this activity.

79 of 134 LAS Ambulance - Summary & Headlines Month 10 - January

SWL CCG Croydon Hospital Kingston Hospital St. Helier Hospital St. George's Hospital

Total Handovers 6,524 1,730 1,623 1,384 1,787 Vs Last Month: -308 Vs Last Month: -142 Vs Last Month: -126 Vs Last Month: -14 Vs Last Month: -26

Percentage of handovers 22.53% 12.77% 25.88% 23.70% 28.04% within 15 Min Vs Last Month: -3.79% Vs Last Month: -6.72% Vs Last Month: -4.65% Vs Last Month: -0.41% Vs Last Month: -2.96%

30 Min 538 264 10 164 100 Breaches Vs Last Month: +94 Vs Last Month: +65 Vs Last Month: -5 Vs Last Month: +43 Vs Last Month: -9

60 Min 319 244 0 72 3 Breaches Vs Last Month: +62 Vs Last Month: +66 Vs Last Month: +0 Vs Last Month: -4 Vs Last Month: +0

Commentary • December was a challenging month for CHS, who experienced the highest number of delayed handovers in SWL. The ICS has worked with local Trusts and LAS to reduce hand over times at CHS through the use of Mutual Aid, diverts and Enhanced Intelligence Conveyancing. A non-blue light divert was put in place on 21.01.21 at 18.00 until 06:00 on 22.01.21, followed by Enhanced Intelligent conveyancing to support the decompression of ED and the wider hospital at CHS until Monday January 25 at 6.00am. • These actions heralded an intensive week within the Croydon system using the Perfect Week methodology to restore flow through the hospital. Non-clinical staff members within the Trust and Croydon system were redeployed to provide additional support and a command-and-control structure was put in place, focusing work on patients that were medically fit for discharge and followed up all patients that were discharged the following day with a phone call. • The impact of the initial divert showed a dramatic reduction in ambulance conveyances, as well as a corresponding reduction in admissions. In summary, the divert and intelligent conveyancing from the first weekend proved to be very successful and did not cause problems for other SWL acute trusts. • It remains a regional priority for sectors to deploy a Mental Health Response Vehicle (MHRV) and discussions continue in order to ensure that such a service is provided following the second wave. LAS are preparing to step up their response to meet the mental health needs of patients and ICS leads for LAS and mental health are part of the engagement process.

80 of 134 LAS Ambulance - South West London ICS Month 10 - January

Total Handovers LAS SWL 15min Handover Performance LAS SWL 30min Breaches (Validated) 45% 800

6,524 40% 700 Vs Last Month: -3.79% 35% 600 30% 500 Handover within 25% 400 15 min 20% 300 15% 22.53% 10% 200 Vs Last Month: -3.79% 5% 100 0% 0 30 Min Breaches 538 Vs Last Month: +94 LAS SWL 60min Breaches (Validated) LAS SWL Conveyances 350 9000 60 Min Breaches 300 8500 319 250 8000 7500 Vs Last Month: +62 200 7000 150 6500 100 6000 50 5500

0 5000

81 of 134 RTT Summary & Headlines (92% Threshold) Month 9 - December

SWL CCG Croydon Hospital Kingston Hospital Epsom & St. Helier St. George's Hospital

76.56% 83.46% 81.97% 72.73% 71.37% Performance Last Month: 76.17% Last Month: 84.45% Last Month: 80.18% Last Month: 71.88% Last Month: 71.03% Change: +0.39% Change: -1% Change: +1.79% Change: +0.85% Change: +0.34%

PTL Size 112,331 22,515 20,607 27,756 46,274 (Waiting List) Vs Last Month: +1,225 Vs Last Month: +982 Vs Last Month: +162 Vs Last Month: +725 Vs Last Month: +146

52 Week Waits Vs. LM Vs. LM Vs. LM Vs. LM Vs. LM 1,798 +175 77 -12 95 +7 514 -16 1,455 +194

Commentary • The percentage of patients treated within 18 Weeks of Referral has continued to increase since elective activity restarted in August. Performance in December increased by 0.39% on November's outcome to 76.56%. SWL CCG remains the highest performing STP in London for the RTT standard (London average = 72.3%) and exceeds the National average performance (67.8%). • The ICS remains ahead of its Phase 3 Plan for both waiting list (PTL) size and also the number of patients waiting over 52 Weeks for treatment. The impact of the COVID surge that began in December has affected performance, with an increase in the number of patients waiting over 52 weeks (n=+175) and a slight growth in the Waiting List (n=+1,225). • St George's (SGH) had the biggest growth in patients waiting over 52 Weeks, accounting for 923 of the total 1,335 SWL patients waiting at SWL Trusts. A further 463 SWL resident patients were waiting at Trusts outside the sector,predominantly Guys and St Thomas' hospital (n=124) and Chelsea and Westminster hospital (n=97). • Following national guidance and the increasing pressure from non-elective COVID admissions, January and February 2021 have seen a reduction in elective activity. Provisional data indicates that this will have a significant impact on Long Waiters, which are expected to continue increasing over the coming months. • The drivers for these increases were the reduction in routine elective work (except for clinically urgent procedures) and the need to accommodate the increasing numbers of patients admitted who were testing positive for COVID. In addition, the redeployment of staff to support Covid care led to a reduction in Outpatient appointments, however, most Trusts were able to maintain their virtual clinics.

82 of 134 RTT - South West London CCG (92% Threshold) Month 9 - December

Performance Performance PTL Size 76.56% 100% 140,000 Last Month: 76.17% 90% 120,000 Change: +0.39% 100,000 80% 80,000 70% PTL Size 60,000 60% 112,331 40,000 50% 20,000 Vs Last Month: +1,225 40% 0 Jun-19 Jun-20 Jun-19 Jun-20

52 Week Waits Oct-19 Oct-20 Oct-19 Oct-20 Feb-19 Apr-19 Feb-20 Apr-20 Feb-19 Apr-19 Feb-20 Apr-20 Dec-18 Dec-19 Dec-20 Dec-18 Dec-19 Dec-20 Aug-19 Aug-20 Aug-19 Aug-20

Vs. LM 1,798 +175 Top 10 Trusts Backlog Makeup

IMPERIAL COLLEGE HEALTHCARE NHS TRUST 37

KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 56

GUY'S AND ST THOMAS' NHS FOUNDATION TRUST 124

SOUTH WEST LONDON AND ST GEORGE'S MENTAL HEALTH NHS TRUST 1

MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST 23

CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 97

EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 290

CROYDON HEALTH SERVICES NHS TRUST 52

KINGSTON HOSPITAL NHS FOUNDATION TRUST 70

ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 923 0 2,000 4,000 6,000 8,000 10,000 12,000 18-26 26-52 52+ 83 of 134 RTT - South West London Providers - 92% Month 9 - December

Provider Performance Breakdown of SWL Providers PTL by SWL Provider Backlog Makeup by TFC weeks waited General Surgery 226 75.88% Urology 82 52+ Trauma & Orthopaedics Last Month: 75.37% 144 7% Ear, Nose & Throat… 227 Change: +0.51% Ophthalmology 60 Oral Surgery 30 PTL Size Neurosurgery 62 Plastic Surgery 99 41-52 Cardiothoracic Surgery 24% 117,152 18-26 General Medicine 44% Vs Last Month: +2,015 Gastroenterology 79 Cardiology 216 Dermatology 57 52 Week Waits Thoracic Medicine 3 Neurology 11 Rheumatology 35-41 20 Geriatric Medicine Vs. LM 6% 2141 +173 Gynaecology 133 Other 692 26-35 0 2,000 4,000 6,000 8,000 19% 18-26 26-35 35-41 41-52 52+ 18-26 26-52 52+

Commentary • The specialties with the largest cohorts of long waiting patients in SWL are ENT (n=227) and General Surgery (n=226) and 'Other' (n=692). Local, unvalidated data from the end of December breaks the ‘Other’ category down further, which shows that the specialties accounting for the most of the 'Other' activity were Maxillofacial Surgery (n=161), Audiology (n=123) and Colorectal (n=115). • There has been some growth in the patients waiting in T&O driven by the use of South West London Elective Orthopaedic Centre (SWLEOC) as an ITU hub for SWL; however, this was not unexpected and the ICS is confident we are able to manage the waiting lists appropriately. • Trusts are prioritising patients based on clinical need, with the most clinically urgent (P1 and P2 categories) patients continuing to be seen at this time. Regular reviews are being undertaken to ensure that patients whose condition worsens are recategorised appropriately. • CHS have been providing mutual aid to the South West London sector with the Trust looking to deliver increased activity by improving and revising Outpatient clinic templates to more effectively utilise virtual and face to face consultations. • Urgent and cancer surgical activity that cannot be carried out on-site at NHS hospitals due to bed pressures is being done in the Independent Sector (IS). • IScapacity utilisation is being maximised throughout the region and allows for the separation of elective and non-elective patients who will remain in acute Trusts. 84 of 134 Diagnostic Summary & Headlines (99% Threshold) Month 9 - December

SWL CCG Croydon Hospital Kingston Hospital Epsom & St. Helier St. George's Hospital

72.66% 79.77% 49.22% 79.54% 77.80% Performance Last Month: 73.6% Last Month: 75.02% Last Month: 56.17% Last Month: 79.22% Last Month: 80.29% Change: -0.94% Change: +4.76% Change: -6.95% Change: +0.32% Change: -2.5%

WL Size 28,385 7,228 7,227 6,568 9,157 Vs Last Month: -3,291 Vs Last Month: -693 Vs Last Month: -792 Vs Last Month: -1,286 Vs Last Month: -302

6+ Week Waits Vs. LM Vs. LM Vs. LM Vs. LM Vs. LM 7,760 -602 1,462 -517 3,670 +155 1,344 -288 2,033 +169

Commentary Following the first wave of the pandemic, the total Diagnostics waiting list across SWL significantly increased. The total waiting list in April 2020 was 23,850 with 42% waiting under 6 weeks and 58% waiting over 6 weeks in comparison to the position in December 2020, where it is 30,180 with 72% waiting under 6 weeks and 28% waiting over 6 weeks. The performance at a London and National level were78.4% and70.6%respectively. NoCCG within England met the 99% standard. Once services restarted in June 2020, the recovery process was instigated with all Trusts making good progress across Endoscopy, Imaging and Echocardiography. Unfortunately recovery slowed down in December and January due to pressures across the hospitals as a result of the second wave of COVID. Whilst three of our Trusts managed to weather the storm relatively better, unfortunately Kingston Hospital has been significantly challenged across Imaging and Echocardiography services.

However, since February recovery and performance is now back on track, with the waiting list now less than pre- pandemic levels it is anticipated that both Ultrasound and CT backlog will be significantly reduced/cleared by early/mid-March (currently 81% of US and CT patients are seen within 6 weeks). The vast majority of Kingston’s remaining diagnostics backlog (patients waiting longer than 6 weeks) is for echo (68 patients). Work is currently underway to finalise mutual aid across all SWL trusts to ensure Kingston patients receive their Echos swiftly.

85 of 134 Diagnostics - SWL Providers (99% Threshold) Month 9 - December

Provider Performance SWL Provider Performance SWL Provider Waiting List Size 71.81% 100% 45,000 40,000 Last Month: 72.96% 80% 35,000 Change: -1.16% 30,000 60% 25,000 WL Size 40% 20,000 15,000 20% 10,000 30,180 5,000 Vs Last Month: -3,073 0% 0 Jun-19 Jun-20 Oct-19 Oct-20 Feb-19 Apr-19 Feb-20 Apr-20 Dec-18 Dec-19 Dec-20 6+ Week Waits Aug-19 Aug-20 Commentary Vs. LM Provider Performance by Modality SWL Endoscopy: Endoscopy activity undertaken in December was 90.83% 8,509 -481 Gastroscopy 45% of the Phase 3 Plan. Challenges arose as a result of Endoscopy Nurses and Cystoscopy 63% Gastroenterology Consultants being redeployed to cover COVID wards, Flexi-Sig. 47% which mostly impacted SGH and KHFT, and also the re-purposing of the Colonoscopy 55% Endoscopy Suite at SGH to become an ITU. Most Trusts are continuing to Urodynamics 63% prioritise 2 Week Wait, urgent and inpatient referrals over routine referrals. Trusts have responded to the challenges by using alternative Sleep Studies 61% provision, including the Independent Sector (SGH are utilising The Nelson Neurophysiology 90% Health Centre, Queen Mary’s, and Parkside Hospital, and KHFT is utilising Electrophysiology 20% Parkside Hospital). Echo 37% SWL Imaging: Imaging activity undertaken in SWL in December was 9% Audiology 63% below the Phase 3 plan, predominantly driven by infection prevention DEXA Scan 98% measures causing increased appointment times at SGH as well as the Barium Enema usual seasonal reduction. Local, unvalidated data shows that all Trusts Ultrasound 86% have seen an improvement in activity levels in January and early February CT 76% showing an overall reduction in the waiting list across SWL by approximately 8%. Trusts are working across the sector to utilise the IS MRI 89% capacity where possible as well as optimising examination time and 0% 50% 100% employing additional agency and clerical support staff.

86 of 134 Cancer Summary & Headlines Month 9 - December

SWL CCG Croydon Hospital Kingston Hospital Epsom & St. Helier St. George's Royal Marsden

96.77%Last Month: 97.31%Last Month: 98.38%Last Month: 98.84%Last Month: 94.36%Last Month: 93.40%Last Month: 2WW 96.28% 98.49% 98.65% 98.31% 91.21% 89.91% 93% Target Change: +0.48% Change: -1.18% Change: -0.27% Change: +0.54% Change: +3.15% Change: 3.49%

83.93%Last Month: 83.76%Last Month: 95.07%Last Month: 87.80%Last Month: 70.72%Last Month: 88.37%Last Month: 62 Day 80.97% 85.84% 88.59% 91.23% 65.22% 82.72% 85% Target Change: +2.96% Change: -2.08% Change: +6.48% Change: -3.42% Change: +5.5% Change: 5.66%

Commentary • SWL CCG was the highest performing CCG in London for ensuring that patients were treated within 62 Days of referral with an achievement of 96.8%, which compares favourably to both regional (93.9%) and national (87.5%) positions. At the same time, the overall numbers of patients referred into the 2 Week Wait pathway has increased by 7% inDecember compared to December 2019, when there were 4,561 referrals. • In December, all SWL Trusts performed above the 93% threshold for 2 Week Waits. St George's hospital (SGH), in particular, focused recovery efforts on restoring Straight to Test (STT) pathways for Lower GI, Upper GI and Urology, as well as increasing Breast outpatient capacity, which has helped achieve an outcome of 94.4%. • At a combined Trust level, there was a 6% increase in 2 Week Wait referral activity in December 2020 (5,685) compared to December 2019 (5,373).This is the first month since the pandemic that 2020 referrals have exceeded 2019 levels for the corresponding month. National and local social mediacampaignscommenced in December to help boost awareness around potential cancer symptoms and the need for patients to see their GP if they have concerns.The Cancer Alliance (RM Partners) have worked with SWL Comms and the SWL Cancer Team to develop messaging specific to SWL patients to help increase access and increase public confidence. • SWL was the highest performing CCG in London for the percentage of patients being treated within 62 Days of referral, which again compares favourably to both regional (78.2%) and national (75.2%) averages. Month on month improvements were seen at both St George’s (+5.5%) and The Royal Marsden (+5.66%), which demonstrates good resilience in the continued provision of cancer treatment • Both Croydon Hospital (CHS) and SGH did not achieve the 62 Day target for December and have seen an associated increase in their backlog of patients waiting over 62 Days for treatment.

87 of 134 Cancer - South West London Providers Month 9 - December

2WW 2 Week Wait - 93% Target 62 Day - 85% Target 100% 95% 96.73% 98% 90% Last Month: 96% Change: +1.11% 94% 85% 92% 80% 90% 62 Day 88% 75% 86% 70% 84% 65% 84.45% 82% Last Month: 83% 80% 60% Change: +1.45% Jun-19 Jun-20 Jun-19 Jun-20 Oct-19 Oct-20 Oct-19 Oct-20 Feb-19 Apr-19 Feb-20 Apr-20 Feb-19 Apr-19 Feb-20 Apr-20 Dec-18 Dec-19 Dec-20 Dec-18 Dec-19 Dec-20 Aug-19 Aug-20 Aug-19 Aug-20

Commentary • The majority of bids that were previously submitted to the Cancer Alliance to increase outpatient and diagnostic capacity were approved in January. The impact of the second wave has the potential to impact adversely on some of those gains, although Waiting List Initiatives have also commenced at all SWL Trusts, which are focussing on further increasing capacity. • South West London CCG has done very well to maintain resilience in the delivery of Cancer services, which can be evidenced by delivering 96.8% of 2 Week Wait activity in December 2020 compared to December 2019. As such, an additional 293 SWL patients were seen within 2 Weeks of referral in December that were over and above the commitments made in the Phase 3 Plan. • Whilst December performance was positive, unvalidated data from January indicates that at the end of the month there were 330 patients waiting over 62 Days for treatment compared to the Phase 3 commitment of 278. All Trusts are broadly in line with their plans for 62+ Day Waiters other than St George’s, who were far in excess of what they planned (139 patients were waiting over 62 Days, compared to a plan of 60). The tumour types accounting for the most over 62 Day Waiters were Lower GI (n=79, which is being driven mostly by ESTH [n=30] ) and Head & Neck (n=50, which is being driven mostly by STG’s [n=24] ). • St George’s has worked closely with the Cancer Alliance to make improvements to the Head & Neck Pathway, which has seen a reduction from 43 patients waiting over 62 Days as of the week ending 3rd January 2021 compared to 24 patients waiting as of the week ending 31st January 2021.

88 of 134 SMI Physical Health Checks (60% Threshold) Quarter 3 - 2020/21

SWL CCG Croydon Kingston Merton Richmond Sutton Wandsworth 23.56% 21.23% 29.76% 17.10% 21.23% 20.81% 35.28% Vs. Last Quarter Vs. Last Quarter Vs. Last Quarter Vs. Last Quarter Vs. Last Quarter Vs. Last Quarter Vs. Last Quarter -0.28% +4.43% -7.44% -3.86% -3.62% +0.68% +0.85%

No. of Checks SWL Perf By Quarter Current Quarter Performance By Test 20,000 80% 3,733 SWL CCG Croydon Kingston Merton Richmond Sutton Wandsworth Vs. Last Quarter 15,000 60% Alcohol 41.9% 35.6% 43.6% 33.4% 34.3% 35.0% 58.6% +2 Glucose 50.3% 45.9% 60.9% 43.1% 51.2% 46.8% 54.9% 10,000 40% London Region Blood lipid 49.5% 44.5% 57.7% 43.0% 46.9% 46.5% 56.8% 5,000 20% Blood Pressure 51.1% 34.6% 66.1% 60.6% 29.8% 57.4% 64.0%

26.18% 0 0% BMI 60.6% 60.3% 60.4% 60.6% 54.7% 59.5% 64.1% Vs. Last Quarter 19/20 q3 19/20 q4 20/21 q1 20/21 q2 20/21 q3 Smoking +0.02% No. of full checks Register Performance Target 62.4% 56.5% 60.5% 56.4% 74.2% 58.6% 69.6%

Commentary • The 2020/21 Q3 position of 23.6%, shows performance levels for SWL ICS have marginally decreased from 23.8% during Q2. Considering the current pandemic pressures on primary care, together with prioritisation of the national vaccination programme, this relatively static outturn is consistent with the Regional trend. • Three of the six health checks are incentivised in the QOF (smoking status, BMI weight and blood pressure). These tests have the highest levels of compliance. From 2021/22, the remaining 3 checks will be incentivised. This change acknowledges that all elements of the check are equally important. Additional training support is likely to be made available to general practice to support completion of the checks. • A Task and Finish Group was established to facilitate improvement by drawing upon the pockets of best practice that currently exist within SWL. The group consists of a number of key stakeholders, including primary care leads, GP IT leads, mental health leads and representatives from both of the mental health Trusts that serve SWL (South West London & St Georges and South London Maudsley) The Task and Finish Group have implemented an Action Plan with workstreams that include: o Funding that has been secured to support primary care to outreach to the most vulnerable to encourage health check uptake o A 'Technical Workgroup' has been put in place to better understand the data quality issues as well as standardising data reporting across all 6 boroughs to ensure data extraction and reporting is consistent across SWL. A review of each LDU's coding to ensure work carried out in primary care is not under-reported. o Development of a 'good practice' guide to support with issues that have been identified in practices relating to carrying out physical health checks for people with SMI.

89 of 134 LD Health Checks (Threshold 67%) Quarter 2 - 2020/21

SWL CCG Croydon Kingston Merton Richmond Sutton Wandsworth

Year to date (Q2) Year to date (Q2) Year to date (Q2) Year= to date (Q2) Year to date (Q2) Year to date (Q2) Year to date (Q2) 18.8% 28.6% 15.4% 10.6% 8.6% 12.1% 19.4% Last year to Q2 Last year to Q2 Last year to Q2 Last year to Q2 Last year to Q2 Last year to Q2 Last year to Q2 22.2% 21.5% 20.2% 18.6% 16.0% 24.6% 27.2%

SWL CCG Year on Year Performance Performance in Individual Quarters 70% 25% 60% 50% 20% 40% 15% 30% 20% 10% 10% 5% 0% Q1 Q2 Q3 Q4 0% 19/20 20/21 19/20 Q1 19/20 Q2 19/20 Q3 19/20 Q4 20/21 Q1 20/21 Q2 20/21 Q3 20/21 Q4

Commentary • Whilst Quarter 3 data has not been published, provisional data shows a reduction in annual health checks in January 2021 in light of pressures on Primary Care to deliver the COVID vaccination programme. Whilst primary care has made tremendous efforts to improve the delivery of LD Health Checks and was previously on track to deliver the trajectory, the impact of the pandemic now inevitably puts that at risk. The provisional data available from January shows that SWL has achieved 50.9% (year to date), which masks the fact that Croydon have done really well in improving their position with an achievement of 62.1%; whereas, the performance for the remaining boroughs ranges between 42.0% and 47.9%. • The CCG continues to work with individual GP practices to ensure activity is correctly recorded to reflect the work carried out in general practice. • Dr. Clare Armstrong (a GP from Kingston who has helped to develop best practice with LD Health Checks) delivered training in December to primary care colleagues, which was recorded and was made available for wider dissemination on Teamnet (an online platform for GPs). Further training directed at GP practice staff will be delivered in March 2021. SWL remains committed to improving the provision of LD Health Checks in line the additional emphasis that NHSE has recently placed upon this performance area in correspondence relating to planning and prioritisation. 90 of 134 IAPT Access Rate - SWL CCG (Threshold 5.5%) Month 9 - December

SWL CCG Croydon Kingston Merton Richmond Sutton Wandsworth 4.95% 5.03% 3.51% 4.94% 5.74% 5.51% 4.68% Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month -0.25% -0.27% -0.06% -0.38% -0.44% +0.31% -0.36%

Referrals Referrals Referrals Referrals Referrals Referrals Referrals 3,559 910 320 511 457 512 849 Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month -625 -163 -51 -59 -89 -185 -78

SWL Access Rate SWL Referrals

6% 6,000 5% 5,000 4% Diagnostics 4,000 3% 3,000 2% 2,000 1% 1,000 0% 0

Commentary • The latest provisional data available shows that the rolling quarterly access rate for SWL CCG decreased from 5.20% in November 2020 to 4.95% in December 2020. The decrease is largely attributable to the seasonal trend during the Christmas period, where clients often decide to delay their treatment until the new year. • The IAPT service provider for Merton, Sutton and Wandsworth have reported capacity issues, as a result of staff sickness following COVID vaccinations. This affected staff for approximately 24-48 hours following their vaccination and led to decreased treatments being delivered during the period. Other SWL IAPT Providers did not report similar issues. • Most boroughs reported decreases in treatment levels compared to the previous month, other than Sutton. This reflects the expected seasonal trend during this time of the year. Richmond’s performance, although decreasing, remains resilient to pressures and their performance continues to meet the national threshold of 5.50% with performance reported at 5.53%. 91 of 134 IAPT Recovery Rate (Threshold 50%) Month 9 - December

SWL CCG Croydon Kingston Merton Richmond Sutton Wandsworth 54.54% 52.17% 53.55% 59.67% 52.07% 54.35% 56.43% Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month +5.92% +2.92% +41.05% +0.69% -4.8% +2.08% +5.27%

SWL CCG Recovery Rate SWL CCG Patients Moving To Recovery 70% 2,000 1,800 60% 1,600 50% 1,400 1,200 40% 1,000 30% 800 600 20% 400 200 10% 0 0%

Cases moving to recovery Total Cases

Commentary A data quality issue affecting Kingston has been identified. There was an omission in reporting for the months of September – November 2020, where approximately 154 patient pathways were under-reported. The data issue has significantly affected multiple reporting areas (access, referrals, waiting times for treatments and in particular recovery rates) and is due to an 'IAPTus' system upgrade. The service provider is investigating the issue. The CCG are awaiting further information, including the corrective actions being taken. The on-going key actions in response to the national pandemic, include: • Priority of treatment continues to be given to health care/local authority and care home staff who are registered in those boroughs. • Online and telephone consultations continue to play a pivotal role in the delivery of treatment. • A SWL text campaign to encourage take-up of IAPT services is currently in the final planning stage (as of February 2020). • As well as raising awareness of services available, it is also hoped this will lead to increased referrals and assist the CCG achieving the national access rate target which increases from 5.50% (Quarter 1-3) to 6.25% during Quarter 4. 92 of 134 Dementia Diagnosis Rate (Threshold 67%) Month 9 - December

SWL CCG Croydon Kingston Merton Richmond Sutton Wandsworth 68.23% 71.52% 60.41% 65.24% 62.81% 68.21% 76.66% Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month Vs. Last Month -0.16% +0.36% -0.58% -0.55% -0.81% -0.16% -0.16%

SWL CCG - Dementia Diagnosis Rate 73%

72%

71%

70%

69%

68%

67%

66%

65% Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20

Commentary • SWL CCG continues to achieve the performance threshold of 66.7% of patients with dementia being identified, achieving 68.2% during December 2020. • Whilst the threshold has been achieved overall, at a borough level that was not the case for Kingston (60.4%), Merton (65.2%) and Richmond (62.8%). • The MAS (Memory Assessment Service) provided by South West London and St George's (SWLSTG) for five of the six SWL boroughs temporarily closed during the first COVID lockdown. The service has re-opened to deliver remote routine assessments, which are challenging for dementia diagnoses due to the client group having access to technology and their ability to use equipment. During November 2020, SWLSTG were able to offer face to face assessments (with limited capacity) and the Trust continues to work closely with MH borough leads to improve performance.

93 of 134 CYP Access Rate SWL CCG - 35% Annual Month 8 - November

This month

Pts. with 2 or more contacts 940 Vs. Last Month +105

Percentage 3.33% Vs. Last Month +0.37%

Year to Date

Pts. with 2 or more contacts 7,050 Percentage 24.97%

Commentary • The latest data available for this indicator (*provisional December 2020) shows cumulative (YTD) performance at 26.56% against the national threshold of 35%. • The monthly snapshot position (December 2020: 2.39%) shows that although performance has dipped below the threshold of (2.83%), there is a strong annual improvement when compared to the same period in the previous year (monthly snapshot December 2019: 1.68% / cumulative: 23.71%). • Whilst there was a reduction in referrals for CYP mental health services between March to August, the number of referrals has now recovered to pre- COVID levels. The Mental Health Support Team continue to work with partners to reduce risks brought about by lower uptake by children and families. • The was a rise in the number of CYP presenting to A&E in crisis in October and November, although this reduced in December and January. As a result, HLP (Healthy London Partnership) and SLP (South London Partnership) are reviewing crisis pathways to get a greater understanding of what has been driving this concerning trend 94 of 134

NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Richmond and Kingston IAPT contract proposals Document Title

Lead Director Tonia Michaelides, Executive Locality Director – Kingston and (Name and Role) Richmond Clinical Sponsor Stavroula Lee – Clinical Lead for Mental Health, Richmond (Name and Role) Phil Moore – Clinical Lead for Mental Health, Kingston Author(s) Martin Ellis, Director of Transformation (Name and Role) Agenda Item No. 7 Attachment No. 06

Purpose Approve  Discuss  Note (Tick as Required) Executive Summary

South West London CCG Governing Body are asked to note proposals for both Richmond and Kingston Improving Access to Psychological Therapies (IAPT) services which are intended to ensure continuation of service provision and increased access rates whilst enabling the development of transformation to be delivered through local strategic partnerships.

Richmond

East London Foundation Trust (ELFT) have given notice to cease providing the Wellbeing Service which includes IAPT and Primary Care Liaison (PCL) services, to Richmond Borough. ELFT have been the provider of these services since 2012 and have worked collaboratively with other providers of mental health services within Richmond.

ELFT indicated to SWLCCG in November 2020 that they wish to withdraw from their existing contract for the provision of IAPT services for Richmond Borough within 2020/2021. It was explained that this will enable the Trust to focus on its main areas of service delivery in East London and Luton and Bedfordshire.

Following an options paper to Richmond Borough Committee on the 8th of December 2020 then to the contracts and performance group in January 2021 and further discussion between executive leads within the Integrated Care System and ELFT, the executive team have considered all the advice and propose taking forward the preferred option below;

• For the CCG to increase the scope and value of the main contract with SWLSTG, to include IAPT and PCL provision in Richmond, • SWLSTG will establish a sub-contract for these services with ELFT from 01 April 2021 for 1 year to allow for a smooth service transition from ELFT to SWLSTG.

Kingston

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The CCG commissions IAPT services (the Kingston iCope service) for Kingston residents from Camden and Islington NHS Foundation Trust (C&I). This is part of a wider contract for the provision of primary care mental health and substance misuse services.

The initial contract for the three services above was awarded in April 2013 for five years with an expiration date of 31st March 2018. Since then, approval has been given to extend the contract on an annual basis.

To provide reasonable time to determine optimal plans for the commissioning of IAPT services across the new SWL CCG footprint including having regard to the emergent SWL Integrated Care System the advice from SWL CPAG and Finance Committee is to • extend the existing contract terms for a further 12 months from April 2021 via a Single Tender Waiver.

Key Issues For Richmond 1) Collaboration between providers during 2021/2022 to ensure smooth transition of service model by April 2022. 2) To ensure transparency of the process of moving the IAPT investment into the main mental health contract with SWLSTG and authorising SWLSTG to sub- contract to ELFT for one year.

For Kingston 1) The need for an extension of the contract for a further 12 months from April 2021 to March 2022 to allow SWLCCG time to develop new SWL wide service delivery plans for IAPT service for 2022/23 onwards,

2) Both CPAG and the Finance Committee have approved a single tender waiver for one year and C&I have agreed to continue to provide the service.

Conflicts of Interest: Nil Known

Action/Mitigations:

N/A

Recommendation:

The Governing Body are asked to:

(1) Agree the commissioning approach of varying the SWLSTG main contract to include Richmond IAPT and PCL, with the provision of ELFT being sub-contracted by SWLSTG for 21/22 to allow for a year-long transition of service. (2) Agree the Single Tender Waiver for a 1-year contract extension with Kingston iCope, primary care mental health and substance misuse services with C&I.

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Corporate Objectives (1) Enable local people, patients, carers, and stakeholders to This document will impact on have greater influence on the services we commission and keep the following CCG Objectives: the patient voice at the centre of what we do.

(2) Work in partnership with local health and care providers, commissioners, and the voluntary sector to improve and transform services that achieve better health outcomes, are accessible and reduce inequalities

3) Overall delivery of the CCG’s objectives toward integrated working within provider area as part of the Integrated Care System.

Risks (1) The possibility of both Kingston and Richmond IAPT not This document links to the meeting the national NHSE targets for 2020/2021 due to following CCG risks: transition.

(2) Commissioner and provider(s) relationship will suffer. (Trust and goodwill may be broken)

(3) Financial risk to ELFT continuing to employ staff to carry out function.

(4) Potential risk of challenge to SWLSTG in relation to the sub-contract they will need to establish with ELFT for 2021/2022.

Mitigations Actions taken to reduce any Business cases were approved at SMT 26 February 2021 and risks identified: will be validated at finance committee in March to access MHIS funding for ELFT to maintain the employed staffing and recruit for the expansion of services in a timely manner.

For Richmond to vary the SWLSTG main contract to enable them to manage the process going forward with ELFT. This will enable them to work collaboratively with ELFT in transferring over the service model and workforce during the financial year 2021/22.

Establish an executive oversight group and a transitional group that includes senior managers and clinicians from SWLCCG, SWLSTG and ELFT.

Engagement and consultation with our GPs around the change of providers, any change of process and to actively seek feedback regularly.

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Financial/Resource/ The total annual value of the contracts based on 2020/21 QIPP Implications currently estimated contract values and associated budgets for Richmond is £3,772,648 and for Kingston is £3,790,458.

Has an Equality Impact N/A. Assessment (EIA) been completed? Are there any known The services remain open and accessible to the existing implications for population and the provision of services will continue. equalities? If so, what are the mitigations? Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Richmond Borough Wednesday, Support option 3 as stated Enter any Committee 09 December above for Richmond IAPT Committees/ 2020 Groups at which this document has CPAG Wednesday, Richmond Paper presented been previously 03 February on the 13 January & 03 considered: 2021 February 2021. To award ELFT an extension of contract to be managed by SWLSTG. Kingston paper approved for Single Tender Waiver Finance Committee Thursday, 04 Kingston Single Tender February Waiver was approved 2021 Finance Committee Friday, 26 Approaches to the February Richmond IAPT approved 2021

Supporting Documents See attached below

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South West London Clinical Commissioning Group Governing Body Public Meeting Paper 03 March 2021

Richmond and Kingston IAPT Contract Proposals for 2021/22 South West London CCG Governing Body are asked to note proposals for both Richmond and Kingston Improving Access to Psychological Therapies (IAPT) services which are intended to ensure continuation of service provision and increased access rates whilst enabling the development of transformation to be delivered through local strategic partnerships.

Background: For the Richmond service East London Foundation Trust (ELFT) as the provider of NHS Richmond Wellbeing Service, comprises of Richmond IAPT and Richmond Primary Care Liaison (PCL) service April 2012. Richmond Mind has been sub-contracted by ELFT to provide Low Intensity Therapy for the IAPT service. These two services have been working well together to provide Richmond population with high level psychological therapy as well as achieving NHSE national targets over the years on access, recovery rate, and 16 weeks waiting times. ELFT notified South West London CCG in November 2020 that they wished to cease providing services within Richmond under the existing arrangements from April 2021. Discussions with senior executive directors at SWLCGG, South West London and St Georges Mental Health Trust (SWLSTG) and ELFT took place and an agreement reached that we would explore solutions to ensure that ELFT were able to exit from Richmond services however it was additionally agreed that an immediate exit would not be beneficial and therefore a solution was sought through the CCG’s governance processes. The local mental health provider for Richmond is SWLSTG who currently provide IAPT services to 3 out of the 6 boroughs within South West London. An additional aspect to the contract for Richmond services is The Primary Care Liaison (PCL) that works collaboratively with GP’s in a primary care setting and offers psychiatric reviews and treatment to people requiring mental health interventions. The service works within PCN hubs and support a more systematic approach to annual health checks and annual medication reviews. For Kingston our IAPT services (the Kingston iCope service) are provided by Camden and Islington NHS Foundation Trust (C&I). This is part of a wider contract for the provision of primary care mental health and substance misuse services. Substance misuse services are funded by RBK Public Health, but NHS Kingston leads on the contract which incorporates the above three services. There is an overarching S75 agreement in place which determines these contractual/financial arrangements between RBK Local Authority and NHS Kingston The initial contract was awarded in April 2013 for five years with an expiration date of 31st March 2018. Since then, approval has been given to extend the contract on an annual basis. In 2018/19, the Finance Committee approved a minimum of a one-year extension to March 2020. No contract has been put in place during 2020/21 due to the COVID-19 Pandemic and payments are been made in line with the National COVID block funding arrangements that

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have been put in place by NHSE. C&I has confirmed its willingness to continue providing these services in Kingston from April 2021. The merger of the six CCGs allows a more co-ordinated approach to the provision of services across the STP footprint, however a full commissioning review during this past year has been hampered by the CCG response to COVID-19. Therefore, by extending the contract for a further 12 months allows the CCG necessary and reasonable time to determine plans for the commissioning of IAPT services across SWL including having regard to the emergent SWL Integrated Care System. The request for an extension of the contract for a further 12 months from April 2021 is considered an essential enabler to agree optimal services for local patients for the future. RBK Public Health intends to align with the CCG's plan in requesting a twelve-month extension of the contract pending formal agreement via RBK's Commissioning Governance Board. The ongoing partnership between the CCG and RBK is detailed in Schedule E of the Kingston Section 75 agreement.

Procurement and contractual arrangement For Richmond services, the preferred option is to extend the scope of the main contract with SWLSTG to include the IAPT and Richmond Primary Care Liaison service who will inturn sub-contract these services from ELFT via a contract direct award. SWLSTG have followed their own internal governance to allow this direct award to commence from 01 April 2021 for 1 year. This approach allows time for the smooth transition of services from ELFT to SWLSTG. The SWLCCG contract and procurement group and the Finance Committee is supportive of this approach and to authorise SWLSTG to put this sub-contracting solution into place. For Kingston services both CPAG and the Finance Committee approved a one-year contract extension via a Single Tender Waiver to allow services to continue for a further year. The CCG retains an obligation to ensure transparency of this decision with the market through the publication of a Contract Award Notice (CAN).

21/22 mobilisation Richmond Regular weekly meetings are taking place between director level officers to ensure that the contractual agreements are progressing accordingly. A transition group will lead the process for the transfer of services to SWLSTG over the 2021/22 year and ensure that the service is able to maintain it excellent performance and the team will additionally ensure that current developments and discussions to improve the service will continue. A mobilisation plan is being finalised and will capture actions, risk and mitigations and will be used as a live document lead by SWLSTG to ensure a smooth transition. A communications and engagement plan will be agreed between the lead directors of each organisation. ELFT with develop an exit plan for the end of March 2022. This will offer assurance that they will not withdraw from the contract until fully transitioned. Regular update will be presented to the Kingston and Richmond borough committee for oversight of progress. Page 6 of 7

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For Kingston services, we will continue with current arrangements and ensure future discussions are held with senior SWLCCG leads. For both Boroughs contract terms will be agreed prior to 1st April fully and signed by the appropriate parties.

Recommendation The Governing Body are asked to (1) Agree the commissioning approach of varying the SWLSTG main contract to include Richmond IAPT and PCL, with the provision of ELFT being sub-contracted by SWLSTG for 21/22 to allow for a year-long transition of service. (2) Agree the Single Tender Waiver approach for a 1-year contract extension with Kingston iCope, primary care mental health and substance misuse services with C&I. Mental Health Trust.

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NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Update on Kingston and Richmond Community Provider Document Title Collaboration Lead Director Tonia Michaelides, Executive Locality Director – Kingston and (Name and Role) Richmond Clinical Sponsor (Name and Role) Author(s) Martin Ellis, Director of Transformation– Kingston and Richmond (Name and Role) Agenda Item No. 8 Attachment No. 07

Purpose Approve Discuss  Note  (Tick as Required) Executive Summary In November 2020 SWL CCG Governing Body supported the award of contract for a Lead Provider model for a single community service offer across Kingston & Richmond (K&R) supported by a single contract to be delivered from 1 April 2021.The model would bring together the 2 separate community providers, Hounslow and Richmond Community Health (HRCH) in Richmond and Your Healthcare Community Interest Company (YH) in Kingston, to deliver an integrated community services delivery model. The new community service model would provide best value, demonstrate better outcomes, and prove to be operationally and strategically resilient.

Key points: • A Contract Advisory Notice (CAN) was published on the Official Journal of the European Union (OJEU) on 13 November 2020. The 30-day standstill for the CAN ended on 12 December 2020 and no enquiries, challenges or issues were raised. • HRCH and YH have completed a due diligence process to assess the new Lead Provider arrangement in terms of capacity, capability and provider standing. The due diligence process identified the following areas - clinical leadership; joint governance; joint policies; contract reporting and meetings as not meeting the full due diligence requirements and an action plan has been put in place to address these.

With the implementation of the actions arising from the due diligence SWL CCG is assured of the suitability of both providers to deliver the new contract.

Key Issues:

To ensure transparency and a form of risk mitigation, the market was alerted to the direct award decision by the Contract Award Notice (CAN). No enquiries, issues or challenges were raised.

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Conflicts of Interest:

Nil known

Mitigations: N/A

Recommendation:

The Governing Body are asked to: • note the progress on this programme of work.

Corporate Objectives Overall delivery of the CCG’s objectives This document will impact on the following CCG Objectives:

Risks Potential risk of challenge in relation to the decision to This document links to the approve the direct contract award. following CCG risks: Mitigations The following mitigations will be enacted: Actions taken to reduce any • the market was alerted of the direct award decision risks identified: in the form of a Contract Award Notice (CAN). No issues or challenges were raised. • a short-term contract was awarded (1+1 years) which was less appealing to external providers.

Financial/Resource/ The total annual value of the contracts based on 2019/20 QIPP Implications contract values and associated budgets is £47,560,000

Has an Equality Impact A procurement process (rather than a direct contract Assessment (EIA) been award) may have destabilised the workforce potentially completed? leading to the inability to reach vulnerable patients including patients on community nurse’s caseload, support to care homes delivered through the care home support team, reaching vulnerable patients identified through the shielding process.

This would have impacted particularly on elderly patients, BAME groups particularly patients with long term

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conditions such as diabetes (including those prioritised for podiatry services), hypertension, patients with learning disabilities and services for patients at the end of life. Are there any known Implications as noted above. implications for Mitigation is to achieve stability by extending the existing equalities? If so, what services. are the mitigations?

Patient and Public Included in Communication and Engagement Plan. Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups SWL CCG GB Part 2 Wednesday, GB supported the Enter any 02 approach. Committees/ September Groups at which this document has 2020 been previously SWL CCG Contracts & Wednesday, CPAG supported the considered: Procurement Advisory 07 October direct award approach Group (CPAG) 2020

SWL CCG Finance Tuesday, 27 FC approved direct Committee (FC) October 2020 award of contract and STW SWL CCG GB Part 2 Wednesday 4 GB ratified the direct November contract award 2020

Supporting Documents See attached

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Community Services in Kingston and Richmond (K&R) – January 2021 Update Background Community services in Kingston and Richmond (K&R) are delivered by two separate community providers: • Your Healthcare (YH) Community Interest Company – Kingston • NHS Hounslow and Richmond Community Health Trust (HRCH) – Richmond Both providers will be out of contract on 31 March 2021, which provides an opportunity to deliver an integrated delivery model which realises: • Improved services provided to K&R residents evidencing best value, delivering better outcomes and patient experience whilst enabling innovation • Increased alignment and empowerment of frontline staff staff to enable greater collaboration and integration. This will deliver more resilient and sustainable services together with improved responsiveness at times of system pressure / surge • The establishment of a stronger platform for joint working with a combined leadership supporting the development of the health and care model across Kingston and Richmond • Reduced management costs/overheads SWL CCG asked YH and HRCH to agree on a single community service offer across Kingston & Richmond (K&R) supported by a single contract to be delivered from 1 April 2021. HRCH and YH worked through options on delivering the ask through their Working Together Board which was established between the two organisations in March 2020. Through the Working Together Board, HRCH and YH have agreed on a Lead Provider model which would meet the requirements set out by SWL CCG. To establish a true partnership, the need for a ‘Partnership Agreement’ and a “Committee in Common” to supplement the services contract structure was identified. In September 2020 SWL CCG Governing Body supported the proposal for the Lead Provider model for a single community service offer across Kingston & Richmond (K&R) supported by a single contract to be delivered from 1 April 2021 Procurement & Contracts The new Lead Provider model contract will be between SWL CCG and HRCH, with YH as a sub-contractor to HRCH. The sub-contract will be a mirror contract with YH continuing to deliver the services they currently provide in Richmond and Kingston. The contract will be for be one year (2021/22) with the option to extend for a further year (2022/23). This requires a direct contract award to HRCH in line with SWL CCGs Single Tender Waiver (STW) process. This was approved by SWL CCGs Finance Committee (FC) on 27 October 2020 and ratified at the SWL CCG Governing Body Part 2 on 4 November 2020. Following the ratification HRCH and YH were formally notified of the contract award subject to a due diligence/assurance process.

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A Contract Award Notice (CAN) was published on the Official Journal of the European Union (OJEU) on 13 November 2020. The 30-day standstill for the CAN ended on 12 December 2020 and no enquiries, challenges or issues were raised. SWL CCG, HRCH and YH have started work on updating contract schedules (service specifications, activity, KPIs) for including in the new contract with HRCH and subcontract with YH for 2021/22. The plan is to have made good progress in January & February 2021 (subject to National Guidance) for signing in advance of the commencement date of 1 April 2021. The contract will be supported by a Partnership Agreement (see below) between HRCH & YH, governed by a Committee in Common, as well new integrated and aligned community service specifications. A programme of work is underway between SWL CCG/HRCH/YH to update and agree new standardised service specifications, commencing from 1 April 2021. Due Diligence

A provider due diligence/assurance exercise with HRCH/YH has been completed to ensure that there is an audit trail of the assessment of the proposed Lead Provider arrangement. A due diligence questionnaire was sent to HRCH/YH which covered the following areas: • Vision and Leadership • Contract Governance • Service Provision • Mobilisation and Transition • Transformation • Clinical Governance • Workforce • Public and Patient Engagement • Safeguarding • Information Management and Technology • Finance • Risk Management

The due diligence submission was reviewed by a SWL CCG panel which included: • Director of Transformation (K&R) • Director of Quality (K&R) • Chief of Staff (SWL CCG) • Deputy Head of Transformation (K&R) • Deputy Director of Finance (K&R) • Head of Non-acute Contracting (SWL CCG) • Lead Engagement Manager (K&R) • Transformation Manager – Community (K&R)

The panel members assessed their individual areas of expertise and then a panel meeting was convened to finalise scooring and to raise any concerns or questions.

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Clarifications were provided by HRCH/YH on the areas where insufficient information or details were provided. The panel then reconvened to review the scoring. The panel were assured by most of the clarification responses however some issues still need to be addressed. An action plan and timeline for addressing these has been agreed between HRCH/YH/SWL CCG. The areas for inclusion in this are: • Clinical Leadership • Joint Governance • Joint Policies • Contract Reporting/Meetings

The panel agreed that along with the implementation of these actions, SWL CCG is assured of the suitability of both providers to deliver the new Lead Provider model and contract. HRCH/YH Progress

HRCH and YH Boards and senior management teams have and continue to work closely to develop formal agreements and governance between the two organisations to operate within the proposed 2021/22 contract. A legally binding Partnership Agreement is expected to be ratified by both HRCH and YH Boards in December 2020, and from 17 December 2020 the associated Committee in Common and Joint Operating Group replaced the joint working together partnership board, that was established in March 2020. The Committee in Common governance and assurance mechanisms include reporting arrangements and quality monitoring. A Communication and Engagement Plan has been developed with the aim to: • ensure staff and members are kept engaged so that there is a positive platform for collaboration; • ensure staff, members and local people are informed about developments to help minimise any anxieties around change; • ensure key stakeholders and community groups are pre-briefed and have advised on the content and tone of communications to help minimise any anxieties around the proposed changes, such as relationship/ partnership, service delivery, efficiencies/financials and so on; • ensure any queries from staff, members, the public (including service users), or the press are responded to in a timely way to underpin positivity. Next Steps (March 2021)

1. Complete Service Specification alignment and standardisation; 2. Monitor action plan to address areas identified through due diligence;

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3. Agree contract monitoring and management group for the new contract (Clinical Leads, etc); 4. Agreed contract for signing prior to 1 April 2021.

Martin Ellis

Director of Transformation / Deputy Locality Director (Kingston & Richmond)

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NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021 South West London, Clinical Commissioning Group, Board Document Title Assurance Framework

Lead Director Ben Luscombe, Chief of Staff (Name and Role) Clinical Sponsor N/A (Name and Role) Author(s) Leigh Whitbread, Corporate Governance Team (Name and Role) Agenda Item No. 9 Attachment No. 08

Purpose Approve Discuss  Note  (Tick as Required)

Executive Summary

The Board Assurance Framework (BAF) forms the basis for the Governing Body to assess its position regarding achieving its corporate objectives. It uses principal risks to the achievement of those objectives as the foundation for assessment and considers the current level of control alongside the level of assurance that can be placed against those controls.

Background:

This paper informs the Committee of the status of the current high impact risks on the Corporate Risk Register, which are considered part of the Board Assurance Framework (BAF).

The BAF has been created from three core areas of the CCG’s more detailed Corporate Risk Register: • Risks with a significant residual score, i.e., those that score over 15; • Those risks that we believe are either likely to be growing in significance or that we wish to flag to the Governing Body as posing a risk to delivering essential areas of work; and • Overarching risks that collate and summarise a number of more detailed risks present on the risk register. For example, finance.

The SMT reviews the Corporate Risk Register monthly, and each of the Governing Body’s Committees receives and is asked to review, risks relevant to its scope regularly.

An NHS standard risk scoring matrix (CASU 2002) has been used to determine the scales of impact and likelihood of adverse events. The scale is scored from 1-25 (with one being the least severe and 25 being the most).

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Purpose:

Ownership of the BAF process lies with the Governing Body and, as such, twice a year, the Governing Body reviews the content of the BAF as a means of assessing the current level of risk. The BAF was last provided to the Governing Body in November.

Key Issues:

In total, there are 13 risks that we wish to bring to the attention of the Governing Body. Using the residual risk rating (i.e., after controls are taken into account), there are four risks of significant nature (significant risks are those on the risk register scored at 15 and above):

• RRSWLCCG008 – The impact of elective Referral to Treatment (RTT) (including diagnostic and cancer pathways);

• RRSWLCCG051 – NHS Constitution Standards;

• RRSWLCCG004 – Integrated Urgent Care (IUC) Contract;

• RRSWLCCG101 – Roll out of COVID-19 Vaccination Program Across SWL.

After a monthly review of the BAF entries by their owners and the SMT, three risks were assessed to have decreased in score to an extent that they met their target scores. Therefore, these risks have been removed from the BAF.

• BAF1 – Lack of supplies in Health & Care areas;

• RRSWLCCG030 – Lack of rapid Covid Testing Capacity;

• RRSWLCCG082 – Failure to meet national targets for flu vaccination.

One risk, BAF2 – Impact of COVID-19 pandemic on CCG staff, functions, and service provider, has been re-written to better reflect the challenges facing the CCG. This risk has been replaced by BAF3.

Nine risks are scored below 15, but are of a significance that we think they should be identified on the BAF and brought to the Governing Body’s attention.

• BAF3 – Ineffective CCG Response to COVID-19;

• RRSWLCCG017 – Increase in demand for Mental Health services across all ages;

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• RRSWLCCG098 – Discharge of Covid positive patients from the acute setting to care homes;

• RRSWLCCG072 – Inadequate support for care home settings during COVID-19;

• RRSWLCCG064 – Financial instability caused by Covid;

• RRSWLCCG066 – Achievement of Financial Balance;

• RRSWLCCG003 – EU Exit - Impact on Commissioned Services;

• RRSWLCCG055 – Provider Quality Oversight (General);

• RRSWLCCG075 – Impact of Coronavirus Pandemic on the CCG staff.

Note:

The BAF scoring under the Residual Risk Score will reflect the previous month's score in brackets where relevant.

The arrows to the right of the Risk Number reflect the trend of the score from the previous month.

Conflicts of Interest:

No specific issues or information giving rise to conflicts of interests are highlighted in this paper.

Some members responsible for raising risks from localities within SWL CCG have joint role with provider organisations.

Mitigations:

Joint roles of locality Directors with provider organisations should be declared.

Recommendation:

That the board notes the current risks and considers whether any further mitigations could be taken to ameliorate those risks already on the risk register; whether any new risks should be included; and whether any risks can be closed.

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Corporate Objectives Identifying risks is essential to the overall delivery of all of This document will impact on the CCG’s objectives. the following CCG Objectives:

Risks All SWL wide risks are listed on the risk register. This document links to the following CCG risks: Mitigations This paper describes the work taking place to develop the Actions taken to reduce any CCG risks for consideration at future Committees. risks identified:

Financial/Resource/ None QIPP Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

Patient and Public N/A Engagement and Communication

Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Enter any SMT Thursday, 04 Committees/ February Groups at which this document has 2021 been previously QPOC Wednesday, considered: 10 February 2021 Audit Committee Tuesday, 12 January 2021

Supporting Documents South West London Board Assurance Framework – Annex A

113 of 134 Page 4 of 4 RRSWLCCG008 Risk Title: Delivering Access To Planned Care Jonathan Bates

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 4 5 20 4 5 20 2 2 4 Cause & Effect Risk Control Action Required Risk Description: - Individual providers are carrying out validation of their Following submission of phase 3 Operating Plans, (agreed Backlog and waiting times on service delivery for patients patients tracking list. trajectories), need to: creates a delay to patient treatment and an increase in waiting times. - Service changes have been implemented to enable - Ensure regular review of actual activity against planned adherence to IPC guidance. Providers are communicating activity. Cause: these changes to the public and patients. - Cessation of non urgent elective activity during the peak of - Have early oversight of any bottlenecks to increasing the COVID-19 pandemic, in addition to a slow restart of - Tracking of actual weekly activity allowing monitoring activity. elective activity while adhering to Infection Prevention and against BAU activity levels, (as per NHSE instructions). Control guidance, (limiting numbers of patients in areas for Person responsible: Gayathri Sivapalan. patient safety). To be implemented by: 31 March 2021. - Compromised recording systems in implementation phase. - Complexities and challenges of system implementation. - Inaccurate and untimely reporting output. - Reduced capacity for elective work due to management of Infection, Prevention Control (IPC) limitations. - Reduce patient appetite to attend hospital for elective treatment through concerns related to COVID-19 infection.

Effects: - The impact of RTT backlog and waiting times on service delivery for patients. - Patients wait longer than required for treatment which will result in poor performance and potential harm to patients. - Unable to provide accurate patient information to GPs. - Decreased volume of patients seen. - This could effect SWL's financial provision. - Poor performance and quality monitoring. - Reduced elective activity. - Patience reluctance to engage with services following 114 of 134 COVID-19, may create longer term issue. 1 RRSWLCCG051 Risk Title: NHS Constitution Standards Jonathan Bates

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 4 5 20 4 5 20 3 2 6 Cause & Effect Risk Control Action Required Risk Description: - Regular Performance Quality and Workforce meeting to - Regular review at Joint Recovery Delivery Group. If providers do not meet national and local quality and monitor and manage performance against the Constitutional performance standards, then the CCG population does not standards. This would also include regular update reports as - SWL CCG in the process of recruiting a Chief Nurse to have constitutional pledges honoured by providers e.g. A&E and when required. ensure quality review. waits, Cancer wait standards, RTT waiting times and list size, HealthCare Associated Infections (HCAIs), Improved Access to - Quality and Service delivery reviewed on a bi-monthly basis Person Responsible: Julie Hesketh, David Peck, Amelia Phycological Treatments (IAPT) access and recovery rate. at SWL CCG Quality and Performance Oversight Committee Whittaker. meetings. The Health Commissioning Manager is currently To be implemented by: 31 March 2021. Cause: carrying out additional work such as assessments & reviews Underperformance of providers against quality and for Personal Health Budgets. performance standards. - The Health Commissioning Manager is undertaking Effects: Transforming Care work related to Learning Disabilities and CCG not meeting constitutional standards with reputational and Autism. This includes maintaining the dynamic risk register performance standards affected, adverse impact on patient for Adults & Children, and carries out Care & Treatment care. reviews when required. Establishment of clear and frequent monitoring and reporting of delivery.

- Management and Clinical Urgent Care lead in post. Joint System Sustainability Plan in place - To be assured by NHS England.

- Long, medium and short term operational and clinical opportunities are being explored and implemented as part recovery to ensure improved and sustained achievement of constitutional standards.

115 of 134 2 RRSWLCCG004 Risk Title: IUC Contract Jonathan Bates

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 4 4 16 4 4 16 2 2 4 Cause & Effect Risk Control Action Required Risk Description: - The IUC team continues to work collaboratively with the Due to the large and sudden increase in call volumes coupled with provider to improve performance, including investing in both Continue to report back to the Clinical Quality Oversight Group, difficulty in the 60 second call answering target, there are some call handling infrastructure and staff to support the expected implementing actions from quality and safety assessment work concerns that patients are not receiving the expected quality of increase in call volumes and planning for the winter NHS plan. service, and as we roll out the 111 First campaign patients could 111 First campaign. Weekly assurance meetings continue to lose confidence in the service. take place between commissioner and provider to ensure Person Responsible: Charity Mutiti. that service delivery remains safe, effective and provides To be implemented by: 31 March 2021. Given the requirement for the 111 service to increase its call good experience. handling capacity rapidly to support the UEC Recovery Plans, this - A new national service specification has been published in presents a risk both to 111 service delivery and to UEC recovery. - The provider, supported by the IUC team, has developed a December which needs to be reviewed and implemented, costed plan with clear milestones and deliverables which will alongside a new data set. Cause: enable a contract variation to be issued once an agreement The contract provider has experienced issues with their workforce is reached. This mechanism will be used to hold the provider - The Clinical Assessment Service needs to be reviewed and which has caused difficulty in meeting the changing demand for 111 to account for delivery. the senior clinical input into the service increased to support services throughout the contract term. Although proactive ED and Ambulance disposition revalidation. interventions by the SWL IUC team have produced positive - SWL CCG has received additional central funds to uplift the improvements in both performance and quality, we are aware that contract with the provider for the winter period, however the - The longer term approach to commissioning this service performance tends to decrease once this enhanced focus is CCG will also be required to identify further funding to needs to be agreed to enable the team to plan beyond the removed. This suggests that frequent assurance meetings with enable this service to increase its offer. end of the current contract in October 2021 sustained periods of engagement are required to ensure that new ways of working which have shown to improve performance are - Continuous monitoring via CQRG and Service Improvement Person Responsible: Caroline Morris. fully implemented and embedded. We continue to work Group (SIG) as part of BAU quality monitoring. To be implemented by: 31 March 2021. collaboratively with the provider to improve performance. - Quality and safety assessment will be a continuous process Effects: and rolling to adopt to the areas of concern until the contract Calls not being answered in a timely manner could potentially ends. impact the effectiveness of the 111 First approach, and may increase attendances at healthcare facilities, increase in 999 calls - Working with the Quality, Performance and Oversight or in some cases patients go without advice or treatment. This Committee, the SWL IUC team have undertaken a quality could also add pressure to other services within the UEC system. review to ensure standards are met. 116 of 134 3 RRSWLCCG101 NEW Risk Title: Roll Out Of COVID-19 Vaccination Programme Across SWL Tonia Michaelides

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 5 4 20 5 3 15 4 2 8 Cause & Effect Risk Control Action Required Risk Description: - Robust Governance and programme structure in place to - Planning for the delivery of the roll out of the vaccine to Failure to meet the national targets set to support the roll out of support delivery, dedicated resource supporting the cohorts 5-9 and the under 50s has begun, factoring the need the COVID-19 vaccination programme across SWL CCG. programme. SWL programme linked in through SROs to to deliver the 2nd doses as well. regional and national programme. Cause: - Reviewing the optimal delivery model for priority cohorts Operational failure of the roll out of a new vaccine at pace - Primary care ES signed and lead provider for the beyond 1-4 ensuring that sites and workforce to provide the across a complex delivery model leads to targets being missed. programme identified and contract in place – Croydon vaccine are secured. Vaccine hesitancy in the population and health and care staff Hospital. groups reduces the numbers of people coming forward to have - Continuing to iterate the communications and engagement the vaccine leads to targets being missed. - Sites operating across all six boroughs – Hospital Hubs, plan to encourage vaccination hesitant and reflect the Local Vaccination Centres, Vaccination Centres, and change in cohort focus. Effects: community pharmacies. Failure to vaccinate enough individuals in SWL means that - Put in place a substantive programme structure to support acuity and mortality from COVID19 will not reduce in SWL - Roving model for care homes and housebound in place the delivery of the programme going forward. putting pressure on NHS capacity. Recruitment for workforce to support vaccination is on- going; good response rate to date. Person responsible: Tonia Michaelides. To be implemented by: 30 June 2021. - Staff survey to inform engagement with HSCW to secure high levels of uptake. Regular meetings with providers and local authorities to optimise uptake in health and social care workers.

- Recruitment for workforce to support vaccination is on- going; good response rate to date.

- Communication and Engagement plan in place and resourcing identified focused on increase uptake in vaccine hesitant communities.

117 of 134 4 BAF3 NEW Risk Title: Ineffective CCG Response to COVID-19 Sarah Blow

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 5 4 20 4 3 12 3 3 9 Cause & Effect Risk Control Action Required Working with its partners across SWL, the CCG has put in place Risk Description: multiple mechanisms to coordinate the SWL response to COVID-19 There is a risk that the CCG does not respond effectively to the Person Responsible: Sarah Blow. These include: COVID-19 pandemic. The impact of this is that the CCG may To be implemented by: 30 June 2021. delay or disrupt the pandemic response by providers, NHS - An SWL Incident Control Room and framework. England or multi-agency partners, with consequences for - Outbreak management protocols. patients, provider or partner emergency response and - Specific work streams for Clinical, Community, Primary Care, perception of the CCG. Acute, Workforce, Communications, Supplies, Finance and digital. Executive Directors and Clinical Leads are leading delivery. Cause: - Specific measures in place to protect all of our staff (including the - Increased levels of sick absence across teams means there most vulnerable). For example, staff COVDI-19 risk assessments, is reduced capacity to complete all work. majority of staff working from home. - Work and resource may need to be re-prioritised. - Daily COOs SitRep call. - In effective processes and communication channels in place - Remain sighted on, and adhere to, national and local guidance for - In effective co-ordination of the response to the pandemic health and social care providers across SWL - Co -ordinate system restoration and recovery programme - Due to COVID-19 the creation of one SWL CCG was not - Work with partners to agree and implement improved care models celebrated or referenced in the way it had been planned. to delivery better outcomes. Also staff working remotely from their homes impacted on - Continue to work proactively with providers and partner feeling connected to the new organisation. organisations (including NHSE/I, Local Authorities, and the Local - Due to COVID-19 a number of staff have not been involved Resilience Forum) to adopt a co-ordinated approach to managing in business as usual work activities which has impacted their the crisis, restoring, and recovering services. ability to recruit into vacant positions or carry out their - HR have been working closely with the internal communications normal work activities. team to improve access to information and interaction through the daily comms messages; new CCG intranet in place; All staff Effects: briefing sessions held to update staff on the CCG and its focus - Un-coordinated and ineffective response to the pandemic in during COVID-19 Leadership Forum meetings held to go over SWL. priorities and focus. - Patients receive a reduced level of care. - SMT have reviewed priority order of vacant posts to recruit to; the - In appropriate use of CCG funds. management team have identified business critical posts and those - The CCG is unable to deliver statutory duties. have been covered where they118 canof 134 by temporary staff; a new recruitment process and vacancy control panel is in place to enable 5 recruitment to be done quickly. RRSWLCCG017 Risk Title: Increase In Demand For MH Services Across All Ages Tonia Michaelides

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 3 5 15 4 3 12 3 2 6 Cause & Effect Risk Control Action Required Risk Description: - Capacity in MH has been maintained throughout COVID-19 - SWL MH Recovery Group plans include modelling of Increase in people experiencing Mental Health (MH) across all and services moved quickly to offer alternatives to face-to- expected trends post similar incidents so that anticipatory age groups. Demand for all Mental Health services potentially face contact using digital and phone. Demand for services at action can be taken and working with partners to ensure increases above pre-COVID-19 levels. pre-COVID-19 level following significant decrease in access capacity is maintained. Additional services put in place in the numbers of people accessing services through the quickly in response to COVID-19 will continue and be Cause: first phase of the COVID-19 Pandemic. evaluated in Q3. Evidence that the COVID-19 Pandemic and its consequences impacts negatively on people's health and emotional well-being. - Additional services were set up including MH Emergency - Work with schools, particularly through the MHST work, to Reported increases in anxiety and depression across all ages, Services and 24/7 Crisis Line and are continuing for the identify actions to support CYP as they return to schools. including Children and Young People (CYP). People with remainder of 20/21. MHST has adapted its approach to support the emerging (Severe Mental Illness) are not able to access support and care needs of CYP, working closely with partners. in primary or community care settings. - For CYP Mental Health Support Teams (MHST) have been providing local support. This is a joint risk which will be - Vulnerable patients have been signposted to services via Effects: shared with schools and local authorities. SWL has also primary care and the Shielded Patient List is being cross- Services are overwhelmed with demand and cannot respond to commissioned Kooth to increase digital access to emotional checked with SMI and other lists to ensure these patients needs; acuity of patients rises due to reduced access to care. wellbeing provisions. are contacted. Increase in crisis presentations due to inability to access services, leading to poorer health outcomes. - Phase 3 planning response confirms South West London Person responsible: John Atherton. (SWL) commitment to deliver Long Term Plan (LTP) To be implemented by: On going. trajectories in priority areas – Improving Access to Phycological Therapies (IAPT), CYP, Crisis services to ensure capacity to meet the demand. Mental Health Investment Standard (MHIS) focused in increasing capacity to meet demand in in priority areas.

119 of 134 6 RRSWLCCG098 Risk Title: Discharge Of COVID-19 Positive Patients From The Acute Setting To Care Homes Lucie Waters

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 5 4 20 4 3 12 3 3 9 Cause & Effect Risk Control Action Required Risk Description: - Partnership working with the LA to identify TADD’s. - Procure TADD sites. If there is insufficient capacity to discharge patients who are still COVID-19 positive into ‘alternative discharge settings’ there is - Develop a unified approach to a service delivery - Develop and sign off the service specification. a risk that the hospitals in SWL become unsafe and unable to specification. admit emergency, urgent and elective patients. - Implementation of the clinical pathway (Admission and - Identify sites to become TADDs; one identified as the pilot discharge) Use feedback from the pilot site to inform future Cause: site. TADDs. - Increased number of admissions to the acute setting - Increased number of COVID-19 positive patients who are - Develop the procurement process. Person Responsible: Lucie Waters. well enough to be discharged. To be Implemented by: 31 March 2021. - Care homes unable to receive COVID-19 positive people - Collaboration with all settings, acute, LA's primary care and into or back into their care. community to develop a unified approach to deliver a safe - Insufficient Temporary Alternative Discharge Destination and effective Admission and Discharge pathway. (TADD). - Supporting care homes with education on COVID-19 via Effects: webinars and provision of PPE, Infection control training, Pressure in the acute beds, inappropriate care settings for the swabbing advice. frail elderly. - Dedicated care home support teams.

- IPC specialist supporting care homes.

120 of 134 7 RRSWLCCG072 Risk Title: Inadequate Support For Care Home Settings During COVID-19 Lucie Waters

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 4 4 16 4 3 12 3 3 9 Cause & Effect Risk Control Action Required Risk Description: - Designated Safeguarding Adults Professionals in place to - Assure implementation of the Enhanced Health and Care If the CCG is unable to provide appropriate support for support safeguarding issues in care homes. Homes DES. residents in a care home setting, this increases the risk of harm. Appropriate support includes GP leadership, community - In Reach Community Health teams in place to support care - Senior Directors will be seeking assurance from all nursing support, end of life care support, infection control homes in SWL CCG: Directed Enhanced Services (DES) is boroughs to confirm additional support for the in Reach training. implemented across the CCG, including Multi Disciplinary Team to care homes is in place. Team (MDT) meetings for care home residents. Cause: - Mutual aid across community health providers for hotspot Inadequate planning or delivery of integrated care support into - Liaison nurses in community teams who work to quality of management. care homes; inadequate process for tracking and responding to care in care homes through the provision of bespoke care home risks and issues. training. - Flexible working within community providers to support homes in need. Effects: - Supporting care homes with education on COVID-19 via Potential harm to vulnerable clients/service users. This risk webinars and provision of PPE, Infection control, swabbing Person Responsible: Andrew McMylor, Sandy Keen & Viccie refers to each of the boroughs within SWL CCG. advice via Incident Control Room (ICR) functions and Nelson. recovery workstreams, as part of the Integrated Care To be implemented by: 31 March 2021. programme. Partnership working with Local Authority Safeguarding team and Local Adult Safeguarding Board membership.

- LA lead – each borough has a Provider Risk Panel oversees quality and monitors quality dashboards for care homes – shared approach in each borough.

- Ensuring completion of the NHS capacity tracker to ensure information about rising tide risks of infection, staffing or PPE is well understood.

- Merton - Further update agreement reached to recruit additional team members from St George's Hospital, to 121 of 134 deliver Enhanced Healthcare in care homes (EHCH). 8 RRSWLCCG064 Risk Title: Financial Instability Caused By COVID-19 James Murray

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 5 3 15 4 3 12 3 3 9 Cause & Effect Risk Control Action Required Risk Description: - Close monitoring of system position, liaise with NHSEI and - Ensure that we are working to the revised financial Increased and unplanned spending on COVID-19 NHS EI London on evolving guidance. governance for COVID-19 to ensure we are able to meet countermeasures and recovery causing financial instability challenge of new financial regime. within the CCG. - Bi Weekly meetings between AO, CFO, Audit and finance committee. - Review of underlying financial position and routine review of Cause: COVID-19 costs Financial instability & breach of SFIs, increased capital costs, - Review at finance committee. increased GPIT costs. Person Responsible: Neil McDowell. To be implemented by: 31 December 2021. Effects: - Lack of confidence in SWL Finance Management teams and systems. - In year and underlying deficit.

122 of 134 9 RRSWLCCG066 Risk Title: Achievement Of Financial Balance James Murray

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 4 4 16 4 3 12 4 2 8 Cause & Effect Risk Control Action Required Ensure that robust reporting to NHSEI is carried out monthly to justify Risk Description: - SWL CCG Finance Committee oversees the reported any differences between the allocation and the actual expenditure. This There is a risk that the CCG will exceed its expenditure against financial position and any mitigations required. will mean that the CCG will receive the appropriate top up for its its control total. COVID-19 has led to new financial regime services in the first 6 months of the financial year. COVID-19 - costs - being implemented for 2020/21. - Close monitoring of system position, liaise with NHSEI and Ensure that we are working to the revised financial governance for NHS EI London on evolving guidance. COVID-19 to ensure we are able to claim back expenditure. Cause: Review financial regime for second half of year and note limit on - This will be exacerbated by the level of underlying recurrent - Bi Weekly meetings between AO, CFO, Audit and Finance investments and impact of COVID-19 costs. deficit coming out of the former SWL CCGs and Committee. implementation of the interim financial regime. SMT to review COVID-19 investments and ensure appropriate review and controls in place. - Increased and unplanned spending on COVID-19 countermeasures and recovery causing financial instability Person Responsible: Neil McDowell. within the CCG. To be implemented by: 31 March 2021. The SWL CCG pharmacy leads meet on a weekly basis, and where - Allocations have been reset on actuals so reduced flexibility issue arise with regards to increases in prices; they inform finance for investment. leads. On a monthly basis, the pharmacy leads in each of the boroughs communicate any financial risk or pressure to the Finance Leads, who - Impact of new discharge funding process. then make the appropriate financial adjustments, by considering the contingency reserve for this speciality. Funding for devices such as - Prescribing risks as part of revised working in primary care. continuous glucose monitoring will come from reserves: active management of patients should lead to a reduction of patients being Effects: admitted/seen in hospital. - Not achieving financial balance. Person Responsible: Neil McDowell, Nick Beavon. - Unable to invest in the priority areas. To be implemented by: 31 March 2021.

- The drug budgets in the Boroughs may become overspent Close working with local boroughs to develop CHC and discharge leading to SWL CCG financial pressure. controls and monitor expenditure

Person Responsible: Geoff Price, Liam Bayley, Jennifer Sinnot, 123 of 134 Marion Johnson To be implemented by: 31 March 2021 10 RRSWLCCG003 Risk Title: EU Exit - Impact On Commissioned Services Jonathan Bates

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 4 5 20 4 3 12 12 (16) 3 1 3 Cause & Effect Risk Control Action Required - The CCG has documented and approved emergency planning and Risk Description: resilience response plans in place as part of the Business Continuity Plan. - Continued careful scrutiny of any delays to receiving goods Due to the extension of trade talks with the EU into late All parts of the system have identified their risks and actively sought to associated with new customs arrangements and proper November or even December resulting in ongoing uncertainty mitigate them. paperwork. particularly in relation to the supply chain, the CCG's planning - The SWL ICR has assumed the responsibility for managing any EU exit for the end of the Transition Period is insufficiently robust. incidents alongside Winter and COVID incidents as they arise. Guidance - Continued encouragement of EU staff to apply for settled and SOPs have been issued to support this new role. To date no impacts status to avoid any long term staffing issues. have been reported. Cause: - The CCG has a named EU Exit lead and fully participates in national and - SWL CCG fails to prepare for the end of the EU transition regional planning/review processes . The regional process for London - Embedding of new payment arrangements within systems. period and its impacts effectively due to ongoing uncertainty has been stood up and SWL is attending regularly. on the impacts to the system, and particularly the supply - NHSE Exit Co-ordination Centre set up to gather intelligence and identify - Manage legacy of payments for planned care undertaken in chain. issues, and has appointed an incident commander. Provide a single point the EU prior to 31 December. - Due to COVID-19 pandemic, there has been impact on the of contact for regions and support local and regional teams resolve resilience of supply chains and many stockpiles that had escalating issues. - Continued review of data flows to identify any further risks been developed nationally may have been exhausted. This - Use of existing reporting routes for escalation of concerns to the regional as national level discussions on the future of Trusted EU exit coordination centre. increases the risk of shortages when the transition period Country status are concluded. - An ICS-wide group has been set up at EPRR level and for EU-Exit SROs finishes on 31 December 2020. as required. - The end of the Transition Period coinciding with Christmas - Data flows have been assessed for any flows coming from Europe and holidays and the COVID-19 pandemic could mean some EU relevant actions to prevent any cessation of flows taken. The Trade Deal Person responsible: Jonathan Bates. workers choose to remain in their home country following provides the UK with temporary Trusted Country status which enables To be implemented by: 31 December 2021. the holiday period. continued data flows. - Increased demands on frontline services, staffing and - National arrangements regarding supply chain contingencies have been supplies during winter. communicated to ICS with clearer understanding of which suppliers are being managed at national level and which at ICS level. Guidance on lead Effects: times and how to arrange emergency supplies have been communicated. - Advice regarding reciprocal health arrangements and charging has been There is a potential for services to be impacted across all supplied and communicated across Trusts following the announcement of providers commissioned by the CCG. Patients, public, health the Trade Deal. care staff and care providers could all be impacted, with - A national process to manage any pharmaceutical shortages has been set consequences for the quality of service provision, finances and up and is in operation. staff retention and recruitment. This could result in the shortage - The Trade Deal agreed has clarified a number of outstanding areas, of medicines or medical devices, other supplies and impact on particularly in removing any risk of quotas in supplies from the EU into the 124 of 134 the continued availability of staff resource and widespread UK. 11 disruption of transport & logistics networks. - Arrangements for EU staff to work in the NHS will not change for 24 months. RRSWLCCG055 Risk Title: Provider Quality Oversight (General) Gloria Rowland

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Priority Impact Likelihood Priority Likelihood Priority 4 3 12 3 2 6 2 2 4 Cause & Effect Risk Control Action Required Risk Description: - Contract monitoring (quality and performance) through - Development of Quality and Performance Oversight If there is inadequate oversight of the quality of care delivered formal and informal communications. Committee annual plan and reports to the SWL CCG by SWL providers this could lead to an unacceptable level of Governing Body. patient experience/ patient safety/ ineffective service delivery. - Reporting of patient safety and serious incidents. - Develop a wider understanding of a revised CQC inspection Cause: - Quality team engagement with providers through CQRG and framework and connection with ICS quality assurance - Failure to identify inadequate quality and performance at a other quality scrutiny meetings. ‘Patient Safety Committees’ processes. Strengthening of the quality assurance and provider level leading to delays in remedial action being (internal trust meeting) have CCG membership. oversight of primary care through Quality, Performance and taken. Oversight Committee (QPOC) and Primary Care - Quality assurance of serious incident reports. Commissioning Committee (PCCC) chairs. - Failure to identify lessons learnt following adverse events. - Make a Difference reporting of quality concerns regarding - Develop longer term approach of ICS partnership to - Insufficient sharing of best practice and lessons learnt providers service delivery. "declarations" of provider assurance. across the system. - Borough Committee oversight and engagement with - Quality leads will hold monthly Quality Risk Management Effects: provider leadership. meetings with SWL CCGs Risk Manager; this allows for on Patients experience a less than acceptable level of service - Intelligence sharing with CQC and NHSE/I regarding going monitoring of quality concerns and an opportunity for delivery, which could result in patient harm and less favourable provider concerns. new concerns to be considered across the boroughs/CCG. outcomes. Services fail to deliver satisfactory patient experience or an unacceptable level of service delivery. - Review of provider reports (e.g. patient experience/ Person Responsible: Julie Hesketh, Elaine Clancy and Fergus complaints/ safeguarding/ board assurance reports/ safer Keegan. staffing levels). . Recommencement of the Friends and To be implemented by: 30 June 2021. Family Test reporting.

- Clinical Quality Assurance processes following COVID-19 pandemic are in place, as above.

125 of 134 12 RRSWLCCG075 Risk Title: Impact of COVID-19 Pandemic On The CCG Staff Karen Broughton

Inherent Inherent Inherent Risk Residual Residual Residual Risk Target Impact Target Target Risk Impact Likelihood Score Impact Likelihood Score Likelihood Score 3 3 9 3 2 6 2 2 4 Cause & Effect Risk Control Action Required Risk Description: - All staff working from home whilst lockdown in place. Management to monitor sickness levels more closely. There is a risk that staff within the organisation may become ill due to the speed and spread of the Coronavirus. Impact of - All SWL CCG buildings assessed as being COVID-19 Person Responsible: Sarah Patmore. COVID-19 on CCG functions and service providers. secure. To be implemented by: 31 March 2021.

Cause: - Regular SWL Communications published to all staff within All departments to review and refresh their BCP and local A group of viruses that causes illnesses such as the common the organisations. plans, including service partners. cold, to more severe conditions such as pneumonia, Middle East Respiratory Syndrome (MERS) and Severe Acute - Self isolation if in contact with the virus or returning back Person Responsible: Caroline Morris. Respiratory Syndrome (SARS). from areas of concern or countries. To be implemented by: 31 March 2021.

Effects: - All staff risk assessments and building risk assessments SWL CCG to confirm service partners business continuity Depleting CCG staffing levels due to illness. The CCG is undertake to establish personal level of risk for vulnerable plans. unable to deliver statutory duties due to decreasing levels of staff. staff. CCG Black, Asian, Minority Ethnic (BAME) staff are Person Responsible: Caroline Morris. disproportionately affected. - All the areas have 1-2-1, and staff catch up meetings. Staff To be implemented by: 31 March 2021. have been offered £150 to procure IT equipment and £150 to procure office equipment. Implement ways of working Ways of working implementation plan to be delivered across action plan. SWL CCG.

Person Responsible: Ben Luscombe. To be implemented by: 31 March 2021.

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NHS South West London Clinical Commissioning Group Governing Body Part 1 in Public

Date Wednesday, 03 March 2021

Document Title IG Annual Report Lead Director Ben Luscombe, Chief of Staff (Name and Role) Clinical Sponsor Les Ross, Secondary Care Doctor & Caldicott Guardian (Name and Role) Author(s) Ben Luscombe, Chief of Staff (Name and Role) Alison Tingle, IG Subject Matter Expert Manager Agenda Item No. 10 Attachment No. 09

Purpose Approve Discuss Note  (Tick as Required) Executive Summary

The Governing Body has a responsibility to ensure that information risk is managed appropriately. This report provides the Governing Body with an overview and update of the work of the Information Governance team to ensure that we are not only meeting our statutory obligations but delivering best practice across SWL and leading the Information Governance agenda.

2020/21 has continued to see a great deal of work for the Information Governance team in supporting SWL response to the COVID-19 pandemic. IG Leads from across SWL have come together to work collaboratively and proactively to produce robust advice and assurance documentation to support the health and care system as a whole.

In addition to this, the CCG is on track to complete all statutory and mandatory IG requirements that form the annual Data Security and Protection Toolkit return to NHS Digital, as a result of a strong IG culture that has been embedded into business as usual.

Background:

This paper provides an end of year report detailing the information governance activities that have taken place in the CCG throughout the year, including the adaptations made in line with legislative changes arising from the COVID-19 pandemic.

Purpose:

For information and assurance.

Key Issues:

1. Note the changes to information sharing brought about by the Control of Patient Information notice issued on 17 March 2020. 2. Note the creation of the South West London COVID-19 IG Strategy Group.

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3. Note the progress made against compliance with statutory and nationally mandated information governance standards.

Conflicts of Interest:

N/A

Mitigations: N/A

Recommendation: Note the contents of attachment 09.

Corporate Objectives The paper describes the activities undertaken in line with the This document will impact on CCG’s IG agenda and framework. the following CCG Objectives:

Risks The paper relates to all information governance risks, which are This document links to the captured in the IG risk register. All are being managed and are following CCG risks: not scored as ‘high’. Mitigations As above, details of individual risk mitigations are outlined in the Actions taken to reduce any IG risk register. risks identified:

Financial/Resource/ N/A QIPP Implications

Has an Equality Impact N/A Assessment (EIA) been completed? Are there any known N/A implications for equalities? If so, what are the mitigations?

Patient and Public N/A Engagement and Communication

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Previous Committee/Group Name: Date Outcome: Committees/ Discussed: Groups Click here to Enter any enter a date. Committees/ Groups at which Click here to this document has enter a date. been previously Click here to considered: enter a date.

Supporting Documents Attachment 09

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South West London Clinical Commissioning Group Governing Body Public Meeting Paper 19 February 2021

Information Governance Annual Report 2020/21

Background

1. The Governing Body has a responsibility to ensure that information risk is managed appropriately. As a large NHS organisation, responsible for the commissioning of services for the population of South West London (SWL), the Clinical Commissioning Group (CCG) must ensure that all of the personal and sensitive corporate data it manages or, has an influence over, is managed appropriately. This is to ensure we protect the privacy of individuals and the business interests of the NHS, whilst ensuring that this data is used effectively to deliver the best standard of care possible.

2. The Governing Body discharges this duty via the Information Governance Steering Group (IGSG); the organisations Senior Information Responsible Officer (SIRO (Ben Luscombe)); and the Caldecott Guardian (Les Ross).

3. In 2020, as a response to the COVID-19 pandemic, the Government made it easier for the NHS to share information between organisations to aid its efforts to tackle the pandemic. In response to this, we also created the SWL Information Governance Strategy Group, Chaired by Les Ross as Caldicott Guardian.

4. In order to provide the Governing Body with assurance on the structures and measures in place and that the CCG is adequately able to manage and address information risk, this report provides details on the assurance framework in place at the CCG and a summary of the activities that have been undertaken against that framework.

Changes to Data Protection Legislation during COVID-19

5. In March 2020, the Secretary of State for Health issued a notice under the Regulation 3(4) of the Health Service Control of Patient Information (COPI) Regulations 2002 instructing NHS organisations to share data where it is needed for the response to COVID-19. In light of this instruction and due to the pressures of the pandemic, the Information Governance (IG) agenda has been adapted to meet the needs of the local and system-wide response to the pandemic. The provisions outlined within this notice have been extended a number of times in-line with the Government’s management of the pandemic. They are currently due to expire at the end of September.

6. Further detail on how we have managed this process throughout the pandemic is outlined below.

SWL CCG IG Management Framework

7. The CCG has established an IG Steering Group that has representation from the key services across the CCG, such as primary care, finance, ICT and quality. The IG Steering

130 of 134 Group drives the CCG’s IG agenda and monitors the CCG’s compliance with national standards. In addition, the CCG has appointed the following IG key roles:

• Senior Information Risk Owner: Ben Luscombe • Deputy Senior Information Risk Owner: Steve Crocker • Caldicott Guardian: Les Ross • Deputy Caldicott Guardians: Julie Hesketh and Fergus Keegan • Strategic IG Manager and Data Protection Officer (NEL): Claire Clements • IG Subject Matter Expert Manager (NEL): Alison Tingle • IG Compliance Manager (NEL): Lia Holmes

SWL COVID-19 IG Framework

8. As reported in the Information Governance update provided to the Governing Body in September, and mentioned above, we have also established the South West London COVID-19 IG Strategy Group.

9. The Group, Chaired by Les Ross, consists of NHS partner organisations from across SWL and provides a decision-making forum to ensure that, across SWL, we take a consistent, proportionate and swift response to all data sharing requests.

10. Once approved by the group, all data flows are added to the SWL COVID-19 Information Asset Register, which is reviewed by the Group bi-weekly. Working with the Group, the SWL IG team are also establishing all of data flows, created in response to the pandemic, that may go beyond the current COPI notice and therefore need a more in-depth Impact Analysis and approval by the SWL IG Steering Group.

11. In Quarter 2 of 2020/21, an external audit of the SWL COVID-19 IG Framework was undertaken by RSM (SWL CCG’s internal auditors). The audit found ‘significant assurance’ in the processes that the CCG had put in place.

Data Security and Protection Toolkit (DSPT)

12. All organisations that have access to NHS patient information must provide assurances that they have the proper measures in place to ensure that this information is kept safe and secure. Completion of the DSPT is required for a number of reasons:

• It is a contractual requirement specified in the NHS England standard conditions contract; • It is Department of Health and Social Care policy that all bodies that process NHS patient information, for whatever purpose, provide assurances via the DSPT on an annual basis; • Completion of the DSPT is necessary for organisations that use national systems such as NHSmail and the e-referral service; and • Meeting the standards of the DSPT also demonstrates to partner organisations that the CCG has the appropriate measures in place to protect personal data.

13. The DSPT is based on the 10 Data Security Standards set out by the National Data Guardian. Via the SWL IG team, we have an approved IG Workplan in place that outlines 2

131 of 134 the tasks and documents required for completion of the return. A large proportion of the mandatory requirements have already been completed, including the approval of a suite of IG policies and the IG Framework. Work is currently underway to update the existing information asset registers held by each of the CCG’s teams, which supplement the SWL COVID-19 Information Asset Register.

14. Because of COVID-19, this year’s deadline for compliance has been pushed back by NHS Digital from the original date of 31 March 2021 to 30 June 2021. However, the CCG is on target to submit by the end of March 2021.

Privacy Notices

15. The CCG has published privacy notices on its website to cover all of the ways it uses personal data as follows:

• Complaints, subject access and freedom of information requests • COVID-19 including vaccination • Direct care • HR, staffing, employment recruitment and training • Medicines management • National screening and reporting programmes • Patient communications • Patient participation or engagement group • Payments • Public health • Quality alerts • Risk stratification

Subject Access Requests, IG Incidents and IG Training

16. Since 1 April 2020, the CCG has received 23 subject access requests, which were managed by the NEL IG Hub service. All requests, aside from one, were completed within one calendar month, as per the statutory timeframe. The one exception is a highly complex request, for which the CCG has invoked its right under data protection legislation to extend the deadline for response by 60 days due to the complexity. This has been communicated to the requestor, and the CCG is working in conjunction with the SWL CCG DPO and NEL CSU Head of IG to respond as soon as possible.

17. There were 11 internal incidents and 34 provider incidents in 2020/21. All incidents have been logged by the NEL IG Hub, investigated, actions taken to prevent recurrence and closed. All CCG incidents were assessed by the IG Team as low level and therefore did not meet the threshold for reporting to the Information Commissioner’s Office, NHS England or the Department of Health and Social Care.

18. It is a mandatory DSPT requirement for the CCG to achieve 95% IG training compliance for all staff. The IGSG regularly monitors IG training compliance statistics and will continue to put measures in place, such as targeted emails, to ensure the compliance of all staff for 2020/21.

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19. The majority of projects (over 60) in 2020/21 have been completed under the COVID-19 IG Framework as short DPIAs. However, a number of full DPIAs have also been completed and been taken through the IGSG approvals process. The full DPIAs approved for projects and services in 2020/21 are:

• Get U Better (Wandsworth) • Diabetes DR-EAM Project • CYC2 • Long Term Conditions (LTC) Proactive and Preventative LCS (Croydon) • Spirometry • PA Support Service (Croydon) • Dr Link • Lung Health Check (Sutton) • Egton Tokens for GPs • eRed Bag • Edenbridge

Risk Management

20. The IG Risk Register is regularly reviewed by the IGSG, and feeds into the overarching CCG risk register. All risks have appropriate mitigations in place, and none are scored as ‘high’ (16 or above).

Complaints

21. In November 2020, the CCG was informed that a complaint had been filed with NHS England concerning the data sharing arrangements in regard to three specific projects within SWL. Following an investigation into these complaints, which concluded the arrangements in place were lawful, the CCG’s Accountable Officer, SIRO and Caldicott Guardian approved a response to NHS England in December 2020. The CCG’s response was acknowledged by NHS England and no further communications on the matter have been received.

22. In May 2020 the CCG received a complaint regarding the data sharing arrangements surrounding the Eclipse project. The complainant questioned the legality of the Information Sharing Arrangements and asked for these to be investigated. Working with the relevant Locality Executive Director and SIRO and due to the obvious Conflicts of Interest in reviewing their own work, it was agreed that the SWL IG team would request a review of the arrangements by another ICS IG team. It was subsequently agreed that a further review would be commissioned by the Capsticks Data Protection legislation expert. Both reviews found that the arrangements were lawful but could be strengthened. The recommendations from both reviews were incorporated into revised agreements.

23. A full response was subsequently provided to the complainant and no further correspondence has been received.

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Recommendation

24. That the Governing Body notes the actions and progress made both within the CCG and the wider SWL footprint over the past 12 months.

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