Tower Hamlets Clinical Commissioning Group Governing Body Meeting - Part I Agenda
Wednesday, 10 May 2017, 14.30 – 17.10 Room 101, Professional Development Centre, 229 Bethnal Green Road, London, E2 6AB
Please look over the agenda and reflect on whether any topics or papers might present an area of interest for you. This means an item where a decision or recommendation made may advantage you, your family and/or your workplace. These advantages might be financial or in another form such as the ability to exert unseen influence.
Where anything on the agenda has the potential to put you in such a position, or raised in the meeting along the way, you should inform the meeting attendees and Chair immediately. This means we can ensure that our decision, recommendations or actions can be guarded from the impact of any possible conflict you or others could have and be seen to be so. If you are unsure, it is best to raise the possibility with the chair before the meeting, or at any point during the meeting if a possible interest strikes you. This openness is important and ensures we can discuss how to manage decision making in a complex environment and learn together how to manage these issues effectively.
Meeting attendees are agreed that we will challenge others on areas of interest or possible conflict as it is recognised that sometimes these issues can be overlooked.
1.0 General Business Action Presenter Enc. Time Page
1.1 Welcome, Introductions and Apologies - Sam Everington, Verbal 1.2 Declarations of Interests & Chair Register of Interests - 14.30 1 - 6 1.3 Chair’s Report Sam (5 mins) For Noting Everington, Chair Paper A 1.4 Chief Officer’s Report Simon Hall,
For Noting Acting Chief Officer 1.5 Members’ Story – St Paul’s Way 14.35 For Noting Sam - Everington, (10 mins)
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THCCG Governing Body Meeting 10th May 2017 Part I
Chair 1.6 Draft Minutes, Matters Arising & Paper Action Tracker of the Meeting held For Sam Everington, 14.45 B 8 - 17 on 7 March 2017 Approval Chair (5 mins)
2.0 Performance and Operations
2.1 2.1.1 Finance Report M12 Henry Black, Chief Finance Paper Officer C 18-27 For 14.50 Discussion Ali Kalmis, 2.1.2 Activity Report M12 (20 mins) 28-33 & Noting Director of Paper Acute Contract D Management, NEL CSU 2.2 Performance and Quality Report Archna Mathur For Paper Director of 15.10 Discussion E 34-45 Performance & (15 mins) & Noting Quality 2.3 GP Care Group CIC Provider For Chris Banks, Paper 15.25 Update Discussion GP Care Group 46-59 F (30 mins) & Noting CIC 2.4 Audit Committee Annual Report to Mariette Davis, For the Governing Body Paper 15.55 Discussion Governing Body 60-74 G (5 mins) & Noting Lead for Audit & Governance BREAK – 5 MINS
3.0 Commissioning and Strategy
Tower Hamlets CCG Governance Simon Hall, 16.05 3.1 For Paper Update Acting Chief (10 mins) 75-81 Discussion H Officer 3.2 Financial Plan & Approval of 2017-18 Budgets For Henry Black, 16.15 Paper Discussion Chief Finance (20 mins) 82-90 I & Approval Officer
Healthy London Partnership 3.3 Simon Hall, For Paper 16.35 91- Approval Acting Chief J (10 mins) 103 Officer 3.4 East London Healthcare Jane Milligan,
Partnership - STP programme Chief Officer 104- Partnership Agreement and Executive For Paper 16.45 134 Lead for East Approval K (10 mins) London Healthcare Partnership
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THCCG Governing Body Meeting 10th May 2017 Part I
4.0 For Information 4.1 Finance, Performance and Quality Committee Minutes Mariette Davis, Paper Governing Body L Lead for Audit & Governance
4.2 Primary Care Commissioning Mariette Davis, Committee Minutes Paper Governing Body M Lead for Audit &
Governance
4.3 Executive Committee Minutes Paper Simon Hall, 16.55 136- N Acting Chief (5 mins) 175 For Officer Information 4.4 Audit Committee Minutes Mariette Davis, Governing Body Paper Lead for Audit & O Governance 4.5 Transformation Committee Julia Slay, Minutes Governing Body Paper Lead for Patient P and Public Involvement 5.0 Questions from the Public Chair 17.00 (10 mins) All questions received 48 hours before the meeting in will be recorded in the minutes of the meeting. If you are asking a question at the meeting please use the sign in sheet in the public area of the meeting. You will be asked for your name and the agenda item number your question refers to. You will be expected to retain a copy of your question. Questions that are asked verbally at the meeting will only be answered if an accurate answer can be provided. Otherwise, the question will be taken on notice and will be answered at the next meeting. Please email [email protected] for more information. 6.0 Date of next Governing Body Meeting Chair Wednesday 5 July 2017, 14:30 – 17:00, Venue TBC
7.0 Part II- Meeting Chair
To resolve that as publicity on items contained in Part 2 of the agenda would be prejudicial to public interest by reason of their confidential nature, representatives of the press and members of the public should be excluded from the remainder of the meeting. Section 1 (2) Public Bodies (Admission to meetings) Act 1960.
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THCCG Governing Body Meeting 10th May 2017 Part I Enclosure A
Chair’s and Chief Officer’s Report
1 Purpose
The Chair’s and Chief Officer’s report highlights items of interest to Governing Body members and the public. The Governing Body is invited to note this report and pursue any points of clarification or interest.
1.2 Chair’s Report
Tower Hamlets Together Celebrates Its Two-Year Anniversary
Tower Hamlets Together, the partnership of local health and social care organisations in the borough, is celebrating its two-year anniversary of being awarded ‘vanguard’ status to develop pioneering ways to provide care to its communities.
Back in 2015, NHS England invited health and social care organisations to bid for funding to become part the NHS New Care Models programme – established with the aim of exploring new and innovative ways to provide the best ever standards of care. This was in response to rapidly increasing demand for care from an ageing population as well as recognition of the opportunities to improve quality and efficiency through closer working between health and social care services.
Tower Hamlets was one of 50 sites nationally to successfully bid for funding which would support a three-year programme of work. As the partnership looks ahead to the final year of funding, it’s reflecting on achievements so far as well as its priorities for the next 12 months.
The Tower Hamlets Together programme comprises three main strands of work – improving services for children and young people, improving services for adults, in particular those with a long term health condition or who are vulnerable to illness, and finally a focus on prevention and supporting people to lead a healthy life.
Each of the three main strands of work are made up of a number of smaller projects, all of which have the common goal to improve health and wellbeing.
New ‘Red Bag’ Scheme Set to Bring Benefits for Care Home Residents
Tower Hamlets Together (THT) is launching a brilliantly simple initiative to help people living in Tower Hamlets care homes receive quick and effective treatment should they need to go into hospital in an emergency. The “red bag” keeps important information about a care home resident’s health in one place, making it easily accessible to ambulance and hospital staff. This includes standardised information about the resident’s general health, any existing medical conditions they have, medication they are taking, as well as highlighting the current health concern. This means that ambulance and hospital staff can more effectively determine the treatment required. The red bag will also be used to deposit the discharge
THCCG Governing Body Meeting 10th May 2017 Part I 1 summary at the end of the patient’s stay, thereby creating a more seamless link between first response teams, healthcare providers and social care providers.
The red bag scheme launched in March and has been used to support residents in two local care homes - Aspen Court and Hawthorne Green. If proven successful, it is intended for the scheme to be introduced in residential homes across the borough. We are looking forward to seeing the outcome of this scheme, and hope that it contributes to safeguarding patient health, welfare and experience in the borough of Tower Hamlets
Choose and Consult
I recently authored an article for the Healthcare Leaders online magazine, where I discussed looking at our plans to improve the referral system where primary and secondary care clinicians are encouraged to manage patients in the most cost effective way. The plan, Choose and Consult rather than Choose and Book, will result in the consultant team receiving an e-referral and then being able to choose to send advice back, phone the patient or GP and, if needed, book an appointment. All GPs and consultants would have access to GP and hospital notes. The report highlights Saint Bartholomew’s Hospital as a best practice example where all GPs have a direct line and can ask to be put through to a consultant’s mobile for urgent advice.
Further information available at this link: http://bit.ly/2pNlOUi
Tower Hamlets Tops Public Health England Ratings For Flu Vaccine Uptake
Public Health England (PHE) have published results from the end of the seasonal flu vaccination programme which includes data for Tower Hamlets.
Tower Hamlets came top for 65 years plus and pregnant women, and second in London for under 65 years with medical conditions. Congratulations and many thanks to all those who contribute to these numbers. This not only demonstrates the significant engagement that took place with local patients in Tower Hamlets but also highlights the great care taken to safeguard the health of our local population by many of our partner organisations.
New GP Practice Premises Opens
An exciting new chapter has begun for a GP practice in east London. St Paul’s Way Medical Centre has moved into new state-of-the-art premises that provide improved facilities for its GPs and staff – and offer major benefits for its patients.
The practice – which is rated ‘outstanding’ by the Care Quality Commission – moved into its new first-floor premises in January. In addition to nine consultation rooms and three treatment rooms, the modern facilities, developed in close liaison with patients, include a surgery ‘pod’ where patients can log-in and check their own blood pressure, a spacious interactive patient waiting area with TV screens and iPads for browsing, baby changing and feeding areas for patients with young children and a group room designed for holding training courses and health promotion sessions.
The new GP practice is the first project to be completed as part of a major investment in new primary care medical facilities in Tower Hamlets to meet the needs of the borough’s rapidly- growing population and increasing demand for local healthcare services.
The programme, which includes plans for six new medical centres, is being led by Tower Hamlets Clinical Commissioning Group (CCG), using capital grants from Tower Hamlets
THCCG Governing Body Meeting 10th May 2017 Part I 2 Council. Development of the new practice was coordinated by the CCG in close partnership with NHS Property Services, NHS England, the council and medical practice.
The new St Paul’s Way Medical Centre premises also has a more spacious and better- equipped staff area for its eight GPs and the team who work alongside them. The extra space and improved IT has enabled the practice to offer additional services for its patients, including sessions with a midwife and a psychologist, and welfare and benefits advice. It also runs a social prescribing project which allows GPs to refer patients to services that will help them with employment, benefits, healthy lifestyles or their mental health.
The practice is also working with Morgan Stanley on a public health education project that seeks to promote self-care and healthy lifestyles. Twenty people have already come through the six-week course and another 24 have signed up to take part with a further 30 on the waiting list.
Welcome to NHS Barts Health’s New Chair Ian Peters
I would like to extend a warm welcome to Ian Peters, who has been appointed as permanent chair of Barts Health NHS Trust.
Ian is the outgoing chair of one of London’s largest housing associations, Family Mosaic, and will be standing down as a non-executive director at Central and North West London NHS Foundation Trust. He will lead NHS Barts Health’s board from 1 April 2017.
Ian brings with him a wealth of experience that can really help NHS Barts Health build on its recent progress. After a successful career in financial services and energy, Ian retired in 2015 from Centrica, the parent company of British Gas, where he held a number of senior roles including managing director. He is chair of British Gas Services Ltd, a trustee and treasurer of the charity Carers UK and is involved with a number of small technology companies. Ian will also take on the role of vice chair of the Peabody housing association when it merges with Family Mosaic this summer.
Ian takes over from Alastair Camp, who has been acting chair since October 2016 and will continue in his role as vice chair. I thank Alastair for his work as acting chair in improving care for patients at Barts Health, and look forward along with the rest of Tower Hamlets CCG to continue the good work already taking place at NHS Barts Health.
THCCG Governing Body Meeting 10th May 2017 Part I 3
1.3 Chief Officer’s Report
New Approach to Community Health Services in Tower Hamlets
People in Tower Hamlets will have access to improved community health services under a ground-breaking partnership.
NHS Tower Hamlets Clinical Commissioning Group (CCG) has signed an alliance partnership agreement between three local healthcare providers: Tower Hamlets GP Care Group Community Interest Company (CIC), Barts Health NHS Trust, and East London NHS Foundation Trust (ELFT). The partnership will enable local GPs to work much closer with hospital and community trusts to offer patients more joined up health services across the borough and reduce duplication. By adopting the alliance model, the CCG and the three providers are looking to build on the strong working relationships they have developed as part of the Tower Hamlets Together vanguard.
Services within the partnership range from district nurses visiting people at home to speech and language therapists working with children in schools and local health centres, and include a stroke rehab team who support patient rehabilitation in hospital as well as helping people to get well after they have left hospital, and specialist diabetes nurses.
It was important to Tower Hamlets CCG that this contract negotiation had minimal effect on patients and we are pleased that from the first day of operation, patients have received the same services from the centres they previously did and contact numbers have remained the same. We also worked to improve patient experience and a number of key developments have occurred - a new single point of access is available 24 hours a day, seven days a week, which is coupled with better integration of adult and children services, and a single patient record. This will no doubt support the efficiency of the partnership and form part of a steady foundation for the future of healthcare in Tower Hamlets.
I want to thank the Tower Hamlets community for its support. We couldn’t have reached this point without the help of the patient leaders, voluntary organisations and other local groups that were involved in the commissioning process. I’d also like to reassure patients that they will continue to be able to access community services throughout this transition period.
Taking Forward Devolution in Health and Care for London
London faces significant population, health, organisational and financial challenges which must be addressed if we are to support Londoners to be as healthy as they can be and for services to be sustainable. London Partners, including London CCGs, have committed to work more closely together to support those who live and work in London to lead healthier, independent lives, prevent ill-health, and to make the best use of health and care assets. London health and care leaders have worked closely together at local, sub-regional and regional level over a number of years to develop a clear vision for better health and care, built on the views of Londoners, and central government and national bodies backed this commitment through the 2015 London Health Devolution Agreement.
Throughout 2016, local, multi-borough and sub-regional (STP) areas in London have worked hard to plan rapid improvements to health and care within existing powers. Five London devolution 'pilots' have also explored how more local powers, resources and decision- making could accelerate the improvements that Londoners want to see. Our devolution work has underscored the importance of working at different levels in London under the three themes of prevention, integration and estates. We are clear that transformation must be
THCCG Governing Body Meeting 10th May 2017 Part I 4 locally led and that many services can only be delivered at the borough or smaller locality level, whereas others are more appropriately aggregated across boroughs or London-wide. The forthcoming London Health and Care Devolution Memorandum of Understanding (MoU) will express commitments by national bodies to enable these improvements to go further and faster, based on the different ambition and appetite of local areas.
We have also been working to commence delivery of more collaborative health and care governance and delivery capability at London-level working within the London Health Board arrangements. This aims to complement and support local areas in their transformation ambitions. As an example the London Estates board has started to meet in shadow form, looking at what projects need help at a London level to progress more speedily and the utilisation of NHS buildings. This work will help to deliver the modern buildings which London's health service needs, use them as intensively as possible and potentially deliver the land for much needed new housing.
General Practice Summit
NHS Tower Hamlets CCG’s Primary Care Team and colleagues hosted a wonderfully successful and well attended General Practice Summit that looked at the need for closer collaborative working between commissioners and providers.
Discussions focused on how all healthcare staff (clinical and non-clinical) can work together as a single ‘primary care system’ to effectively deliver services in challenging times and identifying and prioritising areas where joint action is required to help achieve this. Guest speakers included commissioners and primary care professionals from across the system.
A forum was held that encouraged attendees to share their views and experiences, and take part in a vision and purpose workshop that will helped us agree and shape the next steps we can take together.
The event received really positive feedback and supported the collaborative nature of working that is become a staple of the Tower Hamlets attitude towards healthcare – thank you to the Primary Care team and their clinical colleagues for arranging such a wonderful event.
Annual Information Governance Toolkit Submission
NHS Tower Hamlets CCG submitted its annual Information Governance toolkit submission and we are pleased to report that we have evidenced that we meet level 2 on all of the mandatory requirements. We have also improved our overall ‘score’ reaching 73%, this is evidence of our ongoing commitment to the safe storage of information and data protection management.
NHS Tower Hamlets CCG Staff Survey
NHS Tower Hamlets CCG took part in the national NHS Staff Survey in 2016 that looks at various aspects of staff welfare and acts a good bench mark to see how the CCG is doing in terms of its approach.
I am pleased to report that the CCG had a good response rate of 62.5% and results which were overall really positive. Some of the positive headlines include:
• 85% of people would recommend the CCG as a place to work – against a CCG average of 61%
THCCG Governing Body Meeting 10th May 2017 Part I 5 • 20 percentage point improvement in people feeling they are able to make improvements happen in their area of work – now 87%
• 26 percentage point improvement in people feeling their work is valued after appraisal/performance review – 33% - 59%
The CCG discussed the survey results at the April staff away-day, celebrating the areas of good practice and exploring ways of tackling the few areas identified for further development.
NHS Tower Hamlets CCG 360o Survey 2017
In 2017, Ipsos MORI conducted the survey on behalf of NHS England looking retrospectively at the past year. Stakeholders that were interviewed included the 36 GP member practices, Healthwatch and patient groups, NHS Providers, the local council and neighbouring CCGs. The CCG had the opportunity to invite wider stakeholders that it considered to have important relationships with. Survey responses are confidential and do not identify people or organisations that took part.
59% of stakeholders took part in the survey, which is an improvement from the 2016 survey and compares well against other CCGs that have a similar patient population to Tower Hamlets. Stakeholders were asked about how well it feels the CCG engages their organisation, patients and public involvement, how confident they feel about its leadership, the CCGs competence and decision-making abilities, how well it manages the performance and quality of healthcare services that it commissions and about its plans and priorities.
The survey results have told us that there is significant improvement since 2016 in a number of areas including - ‘patient and public involvement’ section, where 92% of respondents said that the CCG is a ‘very/fairly effective’ local system leader.
- 86% of stakeholders who took part in the survey thought that the ambitions of the CCGs plan to improve healthcare in Tower Hamlets are ‘very/fairly good’.
- 93% of stakeholders who took part in the survey thought that the CCGs level of innovation to improve healthcare in Tower Hamlets is ‘very/fairly good’.
End of Report
THCCG Governing Body Meeting 10th May 2017 Part I 6 THCCG Governing Body Meeting 10th May 2017 Part I 7
Enclosure B
Draft minutes of the NHS Tower Hamlets Clinical Commissioning Group Governing Body Meeting (Part 1)
Tuesday, 07 March 2017, 14.30 – 17.00
The Theatre Room, Oxford House, Bethnal Green
1.1.1 Present
Name Role Organisation Sam Everington Chair & Network 6 Representative NHS THCCG Simon Hall Acting Chief Officer NHS THCCG Mariette Davis Lay Member for Governance NHS THCCG Henry Black Chief Finance Officer for THCCG & North East NHS THCCG London Sustainability & Transformation Plan Victoria Tzortziou- Network 3 Representative NHS THCCG Brown Sarit Patel Network 4 Representative NHS THCCG Isabel Hodkinson Network 5 Representative NHS THCCG Judith Littlejohns Network 1 Representative NHS THCCG Virginia Patania Practice Manager Representative NHS THCCG Osman Bhatti Network 7 Representative NHS THCCG Shah Ali Network 8 Representative NHS THCCG Somen Banerjee Director of Public Health LBTH Julia Slay Lay Member for Public & Patient Involvement NHS THCCG Jane Milligan Chief Officer & Executive Lead for North East NHS THCCG London Sustainability & Transformation Plan / NEL STP Tan Vandal Secondary Care Representative - Doctor NHS THCCG Noah Curthoys Lay Member for Corporate Affairs NHS THCCG Linda Aldous Practice Nurse Representative NHS THCCG
1.1.2 In attendance
Name Role Organisation Josh Potter Acting Director of Commissioning NHS THCCG Archna Mathur Director of Performance and Quality NHS THCCG Ellie Hobart Deputy Director of Corporate Affairs NHS THCCG Ali Kalmis Director of Acute Contract Management NEL CSU Justin Phillips Corporate Governance Manager NHS THCCG Sophia Beckingham Corporate Governance Officer NHS THCCG
1.1.3 Apologies Name Role Organisation Denise Radley Director of Adults’ Services LBTH Maggie Buckell Secondary Care Representative - Registered Nurse NHS THCCG Imrul Kayes Network 2 Representative NHS THCCG
THCCG Governing Body Meeting 10th May 2017 Part I 8
1.1 Welcomes
Sam Everington (SE, Chair) welcomed members and attendees to the meeting, including welcoming Compass Wellbeing and friends who are a part of a local Tower Hamlets provider specialising in mental health services.
SE also welcomed members of the public seated in the public gallery.
1.2 Declarations
SE asked Members for any declarations of interest relating to matters on the agenda. No additional declarations of interest were noted for Part I of the meeting.
It was noted that the CCG Register of Interests was available in hard copy at the meeting and the complete register of interests is published on the NHS Tower Hamlets Clinical Commissioning Group’s website: http://www.towerhamletsccg.nhs.uk/about/conflict-of- interest-register.htm
1.3 Chair’s Report
Sam Everington (SE, Chair) presented the Chair’s report, giving thanks to Isabel Hodgkinson, Victoria Tzortziou-Brown and Osman Bhatti for their work on transformation in the outpatient services project which is working to improve quality and outcomes for patients. SE noted the fantastic engagement from consultants and teamwork in working to improve patient pathways.
The Governing Body Members NOTED the report.
1.4 Chief Officer’s Report
Simon Hall (SH, Acting Chief Officer) presented the Chief Officer’s report, and asked Governing Body members to note that the CCG would be moving the days of its public meetings to Wednesdays as of May 2017. The CCG has agreed this in order to align with our two neighbouring CCGs to better tackle issue in the local healthcare system going forward. SH noted that this had been done with difficulty, so passed on thanks to the Governing Body Members and Ellie Hobart for arranging the changes.
The Governing Body Members NOTED the report.
1.5 Minutes and Matters Arising
SE asked the Governing Body members to check and confirm the accuracy of the previous draft minutes of the meeting held on 24th January 2017. The minutes were APPROVED as an accurate record of the meeting.
1.6 Patient Story – Compass Wellbeing
Judith Littlejohns (JL, Governing Body Member, Commissioning Representative for Network One and Mental Health Clinical Lead) welcomed and introduced colleagues Lucy Marks (Chief Executive Officer), Pauline O’Halloran (Director of Business Development) and Azom Mortuza (Director of Finance & Performance) and friends from Compass Wellbeing, noting that Compass Wellbeing are a local provider and a ‘home-grown’ Tower Hamlets based organisation.
THCCG Governing Body Meeting 10th May 2017 Part I 9
JL introduced the Patient Story, outlining the background of Compass Wellbeing and their history in Tower Hamlets. JL outlined the services Compass Wellbeing provide and noted that they provide a range of treatment modalities for patients experiencing mental health issues for the population of Tower Hamlets including the IAPT (Improving Access to Psychological Therapies) service.
Paula’s Story Paula is a local Tower Hamlets resident and a friend of Compass Wellbeing who shared her experiences in working with the organisation. Paula gave her history, noting that she is registered blind and is involved heavily with local volunteering work and had worked with the Paralympics and their legacy project. Paula explained that she been had referred to Compass Wellbeing by her GP after experiencing panic and anxiety which caused her to stop her volunteering with the Paralympic legacy groups and outlined the extremely negative impact panic and anxiety had on her life. Paula explained that after working with Compass Wellbeing and having treatment sessions for six weeks, she has been able to start to take up aspects of her life that had been affected by her anxiety. Overall, Paula noted that her therapist was particularly supportive and the work they had conducted in their sessions had been life changing for her.
SE thanked Paula for sharing her story, noting that it was a really good example of what the health care community in Tower Hamlets is all about.
3.0 Performance and Operations
3.1 BAF
Ellie Hobart (EH) introduced the Board Assurance Framework, asking the Governing Body to note the changes to the risk ratings, risk narrative, controls and assurances provided within the framework. She highlighted the purpose of this report to provide the Governing Body members with assurance on the progress achieved in mitigating those risks that could prevent the CCG from meeting its corporate objectives including 5 significant changes. She further noted that the revised Assurance Framework is due to be reviewed by the March Audit Committee with a further workshop due to take place in Executive Committee to outline any possible risks not yet sighted on the BAF such as joint commissioning and Sustainability and Transformation Plan. EH noted that the primary care cost pressures risk would be reintroduced for 2017/18 given the shortfall in the Tower Hamlets Primary Care allocation from NHS England.
EH thanked the Governance Team for their work on improving the BAF and noted that the Board Assurance Framework and the Conflicts of Interest Management had been through an internal audit and had received reasonable assurance which is positive. SH and MD echoed EH’s sentiments regarding the BAF and the Governance Team’s work. SH noted that risk 2.1 relating to the Community Health Service (CHS) contract would be subject to change due to the pending CHS contract signing being signed will effectively mitigate this risk. SH explained that a private Governing Body session was due to take place in order to sign off the CHS contract in the near future and the CCG are expecting to meet the go live date for 1st April, further mitigating the CHS related risk.
The Governing Body NOTED the Board Assurance Framework.
THCCG Governing Body Meeting 10th May 2017 Part I 10 3.2 Finance Report
3.2.1 Finance Report M10
Henry Black (HB) presented the Month 10 Finance report, providing an overview of key risks and issues, CCG financial position and key areas of discussion for the CCG Governing Body.
HB explained that the CCG were on target to meet the statutory surplus that has been planned and agreed with NHS England. He informed the Governing Body that finances were likely to be constricted in 2017/18, noting that two main factors impact the flexibility that the CCG had enjoyed previously. The CCG had hoped to clawback the historic surplus of 1% that CCGs had been required to hold but HB explained that the CCG has now been given confirmation that they will be unable to access this 1% as expected due to deterioration in the acute sector nationally.
HB outlined that a number of budgets were overspending with an £8.1 million overspend forecast, noting that London Ambulance Service (LAS) has experienced extreme pressures over previous years with a continual issue with demand and has resulted in the CCG adding an additional spend of £573,000 to support the organisation.
HB highlighted other pressures on finances including issues in allocations that the CCG will receive, noting that the allocations for Primary Care Co-Comissioning given by NHS England and the actual spend differ, thus resulting in an overspend. HB asked the Governing Body to note funding £136,000 for practice resilience, which had been previously committed to and supported by the CCG Governing Body. HB noted that there is pressure in non-elective activity and outpatients which the CCG are working hard to transform.
HB explained that the CCG will be increasing the QIPP target as the delay in finalising the CHS procurement had affected the ability to deliver in full, noting that the level of QIPP target will have to increase in the next financial year.
The Governing Body NOTED the report.
3.2.2 Activity Report M10
Ali Kalmis (AK, Director of Acute Contract Management, NELCSU) presented the Activity Report, outlining the overspend related to the acute portfolio and NHS Barts Health Trust. AK outlined that the CCG is predicting a financial year end surplus of £11.9m which is in line with the financial plan for 2016/17. Within this, the acute care spend is forecasted to be £8.1m above budget and within the above £8.1m, NHS Barts Health Trust (Acute) is forecasting a £5.4m overspend for Tower Hamlets activity.
AK assured the Governing Body Members that, regarding NHS Barts Health Trust, NELCSU are working to complete the actions agreed with the Trust as part of the quarter four work programme. The CSU have also supported the CCG in finalising the year end agreement provisionally reached with NHS Barts Health Trust in order to mitigate the risks of overspend. AK noted that the key drivers of over performance include Critical Care, Elective & Day Cases, High Cost Drugs, Non Elective, Outpatients and Outpatient Procedures.
AK outlined other key areas of THCCG contracts and informed the Governing Body that the East London Foundation Trust continues to meet the majority of its contractual requirements and that the 2017/19 contact was signed on the 23rd December.
Osman Bhatti queried the overspend relating to London Ambulance Service and the impact of its current performance. HB explained that that LAS issues are historic and work is being
THCCG Governing Body Meeting 10th May 2017 Part I 11
conducted London-wide in order to support LAS to reaching a solution for its current problems. AK agreed and felt that the performance for LAS was at a level that many CCG’s locally would find unacceptable, and AK explained that there is a bigger piece of work being conducted across North East London as part of the Sustainability and Transformation Plan regarding trajectories that should support the recovery of LAS’s performance.
OB noted that the new 111 model could support change in the system and support the recovery of LAS. HB agreed, explaining that there is the view that 111 calls divert more patients towards the ambulance service/A&E and the new model should make the system more efficient and therefore lessen the surges in demand that LAS experience.
The Governing Body NOTED the report.
3.3 Performance and Quality Report
Archna Mathur (AM, Director of Performance and Quality) presented the Performance and Quality report, highlighting the key issues, current performance against National Constitution standards and actions taken by providers and Tower Hamlets CCG in managing the provider performance and quality portfolio for acute, community and mental healthcare in Tower Hamlets.
AM informed the board that NHS Barts Health Trust continues to perform well against the cancer standards, achieving 8 out of 8 in November. AM asked the Governing Body to note that Tower Hamlets failed the standard for the 31 day 1st treatment for cancer, and noted that the CCG is working to have clear sight on this issue via a series of deep dives for RTT and cancer. AM explained that referral to treatment also continues to underperform and the CCG are managing this via a data quality plan and monthly deep dives on the most challenging specialities with a focus on the ‘52 week waiters’.
AM informed the Governing Body that A&E remains challenged with an increase in non- elective attendances which has made it challenging for the Royal London Hospital to meet its targets. AM assured the Governing Body that rigorous work had been done to investigate local system response when the Royal London Hospital experiences surges in patients, but noted that this was a difficult challenge where, in one instance, 40-50 patients were waiting over subsequent hours indicative of a constant pressure. AM explained that recent issues have resulted in the arrangement of a “Senior Operational Hub” which has been set up as a core group of 42 senior managers from the Urgent Care Working group as a vehicle for escalation with the aim of expediting discharges. The Senior Operational Hub is instigated on the basis of triggers being hit and then de-escalated in accordance with these triggers also. This has proved positive and supports the hospital to have de-escalation plans and not view system stress as ‘business as usual’. AM noted that work will need to be undertaken to review the current A&E recovery plan as performance has remained below trajectory and the CCG are posed to sign off a new recovery plan.
AM noted that LAS handover times overall for Royal London Hospital are a reflection on front door processes for transfer of patients and noted that there is less of challenge at the Royal London Hospital than other NHS Barts Health Trust sites. AM explained that there are good new stories in the data, noting that serious incidents for NHS Barts Health Trust currently stand at 31 overdue with 4 at Royal London Hospital which reflects the best position for overdue serious incidents that the Royal London Hospital has had to date. AM also informed the Governing Body that the reporting of incidents via datix is at a sustainable level, ensuring more robust oversight on incidents and greater assurance for the CCG.
Tan Vandal (TV) asked to see numbers rather than percentages for the figures regarding cancer specialities as this could show up issues in particular specialty areas. TV noted that the Senior Operational Hub was a good idea and queried if the hub had good clinical engagement underway. AM explained that currently the hub consisted of managers but there
THCCG Governing Body Meeting 10th May 2017 Part I 12 is work to incorporate clinical leaders and agreed that numbers would be helpful to present in the paper.
SH agreed with AM regarding A&E and noted that the CCG and local healthcare system need to think in a more radical way in order to deliver good services to the local public. SH queried where the mixed sex accommodation breaches occurred within the hospital. AM explained that mixed sex accommodation breaches had occurred in critical care and this is an area often affected by seasonal variation and space constraints within the hospital. IH noted that the 4 hour wait target was encouraging clinicians to manage A&E inappropriately. AM agreed and noted that the groups who are attending A&E are unusual in some areas, and noted that paediatric, unregistered and over 85 patient attendances are very high.
SE thanked AM for the presentation and noted that the Royal London Hospital had moved in its CQC rating from ‘inadequate’ to ‘requires improvement’, which was a ‘good news’ story. SE further noted that NHS Barts Health Trust had the most improved year on year results for the NHS National Staff Survey and that the finances for NHS Barts Health Trust should stabilise if the Trust maintains their financial trajectory. Overall, this is indicative of improvement and evidence of the hard work being conducted by NHS Barts Health Trust as well as AM and her team.
SE asked if AM could advise on the comparison with Royal London Hospital A&E against A&E’s nationally, if triaging doctors have ‘gold command’ abilities (to directly triage to outpatients) and if dementia diagnosis was above target because of good diagnosis or higher rates in the borough.
AM explained that the A&E issues being experienced at the Royal London Hospital are generally comparative across London and that there are very few trusts in London in hitting their A&E targets. AM explained that NHS Barts Health Trust is 8th within the bottom half, indicating that whilst this position is not good, the Royal London Hospital is not in the worst position. Overall, London remains challenged as a city but generally performs well against the rest of the country. Regarding ‘Gold Command’, AM explained that the Royal London Hospital are exploring this option but it is not yet in place. AM noted that it is dependent on other areas in the system and so requires investigation and thought.
JL explained that, with respect to dementia diagnosis, all KPIs are based on expected dementia rates in the borough which in turn is based on demographics. Tower Hamlets has a ‘young borough’ and so rates are not expected to be high. Tower Hamlets is doing consistently well and the dementia clinic is hitting its targets in areas such as diagnosis and treatment timeliness. Overall, this indicates very good practice rather than a high incidence of dementia.
Linda Aldous asked how the paediatric A&E attendances compare with the rest of London. AM explained that she would check these figures but it would be good to note that, of these attendances, the majority of young people are not admitted.
The Governing Body NOTED the report.
3.4 Improving Access to Psychological Therapies – Compass Wellbeing Presentation
Lucy Marks (LM, Chief Executive Officer, Compass Wellbeing) presented the Compass Wellbeing report, thanking the CCG for the invitation to present at the Governing body and thanked the Friends of Compass Wellbeing for attending.
THCCG Governing Body Meeting 10th May 2017 Part I 13 LM outlined the history of the Compass Wellbeing, giving detail on the support the CCG gave Compass Wellbeing when they moved away from being part of NHS Barts Health Trust into its own social enterprise; LM noted that the organisation are grateful for this support and encouragement from the CCG.
LM explained that Compass Wellbeing have provided psychology and counselling in Tower Hamlets for over 30 years and have developed many programmes to support the mental health of local patients. Compass Wellbeing’s social mission is important to the organisation, and LM explained that key to Compass Wellbeing’s mantra is creating change and this forms part of their values. The organisation aims to bridge physical and mental health with a focus on prevention and early intervention. LM noted that good relationships with their clients are integral as are good relationships with referrers, staff and collaborators across services. LM noted that Compass Wellbeing are eager to work with partners in acute and primary care in order to ensure efficient clinical decision making and support with struggles that may be faced with complex patients. LM explained that in recent years, Compass Wellbeing are working on mental health support in local schools, utilising nursing teams and providing a programme of training and helping the school health service change based on mental and physical health interventions.
LM outlined challenge that the organisation is currently facing, particularly in regard to IAPT and access, noting that Compass Wellbeing are aware that IAPT is currently under a lot of scrutiny in regards to patients entering and access to treatment. LM noted that there was some struggle in meeting access targets but these had been somewhat remedied by the movement of the organisation to a social enterprise organisation.
LM explained that Compass Wellbeing patients have reached 50 per cent recover rate and noted the importance of sustaining this level in the face of an increase in case management. Compass Wellbeing are poised to introduce digital therapy and online therapy sessions in order to increase the range of therapy options with an aim to improve patient engagement and retention. LM informed the Governing Body that 96 per cent of patients are seen within 6 weeks for IAPT and all patients that are seen are given patient experience questionnaires; LM noted that 98 per of cent patients seen felt they received the help that mattered to them. LM quoted a patient who said ‘this has changed my relationship with my wife and I am becoming my old self again.’
Shah Ali (SA, Governing Body Member and Network Representative for network 8) queried how Compass Wellbeing determine recovery. LM explained that this was informed by the self-reported questionnaire and scoring ‘caseness’ against ‘non-caseness’.
Osman Bhatti (OB, Governing Body Member and Network Representative for Network 7) noted that the self-referral access pace on the Compass Wellbeing page was difficult to navigate. Azom Mortuza (AzM, Director of Finance & Performance) from Compass Wellbeing explained that the new and much improved referral portal is imminent and explained that the website will have the capacity to feature on school intranets; Compass Wellbeing will also be working on marketing across schools and local boroughs.
Julia Slay (JS) noted the good work being conducted on patient engagement and asked if there was any learning that could be shared regarding working with the ‘Friends of Compass Wellbeing’ user group. Pauline O’Halloran (Director of Business Development) explained that the group had self-defined and named their group, and the group had set itself up to support individuals to use and leave the group as and when they felt it was appropriate; this meant users could join for one off projects or on a more long term basis, offering much needed flexibility. The group offers projects, training and a qualification that enables users to take this to future employers and request references. Tracy (a Friend of Compass Wellbeing) noted that she felt that being part of Friends of Compass Wellbeing had given her
THCCG Governing Body Meeting 10th May 2017 Part I 14 a better quality of life and since she has been there she has been part of their interview panel which has boosted her confidence to come along to the CCG Governing Body and speak.
SE noted that the work regarding school nursing services was interesting, and queried if LM had a sense for the future of the school nursing services and mental health. LM explained that she felt this had been an exciting opportunity and had allowed for conversations to open up between nurses regarding mental health. LM reported that nurses had been excited to use the tools that had learnt within their training and reflective practices and supervision had been encouraged. LM noted that most mental health problems start by the age of 14 and this work with school nurses would underpin support for mental health services generally and that nurses felt more confident using this system. This has naturally rolled out to looking at support for school staff who are also finding themselves under system stress and parents have requested a parents group regarding mental health which Compass Wellbeing are exploring.
SE passed on his thanks to Compass Wellbeing, both for their presentation and for their work on improving mental health in the borough. SE outlined his view that Compass Wellbeing are national leaders for mental health, particularly their work regarding schools and mental health in education.
4.0 Commissioning and Strategy
4.1 Transformation
Josh Potter (JP, Acting Director of Integrated Commissioning) presented the Commissioning Intentions and QIPP 2017/18. JP explained that the commissioning directorate has been in process of developing commissioning intentions and associated savings plans. JP explained that the Gross QIPP plan of £16.5m is offset against £6m of investment proposals (mixture of recurrent and non-recurrent funding). This has resulted in a prioritisation process in place at Transformation Board in December and January to reduce investments in line with 2017/18 budgets.
JP explained that Commissioning Intensions and QIPP Schemes had been through extensive development, noting that the Finance Team had supported the Transformation Team in affordability analysis of the schemes based on the CCG’s financial position; this resulted in the final proposal of commissioning plans. JP outlined the process in which the commissioning intentions had been developed, including development, business cases and affordability analysis.
JP outlined which schemes had been subsequently approved in principal in light of the Transformation Boards approval and the affordability analysis. The schemes have been grouped into three categories; ‘fully approved and funded by CCG’, ‘approved but funded from other sources’ and ‘schemes approved in principal but funding released if/when funding becomes available’. JP asked the Governing Body to focus on the net QIPP delivery, and noted that the majority of the fully funded schemes are where savings and quality can be quantified.
JP felt that there was assurance amongst CCG colleagues that these schemes would be a success but asked the Governing Body to be reminded that financial challenges exist and there is a future unidentified savings target. This is due to greater than expected in contracts effects baseline, change by NHSE in how we manage services and the CCG’s contribution to STP area. CCG teams will be meeting soon to discuss how the CCG will meet this gap
THCCG Governing Body Meeting 10th May 2017 Part I 15 and are likely to look at budget review, conduct risk assessment of schemes and expand delivery of areas or identification of new schemes.
JP asked the Governing Body to approve the schemes outlined above following approval by the CCG’s Transformation Board, and subject to sufficient finances being available, note the ongoing financial situation and support the CCG’s ongoing efforts to meet the sustainability challenge.
TV felt that the papers presented were heavy on financial information and difficult for the public to digest, and asked if assurance could be given that quality of care would be maintained. SH explained that efficiency in the system more than often produced improvements in quality for patients and noted that the papers could be more publically accessible in terms of identifying QIPP in word terms. SH also noted that the paper should reiterate that the figures listed are ‘thousands of pounds’.
SE thanked JP and his team for their work on the Commissioning Intensions 2017/18 and QIPP paper, and SE stated that he appreciated that the CCG’s financial position had meant the process had been difficult.
The Governing Body APPROVED the schemes outlined above following approval by the CCG’s Transformation Board, and subject to sufficient funding being available, NOTED the ongoing financial situation and SUPPORTED the CCG’s ongoing efforts to meet the sustainability challenge.
6.0 Questions from the Public
A member of the public from Tower Hamlets’ local LGBT community forum attended the meeting, and highlighted to the Governing Body the issues that local LGBT have been experiencing in their healthcare and their health and wellbeing. The member of the public highlighted that the Tower Hamlets LGBT Forum carried out research last year that showed there had been an increase in HIV and AIDS which correlated with the increase of instances of ‘Chem Sex’. The member of the public also noted that there is a lack of alternative family planning and some LGBT local people are reporting that there is a lack of training opportunities for terminology for LGBT staff. Members of the public have also reported a lack of visibility for LGBT people in the healthcare environment, with the LGBT Forum representative noting that some elderly LGBT people had to ‘de-gay’ their homes in order not to offend carers and at worst, some LGBT people have been refused services.
SH thanked the member of the public for bringing this to the CCG Governing Body and agreed that work had to be done to improve the issues that had been reported. SH felt that it would be useful to share the research that the Tower Hamlets LGBT forum had produced to better inform the CCG, and noted that the CCG, local LGBT forums and the Local Authority should link together and look at developing plans across the borough to make improvements. SH invited the member of the public to come to a CCG Governing Body Organisational Development Session in order to begin a more detailed discussion of how the CCG can ensure that services we commission are more LGBT friendly.
Isabel Hodkinson (IH, Governing Body Member and Representative for Commissioning network 5) recognised that GP registration can sometimes pose difficulties for LGBT people, and noted that she was interested in how primary care clinicians and primary care services might build questions regarding protected characteristics in a supportive way.
SE thanked the member of the public for their question.
THCCG Governing Body Meeting 10th May 2017 Part I 16
End
THCCG Governing Body Meeting 10th May 2017 Part I 17
Governing Body Meeting Enclosure
Date of meeting 10th May 2017 C
Agenda item 2.1 (2.1.1)
Title of report: Month 12 Finance Report – 2016/17 Henry Black – Chief Finance Officer Author(s): Richard Quinton – Financial Adviser Andrea Antoine – Deputy Chief Finance Officer
Presented by: Henry Black – Chief Finance Officer – NHS Tower Hamlets CCG Sponsor (if different): For further information Andrea Antoine – Deputy Chief Finance Officer [email protected] - 020 3688 2510 The Month 12 report provides the Governing Body with the financial position of the CCG as at 31st March 2017. The results show that the CCG met its statutory duties for the year, though still subject to audit. The report contains: - Executive Summary Revenue Resource Allocation Executive summary Draft Month 12 Financial position Acute provider position – specifically Barts Health and LAS Acute contract position Health Care provision financial position – including Primary Care Co-Commissioning position. Corporate Costs QIPP Month 12 Position Recommendation
Information Approval To note Decision
To note the content of the report, and discuss any actions required
The CCG met its financial duties though under substantial pressure, Key issues in particular from acute over performance. Conflicts of Interest There are no identified conflicts of interests.
Report history The Finance, Quality & Performance (FPQ) meetings of the CCG reviewed the results and informed this Governing Body report
Patient and Public N/A involvement
THCCG Governing Body Meeting 10th May 2017 Part I 18 Link to the Board Addresses several corporate objectives, in particular those around Assurance Framework the CCG finances; ensures the Governing Body is sighted on key finance and performance targets for 2017/18: Strategic Objective 3: Creating a thriving and stable health and social care economy Strategic Objective 4: Delivering against our statutory duties.
Impact on Equality and N/A Diversity
Resource None requirements
Next steps Action and next steps for each area, where applicable are identified in the report.
THCCG Governing Body Meeting 10th May 2017 Part I 19
Month 12 Finance Report – 2016/17
Executive Summary
This report provides an update on the financial position for the CCG at Month 12 (March 2017), which for Month 12 includes the Month 12 QIPP position. At month 12, the CCG is reporting a draft result subject to audit showing a surplus of £11K for the year and a cumulative surplus of £11.9M, in line with the CCG’s Financial Plan and meeting the statutory requirements. In addition, the CCG closed the year with £273K of cash, also in line with NHSE requirements. Revenue Resource Allocation The table below shows the CCG’s Revenue Resource Allocation as at Month 12. This shows the opening revenue budgets as at Month 11 and any in month changes in the CCG’s allocation up to Month 12.
M11 In Month Closing M12 Tower Hamlets CCG ‐ 2016/2017 Revenue Resource Limit at Month 12 Opening RRL movements RRL 2016/17 Revenue Resource Limit £000's £000's £000's Return of Surplus/(Deficit) (11,943) (11,943) Initial CCG Programme Allocation (353,213) (353,213) Initial CCG Running Cost Allocation (6,299) (6,299) Transfer to Co‐Commissioning Funds to CCGs (42,590) (42,590) Vanguard Q1 MCP Tower Hamlets (652) (652) Q1 Eating Disorder Service Correction (155) (155) Q1 TB Corrections (25) (25) IR RULES TRANSFER 325 325 UCLH Transition Funding for Transfer of Heart Hospital to Barts 500 500 HLP & Levis 720 720 Quarter 2 Allocation ‐ Tower Hamlets vanguard (1,236) (1,236) Local Evaluation Funding (50) (50) Safeguarding children named GPs (26) (26) 08V ‐ GP Development Programme ‐ reception and clerical training (26) (26) Latent TB Q2 ‐ NHS Tower Hamlets CCG (25) (25) CYP Local Transformation Mental Health M7 ‐ NHS Tower Hamlets CCG (65) (65) Q3 Vanguard Funding ‐ THIPP MCP (734) (734) Q2 Local Evaluation Funding ‐ Tower Hamlets MCP (50) (50) Children and Young transformation (24) (24) Mth08 CEOV adjustment 3,545 3,545 Primary Care access (GPFV £30M) (1,531) (1,531) GP Resilliance (136) (136) Waltham forest ‐ comms to promote use of primary care (15) (15) Waltham forest ‐ Re ‐ directing ambulatory A&E Attendances (25) (25) QUALITY PREMIUM AWARDS 2015/16 (280) (280) Healthy London Partnership Underspend (1,735) (1,735) OCCG admin levy (65) (65) MCP ‐ Tower Hamlets local evaluation 3rd qtr funding (50) (50) MCP ‐ Tower Hamlets vanguard Q4 funding (1,323) (1,323) CYP WL & WT Reduction: 2nd tranche (65) (65) non‐recurrent allocation to mitigate impact of NHS PS move to market rents (1,101) (1,101) CEOV reimbursement from C&H CCG (correcting NHSE M8 error) (3,063) (3,063) CYP Underspend ‐ CAMHS transition worker (12) (12) CYP Underspend ‐ MH support to integrate children's health services (119) (119) 1% System Risk Reserve Transferred to Havering CCG 1,435 1,435 1% System Risk Reserve Transferred to Barking & Dagenham CCG 1,115 1,115 1% System Risk Reserve Transferred to Redbridge CCG 1,408 1,408 Resiliance programme (25) (25) CYP HiJ (74) (74) CYP IAPT Backfill ‐ Jan/Feb (28) (28) MCP ‐ Tower Hamlets local evaluation 4th qtr funding (50) (50) Total Resource Limit (421,543) 3,781 (417,762)
THCCG Governing Body Meeting 10th May 2017 Part I 20
In Month 12 the CCG transferred £3.958m to the BHR CCG’s in line with the systems risk agreement.
Revenue Financial Position at month 12
The CCG’s revenue financial position is summarised below.
Variance Last Mth Forecast Tower Hamlets CCG ‐ Financial Annual Budget M12 Actual (Under)/Overs Forecast In‐Month Position as at M12 ‐ 2016/17 £’000 £’000 pend Variance Movement £’000 £’000 £’000 Delegated In Sector Acute Trusts 145,654 150,793 5,140 5,134 6 Out of Sector Acute Trusts 20,716 22,636 1,920 1,645 276 Other Acute 12,910 16,806 3,896 1,131 2,765 Subtotal Acute 179,279 190,235 10,956 7,911 3,046
Mental Health 48,295 48,061 (233) (222) (11) Community Health 49,578 50,715 1,137 1,518 (381) Other Non Acute 20,085 14,154 (5,931) (3,069) (2,864) Subtotal Non Acute 117,958 112,930 (5,027) (1,773) (3,257)
Prescribing 31,557 32,451 894 (35) 929 Primary Care Co‐Commissioning 42,874 43,360 485 490 (5) Prime Ministers Challenge Fund 4,184 4,183 (1) 0 0 Other Primary Care Services 10,476 10,818 343 (84) 426 Subtotal Primary Care 89,091 90,812 1,721 371 1,350
Reserves 8,451 1,792 (6,659) (6,660) 0
TOTAL CCG 394,779 395,769 990 (151) 1,140
Corporate 11,040 10,040 (1,001) 151 (1,150) TOTAL CORPORATE 11,040 10,040 (1,001) 151 (1,150)
GRAND TOTAL 405,819 405,809 (11) 0 (10) IN YEAR RESOURCE LIMIT (405,819) (405,819) 0 0 0 IN YEAR (SURPLUS)/DEFECIT 0 (11) (11) 0 (10) PRIOR YEAR SURPLUS (11,943) (11,943) 0 0 0 TOTAL (SURPLUS)/DEFICIT (11,943) (11,954) (11) 0 (10)
THCCG Governing Body Meeting 10th May 2017 Part I 21
Acute Contracts
The total acute budget is £179.3m. At month 12 the acute position is showing a full year over performance of £10.9m.
Tower Hamlets CCG 2016/17 Acute Financial Position at Month 12 Full Year Full Year Full Year Provider Budget Actual Variance £'000 £'000 £'000 Barking, Havering and Redbridge Hospital NFT 544 652 108 Barts and The London NHS Trust 141,058 145,960 4,903 BMI Healthcare Ltd 2,781 3,331 550 Chelsea and Westminster Hospital NHS Foundation Trust 501 468 (33) Great Ormond Street Hospital for Children NHS Foundation Trust 335 523 188 Guy's and StThomas's NHS Foundation Trust 4,092 4,552 460 Homerton Foundation Trust 4,596 4,833 237 Imperial College Healthcare NFT 675 685 11 King's College Hospital NHS Foundation Trust 578 554 (24) Lewisham & Greenwich NHS Trust 431 463 32 London Ambulance Service 9,383 9,978 595 Mid Essex Hospital Services NFT 91 94 3 Moorfields Eye Hospital NHS Foundation Trust 4,623 4,615 (8) NCAS/OATS 2,643 3,439 796 North Middlesex University Hospital NFT 154 127 (28) North West London Hospitals NFT 176 174 (2) Other Acute 884 847 (37) Overseas Visitors Barts Health NHS Trust 0 1,128 1,128 Royal Brompton and Harefield NHS Foundation Trust 61 65 4 Royal Free Hampstead NFT 466 674 208 Royal National Orthopaedic Hospital NFT 430 427 (3) St George's Healthcare NFT 137 157 20 The Royal Marsden NHS Foundation Trust 81 84 3 University College London Hospitals NHS Foundation Trust 4,329 4,737 407 Whittington Hospital NFT 232 253 21 Barnet and Chase Farm Hospitals NFT 033 Barts and The London NHS Trust ‐ RTT 0 1,414 1,414 Total Acute 179,279 190,235 10,956
The projected overspend position relates mainly to the over performance of Barts Health, BMI, Guy’s, LAS as well as provisions for RTT and overseas visitors.
Barts Health – The table below shows the main areas of over performance are in drugs and devices, Critical Care, Non elective and Outpatients.
Barts Health ‐ Financial Position Full Year Full Year Forecast @ Month 12 (£000's) Plan Actual Variance
Accident and Emergency 11,980 12,710 731 Community 11 2 (10) Critical Care 5,917 7,107 1,190 Diagnostic Imaging 14,394 13,750 (644) Drugs and Devices 5,173 6,953 1,780 Elective 17,222 18,111 889 Maternity 19,766 19,210 (556) Non-Elective 38,738 41,238 2,500 Outpatients 21,077 25,645 4,568 PTS 2,957 2,262 (695) Regular Attenders 1,870 2,027 157 Other 1,953 (3,056) (5,009) Grand Total 141,058 145,960 4,903
THCCG Governing Body Meeting 10th May 2017 Part I 22
Drugs and Devices – This area is reporting a full year over performance of £1.780m against the plan at Month 12. Key drivers of the over performance relates to cytokine modulators, subfoveal choroidal neovascularisation and drugs effecting the immune response system.
Non electives – This area is reporting a full year over performance of £2.500m against the plan at Month 12. The key driver of this over performance is related to Respiratory System Procedures and Disorders.
Critical Care - This area is reporting a full year over performance of £1.190m against the plan at Month 12. This is driven by 882 more bed days than planned, with over performances in 1, 2 & 3 organ supported activity.
Outpatients - This area is reporting a full year over performance of £4.568m against the plan at Month 12. Key speciality drivers for this over performance in the outpatient’s area are within Gastroenterology, Dermatology, Hepatology and General Medicine. Key speciality drivers in outpatient’s procedures are within Female Reproductive System Procedures, Cardiac Procedures, Orthopaedic Non-Trauma Procedures and Breast Procedures and Disorders.
Other – This line includes known adjustments which are expected to the Barts Health position. This includes adjustments for Readmissions, productivity metrics, penalties and Claims.
BMI – This associate contract is reporting a full year over performance of £550k. The main areas of over performance are in Day Case, elective and outpatients relate in the main to Trauma & Orthopaedics.
Guy’s – This associate contract is reporting a full year over performance of £460k related mainly to maternity pathways and deliveries as well as the largest over performance being in non-elective clinical haematology.
LAS – This contract is reporting a full year over performance of £595k – This includes Tower Hamlets provision in relation to the LAS request for an additional £10m funding requirement as well as 4 quarterly over performances as advised by NHSE.
Overseas visitors - The CCG has included a provision of £1.128m for the CCG’s share of the costs of any overseas visitor’s charges which are unrecoverable by Barts Health.
RTT - The CCG has included a provision of £1.414m based on Barts Health information in regards to back logs in the areas of gynaecology, ophthalmology, Paediatrics, respiratory medicine, trauma and orthopaedics and urology.
THCCG Governing Body Meeting 10th May 2017 Part I 23
Healthcare Provision
A summary analysis of the year to date and the forecast for healthcare provision budgets are shown below.
Tower Hamlets CCG 2016/17 ‐ Healthcare Provision Financial Position at Month 12 Variance Annual Full Year (Under)/ Service Function Budget Actual Overspend £’000 £’000 £’000 Mental Health 48,295 48,061 (233) Community Health 49,578 50,715 1,137 Continuing Care 14,130 14,883 753 Other 5,955 (731) (6,687) Primary Care ‐ Prescribing 31,557 32,451 894 Primary Care Co‐Commissioning 42,874 43,360 485 Other Primary Care 14,660 15,002 342 Total Non‐Acute 207,048 203,740 (3,308)
Community Health – The reported over spend in this area of £1.1m relates mainly to the delay to the start of the CHS contract
Primary Care Co-Commissioning – The CCG is reporting a full year over spend of £485k – this relates in the main to the shortfall in allocation received for 2016/17.
Primary Care – Prescribing – The CCG is reporting a full year over spend of £894k, based on the forecast from the latest PMD data up to January 2017. The deterioration compared to M11 forecast is driven by an additional contingency of included in M12 in respect of winter pressures.
Continuing Care – The CCG is reporting a full year over spend of £753k, mainly driven by provision included for joint care packages – as total projections are not yet known as not all patients have been fully assessed.
Other – The under spend in this area of £6.7m relates mainly to the use of non- recurrent in year measures, which have been released into the current year forecast.
THCCG Governing Body Meeting 10th May 2017 Part I 24
Corporate Costs
For this financial year the CCG’s running costs allowance is £6.299m.
Tower Hamlets CCG ‐2016/2017 Corporate Financial Position at Month 12
Full Year Annual Full Year (Under)/ Service Function Budget Actual Overspend £’000 £’000 £’000
ADMINISTRATION & BUSINESS SUPPORT 56 71 15 CEO/ BOARD OFFICE 331 338 7 CHAIR AND NON EXECS 529 524 (5) COMMISSIONING 321 260 (61) COMMUNICATIONS & PR 616 602 (14) CORPORATE COSTS & SERVICES 2,221 2,022 (199) FINANCE 1,277 663 (614) PRIMARY CARE SUPPORT 595 582 (13) QUALITY ASSURANCE 352 337 (15) Sub‐total Running Costs Allowance 6,299 5,399 (900)
PROGRAMME PROJECTS 4,741 4,640 (101) Sub‐total Running Costs Allowance 4,741 4,640 (101)
Total Corporate Financial Position 11,040 10,040 (1,001)
The reported position at month 12 shows that the CCG has spent within its running cost allowance of £6.299m.
The under spend in the corporate budget mainly relates to in year savings made through staff vacancies, driven by the in-year recruitment to posts within the new budgeted organisational structure.
THCCG Governing Body Meeting 10th May 2017 Part I 25
QIPP
At Month 12, the QIPP report shows a full year under-achievement of £656k.
Reporting Period: March 2017 ‐ YTD Full Year M12 Variance FINANCE YTD YTD YTD Full Year Full Year to STATUS Work stream Plan Actual Variance Plan FOT M12 Comments Plan (based on £'000 £'000 £'000 £'000 £'000 £'000 forecast An investigation into T&O & Pain data has uncovered a coding issue which created a multiple record count. This has impacted on the QIPP position as reported throughout 2016/17. The issue has now been res ol ved, but this has res ulted in a worse position than initially forecast before M10. To provide a more accurate position on QIPP and impact of community service on acute activity, commissioners will be taking a new approach to calculate QIPP from 17/18. This will exclude the impact of backlog and RTT on acute spend until backlog cleared. Next steps: * Various action being taken to address low referra l ra tes in IMAPS to increase awareness of Planned Care 3,595 1,831 (1,764) 3,595 1,831 (1,764) Amber the service (e.g. monthly educational sessions and IMAPS helpline set up). •T&O referra l s from GPs are not going into community IMAPS but anticipated this will change in Q2 2017/18. The referral form will be amended to reflect this from 1st April 2017. * Specialist orthopaedic resource will be made available within the IMAPS triage hub to review GP referrals to T&O. This will have better impact on FA T&O and to some extent FU. * Strategy in place to shift activity into T‐OATS and then divert into telederm (Dermatology). * Data from Barts on FA:FU is showing a consistent reduction in face‐to‐face activity (Renal) * Development of a balance score card for Gastro to review activity and impact of service (Gastro) Continued impact on IC investment is on track Falls: Recruitment was completed in Feb 17 and scheme has been rolled out. There is a CCG lead overseeing the Falls project and baseline data has been collected. Work is focusing on Integrated Care 2,464 4,543 2,079 2,464 4,543 2,079 Green assessing potential savings for 2017/18 LFT unbundling: Investigations into double counting has been completed and res olved. There is an overlap on 1 test area with the TST Diagnostic Pathology QIPP scheme. This issue has been res ol ved and g‐glutamyl transferase (GGT) activity is reported vi a the Diagnostics scheme *Liaising with CSU to understand process for the mop‐up exercise *Work continuing to formalise the contract for 2017/18. Urgent Care 856 1,368 512 856 1,368 512 Green
*Delays in project delivery are now being addressed and subsequent activity reductions are expected. Children 39 0 (39) 39 0 (39) Red *Identified that avoided referra ls due to the project are not being recorded and an approach to ensuring this is reflected in the data is now being developed.
This scheme will not release savings for 2016/17 due to the decision to extend the CHS CHS 3,349 (0) (3,349) 3,349 0 (3,349) Red procurement (QIPP should be balanced out with shortfall in NR investment)
On track 1,201 1,427 226 1,201 1,427 226 Green Mental Health Financially on track‐ no commentary to date 323 323 0 323 323 0 Green Acute On track 0 623 623 0 623 623 Green Primary Prescribing •£46k for estate service charge review has been confirmed by NHSE The remaining £339k rel ates to CHP ‐ saving on voi ds & subsidy charges 0 386 386 0 386 386 Green
Other *Investigations into double counting between this scheme and LFT unbundling has been completed. The g‐glutamyl transferase activity (GGT) LFT test is only counted within the TST Diagnostics scheme. 0 671 671 0 671 671 Green *ESR has now been separated as of 29/12/16. AST has also been unbundled which will help to mitigate the loss of savings from Urea which has ye t to be unbundled. Bart’s have proposed Oct 17 as the implementation for Urea. Diagnostic Total 11,827 11,171 (656) 11,827 11,171 (656) The shortfall in achievement within the areas of Planned Care and CHS are due to revised profiling and delayed commencement of schemes which has affected the Musculoskeletal CAS, Pain CAS, Dermatology CAS, New streamlined Gastro STT, Ambulatory Unit pilot as well as the late commencement of the new CHS Contract.
However, the unexpected savings in Helicopter Emergency Services, TST Diagnostic QIPP schemes and CHP savings on voids and subsidy charges have helped reduce the overall under-achievement position.
THCCG Governing Body Meeting 10th May 2017 Part I 26 THCCG Governing Body Meeting 10th May 2017 Part I 27
Governing Body Meeting Enclosure
Date of meeting 10 May 2017 D
Agenda item 2.1.2
Title of report: Tower Hamlets Finance & Activity Summary Report Lee Eborall – Director of Acute Contract Management, CSU Author(s): Deane Kennett – Assistant Director of Contracting, CSU Lee Eborall – Director of Acute Contract Management, CSU Presented by: Deane Kennett – Assistant Director of Contracting, CSU – For further [email protected] information
The report provides a high level overview of finance and activity across Tower Hamlets for the month of March 2017 (based on February 2017 Executive summary activity data). The report highlights the key issues, current performance, key actions and a delivery RAG rating for major providers providing healthcare services in Tower Hamlets.
Recommendation
Information Approval To note Decision
To note the content of the report, and discuss any actions required.
Conflicts of Interest N/A
Key issues The CCG is predicting a financial year end surplus of £11.9m which is in line with the financial plan for 2016/17. Within this, Board members are also asked to note: Acute care spend is forecasted to be £11m above budget. Within the above £11m, Barts Health (Acute) is forecasting a £4.9m overspend.
Report history Information presented at the CCG Finance, Performance & Quality Committee meeting informs this Board report
Patient and Public N/A involvement
Link to the Board This paper affects: Assurance Framework Corporate Objective 1: - To work in partnership to commission high quality hospital services that are accessible, provide the appropriate treatment in the right place, and achieve good patient outcomes for
THCCG Governing Body Meeting 10th May 2017 Part I 28
people of all ages living in the borough. Corporate Objective 3: - To contribute towards a financially sustainable and responsive health and care economy which delivers value for money and innovation and supports the appropriate use of services.
Impact on Equality N/A and Diversity
Resource N/A requirements
Next steps Action and next steps for each area identified is covered in the report. Main areas of work include:
Acute CSU to focus on year-end financial reporting. CSU to review the content and format of the reporting for future months.
THCCG Governing Body Meeting 10th May 2017 Part I 29 Finance & Activity Summary Report Tower Hamlets CCG
April 2017
THCCG Governing Body Meeting 10th May 2017 Part I 30 Tower& HamletsFinance Activity Headlines: April 2017 Finance & Activity
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32 THCCG Governing Body Meeting 10th May 2017 Part I 33
Governing Body Meeting Enclosure
Date of meeting 10 May 2017 E
Agenda item 2.2
Title of report: Performance and Quality Report Archna Mathur - Director Performance & Quality (CCG) Author(s): CSU Performance team Archna Mathur – Director Performance & Quality – THCCG Presented by:
Archna Mathur – Director Performance & Quality - THCCG For further information [email protected] (020 3688 2528) This paper provides a high level overview of performance and quality across Tower Hamlets reported for the month of January and February where data and information is available.The report highlights the key Executive summary issues, current performance against National Constitution standards and actions taken by providers and Tower Hamlets CCG in managing the provider performance and quality portfolio for acute, community and mental healthcare in Tower Hamlets.
Recommendation
Information Approval To note Decision
The Governing Body is asked to note the contents of the report, particularly in relation to the Board Assurance Framework.
THCCG Governing Body Meeting 10th May 2017 Part I 34
Cancer Waiting Times: Key issues Barts Health achieved 8 out of 8 standards in February, including the standards for 2 week urgent referrals (97.6% vs. 93% standard); 31 day 1st treatment standard (96.6% vs. 96% standard) and the 62 day standard GP urgent referral standard (86.2% vs 85% standard). Tower Hamlets achieved 7 of 8 standards in February. This included the 2 week urgent referral (97.6% vs. 93% standard) and the 62 day standard (100% vs 85%) Tower Hamlets failed the standard for the 31 day 1st treatment (94.6% vs 96%), 31 day 2nd treatment (surgery) (90.9% vs 94% standard) and 62 day screening (81.82% vs 90% standard). A full day of elective deep dives is scheduled for the 19 May 2017 to address cancer and > 52 week performance. The cancer deep dives focussed on colorectal, dermatology, gynaecology, orthopaedics and urology. Deep Dives have been enhanced further to now include review of staging data by speciality as a metric for early diagnosis.
Referral to Treatment (RTT): Barts Health continues to underperform against the national waiting time standards at speciality level. The trajectory for backlog and waiting list clearance is being met with a resulting overall reduction in the waiting list size. Main area of concern is number of > 52 week waiters due to ongoing need for validation as a result of poor data quality. Work continues on the data quality plan. Monthly deep dives on the most challenged speciality i.e. Trauma and Orthopaedics are now in place, focussed primarily on reduction of the > 52 week waiters. Further work in place via the CCG QIPP programme to refocus impact of demand management QIPPs to most challenged specialities in terms of RTT backlog clearance.
Diagnostics Barts Health achieved this standard at aggregate level in February 2017 (0.6% vs. 1% standard). Provisional data shows Tower Hamlets CCG achieved this standard in February with 0.77% against the 1% standard.
A&E: Correspondence received from NHSE/I have highlighted national groupings for local urgent and emergency systems. Barts Health and WEL CCGs have been allocated to “Segment 2” on account of underperformance against the national standard and local trajectory requiring regional intervention and support. The requirement for the local system is to reset the current recovery plan for each Barts Health site in order to achieve the revised STF (Sustainability Transformation Fund) trajectory of 90% by September 2017 and 95% by March 2018.
2
THCCG Governing Body Meeting 10th May 2017 Part I 35
We are collectively working to review current plans and resubmit to NHSE/I by the end of April 2017. Plans will focus on a clear diagnostic assessment for reasons of underperformance, actions to address each with quantifiable impact. CCGs are focus specifically on demand management initiatives and out of hospital programmes facilitating discharge. The final plan will be presented to the THCCG Governing Body for sign off in June.
A&E (Mental Health Liaison - ELFT): ELFT A&E performance was 84.4% vs the 95% standard. This is reduction in performance compared to January.
Dementia The dementia diagnosis rate for February was 85.95% vs 66.7% target.
Early Intervention Psychosis Standard ELFT achieved 92.3% vs the national standard (50%) February
IAPT The NHS Digital reported that 3.77% service users accessed treatment at Qtr2 2016/17, above the 3.75% national target for the quarter. The recovery rate for Tower Hamlets CCG was 48.6% for Qtr. 2 2016/17, below the 50% target.
LAS (London Ambulance Service) Handover times: The Royal London continues to fail to achieve against KPI 1 (% turnaround within 15 minutes) with rolling 3 week performance at 47.4% and KPI 2 (% turnaround within 30 minutes) at 92.8%. Performance is strong against the 60min handover target with a rolling 4 week performance demonstrating no 60 minute delays.
SI (Serious Incidents): Barts Health: 36 overdue SIs for February, 8 of which are at RLH and 0 for community health services which is a very significant improvement. The Datix backlog is 50 and a very marked and sustained improvement. ELFT: February – 0 Overdue SIs. .
Never Events Barts Health: 1 further Never Events occurred in March 2017, a wrong site surgery at Newham Hospital.
3
THCCG Governing Body Meeting 10th May 2017 Part I 36
The Never Event total at Barts Health is now 13 for 201617 with 8 of these at RLH. ELFT: Zero never events reported.
Mixed Sex Accommodation: February 17 has seen a significant improvement in MSA breaches across Barts Health and the Royal London Hospital. There were 14 breaches, with 10 at the Royal London
HCAI (HealthCare Associated Infection): The year-end total for Cdiff infections at Barts Health is 72 versus full year threshold of 82. There are currently no cases of C-diff due to lapses in care. 3 cases of C. Difficile were attributed to Tower Hamlets in November, against a DH objective of 3 for the month. (YTD total = 9 vs. YTD trajectory of 12) The MRSA figure for Barts Health at year end was 9
Conflicts of Interest There are no identified conflicts of interest.
Report history Information presented at the CCG Performance & Quality meetings informs this Governing Body report.
Patient and Public The Friends and Family Test (FFT) provides patient feedback to involvement improve service provision as well as NHS Choices providing patient comments on services.
Link to the Board This paper affects all of the risks under Strategic Objective 2: Systems Assurance Framework and processes to monitor challenge and support provider delivery of the NHS Constitution targets.
Impact on Equality and Monitoring and actively improving the performance and quality of Diversity service provision will have a benifical impact for all patients in Tower Hamlets.
Resource requirements N/A
Next steps Action and next steps for each area identified is covered in the report.
4
THCCG Governing Body Meeting 10th May 2017 Part I 37 Tower Hamlets CCG Month 11 2016-17
Monthly Acute Performance and Serious Incidents Report
THCCG Governing Body Meeting 10th May 2017 Part I 38 Tower Hamlets CCG – Quality Premium: NHS Constitution Tower Hamlets CCG rights and pledges The Barts Health Trust board has taken the decision to suspend the monthly mandatory reporting of referral to treatment (RTT) waiting times data from October 2014 (including the retraction of September 2014). The Homerton also suspended reporting from October 2015 to February 2016 due to data quality issues. NHS TOWER HAMLETS CCG QUALITY PREMIUM 2016-17 (NHS Constitution rights and pledges)
Measure Measure 2016-17 Target achieved
Referral to treatment times (18 weeks Incomplete) (April 2016 to January 2017)* 94.29% Y 92%
A&E waits - All types (April 2016 to December 2016)** 87.67% N 95%
Maximum two month (62-day) wait from urgent GP referral to first definitive treatment 84.21% N 85% for cancer (April 2016 to December 2016)
Category A Red 1 ambulance calls (April 2016 to December 2016) 69.40% N 75%
* For the purposes of the quality premium, the percentage of Incomplete pathways within 18 weeks will be calculated by summing the numerators (patients waiting within 18 weeks) from each month end and then dividing by the sum of all the denominators (patients waiting) from each month end.
**The A&E CCG Quality Premium is based on data mapping from NHSE, derived from HES figures. This calculates what proportion of each provider’s activity can be attributed to a given CCG. Any activity under 1% is ignored.
THCCG Governing Body Meeting 10th May 2017 Part I 39 2 Data source: Unify2, HES, Open Exeter, Trust Submissions Tower Hamlets CCG Dashboard - Cancer Waiting Times Note: The NHS Constitution Quality Premium indicators are highlighted in lilac 2016-17 KPI / Measure CCGJan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 2016-17 Target YTD
2 Week Cancer Wait NHS TOWER HAMLETS CCG 94.89% 97.96% 98.74% 97.67% 97.42% 98.30% 98.01% 97.26% 97.67% 98.25% 97.06% 97.93% 98.96% 97.83% 93%
2 Week Cancer Wait (Plan) NHS TOWER HAMLETS CCG 93.07% 93.07% 93.07% 93.02% 93.11% 93.03% 93.12% 93.04% 93.13% 93.08% 93.03% 93.13% 93.09%
2 Week Cancer Wait: NHS TOWER HAMLETS CCG 96.04% 99.18% 98.35% 100.00% 97.37% 96.83% 100.00% 100.00% 97.48% 97.41% 100.00% 92.86% 100.00% 98.39% 93% Breast Symptoms 2 Week Cancer Wait: NHS TOWER HAMLETS CCG 93.48% 93.48% 93.48% 93.69% 93.86% 93.22% 93.44% 93.65% 93.08% 93.28% 93.48% 93.66% 93.20% Breast Symptoms (Plan)
31 day Cancer Wait: NHS TOWER HAMLETS CCG 88.57% 97.73% 92.50% 90.57% 97.67% 93.94% 100.00% 98.00% 97.78% 97.96% 94.23% 91.84% 89.66% 95.10% 96% 1st definitive treatment
31 day Cancer Wait: NHS TOWER HAMLETS CCG 96.19% 96.19% 96.19% 97.62% 97.62% 97.62% 97.67% 97.67% 97.73% 97.73% 97.73% 97.78% 97.78% 1st definitive treatment (Plan)
31 Day Cancer Wait: NHS TOWER HAMLETS CCG 100.00% 94.12% 91.67% 100.00% 100.00% 100.00% 100.00% 100.00% 92.86% 100.00% 85.71% 100.00% 80.95% 95.12% 94% Subsequent treatment (Surgery)
31 Day Cancer Wait: NHS TOWER HAMLETS CCG 96.43% 96.43% 96.43% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% Subsequent treatment (Surgery)(Plan)
31 Day Cancer Wait: NHS TOWER HAMLETS CCG 100.00% 94.44% 100.00% 100.00% 100.00% 100.00% 100.00% 95.45% 100.00% 95.00% 100.00% 100.00% 100.00% 98.94% 98% Subsequent treatment (Chemotherapy)
31 Day Cancer Wait: NHS TOWER HAMLETS CCG 98.00% 98.00% 98.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% Subsequent treatment (Chemotherapy) (Plan)
31 Day Cancer Wait: Subsequent treatment NHS TOWER HAMLETS CCG 90.91% 100.00% 100.00% 92.86% 100.00% 100.00% 100.00% 100.00% 100.00% 94.12% 100.00% 100.00% 100.00% 98.64% 94% (Radiotherapy) 31 Day Cancer Wait: Subsequent treatment NHS TOWER HAMLETS CCG 95.83% 95.83% 95.83% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% (Radiotherapy) (Plan)
62 Day Cancer Wait: NHS TOWER HAMLETS CCG 75.00% 81.82% 85.71% 92.86% 88.46% 92.86% 80.77% 80.00% 75.00% 73.68% 91.67% 82.61% 85.71% 84.39% 85% GP Referral
62 Day Cancer Wait: NHS TOWER HAMLETS CCG 85.00% 85.00% 85.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.46% 88.00% 88.46% GP Referral (Plan)
62 Day Cancer Wait: NHS TOWER HAMLETS CCG 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 81.82% 100.00% 100.00% 96.00% 90% Screening service
62 Day Cancer Wait: NHS TOWER HAMLETS CCG 90.00% 90.00% 90.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% Screening service (Plan)
62 Day Cancer Wait: No NHS TOWER HAMLETS CCG 100.00% 100.00% 100.00% 85.71% 100.00% 80.00% 100.00% 100.00% 0.00% 100.00% 100.00% 100.00% 100.00% 91.67% Consultant Upgrade thresholds
62 Day Cancer Wait: NHS TOWER HAMLETS CCG 85.00% 85.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% Consultant Upgrade (Plan)
Data source: Open Exeter THCCG Governing Body Meeting 10th May 2017 Part I 40 back to Main Menu 3 Trust wide Performance - Cancer Waiting Times Note: The NHS Constitution Quality Premium indicators are highlighted in lilac Top ranked Providers by greatest activity proportion
2016-17 2016-17 Theme KPI / Measure Provider Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Target
Barts Health 94.84% 97.49% 97.92% 97.81% 97.53% 97.75% 97.96% 97.71% 96.49% 97.65% 97.98% 98.30% 98.34% 97.75% 2 Week Cancer Wait Homerton 95.72% 94.97% 95.54% 96.85% 95.97% 98.26% 96.39% 97.18% 97.26% 97.25% 98.39% 96.72% 97.96% 97.24% 93% BHRUT 91.65% 89.55% 93.00% 89.54% 94.64% 94.82% 94.07% 96.22% 93.30% 96.30% 97.54% 97.74% 96.46% 95.01%
Barts Health 99.59% 99.39% 99.68% 100.00% 99.58% 99.53% 99.55% 99.71% 99.67% 98.56% 98.43% 97.67% 98.36% 99.24% 2 Week Cancer Wait: Homerton 97.00% 92.50% 94.78% 93.10% 99.07% 100.00% 100.00% 94.92% 99.05% 97.75% 98.53% 98.28% 96.34% 97.61% 93% Bre ast Symptoms BHRUT 92.19% 97.81% 97.17% 94.17% 94.74% 95.72% 84.39% 95.16% 94.25% 95.87% 100.00% 97.09% 97.22% 94.11%
Barts Health 96.99% 97.38% 97.49% 97.05% 96.20% 98.02% 99.61% 97.58% 97.50% 98.16% 96.35% 96.76% 96.07% 97.32% 31 day Cancer Wait: Homerton 100.00% 96.67% 100.00% 100.00% 100.00% 96.77% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.70% 96% 1st definitive treatment BHRUT 92.97% 95.43% 98.86% 97.12% 98.34% 96.59% 98.51% 100.00% 100.00% 98.96% 97.74% 100.00% 98.71% 98.58% Cancer Waits 31 Day Cancer Wait: Barts Health 98.21% 98.21% 96.23% 94.64% 97.59% 98.90% 95.38% 98.63% 96.30% 100.00% 94.51% 95.45% 94.51% 96.65% Subsequent treatment Homerton 83.33% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 94% (Surgery) BHRUT 88.89% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 95.45% 100.00% 100.00% 100.00% 100.00% 100.00% 99.48%
2016-17 2016-17 Theme KPI / Measure Provider Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Target
31 Day Cancer Wait: Barts Health 99.40% 100.00% 100.00% 99.36% 100.00% 99.33% 100.00% 100.00% 100.00% 98.67% 100.00% 100.00% 100.00% 99.73% Subsequent treatment Homerton 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98% (Chemotherapy) BHRUT 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.04% 99.77%
31 Day Cancer Wait: Barts Health 96.04% 98.57% 97.30% 97.20% 98.32% 99.01% 98.89% 100.00% 100.00% 98.47% 100.00% 98.89% 97.41% 98.81% Subsequent treatment Homerton 94% (Radiotherapy) BHRUT 91.53% 100.00% 100.00% 98.36% 98.08% 97.06% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.33%
Barts Health 81.17% 80.29% 86.05% 86.01% 82.11% 89.00% 87.39% 83.47% 85.71% 86.60% 85.55% 86.51% 84.72% 85.61% 62 Day Cancer Wait: Homerton 86.96% 77.36% 90.20% 87.50% 91.30% 89.80% 90.38% 76.19% 83.33% 80.65% 77.36% 89.19% 87.80% 85.41% 85% GP Referral BHRUT 70.71% 64.86% 76.00% 72.62% 70.83% 79.42% 72.68% 75.76% 69.58% 73.01% 76.70% 80.65% 70.25% 73.93%
Barts Health 92.00% 94.44% 92.86% 93.33% 94.12% 93.75% 90.00% 91.89% 100.00% 92.86% 93.94% 92.86% 94.74% 93.82% 62 Day Cancer Wait:
Cancer Waits Cancer Homerton 100.00% 100.00% 100.00% 100.00% 100.00% 90% Screening service BHRUT 91.18% 96.15% 94.74% 91.53% 95.00% 100.00% 100.00% 96.15% 91.30% 81.82% 91.67% 100.00% 96.08% 93.95%
Barts Health 88.71% 92.16% 86.49% 92.31% 85.19% 88.00% 89.61% 85.90% 85.48% 85.96% 87.67% 90.32% 86.17% 87.66% 62 Day Cancer Wait: Homerton 90.48% 92.68% 92.68% 97.50% 89.13% 96.43% 94.87% 89.13% 89.55% 97.56% 92.31% 91.43% 100.00% 93.24% Consultant Upgrade - BHRUT 81.03% 74.63% 88.89% 82.22% 87.93% 80.95% 94.29% 91.55% 91.30% 91.94% 80.70% 86.79% 84.31% 87.31%
THCCG Governing Body Meeting 10th May 2017 Part I back41 to Main Menu 4 Barts Health NHS Trust Cancer Waiting Times – Barts Health
There is the possibility of variation in data between that published on the national cancer waiting times database and that released by the trust. This may be caused by cases that are on the trust’s system but were either not uploaded to the national system before the deadline or uploaded under legacy sites which will be rejected by the Exeter system. Late uploads will be captured in the quarterly reports which often show a small amount of variation.
THCCG Governing Body Meeting 10th May 2017 Part I back 42to 22 Data source: Barts Health Trust Main Menu Barts Health NHS Trust Barts Health Cancer Waiting Times – 2 Week Wait by Tumour
Data source: Barts Health Trust THCCG Governing Body Meeting 10th May 2017 Part I back43 to 23 Main Menu Trust wide Performance - A&E 4 Hour Waiting Times and Ambulance Response Note: The NHS Constitution Quality Premium indicators are highlighted in lilac Top ranked Providers by greatest activity proportion
2016-17 2016-17 Theme KPI / Measure Provider Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Target
The Royal London Hospital 82.61% 81.01% 82.60% 81.11% 79.95% 80.21% 84.25% 86.08% 87.39% 83.48% 80.32% 75.54% 75.91% 81.41% Newham 89.59% 92.07% 92.61% 92.12% 92.17% 90.16% 92.59% 88.52% 92.60% 91.98% 93.46% 85.89% 80.74% 90.03% Whipps Cross 71.95% 68.55% 72.38% 71.96% 75.41% 75.65% 80.55% 82.61% 80.52% 73.82% 73.29% 64.68% 64.34% 74.37% Homerton 95.66% 93.14% 94.01% 94.06% 93.34% 92.82% 95.44% 96.50% 94.63% 93.33% 93.33% 93.75% 92.93% 94.00% A&E Type I Performance 95% Queen's Hospital 80.05% 76.06% 70.24% 76.43% 77.32% 76.74% 80.57% 90.07% 87.52% 84.17% 85.60% 78.20% 72.07% 80.84% King George Hospital 82.13% 79.55% 75.73% 82.06% 80.71% 85.24% 86.99% 92.46% 91.88% 91.02% 89.89% 87.97% 78.49% 86.64% Barts Health 81.21% 80.21% 82.55% 81.39% 81.75% 81.43% 85.27% 85.66% 86.56% 82.80% 81.63% 75.28% 73.87% 81.54% BHRUT 80.73% 77.17% 72.02% 78.27% 78.43% 79.94% 82.65% 90.84% 88.98% 86.36% 87.02% 81.38% 74.32% 82.76%
The Royal London Hospital 84.67% 83.32% 84.79% 83.17% 82.22% 82.24% 85.81% 87.60% 88.59% 85.09% 82.17% 77.60% 78.21% 83.27% Newham 92.95% 93.97% 94.70% 94.48% 95.16% 93.57% 95.12% 92.72% 95.22% 94.81% 95.86% 90.95% 88.25% 93.61% Whipps Cross 81.75% 79.61% 81.85% 81.87% 83.33% 83.46% 86.21% 87.96% 86.68% 82.55% 82.35% 77.87% 77.70% 82.93% Homerton 95.66% 93.14% 94.01% 94.06% 93.34% 92.82% 95.44% 96.50% 94.63% 93.33% 93.33% 93.75% 92.93% 94.00% A&E All Types Performance 95% Queen's Hospital 80.80% 77.05% 71.27% 77.39% 78.19% 77.78% 81.34% 90.46% 88.11% 84.82% 86.23% 79.02% 73.24% 81.64% King George Hospital 87.12% 85.53% 81.96% 87.33% 86.23% 89.62% 90.73% 94.69% 94.12% 93.38% 92.93% 91.82% 85.20% 90.56% Barts Health 86.37% 85.57% 87.32% 86.34% 86.73% 86.24% 88.88% 89.29% 89.97% 87.29% 86.59% 82.02% 81.27% 86.41% BHRUT 83.32% 80.39% 75.65% 81.37% 81.37% 82.81% 85.02% 92.12% 90.48% 88.19% 88.94% 84.25% 78.29% 85.22%
No of waits from decision to Homerton 00000000000000 admit to admission (Trolley Barts Health 000002 00000002 0 waits - over 12 hours) BHRUT 0 1 0 120 1 0001117
Homerton 00000000000000 Urgent cancelled operations Barts Health 000000000000110 2nd time BHRUT 00000000000000
Category A calls resulting in emergency response London Ambulance Service 67.29% 64.68% 65.57% 69.99% 70.27% 72.21% 68.33% 68.71% 70.08% 69.43% 70.44% 66.27% 67.11% 69.13% 75% arriving within 8 mins (RED NHS Trust
Accident & Emergency and Emergency & Accident 1) Ambulance Calls and Handover and Calls Ambulance
Category A calls resulting in emergency response London Ambulance Service 60.94% 56.35% 57.94% 64.60% 65.13% 65.27% 63.64% 67.37% 63.27% 66.27% 67.08% 64.00% 62.17% 64.84% 75% arriving within 8 mins (RED NHS Trust 2)
Category A calls resulting in London Ambulance Service emergency response 92.57% 91.29% 91.05% 94.22% 94.08% 94.38% 93.10% 94.04% 92.88% 93.76% 93.32% 91.89% 91.34% 93.25% 95% NHS Trust arriving within 19 mins
back to 7 THCCG Governing Body Meeting 10th May 2017 Part I Main44 Menu Trust wide Performance - Ambulance Handover Times Top ranked Providers by greatest activity proportion
2016-17 2016-17 Theme KPI / Measure Provider Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 YTD Target
Royal London Hospital 50.30% 51.20% 48.50% 51.60% 55.20% 52.50% 53.40% 55.33% 51.10% 52.00% 47.70% 49.30% 50.89% 51.57% Newham 30.70% 33.70% 32.80% 30.90% 29.10% 26.50% 30.50% 28.56% 28.20% 32.10% 24.90% 23.10% 18.27% 28.08% % Ambulance Handovers Whipps Cross 38.50% 39.90% 42.40% 43.50% 43.50% 44.40% 44.30% 39.38% 39.80% 34.70% 27.10% 24.10% 31.16% 38.16% 100% within 15 mins: KPI 1 Homerton 70.20% 68.60% 72.30% 73.40% 74.50% 73.90% 75.80% 73.05% 71.50% 70.30% 67.70% 64.50% 69.60% 71.52% Queens Hospital 33.06% 31.14% 32.80% 33.33% 32.84% 34.28% 36.85% 31.85% 30.42% 27.66% 22.73% 19.59% 22.27% 29.68% King George Hospital 31.31% 24.57% 31.13% 27.89% 30.00% 27.48% 29.52% 27.29% 28.50% 31.32% 23.14% 17.90% 27.00% 27.36%
Royal London Hospital 99.30% 99.30% 98.20% 99.90% 99.60% 99.50% 99.90% 99.63% 99.10% 99.70% 99.30% 99.60% 100.00% 99.49% Newham 99.60% 99.60% 99.40% 99.70% 99.60% 99.60% 99.20% 99.03% 99.00% 99.40% 98.20% 97.60% 97.95% 99.03% % Ambulance Handovers Whipps Cross 88.80% 92.60% 93.50% 93.70% 92.50% 95.30% 94.40% 93.59% 90.50% 88.40% 81.90% 77.10% 86.23% 90.09% 100% within 30 mins: KPI 2 Homerton 100.00% 100.00% 99.60% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.80% 100.00% 99.94% Queens Hospital 82.87% 80.15% 84.12% 87.06% 84.30% 82.75% 88.83% 85.88% 83.05% 82.38% 73.13% 67.52% 78.24% 81.63% King George Hospital 90.76% 85.62% 88.87% 87.15% 87.08% 88.19% 89.09% 87.40% 87.97% 89.64% 83.85% 78.81% 87.73% 86.84%
Royal London Hospital 11 8 34249171661570 101 Newham 45643588106192217108 Number of Ambulance Whipps Cross 138 112 86 84 110 68 79 89 121 127 205 232 141 1342 Handover-30 minute 0 Homerton 004 000000002 0 6 breaches Queens Hospital 498 580 451 370 414 454 275 318 422 405 696 808 459 5072 King George Hospital 93 148 113 129 124 113 102 111 96 89 149 205 94 1325
Royal London Hospital 0 4 000000000000 Newham 00000000000000 Number of Ambulance Whipps Cross 23321360 1 0 15 24 34 43 15 153 Handover-60 minute 0 Homerton 00000000000000 breaches Queens Hospital 001 0 1 000022250 31
Accident & Emergency and Accident Emergency & King George Hospital 0 3 00000251110 10
Ambulance Calls and Calls HandoverAmbulance Royal London Hospital 76.40% 81.40% 86.00% 87.10% 86.60% 86.50% 86.60% 88.32% 87.10% 88.40% 88.90% 88.50% 87.80% 87.44% Newham 74.80% 78.20% 82.00% 84.40% 84.10% 77.80% 83.10% 79.37% 78.10% 82.70% 80.00% 78.30% 75.20% 80.63% % Patient records captured Whipps Cross 86.30% 85.10% 86.60% 87.20% 91.60% 88.60% 91.40% 88.42% 90.20% 86.20% 86.00% 84.50% 84.87% 87.88% 90% electronically: KPI 4 Homerton 82.30% 86.40% 89.80% 91.00% 91.30% 93.30% 92.70% 91.09% 91.90% 91.80% 90.60% 92.40% 92.04% 91.61% Queens Hospital 92.01% 90.46% 92.54% 90.92% 90.66% 91.36% 93.00% 91.56% 91.53% 91.78% 91.85% 91.39% 90.40% 91.55% King George Hospital 87.10% 85.02% 89.66% 87.46% 86.96% 86.61% 90.86% 89.60% 87.53% 88.65% 90.37% 89.42% 90.74% 88.84%
back to 8 THCCG Governing Body Meeting 10th May 2017 Part I Main45 Menu
Governing Body Meeting- Part I Enclosure
Date of meeting 10 May 2017 F
Agenda item 2.3
Title of report: Tower Hamlets GP Care Group CIC – Update, May 2017
Author(s): Chris Banks – Chief Executive - Tower Hamlets GP Care Group CIC
Presented by: Chris Banks – Chief Executive - Tower Hamlets GP Care Group CIC For further information [email protected] This report gives an overview of the services provided by Tower Hamlets GP Care Group CIC, outlining the journey of the organisation, Executive summary the organisation structure and areas of work, and its challenges and learning moving forward.
Recommendation:
Information Approval To note Decision
The Governing Body is asked to note the contents of the report.
Conflicts of Interest None identified relating to this report.
Patient and Public As outlined in the report. involvement
Link to the Board This paper affects all of the risks under Corporate Objective 2: To Assurance Framework commission person-centred, integrated health and care service that are sustainable and that equally meet the mental and physical needs of our residents
Impact on Equality and Monitoring and actively improving the performance and quality of Diversity service provision will have a beneficial impact for all patients in Tower Hamlets.
Resource requirements As outlined in the report.
Next steps As outlined in the report.
1 | Page
THCCG Governing Body Meeting 10th May 2017 Part I 46
2 | Page
THCCG Governing Body Meeting 10th May 2017 Part I 47 Tower Hamlets GP Care Group
Presentation to the Governing Body of Tower Hamlets CCG
THCCG Governing Body Meeting 10th May 2017 Part I 48 Networks
Tower Hamlets before 8 Networks1 were formed in the borough during 2009 networks
23 23
5 20 Pop: 33,186 6 19 5 Pop: 29,801 1 3 4 22 20 2 21 26 6 27 6 19 24 3 22 7 1 2 21 26 4 27 8 10 24 9 14 25 Pop: 35,720 7 13 12 30 32 Pop: 28,995 11 8 10 1516 29 31 28 9 14 25 13 12 Pop: 18,027 30 32 11 17 29 18 1516 31 28 Pop: 27,839
Pop: 29,892 17 33 36 18 • 8 LAPs 35 Pop: 31,975 • 36 practices 34 33 36 • Total population of ~245,000 35
• Practice list sizes of 3,000 to 11,000 34
Why networks? • Focus on population health across a geography • Collaborative relationships with wide range of partners (e.g. Borough, schools, charities) • Sufficient scale for specialisation of staff, ability to access rare skills and ensure access, resources (e.g. equipment) • Integration with estates plan
THCCG Governing Body Meeting 10th May 2017 Part I 49 Case for Networks
Wide variation in clinical practice and outcomes for diabetes patients • Economies of scale • Poor uptake of diabetes education and retinal screening • Need to do things differently • The right people to do the right tasks at the right time • Specialist support • Transparency of data • Putting the patient at the centre of their care
THCCG Governing Body Meeting 10th May 2017 Part I 50 GP Care Group Journey
• Establishment of 8 GP networks 2008/9
Nov • Formation of the GP Care Group 2013
Sept • GPCG incorporated as a Community Interest Company 2014
Mar • THT awarded Vanguard status/GPCG awarded PMCF 2015
Oct • CEPN & Open Doors transferred to the GPCG 2015
Apr • GPCG commenced Health Visiting services 2016
Apr • GPCG commenced Community Health Services Contract 2017
THCCG Governing Body Meeting 10th May 2017 Part I 51 GP Care Group
Community Interest Company limited by shares Membership organisation 36 general practices 1 homeless access centre Budget Turnover for 2017/18 £20.5million Board comprises: 8 elected GPs representing each network 2 elected Network Managers; 1 elected Practice Manager and 1 elected Practice Nurse Purpose to be the voice of general practice working at scale to ensure sustainability of general practice
THCCG Governing Body Meeting 10th May 2017 Part I 52 Budget 2017/18
£’000
Health visiting 6,801
Network Improved Services (NIS) 5,653
Community health services (CHS) 5,135
GP Access Fund (formerly PMCF) 1,336
Open Doors 381
CEPN 240
Social prescribing120
Pathology transport 78
Surgical aftercare 65
Sundry other schemes (websites, calibration,etc.) 20
Tower Hamlets Together – host for some of the PMO (approx.) 500
TOTAL 20,329
THCCG Governing Body Meeting 10th May 2017 Part I 53 Organisation Structure
Dr Phillip Benne ‐Richards ‐ GPCG Board ees Sub
& Dr Sella Shanmugadasan Dr Nicola Hagdrup Dr Joe Hall Jane Payling Dr Nicola Hagdrup Contract Management Finance & Performance Quality, Safety and Audit Commi ee Remunera on Commi ee Commi ee Governance Commi ee Commi ee Commi Board
Dr Simon Brownleader Dr Mike Fitche Advisory Communica ons, Engagement and HR, OD and Training Group IT
Director of
ve Tracy Cannell Chris Banks Finance Ruth Walters Chief Opera ng Officer Chief Execu ve (vacancy) Director of Quality [email protected] [email protected] [email protected] Team Execu
Advocacy &
Interpre ng Health Visi ng Jerome John Open Doors CEPN Carrie Vicky Souster Ekramul Hoque Financial Lawrence Office Manager j
Management Myimba McGregor
Pa ent & Carer Primary Care Primary Care Risk Health & Out of Hours Experience Audit Service & Primary IT/IM & Development IT Management Safety Snona Davies Single Point Care Hubs Comms of Access Liane Gareth ons Fitzgerald Leher GPCG Clinical Informa on Jane Baylis Development Safeguarding Governance Governance
Human Payroll Resources Debbie Opera System Leadership/Vanguard Nick Percival Russell
THCCG Governing Body Meeting 10th May 2017 Part I 54 Primary Care at Scale
Current Portfolio
Surgical aftercare Out of Hours/Urgent Care
Pathology transport Single Point of Access
Websites Health advocacy and interpreting
Community Education Provider Network CHS alliance manager/system leadership (CEPN)
Open Doors (Practice nurse training) Pipeline Extended access hubs Medical indemnity Social prescribing pilots Business Intelligence Health visiting QI/ Primary Care resilience System leadership – MCP Vanguard Sexual Health Network improved services scheme
THCCG Governing Body Meeting 10th May 2017 Part I 55 Tower Hamlets Together
MCP Vanguard
GPCG, Barts Health, ELFT, CCG, LBTH, CVS
CHS alliance partnership (stage 1 of MCP)
THT Board
Future = accountable care system (whatever that is?) Joint commissioner/provider board CCG devolves commissioning intentions to THT Outcomes framework Health and wellbeing strategy alignment
THCCG Governing Body Meeting 10th May 2017 Part I 56 CHS Alliance
THCCG Governing Body Meeting 10th May 2017 Part I 57 Alliance Partnership
CHS CONTRACT & GOVERNANCE COLLABORATION
CCG Alliance Board
System Quality and Alliance Management Safety SPR CQRM Manager Commi ee Commi ee
Locality Integrated Care Boards x4
Contractor Contractor Contractor Contractor Contractor Contractor Barts Barts GPCG ELFT GPCG ELFT Health Health
THCCG Governing Body Meeting 10th May 2017 Part I 58 Challenges & Learning
GPCG is currently sustainable without subsidy or member contribution, but at a cost Last 18mths has been more about system participation than about general practice CHS procurement – somewhat distracting The future of partnership model in general practice? Practice and network sovereignty Organisational development Communication and buy-in
THCCG Governing Body Meeting 10th May 2017 Part I 59
Governing Body Meeting Enclosure
Date of meeting 10th May 2017 G
Agenda item 2.4
Title of report: Report (1 June 2015 to 31 March 2017) from the Audit Committee to the Governing Body Mariette Davis – Governing Body – Lay Member for Governance Author(s):
Justin Phillips – Corporate Governance Manager
Presented by: Mariette Davis – Governing Body Lay Member for Governance Sponsor (if different): For further information Justin Phillips – Corporate Governance Manager [email protected]
This paper provides a summary of the work carried out by the Audit Committee during 1 June 2015 to 31 March 2017under each of the key duties of the Committee, as set out in the terms of reference. The Audit Committee’s role is to seek assurance that financial reporting Executive summary and internal control principles are applied and to maintain an appropriate relationship with the organisation’s auditors, both internal and external. The Audit Committee offers scrutiny and advice to the Governing Body, about the reliability and robustness of the CCG’s processes of internal control.
Recommendation
Information Approval To note Decision
The Governing Body is asked to note the contents of the report.
Conflicts of Interest There are no identified conflicts of interests.
Report history This is the first time this report has been presented to the Tower Hamlets CCG Governing Body.
Patient and Public N/A involvement
Link to the Board The Audit Committe reviews the Board Assurance Framework (BAF) at Assurance Framework all Audit Committee meetings to ensure the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the CCG’s activities.
THCCG Governing Body Meeting 10th May 2017 Part I 60 Impact on Equality and N/A Diversity
Resource requirements None
Next steps As outlined in the report.
THCCG Governing Body Meeting 10th May 2017 Part I 61
Report from the Audit Committee to the Governing Body 1 June 2015 to 31 March 2017
Introduction
The requirement for Clinical Commissioning Groups (CCGs) to establish an Audit Committee (The Committee) is included in the Health and Social Care Act 2012. The Governing Body established this Committee of the Governing Body in its Constitution. The Committee is a non - Executive Committee of the Governing Body and has no executive powers, other than those specifically delegated in its Terms of Reference. The Terms of Reference covering the period under review, aligned with the Audit Committee Handbook 2014, published by the HFMA and Department of Health, last reviewed on 21 July 2015, and are included at APPENDIX B.
The CCG faces huge changes which may affect how the Governing Body discharges its statutory and other responsibilities. These changes include working collaboratively with other CCGs and Providers across the North - East London and the City within the North - East London and the City Sustainability and Transformation Plan footprint. Governance arrangements, including the CCG Constitution and the Terms of Reference of Committees need to be continually reviewed and appraised as new working structures develop. The Audit Committee plays a lead role in providing Assurance to the Governing Body on governance arrangements and the management of conflicts of interest, which will take on a new dimension across the new collaborative operating environments.
During the period under review, and going forward, National Health Service England (NHSE) has asked Audit Chairs of CCGs to take on increasing and specific additional responsibility, including:
Counter- signing, with the CCG Accountable Officer, the quarterly self -certification on Conflict of Interest Management of NHSE delegated primary care commissioning functions Counter – signing, with the CCG Accountable Officer, the quarterly Conflict of Interest Indicator under NHSE’s New Improvement and Assessment Framework for CCGs- which assesses the CCG’s compliance with the revised Statutory Guidance on Managing Conflicts of Interest for CCGs published in June 2016 (“The Statutory Guidance”) Counter-signing, with the Accountable Officer, the Annual self -certification of the Conflict of Interest Indicator. Inter alia, this requires confirmation of Lay Members’ capacity and compliance with Conflict of Interest training for all those involved in Commissioning Becoming the CCG’s Conflict of Interest Guardian- a new role, the responsibilities of which are summarised in the Statutory Guidance.
Membership
The Committee membership during the period covered in this report was as follows.
Name Role
Mariette Davis Lay Member for Governance and Chair Cate Boyle Lay member for Patient and Public Engagement ( to Jan 2016) Noah Curthoys Lay Member for Corporate Affairs (from Jan 2016 ) Mr Tan Vandal Secondary Care Specialist
THCCG Governing Body Meeting 10th May 2017 Part I 62
In Attendance
Name Role Organisation
Henry Black Chief Finance Officer NHS Tower Hamlets CCG (to Sep ’16) Jackie Brown Interim Chief Finance Officer NHS Tower Hamlets CCG (Sep ‘16 to Mar ’17) Ellie Hobart Director of Corporate Governance NHS Tower Hamlets CCG (from Mar ’16) Andrea Antoine Deputy Director Finance NHS Tower Hamlets CCG (in CFO’s absence) Keith Dickinson/ Andy NHS Tower Hamlets CCG (Jan to Sep ’16) Interim Governance Manager Nuckcheddee Justin Phillips Corporate Governance Manager NHS Tower Hamlets CCG (Mar ‘15 to Jan ’16; from Sep ‘16 Sophia Beckingham Corporate Governance Officer NHS Tower Hamlets CCG (Sep ‘16 to Mar ’17) Neil Thomas Partner – External Audit KPMG Jack Stapleton Auditor – External Audit KPMG John Elbake Manager – Internal Audit RSM LLP Nick Atkinson Partner – Internal Audit RSM LLP Gemma Higginson Counter Fraud Manager RSM LLP
Others have been invited to attend meetings if required it, for example the Chief Officer attended when the Annual report was reviewed by the Audit Committee to provide assurance over Governance and the Annual Governance Statement.
Meeting schedule
The Committee met 11 times during the period on the following dates, and was quorate at each meeting:
21 July 2015 13 October 2015 19 January 2016 16 February 2016 15 March 2016 10 May 2016 24 May 2016 26 July 2016 11 October 2016 17 January 2017 14 March 2017
Executive Summary of work done by the Audit Committee during the period
The Committee has carried out its duty to provide the Governing Body with assurance (or not) that effective control arrangements are in place. Appendix A sets out the detailed work carried out in accordance with the Committee’s Terms of Reference.
In summary, specifically, the Committee:
Reviewed the Annual Financial Statements, the Annual Report (including the Annual Governance Statement) and recommended that the Governing Body should approve the Financial Statements for the year ended 31 March 2016 Reviewed and monitored the external auditors’ independence and objectivity and the effectiveness of the external audit process.
THCCG Governing Body Meeting 10th May 2017 Part I 63
Met with the external and internal auditors on our own, without CCG officers or employees present, before Audit Committee meetings, to provide the auditors with the opportunity to raise matters concerning conflicts, whistleblowing, internal controls, risks or any other issues which they wished to draw to our attention Oversaw the procurement of External Auditors from 1 April 2017 following the end of the four- year contract expiring on 31 March 2017 and approved the new appointment. Reviewed the Community Health Services procurement process and decision making process throughout the prolonged period during which it was undertaken. Carried out an ongoing review of the revised statutory guidance on managing conflicts of interest for CCGs) issued by NHSE in June 2016. The Committee is overseeing the implementation of changes required to make the CCG compliant with the Statutory Guidance. We have requested a gap analysis and the Corporate Governance Manager is specifically responsible (reporting to the Audit Chair as Conflict of Interest Guardian) to ensure that all gaps are closed by specific actions tasked to named individuals. The main areas in the statutory guidance are:
o The strong recommendation for CCGs to have a minimum of three lay members on the Governing Body
o The introduction of a conflicts of interest guardian in CCGs
o The requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and for anonymised details of the breach to be published on the CCG’s website
o Strengthened provisions around decision-making
o Strengthened provisions around the management of gifts and hospitality
o A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans
o A requirement for all CCG employees, Governing Body and committee members and practice staff with involvement in CCG business, to complete mandatory online conflicts of interest training Reviewed the CCG’s Conflict of Interest, Gifts and Hospitality Policies, updated to reflect the new Statutory Guidance, before being approved by the Governing Body, 6 December 2016. Approved and oversaw a programme of internal audit work on systems and processes of integrated governance and risk management to provide assurance that internal controls and risk systems both at the CCG and at the CSU were in place and are working in practice. Reviewed the Board Assurance Framework and influenced its ongoing development. Conducted deep dives on the BAF, inviting relevant individuals to attend the Audit Committee and present their approach to risk management for areas within their responsibility. Successfully encouraged the Governing Body to engage with the Board Assurance Framework process and to discuss the BAF, presented by the CO, at every meeting of the Governing Body, high up on the agenda. Requested and considered updates on the Sustainability and Transformation Plans (STP) across North East London and the City, with particular focus on the financial and governance implications. Reviewed the CCG’s register of interests and ensured that there was a process for it, and the register of procurements, to be updated regularly by a named and responsible individual and displayed on the CCG website, as was required in the NHSE’s CCG guidance on conflict of interest management dated 18 December 2014. Reviewed and provided comments on the quarterly Primary Care Commissioning self-certification prior to it being signed by the Accountable Officer and the Audit Chair and then submitted to NHSE. The Audit Chair signed the certification as follows “Nothing in this certification is inconsistent with my knowledge of the CCG”; reflecting the limited detail the Audit Chair has of the day to day detailed operations at the CCG.
THCCG Governing Body Meeting 10th May 2017 Part I 64
As part of a general review of governance and review of conflicts of interest management, reviewed minutes of a number of sub-committees’ meetings Supported the Governing Body by continuously reviewing governance and assurance processes. Reviewed the IR35 / PAYE HMRC guidance and sought assurance from the CCG that suitable mitigations are in place. Reviewed our own terms of reference on 14 March 2017. Reported during the year to the Governing Body, in writing, all matters considered significant by the Committee.
Additional pro- active work undertaken by the Audit Chair
The Audit Chair was a founder member of, and meets on a quarterly basis with, a CCG Audit Chairs’ Forum (now comprising around 15 CCG Audit Chairs) to highlight, discuss and propose solutions to national and local healthcare initiatives and challenges. This Group invites guests, e.g. NHSE Audit Chair, LAS Managing Director to discuss important issues The Audit Chair attended and contributed to regular NHSE organised National Forums for CCG Audit Chairs to discuss and share ideas and to propose solutions to National NHS issues The Audit Chair attended several governance and finance workshops relating to the STP and has been invited to sit on a proposed STP Assurance Committee. - Assurance statement The Committee confirms that it fulfilled its duties under the Terms of Reference during the period and there are no matters of which the Committee is aware that have not been disclosed appropriately to the Governing Body. - Recommendation
The Governing Body is asked to:
1. Receive assurance from the Audit Committee about the delivery of the work of the Audit Committee and the work of the Audit Chair during the period under review.
2. To provide the Chair of the Audit Committee with any feedback on this report or the work of the Committee.
Mariette Davis
Audit Committee Chair
31 March 2017
End
THCCG Governing Body Meeting 10th May 2017 Part I 65
APPENDIX A
Work carried out by the Audit Committee during the period 1 June 2015 – 31 March 2017 This Annual Report is divided into sections and describes work done by the Committee following the order of responsibilities as set out in the Committee’s Terms of Reference (Appendix B). Integrated Governance, risk management and internal control The Committee reviewed the Annual Report and Accounts including the Independent Auditors Report to the members of the CCG Governing Body at the 24 May 2016 meeting. Prior to this meeting, the Committee had reviewed relevant disclosure statements, including: The Head of Internal Audit Opinion, External Auditors opinion, Letter of Representation required by the External Auditors and other documents. The Committee reviewed the Annual Governance Statement included within the CCG’s Annual Report and concluded that it was consistent with their knowledge of the CCG’s system of internal control The Committee recommended that the Governing Body approve the Financial Statements. The Committee met with the external and internal auditors on our own, without CCG officers or employees present, before Audit Committee meetings, to provide the auditors with the opportunity to raise matters concerning conflicts, whistleblowing, internal controls, risks or any other issues which they wished to draw to our attention The Committee reviewed the Community Health Services procurement process and decision making process throughout the prolonged period during which it was undertaken.
The Committee has sought assurance from the Chief Finance Officer and the Acting Director of Commissioning regarding the implications for the CCG’s statutory duties in the emerging new models of working, including the NEL Sustainability and Transformation Plan (NEL STP) and the Tower Hamlets Accountable Care System (ACS) proposals.
The Committee reviewed the Board Assurance Framework (BAF) at each Audit Committee meeting, providing feedback and discussing the level of assurance provided to the Governing Body. The Committee requested deep dive reviews of specific risks included in the BAF and called upon relevant risk holders to explain to the Committee how they were managing the risks and to what extent the Governing Body could rely on the information in the BAF mitigating factors. The internal audit function utilises the BAF to ensure that audit work is driven towards providing key assurance over the principal risks. The BAF is regularly updated by the CCG executives and plays a leading role in providing assurance to the Governing Body’s over the management of risks. The Committee noted waivers to the CCG’s standing orders as well as financial write-offs which were presented to the Committee and had been authorised by the Chief Finance Officer or Accountable Officer. As part of the ongoing scrutiny of the CCG’s governance, the Committee reviewed the terms of reference of several committees of the Governing Body, policies covering conflicts of interest, gifts and hospitality and we also reviewed the register of interests. The Audit Chair prepared a written summary report for the Governing Body following each Committee meeting during the period covered by this report.
Internal Audit and Counter Fraud Throughout the period, the Committee oversaw internal audit in order to review and strengthen the CCG’s internal control processes. The Committee: Reviewed and approved the Internal Audit Plan for 2016-17, detailing the programme of internal audit work covering systems and functions within the CCG. Reviewed and approved the CSU Assurance Work plan for 2016-17 to be carried out by the internal auditors to provide assurance on those CCG functions outsourced to the CSU and
THCCG Governing Body Meeting 10th May 2017 Part I 66
received regular CSU assurance reports both from the Internal auditors and from the CCG CFO Assurance group. Reviewed internal audit reports and CSU assurance reports throughout the period covering reviews on the CCG systems and the CSU systems respectively. The Committee discussed and considered their findings and recommendations. The Committee ensured that management had responded appropriately to the reports’ recommendations and monitored the follow up of the implementation of those recommendations. Reviewed and approved the counter fraud plan for the year and considered reports covering counter fraud work carried out by the Local Counter Fraud Service on our behalf as well as being involved in specific investigative fraud cases. External Audit The Committee reviewed and approved the external auditor’s annual audit plan. The Committee reviewed and discussed with the external auditors their work in respect of the 2016-17 audit and reports prepared by them. In particular the Audit Committee reviewed all audit reports prepared by the external auditors, including their report to those charged with governance and agreed the Annual Audit letter before submission to the Governing Body. The Committee oversaw the procurement of External Auditors from 1 April 2017 following the end of the four- year contract expiring on 31 March 2017 and approved the new appointment.
Management The Committee has continually challenged the assurance process when appropriate and has requested and received assurance from CCG management and other sources throughout the year. This process has included calling managers to account when considered necessary to obtain relevant assurance. The Committee has worked closely with the Accountable Officer, the Chief Financial Officer, the Acting Director of Commissioning, the Director of Performance and Quality, the Deputy Director of Corporate Affairs, and the Governance Manager to ensure that the assurance mechanism within the CCG is effective.
Whistleblowing There is a whistleblowing policy in place which was reviewed by the Committee before its approval by the Governing Body. Apart from meeting with the internal and external auditors without executives present, and from members meeting and talking to staff outside formal Committee meetings, the Committee did not carry out specific review work on Whistleblowing, but a review is planned for this coming year.
Financial reporting The Committee, through internal audit, ensured that the systems for financial reporting to the Governing Body, including those of budgetary control, were subject to review as to the completeness and accuracy of the information provided to the Governing Body. The Committee reviewed the CCG’s Annual Financial Statements for the year ended 31 March 2016 at the 10 May 2016 meeting and again at the Extraordinary Audit Committee meeting on 24 May 2016, before they were to the Governing Body for approval. The Audit Committee had no significant matters to draw to the attention of the Governing Body on the financial statements. At the 24 May 2016 meeting the Audit Committee reviewed and discussed, with the CCG Executives, the Governing Body’s response to the external auditor’s Letter of Representation relating to the Annual Financial Statements.
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Conflicts of Interest The Committee continuously considered the CCG’s processes for managing conflicts of interest throughout the CCG and specifically and reviewed the Primary Care Committee’s Terms of reference and a sample of the Minutes of meetings during the period. The Committee recommended a form of words for inclusion on the agendas of every CCG meeting to prompt individuals attending the meeting to consider carefully whether they have a conflict of interest and to declare it at the meeting. The note also highlights that other individuals at the meeting should raise, at the meeting, any conflicts they consider others may have. The Committee reviewed the CCG’s register of interests and ensured that there was a process for it to be updated regularly and displayed on the CCG website, together with the procurement register, as required in the NHSE’s CCG guidance on conflict of interest management dated 18 December 2014. The Committee reviewed and provided comments on the quarterly self-certification covering Primary Care commissioning functions delegated from NHSE prior to it being signed by the Accountable Officer and the Audit Chair and then submitted to NHSE. The Audit Chair signed the certification as follows “Nothing in this certification is inconsistent with my knowledge of the CCG”; reflecting the limited detail the Audit Chair would have of the day to day detailed operations at the CCG.
End
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Appendix B:
Audit Committee Terms of Reference covering the period under review – 1 June 2015 to 31 March 2017
Introduction
The requirement for Clinical Commissioning Groups (CCGs) to establish an Audit Committee is included in the Health and Social Care Act 2012. The Governing Body established this Committee of the Governing Body in its Constitution. The Committee is a non-Executive Committee of the Governing Body and has no executive powers, other than those specifically delegated in this Terms of Reference. Its role is to seek assurance that financial reporting and internal control principles are applied and to maintain an appropriate relationship with the organisation’s auditors, both internal and external. The Audit Committee offers scrutiny and advice to the Governing Body, about the reliability and robustness of the CCG’s processes of internal control.
Membership
The members shall be appointed by the Governing Body, and to maintain its independent assurance and scrutiny role, the Committee will be made up of Lay Members of the CCG Governing Body. A quorum shall be two of the three independent members. One of the members shall be appointed Chair of the Committee by the Governing Body. The Chair of the organisation shall not be a member of the Committee. Current members are:
• Lay Member – lead for Governance – Chair
• Lay Member - lead for Patient and Public Engagement
• Registered Nurse or Secondary Care Consultant
The Chair shall have recognised professional accountancy qualification
Attendance at meetings
The Chief Finance Officer and appropriate internal and external audit representatives shall normally attend meetings.
The Counter Fraud Specialist shall attend at least two committee meetings a year.
The Accountable Officer should be invited to attend meetings and should discuss at least annually with the Audit Committee the process for assurance that supports the Annual Governance Statement. He or she should also attend when the Committee considers the Annual Governance statement and the Annual Report and Accounts.
Other executive directors/managers should be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director/manager.
Representatives from other organisations (for example NHS Protect) and other individuals may be invited to attend on occasion.
The organisation’s secretary (or governance lead) shall be secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the chair and the Committee members.
At least once a year the Committee shall meet privately with the internal and external auditors. THCCG Governing Body Meeting 10th May 2017 Part I 69
Meetings are not open to the public.
Access
The Head of Internal Audit, representative of external audit and counter fraud specialist have a right of direct access to the Chair of the Committee.
Frequency of meetings
The Committee will consider the frequency and timing of meetings needed to allow it to discharge all its responsibilities. The Committee will meet at least quarterly at appropriate intervals in the financial reporting and audit cycle and otherwise as required. The Chair can call a meeting of the Committee as and when required with at least three weeks’ notice.
The Governing Body, Accountable Officer, external auditors or Head of Internal Audit may request an additional meeting of they consider one is necessary.
Outside of the meeting the Chair will maintain a dialogue with the Chief Finance Officer
Authority
The Committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co- operate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.
Responsibilities
The duties/responsibilities of the Committee fall into the following main categories:
Governance, risk management and internal control
The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the CCG’s activities, that supports the achievement of the organisation’s objectives;
In particular, the Committee will review the adequacy and effectiveness of:
• All risk and control related disclosure statements (in particular the Annual Governance Statement) together with any accompanying Head of Internal Audit Opinion, external audit opinion or other appropriate independent assurances, prior to submission to the Governing Body.
• The underlying assurance processes that indicate the degree of achievement of strategic objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.
• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.
• The policies and procedures for all work related to fraud and corruption as required by NHS Protect.
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The Committee will review any incident of fraud, corruption or possible breach of ethical standards, conflicts of interest or legal or statutory requirements that has been brought to its attention and could have a significant impact on the CCG’s financial accounts or reputation.
The Committee will note waivers or breaches to the Prime Financial Policies or standing orders which have been approved by the Chief Finance Officer or Chief Officer.
In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from executives and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.
This will be evidenced through the Committee’s use of an effective assurance framework to guide its work and that of the audit and assurance functions that report to it.
As part of its integrated approach, the Committee will have effective relationships with other key committees (for example the Finance, Performance and Quality committee) so that it understands processes and linkages.
Internal audit
The Committee shall ensure that there is an effective internal audit function established by management that meets Public Sector Internal Audit Standards 2013 and provides appropriate independent assurance to the Audit Committee, Chief Officer and the Governing Body. This will be achieved by:
• Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.
• Review and approval of the internal audit plan and the more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the Assurance Framework.
• Considering the major findings of internal audit work (and management’s response), and ensuring co- ordination between the internal and external auditors to optimise audit resources.
• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the organisation
External audit
The Committee shall review and monitor the external auditors’ independence and objectivity and the effectiveness of the audit process. In particular, the Committee will review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:
• Considering of the appointment and performance of the external auditors, as far as the rules governing the appointment permit.
• Discussing and agreeing with the external auditors, before the audit commences, the nature and scope of the audit as set out in the annual plan.
• Discussing with the external auditors their evaluation of audit risks and assessment of the CCG and associated impact on the audit fee.
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• Reviewing all external audit reports, including the report to those charged with governance (before submission to the Governing Body) and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.
Other Assurance Functions
The Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications for the governance of the CCG.
These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission, NHS Litigation Authority, etc.) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges, accreditation bodies, etc.)
In addition, the Committee will review the work of other committees within the organisation whose work can provide relevant assurance to the Audit Committee’s own scope of work. In particular, this will include the Finance Performance and Quality Committee
Counter fraud
The Committee shall satisfy itself that the organisation has adequate arrangements in place for counter fraud and security that meets NHS Protect standards and shall review the outcomes of counter fraud work in these areas.
Management
The Committee shall request and review reports and positive assurances from directors and managers on the overall arrangements for governance, risk management and internal control.
The Committee may also request specific reports from individual functions within the organisation as they may be appropriate to the overall arrangements
In particular, a separate record of matters discussed during suspension of standing orders shall be kept. These records shall be made available to the Governing Body’s Audit Committee for review of the reasonableness of the decision to suspend standing orders.
Financial Reporting
The Audit Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance.
The Committee should ensure that the systems for financial reporting to the Governing Body including those of budgetary control are subject to review as to completeness and accuracy of the information provided to the Governing Body.
The Audit Committee shall review the annual report and financial statements before submission to the Governing Body, focusing particularly on:
• The wording in the Annual Governance Statement and other disclosures relevant to the terms of reference of the Committee • Changes in, and compliance with, accounting policies, practices and estimation techniques • Unadjusted mis-statements in the financial statements
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• Significant judgements in preparation of the financial statements • Significant adjustments resulting from the audit • Letter of representation • Qualitative aspects of financial reporting. • Explanation of significant variances
Whistle blowing
The Committee shall review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.
Reporting / Accountability
The Committee shall report to the Governing Body on how it discharges its responsibilities.
The minutes of the Committee’s meetings shall be formally recorded by the secretary and made available for the Governing Body to review. The Chair of the Committee shall deliver a summary written report of the key issues discussed to the Governing Body on its proceedings after each meeting on all matters within its duties and responsibilities.
The committee shall make whatever recommendations to the Governing Body as it deems appropriate on any area within its remit
The Committee shall produce an Annual Report to the Governing Body of its work.
Administrative support
The Committee shall be supported administratively by the Governance and Risk Manager, whose duties in this respect will include:
• Agreement of agendas and forward planner with Chair and attendees and collation and circulation of papers in good time • Taking the minutes and helping the Chair prepare reports to the Governing Body • Keeping a record of matters arising and issues to be carried forward • Ensuring that action points are taken forward between meetings • Arranging meetings for the Chair, for example, with the internal or external auditors or local counter fraud specialists • Advising the Committee on pertinent issues/areas of interest/policy developments • Ensuring that Committee members receive the development and training they need • Maintaining a record of all Audit Committee documentation. All Committee papers and minutes will be stored on the CCG I drive under a separate file called Audit Committee. • Maintaining records of members’ appointments and renewal dates etc.
Management of conflicts of interest
If any member has an interest, pecuniary or otherwise, in any matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest as early as possible and shall not participate in the discussions.
The Chair will have the power to request that member to withdraw until consideration of the conflicted item has been completed
If the Chair has a conflict, then an alternative Chairperson will be nominated from the membership of the committee by the other members THCCG Governing Body Meeting 10th May 2017 Part I 73
Review of Terms of Reference
The Committee terms of reference will be reviewed every 2 years unless required sooner.
Last reviewed 21 July 2015
End
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Governing Body Meeting Enclosure
Date of meeting 10th May 2017 H
Agenda item 3.1
Title of report: NHS Tower Hamlets CCG Governance Update – May 2017
Author(s): Justin Phillips – Corporate Governance Manager – TH CCG Simon Hall - Acting Chief Officer – TH CCG
Presented by: Simon Hall - Acting Chief Officer – TH CCG Sponsor (if different): For further information [email protected]
To enable developments across the local health and care system, through more integrated working as part of Tower Hamlets Together (THT), changes to the CCG’s governance are necessary to empower and allow THT and WEL to make system decisions / recommendations Executive summary on behalf of the CCG. This paper sets the case for amendments to the CCG’s governance framework, including the introduction of the Strategic Finance and Investment Committee.
Recommendation
Information Approval To note Decision
The Governing Body is asked to approve the listed delegation of duties to the Strategic and Investment Committee (as outlined in Appendix A) and the updated NHS Tower Hamlets CCG Governance Structure, as well as note the timeline. The Governing Body is also asked to note that these amendments will need to be reflected in the CCG’s Constitution and that the impact of this update will require further amendments across the Governance Framework.
Conflicts of Interest N/A at present
Report history 28 February 2017: Governing Body Organisational Development Meeting – review of emerging trends in the health and care landscape and workshop re: establishing a new a new CCG Governance Framework 26 April 2017: Strategic Finance and Investment Committee – first meeting to establish Scheme of Delegation 4 May 2017: THT Board – Paper to review THT’s governance based on
THCCG Governing Body Meeting 10th May 2017 Part I 75
proposed CCG governance changes.
Patient and Public N/A involvement
Link to the Board Corporate Objective 2: To commission person-centred, integrated Assurance Framework health and care service that are sustainable and that equally meet the mental and physical needs of our residents
Impact on Equality and N/A Diversity
Resource requirements None.
Next steps 10 May – 24 May 2017: NHS THCCG Constitution update to reflect changes – internal consultation 24 May 2017: Governing Body Approval (remotely with Annual Report and Accounts) 24 May 2017 – 31 May 2017: Membership Consultation and Approval 2 June 2017: Submission to NHSE Assurance team 1 July 2017: Updated NHS THCCG Constitution takes effect Sept 2017: Review of effectiveness and appropriateness of new Governance arrangements.
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NHS Tower Hamlets CCG Governance Update – May 2017
Introduction The local and wider health and social care landscape is in a phase of transformation and the below sets the context of current emerging trends: • Emerging role of North East London Sustainability Plan • Alignment of THCCG governance with WEL CCGs i.e. establishment of a Committee in Common • Development of Tower Hamlets Together (THT) – move to Accountable Care Systems • NHSE Vanguard Site and Multispecialty Community Provider (17/18) • Community Health Services provider alliance (17/18) • Longer term integrated system transition (19/20 - 20/21)
To enable these developments, changes to the CCG’s governance are necessary to empower and allow THT and WEL to make system decisions / recommendations on behalf of the CCG.
Next Steps The CCG and THT are working collaboratively to further build on the work of the Vanguard to move closer to establishing a local Accountable Care System, with a view to embedding the below arrangements from July 2017: • THCCG Transformation Board to disband and delegate decision making around strategic clinical transformation priorities to the THT Board • THCCG to establish a Finance and Investment Committee with financial decision making responsibility for THCCG and broader system investments • Establishment of a Joint PMO between THT and THCCG to oversee delivery of transformation activities (i.e. QIPP delivery and Vanguard schemes)
As part of these arrangements the THT Board will be responsible for the below functions which previously sat with the CCG Transformation Board: • Oversee the development and delivery of the CCG’s Commissioning Strategy, including the delivery of QIPP schemes. This will include receiving recovery plans for programmes that are significantly off track (rated Red) • Provide direction to the CCG’s Children and Early Years, Adults, and Complex Adults Programme Boards, and receive regular reports on progress of strategy, transformation and delivery • Ensure that CCG strategy delivers against our priorities: Person Centred Care, Parity of Esteem for Mental Health and ensuring the sustainability of Primary Care. • Review and assess new and revised clinical pathways being proposed (which may have an impact on resources) as part of service transformation • Review and assess the development of business cases in CCG approved format for the CCG service transformation and make recommendations to the Governing Body on commissioning strategy including associated areas for investment, savings and QPP as a result of service transformation, innovation, research and development
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As the CCG remains statutorily responsible for these duties, the CCG will be establishing a new committee of the Governing Body – the Strategic Finance and Investment Committee, to provide assurance on process and ratify recommendations of the THT Board. A full list of proposed delegated responsibilities of this committee can be found in Appendix A.
Proposed Governance Structure from July 2017:
The Governing Body is asked to approve the delegation of duties to the Strategic and Investment Committee (as outlined in Appendix A) and the updated NHS Tower Hamlets CCG Governance Structure, as well as note the timeline below. The Governing Body is also asked to note that these amendments will need to be reflected in the CCG’s Constitution and that the impact of this update will require further amendments across the Governance Framework and the Governing Body will be asked to approve these prior to Membership and NHSE approval as outlined below.
Page 2 THCCG Governing Body Meeting 10th May 2017 Part I 78
Timeline 28 February 2017 Governing Body Organisational Development Meeting – review of emerging trends in the health and care landscape and workshop re: establishing a new a new CCG Governance Framework 26 April 2017 Strategic Finance and Investment Committee – first meeting to establish Scheme of Delegation 4 May 2017 THT Board – Paper to review THT’s governance based on proposed CCG governance changes. 10 May 2017 Governing Body delegation of outlined duties to Strategic Finance and Investment Committee 10 May – 24 May 2017 NHS THCCG Constitution Update to reflect changes – internal consultation 24 May 2017 Governing Body Approval (remotely with Annual Report and Accounts) 24 May 2017 – 31 May 2017 Membership Consultation and Approval 2 June 2017 Submission to NHSE Assurance team 1 July 2017 Updated NHS THCCG Constitution takes effect Sept 2017 Review of effectiveness and appropriateness of new Governance arrangements.
Page 3 THCCG Governing Body Meeting 10th May 2017 Part I 79 Appendix A
Draft Decisions / Duties Delegated by the Governing Body to the Strategic Finance and Investing Committee
Reference Decisions/duties
Planning and strategic direction
1. Approve medium-term financial plans (3 to 5 years), and from it the annual operating plans for each year to: a. ensure the organisation is making financial decisions that support the strategic direction of care. b. ensure plans are affordable, sustainable and enable statutory duties and business planning rules to be met.
2. Recommend to the Governing Body, on an annual basis, that the Commissioning Intentions are affordable.
3. Approve requests for all new in-year investments and confirming funding source.
4. Approve new contractual / commissioning arrangements ie: • Exceptions to standard NHS contract • Contractual changes relating to ACS • Recommend to the Governing Body on changes that require NHSE approval • Recommend to the Governing body on changes that shift the balance of commissioning powers to other organisations • Material risk-share arrangements
5. Financial evaluation of material business cases and pilots including value for money of existing cases.
Regulation and Control
1. The Executive Committee can approve expenditure up to £100,000 subject to budget availability, where there is no budget availability the item must be referred to the Finance and Investment Committee.
2. Scrutiny and review of proposed budgets, clarifying detail in advance of Governing Body approval.
Procurement
1. Oversee the CCG process for managing clinical procurement activity
2. Make recommendation to the Governing Body regarding preferred bidder and contract award.
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Governing Body Meeting Enclosure
Date of meeting 10th May 2017 I
Agenda item 3.2
Title of report: 2017/18 Financial Plan & Budgets Henry Black – Chief Finance Officer Author(s): Richard Richard Quinton – Finance Adviser Andrea Antoine – Deputy Chief Finance Officer
Presented by: Henry Black – Chief Finance Officer – NHS Tower Hamlets CCG Sponsor (if different): Andrea Antoine – Deputy Chief Finance Officer For further information [email protected] - 020 3688 2510 The 2017/18 Financial Plan and 2017/18 Budgets provides the Governing Body with the following; - Executive Summary - Business Planning Rules and assumptions - QIPP Executive summary - 2017/18 Income and Expenditure Budgets - Planned Surplus - Risks - 2017/18 Budget summaries
Recommendation
Information Approval To note Decision
To approve the CCG Financial Plan and Budgets 2017/18 Please note that the Strategic Finance and Investment Committee reviewed the 2017/18 Financial Plan and Budgets on 26 April and recommended them for approval by the Governing Body. The NHS is under significant financial and demand pressures and the Key issues Tower Hamlets population is no exception to that. The growth in population and in the elderly are key components. Thus the financial pressures for 2017/18 mean that increased spending control mechanisms are essential to meet the CCGs statutory financial target. Conflicts of Interest There are no identified conflicts of interests.
THCCG Governing Body Meeting 10th May 2017 Part I 82 Report history Strategic Finance and Investment Committee (SFIC) of the CCG - information obtained at this meeting helped inform this Board report.
Patient and Public N/A involvement
Link to the Board Addresses several corporate objectives, in particular those around Assurance Framework the CCG finances; ensures the Governing Body is sighted on key finance and performance targets for 2017/18: Strategic Objective 3: Creating a thriving and stable health and social care economy Strategic Objective 4: Delivering against our statutory duties.
Impact on Equality and N/A Diversity
Resource None requirements
Next steps Action and next steps for each area identified is covered in the report.
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Tower Hamlets CCG 2017/18 Financial Plan & 2017/18 Budgets
Summary
The attached report sets out the financial plan of Tower Hamlets CCG for 2017/18, which was been submitted to NHSE on 30th March 2017, as well as the 2017/18 Budget, which follows on from the overall financial plan.
These are the final proposed budgets, though subject to minor changes as a small minority of contracts have not yet been agreed. However, all budgets have been signed off by the budget holders.
The Governing Body became statutorily responsible from April 2013 for ensuring that its expenditure does not exceed the budget allocated from NHS England and for ensuring expenditure on administrative running costs is below the specified allowance. The CCG has established financial procedures and systems to ensure that the Governing Body can effectively manage its resources and ensure integrity and transparency in their use through the nationally defined Integrated Single Financial Environment (ISFE) for CCGs. Budgetary control is exercised through the setting of an annual budget and regular periodic reporting of actual performance compared to budget.
Purpose
The CCG’s financial allocations for 2017/18 were issued in December 2016. The purpose of this paper is to set out the financial allocations for the CCG and their basis; any allocation issues; the implications for managing risk and set out the CCG’s running costs allowance as well as the overall commissioning budget of the CCG for 2017/18.
The CCG’s financial strategy is to provide services in the most effective way within the constraints of its healthcare allocation, running costs allowance and cash limit.
Business Planning Rules
For 2017-18 the budgets have been planned to meet the required business and planning rules of NHS England, as per table 1 below.
Table 1. 2017/18 Business Planning Rules % Surplus requirement 1.00% Non‐Recurrent Investment Reserve ‐ uncommitted funds (0.5%) ‐ held as risk 0.50% reserve Non‐Recurrent Investment Reserve ‐ committed funds (0.5%) ‐ support 0.50% transformation & change implied by STP Contingency 0.50%
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As noted above the business planning rules recommends a requirement of a 1% surplus. However, the CCG budget is planning to deliver a cumulative 3.2% surplus.
Planning Assumptions
The budgets have been developed based on the 2016-17 outturn adjusted for known changes and uplifted for expected levels of inflation, growth and technological change. The acute contracts have all been based on forecast outturn activity for 2016-17, uplifted for expected levels of growth. This is a realistic planning methodology and should ensure that the CCG does not see high levels of over performance on acute contracts. All of the provider contracts have been adjusted for the national recommendations on tariff reduction as per the table below.
Activity Gross Activity Table 2. 2017/18 Financial Planning Net tariff Growth Provider Inflation Growth Assumptions inflation (Non‐ Efficiency (Demog) Demog) Acute Services ‐2.0% 2.1% 0.1% 3.25% 0.8% Mental Health Services ‐2.0% 2.1% 0.1% 3.25% 0.0% Community Health Services ‐2.0% 2.1% 0.1% 3.25% 0.0% Continuing Care Services ‐2.0% 2.1% 0.1% 3.25% 0.0% Primary Care Services 0.0% 0.0% 0.0% 3.25% 2.3% Other Programme Services 0.0% 0.0% 0.0% 0.0% 0.8% Running costs 0.0% 0.0% 0.0% 0.0% 0.0%
At this time, a small number of our minor acute contracts have not yet been agreed in terms of activity and finance. The budgets assume a funding envelope for these contracts which is a maximum amount. As contracts are agreed in the next few weeks these numbers will be subject to amendment.
QIPP
The Annual Budget is required to support the CCG’s commissioning intentions for the year ahead. These intentions are the same as the CCG’s QIPP plans, in that all health care commissioning change can be equated to one of the quality, innovation, productivity or prevention aims of the QIPP.
The table below details the main components of the CCG QIPP plans for 2017- 18. Where appropriate these have been secured within the 2017-18 SLAs and the financial impact has been reflected in the proposed budgets.
Table 3.2017/18 Net QIPP Plans £'000 Children 170 CHS 1,804 Integrated care 1,916 Mental Health (932) Other 3,367 Planned Care 2,198 Urgent care 3,453 Diagnostics 1,303 Grand Total 13,279
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2017/18 Income Budgets
Table 4 below shows the breakdown of the CCG allocation for 2017/18.
Table 4. 2017/2018 TH CCG Revenue £'000s Allocation/Income Budgets Recurrent Baseline Allocation £364,541 Primary Care Co‐Commissioning £43,956 Running Cost Allowance £6,384 Brought Forward Surplus £11,943 Non‐Recurrent In Year drawdown £0 Non‐Recurrent IR Changes ‐£2,728 Non‐Recurrent HRG4 changes £1,013
Total Revenue/Income Budget £425,109
2017/18 Expenditure Budgets
The CCG has an allocation of £425.1m for 2017-18 of which £6.4m relates to the running costs allowance. The table below details the main areas of spend for the CCG as included within the financial plan submission.
Table 5. 2017/2018 Expenditure Budgets £'000s Commissioning Budget Acute £188,751 Mental Health £46,587 Community £55,727 Continuing Care £14,403 Primary Care £42,054 Other Programme £12,941 Primary Care Co‐Commissioning £43,956 Total Programme Costs £404,419
Running Costs £6,384
Contingency £2,095
Total Costs (Operating Plan) £412,898
2017/18 Planned Surplus
The CCG submitted its Financial Plan to NHSE on 30th March 2017 with an in-year planned surplus of £267K and a cumulative planned surplus of £12.2m, 2.2% above NHSE business planning rules of 1%.
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2017/18 Budget Process
The first draft budgets for 2017/18 projected a gap of £ 8.2m primarily due to NHSE’s instructions, such as the inability to draw down on the CCG’s surplus funds; the increase required in the 2017/18 surplus target and the QIPP requirement. The Senior Management Team of the CCG have since then worked together to identify a number of new QiPP saving schemes; reductions in recurrent budgets and included efficiency savings or vacancy factors etc. which have been included in the 2017/18 financial plan and budgets. As a result the budget presented to the governing body meets all statutory requirements.
Risks
In setting the budgets for 2017-18 recognition must be given to potential risk that the CCG will be unable to achieve the financial requirements and duties.
The main reasons why this might occur are: Activity growth for services subject to cost and volume payment systems e.g. PbR and CHC (Continuing Health care) Unexpected cost pressures Delay or failure of QIPP schemes to deliver the planned savings
The CCG will therefore need to ensure that these potential risks are managed and are either mitigated or controlled. The tools for achieving this are: Financial systems Governance arrangements
The first control mechanism is having in place sound financial systems and procedures. This includes having a robust ledger and budgetary control system so that the CCG can be informed and take action quickly to address financial pressures.
Each budget has been assigned to a lead director, who will retain overall responsibility for the delivery of this. Each director then has the option to delegate element(s) of their budgets to specific leads who will manage and monitor them on a daily basis.
For each budget there is also a named finance lead who will meet with budget managers on a regular basis (at least monthly) and who will work with the budget managers/directors to deliver a balanced position. It will be the responsibility of the budget manager/director to ensure plans are developed to bring any adverse budgets back on track, an escalation process will be used to manage budgets that do not demonstrate improvement, which could include removal of budget authority.
The other aspect of the financial system control is to reduce risk by keeping a financial contingency reserve. In the budget there is a small contingency of £2.1m as well as uncommitted investments/additional reserves of £2.0m, set aside for this purpose. The creation of these reserves is a major element in the mitigation of financial risk. The table below shows the CCGs assessment of the possible risks as well as the mitigations in place.
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Table 6. 2017/18 Key Risk Assessment £'000s
Risks Qipp Under‐delivery £1,957 Acute SLA's Overperformance £2,731 Continuing Care SLA's ‐ backlog £375 Primary Care Co‐Commissioning £236 Total Risks £5,299
Mitigation 0.5% Contingency £2,095 1% Non‐Recurrent Reserve ‐ 0.5% committed £2,043 Acute Over Performance Reserves £1,833
Total Mitigation £5,971
The second control mechanism is the internal governance arrangements within the CCG. Elements within this form of control include the work of the Audit Committee, Finance, Performance and Quality Committee and meetings of the Governing body.
Other key parts of the governance framework relate to the internal and external auditors of the CCG who will test the robustness of the CCGs internal controls and systems, especially when they have a bearing on the financial health of the organisation.
The 2017-18 budgets will ensure that the CCG is able to deliver all of the required financial business rules and evidence of a credible and sustainable plan.
A detailed breakdown of budgets is in the attached appendices.
Appendix 1 - Commissioning Budget 2017/18
Appendix 2 – 2017/18 Budget compared to 2016/17 Outturn
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Appendix 1
Operating Plan Opening Budget Mar 2017 Tower Hamlets CCG ‐ Commissioning Budget Summary ‐ 2017/18 2017/18 Submission £000's £000's Acute In Sector Acute Barts and The London NHS Trust £149,019 £149,019 Additional Barts QIPP Schemes (£3,629) (£3,629) Homerton Foundation Trust £4,982 £5,028 In Sector Acute Total £150,372 £150,419
Out of Area Sector Acute Great Ormond Street Hospital for Children NHS Foundation Trust £214 £214 Guy's and StThomas's NHS Foundation Trust £4,729 £4,534 King's College Hospital NHS Foundation Trust £559 £559 North Middlesex University Hospital NFT £132 £132 Royal National Orthopaedic Hospital NFT £383 £383 Royal Brompton and Harefield NHS Foundation Trust £67 £65 Royal Free Hampstead NFT £705 £705 Moorfields Eye Hospital NHS Foundation Trust £4,498 £4,498 St George's Healthcare NFT £174 £175 Whittington Hospital NFT £266 £266 Barking, Havering and Redbridge Hospital NFT £553 £553 The Royal Marsden NHS Foundation Trust £89 £89 University College London Hospitals NHS Foundation Trust £4,695 £4,695 Imperial College Healthcare NFT £665 £610 Chelsea and Westminster Hospital NHS Foundation Trust £499 £499 North West London Hospitals NFT £134 £134 Mid Essex Hospital Services NFT £62 £62 Lewisham & Greenwich NHST £459 £459 BMI Healthcare Ltd £3,342 £3,042 Out of Area Sector Acute Total £22,225 £21,673
Other Acute inc NCA'S and Readmissions London Ambulance Service £10,131 £10,131 Acute Readmissions £0 £0 Other Acute ‐ InHealth Diagnostic £749 £749 Overseas Visitors Barts Health NHS Trust £600 £600 £500k for UCLH Transition Funding for Transfer of Heart Services to £500 £500 Barts Acute Overperformance Reserve £1,327 £1,833 NCAS/OATS £2,846 £2,846 Other Acute inc NCA'S and Readmissions Total £16,153 £16,660
Acute Total £188,751 £188,751
Non Acute Community NHS £36,027 £36,027 Community Non NHS £19,700 £19,385 Continuing Care £11,874 £11,858 End of Life Care £2,437 £2,369 Learning Difficulties & Autism £2,529 £2,459 Operational Resilience £1,487 £1,487 Mental Health ‐ ELFT £38,859 £38,859 Mental Health ‐ Other £7,728 £7,021 Other Non Acute (£876) £919 Non Acute Total £119,765 £120,383
Primary Care and Prescribing Community Networks £9,264 £8,957 Other Primary Care (Walk in Centre + Oxygen) £2,123 £2,123 Prescribing £30,667 £30,667 Primary Care Co‐Commissioning £43,956 £43,956 Primary Care and Prescribing Total £86,010 £85,703
Reserves Contingency ‐ 0.5% £2,095 £2,095 1% Non‐Recurrent Reserve ‐ 0.5% committed £2,263 £2,043 1% Non‐Recurrent Reserve ‐ 0.5% uncommitted £1,823 £2,043 Other Committed Investments (HLP + Levies) £973 £973 Reserves Total £7,154 £7,154
Grand Total £401,679 £401,991
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Appendix 2
16/17 Tower Hamlets CCG ‐ 2016/17 Outturn compared to Opening 17/18 Budget Variance Outturn 2017/18 Budget
£000's £000's £000's £000's £000's £000's Income Budgets
Recurrent Baseline Allocation £353,213 £364,541 £11,328 Primary Care Co‐Commissioning £42,590 £43,956 £1,366 Running Cost Allowance £6,299 £6,384 £85 Brought Forward Surplus £11,943 £11,954 £11 Non‐Recurrent In Year drawdown £0 £0 £0 Non‐Recurrent IR Changes £0 ‐£2,728 ‐£2,728 Non‐Recurrent HRG4 changes £0 £1,013 £1,013 Other Non‐Recurrent Changes £3,717 £0 ‐£3,717 Resource Limit as per Operating Plan £417,762 £425,120 £7,358
Less Expenditure Budgets
Commissioning Budgets Acute £190,235 £188,751 ‐£1,484
Mental Health £48,061 £45,879 ‐£2,182
Community £50,715 £55,412 £4,697 Continuing Care £14,883 £14,317 ‐£566
Primary Care £47,452 £41,747 ‐£5,705 Other Programme £1,061 £4,773 £3,712 Primary Care Co‐Commissioning £43,360 £43,956 £596 £395,767 £394,836 ‐£931
Reserves Contingency ‐ 0.5% £0 £2,095 £2,095 1% Non‐Recurrent Reserve ‐ 0.5% committed £0 £2,043 £2,043 1% Non‐Recurrent Reserve ‐ 0.5% uncommitted (minim £0 £2,043 £2,043 Other Committed Investments (HLP + Levies) £0 £973 £973 £0 £7,154 £7,154
Total Commissioning Budget £395,767 £401,989 £6,222
Operating Budgets Running Cost Allowance £5,399 £6,190 £791 Other Corporate Projects £4,640 £4,718 £78
Total Expenditure £405,807 £412,898 £7,091
THCCG Projected Surplus (17/18 in year surplus of £267k) £11,954 £12,223 £267
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Governing Body Meeting Enclosure
Date of meeting 10th May 2017 J
Agenda item 3.3
Title of report: Healthy London Partnership
Author(s): Simon Hall – Acting Chief Officer – Tower Hamlets CCG
Presented by: Simon Hall – Acting Chief Officer – Tower Hamlets CCG Sponsor (if different): For further information www.officelondonccgs.org.uk / [email protected]
Since HLP was established Sustainability and Transformation Plans (STPs) have emerged as mandated local ‘structures’ with a formal role in the delivery of transformation. In light of this, the London Transformation Group (LTG) agreed that an in-depth review of the activity required to enable whole system transformation would be undertaken to inform how HLP should develop. There was a recognition of the need to prioritise HLP activity and resources and reconsider the operating model to support the system in moving from planning to delivery.
Executive summary The attached paper considers:
Progress to date in the Healthy London Partnership;
The output of the 2017/18 planning process, and;
A recommendation to proceed with the proposed programme on the basis that the strategic function and embedded resource costs are agreed for the next two financial years and project costs are agreed for one year with an annual planning cycle to be taken forward
Recommendation
Information Approval To note Decision
The Governing Body is asked to: - Note the in-depth review that has taken place to ascertain the HLP operating model and scope in 17/18. - Note the recent achievements.
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- Approve the London Transformation Group recommendations: - 2017/18 HLP portfolio budget of £14,447k. - HLP operating model and functions. - The HLP and pan-London transformation governance - The conclusion of the programme planning process on the basis that the strategic function and embedded resource costs are agreed for the next two financial years and project costs are agreed for one year with an annual planning cycle to be taken forward.
Conflicts of Interest N/A
Report history Refers to previous updates given to the Tower Hamlets CCG Governing Body in previous meetings.
Patient and Public N/A involvement
Link to the Board N/A Assurance Framework
Impact on Equality and N/A Diversity
Resource requirements Detailed programme plans, included as Appendix 2, set out planned activity and the level of pay and non-pay resource associated with delivery of the programme objectives. Programme plans have all been signed off by their respective Programme Boards, including their member SPG representatives. The programmes within Healthy London Partnership have attracted a number of sources of funding in addition to the contributions made by CCGs and NHS England (London). Details of external funding are articulated in project plans.
These programme plans have been subject to the consideration of the London Transformation Group and were approved on 14 February. As we move into the next financial year, programmes will continue to work closely with STPs to ensure that their activities support the critical priorities identified by local areas. The total cost of Healthy London Partnership programmes to be funded jointly by CCG and NHS England (London) contributions is £14,447k.
Next steps As outlined in the report.
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Healthy London Partnership Healthy London Partnership beyond 17/18
Executive Summary
This paper provides an update to CCG Governing Bodies and NHS England (London) of the continued progress of the Healthy London Partnership (HLP) programme and of HLP planning for 2017/18.
During the 20/6/17 planning round CCG Governing Bodies confirmed two years of funding for HLP, recognising the programme design remains subject to continuous review. Following an extensive review process over the past six months involving CCG, STP and Programme leads refreshed proposals have been developed. This review has been overseen by the London Transformation Group comprising CCG and NHS England representatives (see full membership at Appendix 1). At its meeting on 14th February the London Transformation Group considered and supported programme proposal with a clear recommendation to CCG Governing Bodies and NHS England for approval.
In the light of the more challenged financial position the overall programme budget for 2017/18 has been scaled back by around 24%.
The attached paper considers:
Progress to date in the Healthy London Partnership;
The output of the 2017/18 planning process, and;
A recommendation to proceed with the proposed programme on the basis that the strategic function and embedded resource costs are agreed for the next two financial years and project costs are agreed for one year with an annual planning cycle to be taken forward
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1. Context and background
HLP was established in May 2015 when 13 programmes shown below began mobilising to address London’s priority transformation areas:
Over the last few months, planning for the suite of Healthy London Partnership programmes for the Financial Year 2017/18 has been underway.
Since HLP was established Sustainability and Transformation Plans (STPs) have emerged as mandated local ‘structures’ with a formal role in the delivery of transformation. In light of this, the London Transformation Group (LTG) agreed that an in-depth review of the activity required to enable whole system transformation would be undertaken to inform how HLP should develop. There was a recognition of the need to prioritise HLP activity and resources and reconsider the operating model to support the system in moving from planning to delivery, at pace.
This paper outlines the most recent achievements, the final proposals for delivery in 2017/18, the associated resource requirements and proposed changes to governance arrangements.
2. Recent achievements
Healthy London Partnership programmes have been progressing work at a pan-London level to support and enhance transformation at local and borough levels. When the partnership was initiated there was a commitment to making positive change happen through prioritising key areas where working at a pan-London level would add value. As an illustration of the success of this approach, in 16/17 the Programmes collectively attracted an additional £10million in funding for London and worked collaboratively with partner organisations to deliver health and care transformation.
Other highlights from this past quarter include the Mayor of London, Sadiq Khan formally launching London’s all age section 136 pathway and Health Based Place of Safety specification, following extensive engagement across London’s crisis care system. Engagement included over
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300 service users, London’s Mental Health & Acute Trusts, LAS, Local Authorities and London’s three police forces. This culminated in an agreed pan-London pathway formally endorsed by these agencies as well as the Royal College of Psychiatry and National Crisis Care Concordat.
The Great Weight Debate (GWD) has really picked up momentum across London with 31 boroughs participating and joining the conversation. The GWD has reached over 2m Londoners with a strong presence on social media and events being held across London, including a citizen panel with 120 health champions, a young people’s hackathon at City Hall and a roadshow across 8 boroughs. The GWD results are also influencing and inputting into strategies and policies across London, including fast food outlet restrictions.
A full progress report is shared with CCGs and NHS England (London) quarterly detailing progress, which supplements the monthly progress reports for Interim London Transformation Group that are shared widely and the eNews that provides updates to stakeholders every fortnight. Highlights from the most recent quarterly progress report include:
• In September more than 40 NHS organisations and around 100,000 NHS employees in London took part in Healthy Living week. Over 250 events took place across London, led by HLP in partnership with NHS Trusts and the London NHS Charities Group.
• London Mental Health Dashboard launched in October, designed with mental health clinicians and experts. The dashboard will help providers and commissioners benchmark performance and improve and transform services
• Launched NHS GO, services app for children and young people in London, includes content to support children and young people with issues they have told us they need help with, from blogs to videos to you tuber content. It’s been viewed over 300,000 times and downloaded over 14,676 times
• The London Asthma Toolkit officially launched at the British Thoracic Society’s winter symposium in December
• 90 homeless people interviewed, producing the report ‘More Than a Statistic’ resulting in new commissioning guidance for London with 10 recommendations to improve homeless health
• Early Intervention in Psychosis team supported the mental health system with the new psychosis target and developed a range of materials to support GPs if they suspect someone may be experiencing a first episode of psychosis
• Led the development of the Patient Relationship Manager (PRM), a cloud-based system designed to improve patients' experience of NHS 111, which has won the prestigious UK IT Industry Award for best use of cloud services as well as silver award at the European Contact Centre and Customer Service Awards 2016 in the category of Most Effective Improvement Strategy (Innovation, Technology & Effectiveness)
• The new commissioning model for Cancer Services in London (enabling cancer services to meet and surpass expected national outcomes for patients for 2020) was socialised at a pan-London Partnership event in December
• The Primary Care team have successfully negotiated with the national team on behalf of London’s CCGs to secure agreement to spend the allocated £25.4m of GP Access Monies this year (and next) across 31 London CCGs to spread the offer across London to
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serve a greater population (9m patients) as opposed to national allocation for pilot areas only.
3. Planning round
CCG Governing Bodies have broadly supported the principle of continuing to support the Healthy London Partnership by providing a commitment to continue funding the partnership for the next financial year.
In light of Sustainability and Transformation Plans (STPs) emerging as mandated local ‘structures’ with a formal role in the delivery of transformation, the London Transformation Group requested HLP undertake an in-depth review of the activity required to enable whole system transformation to inform how HLP should develop as part of a robust planning process. At the beginning of the planning process there was a recognition for the need to prioritise HLP activity and resources and reconsider the operating model to support the system in moving from planning to delivery, at pace.
The planning round was based initially on the same set of planning principles as those agreed in FY2016/17, reviewing all priorities and programmes, agreeing programme deliverables beyond 2016/17, and indicating the required resources for 2017/18 and beyond. Consideration was then given to the implications on the operating model and governance arrangements.
Date Forum Outcome
Various in SRO Meetings and Programme Board activity Planning principles for pan-London activity 16/17 defined by SROs and proposed priorities scoped by Programme Boards (including SPG representatives) Dec 2016 – Jan STP CCG Leads prioritisation Alignment of proposed HLP activity to STP 2017 priorities 20 Jan 2017 Payments and Funding Group challenge Value for money recommendations session 14 Feb 2016 London Transformation Group LTG approved the 2017/18 Healthy London Partnership (HLP) scope and resources, operating model and proposed governance arrangements. Feb / March Final paper considered by CCG Governing 2017 Bodies (or committees where appropriate) and NHS England (London)
3.1 Planning principles for 2017/18
The principles that were applied to the planning process are set out below: The planning process has been jointly led by CCG Chief Officers and NHS England Programme SROs and there will be significant engagement across London on the development of the programme priorities and plans Programme planning has been conducted based on the pan-London principles, designed by SROs, Chief Officers and Chairs and upheld by the London Transformation Group. Principles for once for London activity: - Providing a voice for London e.g. lobbying National colleagues for funding / approaches to transformation that best support London as a whole - Delivering a consistent standard of care that all areas can commit to work towards
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- Delivering solutions to consistent issues that are best delivered once Engagement with CCG and STP commissioner leads has continued throughout the process in order to align with STP priorities The planning process has been broadened to incorporate Strategic Clinical Network and Academic Health Science Network planning to ensure alignment is maximised to deliver against agreed London priorities and to minimise duplication across the system The programme governance, specifically the Payments & Funding Group providing value for challenge and the London Transformation Group, has been asked to consider and agree the proposed plans. 3.2 Planning process Programme SROs agreed that all Programme Boards would consider their current programme activity and identify if any areas of work should transition to more local (STP or borough) delivery in light of the pan-London principles. This process included consideration of when pan-London activity would cease; the transition process; plans for evaluation of delivery and ensuring effective knowledge spread. Following the initial bottom-up development of programme plans a series of steps were taken to reduce the total Healthy London Partnership resource request for 2017/18. The steps included an efficiency review of non-pay costs by the HLP director, a value for money challenge session by the Payments and Funding group, prioritisation of projects by STP CCG leads and the identification of external funding. These steps have resulted in around a 24% reduction in the originally proposed resource requirement. Extensive engagement with stakeholders took place throughout the review process. During this there has been broad acknowledgement that a pan-London transformation resource is beneficial and determining the right activity is critical; in doing so, feedback has included that HLP needs to interface effectively with emerging local transformation structures, delivering three functions:
1. Strategic Transformation function that will attract resource and provide a collective voice for London, build strategic partnerships and horizon scan for new opportunities 2. Tightly scoped projects that will deliver products best done once for London 3. Embedded resources in STPs to support delivery connected back to HLP and across STPs
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The proposed HLP operating model responds to feedback and is intended to streamline governance and provide greater flexibility to respond to peaks and troughs in demand in the most efficient way across all programmes, as well as facilitate the transition to delivery with HLP resource embedded within STPs. The operating model is shown in the below figure.
3.3 Final programme resource requirements
Detailed programme plans, included as Appendix 2, set out planned activity and the level of pay and non-pay resource associated with delivery of the programme objectives. Programme plans have all been signed off by their respective Programme Boards, including their member SPG representatives. The programmes within Healthy London Partnership have attracted a number of sources of funding in addition to the contributions made by CCGs and NHS England (London). Details of external funding are articulated in project plans.
These programme plans have been subject to the consideration of the London Transformation Group and were approved on 14 February. As we move into the next financial year, programmes will continue to work closely with STPs to ensure that their activities support the critical priorities identified by local areas. The total cost of Healthy London Partnership programmes to be funded jointly by CCG and NHS England (London) contributions is £14,447k.
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4. Governance
LTG considered revisions to governance arrangements in light of changes to the HLP operating model and the recognition that to achieve system transformation there was a need to engage broader partners.
The proposed governance arrangements bring together the Payments and Funding Group and London Transformation Group; provide comprehensive clinical oversight of the programme portfolio across CCG chairs, STP Clinical leads and Clinical Networks and align clinical leaders and subject matter experts with the overarching national, regional and STP strategy and delivery plans for improving patient outcomes; establish a Clinical Board to inform pan-London transformation; and ensure transformation delivery boards (with revised purpose and membership to existing programme boards) effectively bring together STP leads in an area to focus on joint issues requiring collective system leadership, share solutions and ensure HLP activity is effectively connected to local delivery. Programmes remain accountable to CCGs and NHS England (London) through the London Transformation Group.
5. Recommendation
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CCG Governing Bodies and NHS England (London) are asked to:
- Note the in-depth review that has taken place to ascertain the HLP operating model and scope in 17/18. - Note the recent achievements. - Approve the London Transformation Group recommendations: o 2017/18 HLP portfolio budget of £14,447k. o HLP operating model and functions. o The HLP and pan-London transformation governance o The conclusion of the programme planning process on the basis that the strategic function and embedded resource costs are agreed for the next two financial years and project costs are agreed for one year with an annual planning cycle to be taken forward.
Appendices
1. London Transformation Group Membership 2. Allocations by CCG and NHS England (London) and proposed resource allocations across programmes
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Appendix 1. London Transformation Group Membership
Geographical area Representative members
NWL • Neville Purssell (GP chair , Central London CCG) – • Trevor Begg (Lay Member, Hillingdon CCG) • Rob Larkman (CO, Brent, Harrow, Hillingdon CCGs)
NCL • Sarah Price (Chief Officer, Haringey CCG) • Dr Debbie Frost, Chair, Barnet CCG/Chair, NCL Collaboration
NEL • Conor Burke (CO - Barking, Redbridge, Dagenham CCG) • Paul Haigh (CO Hackney CCG) or Dr Clare Highton (Chair, City and Hackney CCG) • Terry Huff, CO, Waltham Forest CCG
SEL • Dr Marc Rowland (Chair, Lewisham CCG) • Dr Jonty Heaversedge (Chair, Southwark CCG) • Sarah Blow (Chief Officer, Bexley CCG)
SWL • Graham Mackenzie (CO, Wandsworth CCG) - • Dr Naz Jivani (Chair, Kingston CCG) – co-chair • Paula Swann (CO – Croydon CCG)
NHS England • Anne Rainsberry, Regional Director - co-chair (London Region) • David Slegg, Director of Finance • Helen Bullers, Director of HR and OD • Khadir Meer, Chief Operating Officer • Dr Vin Diwakar, Medical Director • Oliver Stanley, Chief Nurse • Jane Barnacle, Director of Patients and Information
Office of CCGs • Andrew Eyres (Chair, Chief Officers Group)
Patient & Public • Nesrin Yurtoglu, Patient and Public Voice, member of London Clinical Senate Representative
London Health • Shaun Danielli, BHfL Programme Director Partnership
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Appendix 2. Allocations by CCG and NHS England (London) and proposed resource allocations across programmes
a) The associated allocations broken down by CCG and NHS England (London) are shown in the table below:
17/18 allocation Organisation HLP Contribution @ 0.11% (£000s) (£000s) NHS Barking & Dagenham CCG 304,903 335.393 NHS Barnet CCG 478,689 526.558 NHS Bexley CCG 306,220 336.842 NHS Brent CCG 421,779 463.957 NHS Bromley CCG 438,178 481.996 NHS Camden CCG 359,966 395.963 NHS Central London (Westminster) CCG 271,999 299.199 NHS City and Hackney CCG 384,971 423.468 NHS Croydon CCG 487,656 536.422 NHS Ealing CCG 493,950 543.345 NHS Enfield CCG 403,873 444.260 NHS Greenwich CCG 374,195 411.615 NHS Hammersmith and Fulham CCG 264,789 291.268 NHS Haringey CCG 358,684 394.552 NHS Harrow CCG 294,268 323.695 NHS Havering CCG 391,881 431.069 NHS Hillingdon CCG 359,080 394.988 NHS Hounslow CCG 344,915 379.407 NHS Islington CCG 340,758 374.834 NHS Kingston CCG 252,790 278.069 NHS Lambeth CCG 469,065 515.972 NHS Lewisham CCG 422,051 464.256 NHS Merton CCG 277,100 304.810 NHS Newham CCG 488,590 537.449 NHS Redbridge CCG 388,537 427.391 NHS Richmond CCG 260,318 286.350 NHS Southwark CCG 409,831 450.814 NHS Sutton CCG 271,401 298.541 NHS Tower Hamlets CCG 414,881 456.369 NHS Waltham Forest CCG 391,641 430.805 NHS Wandsworth CCG 473,000 520.300 NHS West London (K&C & QPP) CCG 359,265 395.192 NHS England (London) 1,292.604 Total 11,959,224 14,447.750
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b) The proposed allocation of these resources across programmes and central functions is shown in the table below:
Programme Project Cost
Cancer Cancer 246,012 Workplace Health 331,938 Prevention Healthy creating environment 254,587 Healthy creating society 300,272 Thrive/MH Roadmap 297,220 Perinatal MH 149,978 Mental Health Homeless Health 200,000 Digital MH and Wellbeing 772,196 Access IUC 240,845 PRM/Digital Crisis Care 888,741 UEC Ambulatory Urgent Care 166,560 MH Crisis Care 369,967 CYP Primary Care 98,377 CYP UEC 56,890 CYP Pharmacy 0 CYP LTC management 65,900 CYP CYP Thrive 0 CYP Commissioning development 30,000 CYP NHS GO 56,000 CDOP 0 CYP Non pay costs across all projects 50,000 Transforming Primary Care 1,043,000 Primary Care Proactive Care 268,883 Digital Healthcare Information Exchange 1,005,536 Workforce 250,000 Enablers Estates 388,286 Devolution 200,000 Specialised Commissioning 271,321
Total project costs £8,002,508
Strategic Function costs £4,475,366
Embedded Resources costs £1,686,587
Total £14,164,461 2% contingency recommended by LTG £283,289 Total 2017/18 cost including contingency £14,447,750
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Governing Body Meeting Enclosure
Date of meeting 10th May 2017 K
Agenda item 3.4
Title of report: East London Health and Care Partnership
Author(s): Rob Whiteman/Jane Milligan – Chair and Executive Officer of East London Health and Care Partnership
Presented by: Jane Milligan – Chief Officer of Tower Hamlets CCG and Executive Officer of East London Health and Care Partnership Sponsor (if different): [email protected] For further information
The East London Health and Care Partnership (ELHCP) Board approved the Partnership Agreement on 29th March 2017 and the Agreement would go live on 1st April 2017. Boards/Governing Bodies are asked to review and sign up to the Partnership Agreement (formerly the MoU, renamed to highlight the focus on partnership working) for the governance arrangements of the ELHC. Areas to note: The Agreement is not legally binding but is intended to ensure a common understanding and commitment between the partner organisations of the ELHCP. The Agreement was originally developed by the STP Governance Working Group, which was chaired by Marie Gabriel, Chair of East London NHS Foundation Trust. It is understood the governance arrangements will continue to Executive summary develop as the work of the partnership unfolds and may need to adapt accordingly. These will be reviewed quarterly and the ELHCP will take into account any feedback received and changes appropriate. The Governing Body are not being asked to delegate any decision making to the ELHCP other than those listed in section 8 of the Agreement. The agreement is intended to ensure a common understanding and commitment between the partner organisations of the ELHCP about the governance arrangements, specifically: The scope and objectives of the ELHCP governance arrangements The principles and processes that will underpin the ELHCP governance arrangements
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Governance Framework/Structure that will support the development and implementation of the EL STP. Agreement has been circulated to all East London Trusts, CCG Governing Bodies and Local Authorities to go through the appropriate governance routes.
Recommendation
Information Approval To note Decision
The Governing Body is asked to approve the agreement in its current form so the ELHCP can continue its work.
Conflicts of Interest N/A at present
Report history Formally the Memorandum of Understanding which was presented and signed off by the THCCG Governing Body, this iteration has been developed by the STP Working Group.
Patient and Public N/A involvement
Link to the Board Corporate Objective 3: To contribute towards a financially sustainable Assurance Framework and responsive health and care economy which delivers value for money and innovation and supports the appropriate use of services
Impact on Equality and N/A Diversity
Resource requirements None.
Next steps As covered in partnership agreement. The Agreement will be reviewed quarterly and the ELHCP will take into account any feedback received and changes appropriate.
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East London Health and Care Partnership
Partnership Agreement
Version 2.10
31 March 2017
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1. Purpose
This Partnership Agreement describes how the health and social care partners in East London (EL) (listed in Appendix D) will co-operate as The East London Health and Care Partnership (ELHCP), setting out the partnership arrangements to support the implementation of the East London Sustainability and Transformation Plan (EL STP).
This Partnership Agreement, built on the EL STP Memorandum of Understanding (MOU), is separate to the East London Sustainability and Transformation Plan (STP). Sign- off or endorsement of the overarching STP will take place on an individual organisational or borough level.
PART 1 – PARTNERSHIP ARRANGEMENTS
2. Introduction
Delivering the Forward View NHS Planning Guidance 2016-17 to 2020-21 released in December 20151 set out a requirement for local areas to come together develop a shared five-year sustainability and transformation plan.
The launch of the sustainability and transformation planning process signalled a new paradigm, with a move towards greater local co-operation including the need to work in the partnership to develop strategy and change at a local level.
In response to this guidance 20 organisations across East London – in The City of London, Barking and Dagenham, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest - have been working together to develop the EL STP:
• The EL STP describes how these Parties will co-operate to turn the ambitions of the NHS Five Year Forward View into reality and deliver the vision of better health and wellbeing, improved quality of care and stronger NHS finance and efficiency.
The EL STP acts as a system level plan for change supported by and aligned to a number of local plans to address certain challenges, such as:
• City and Hackney (CH): Hackney devolution pilot, bringing providers together to deliver integrated, effective and financially sustainable services.
• Barking and Dagenham, Havering and Redbridge (BHR): bringing together health and social care services under a single local accountable care system (devolution pilot)
• Newham, Tower Hamlets and Waltham Forest (WEL): “Transforming Services Together” programme to improve the local health and social care economy.
1 Delivering the Forward View, NHS Planning Guidance 2016-17 to 2020-21, NHS England, December 2015, https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf
THCCG Governing Body Meeting 10th May 2017 Part I 107 An initial set of governance arrangements was established to oversee and manage the development of the draft EL STP that was submitted to NHS England and NHS Improvement on 30 June 2016.
Following this submission the programme moved into the next phase, focused on detailed planning and the mobilisation and implementation of the delivery programmes. The partnership arrangement now needs to be updated to reflect these changes agreed by the STP Board in focus and branding, so that it supports the prioritisation of the different elements of the EL STP projects.
3. Objectives of the ELHCP Partnership arrangements
The objectives of the ELHCP Partnership arrangements are to:
• Support effective collaboration and trust between commissioners, providers, people and carers to work together to deliver improved health and care outcomes more effectively and reduce health inequalities across the EL system
• Provide a robust framework for system level decision making, and clarity on where and how decisions are made on the development and implementation of the EL STP
• To review and ensure clinical sustainability of services at STP level
• Provide clarity on system level accountabilities and responsibilities for the EL STP
• Enable opportunities to innovate, share best practice and maximise sharing of resources across organisations in East London
• Enable collaboration between Parties to achieve system level financial balance over the 5 year STP timeframe and deliver the system control total (once agreed), while safeguarding the autonomy of organisations
• Ensure learning and capacity building across the three accountable care systems.
4. Scope of the ELHCP Partnership arrangements
4.1. In scope • Partnership arrangements for the East London STP • Partnership arrangements for the implementation of the STP schemes defined in the East London STP • Alignment with the wider health system plans and partnership , including devolution programmes and regional boards • Development and operation of the partnership arrangements for the EL STP Financial Strategy to achieve the system control total • Support the development of Accountable Care Systems to enable working towards a sustainable health economy by moving away from tariff based system to a capitation based system to achieve financial stability and to incentivise the right clinical behaviours
THCCG Governing Body Meeting 10th May 2017 Part I 108 4.2. Out of scope • Organisational governance arrangements for CCG Governing Bodies, Provider Trust Boards and Local Authorities • Local partnership arrangements for the delivery of local (non-East London wide) programmes:
o Hackney devolution pilot
o Barking and Dagenham, Havering and Redbridge (BHR) Accountable Care System (devolution pilot)
o Transforming Services Together programme.
5. Principles for the ELHCP Partnership
The development of effective system level partnership arrangements, mobilisation and implementation of the delivery programmes in the EL STP requires collaboration and active engagement (where relevant) from all Parties to ensure the interests of all Parties are appropriately represented.
A key aspect of this process is the agreement of a common set of principles for partnership ways of working and culture. Accordingly, the Parties have adopted the following as a basis for collaborative working between the parties:
• ELHCP Principles (as set out below)
• ELHCP Financial Principles (agreed by the Finance Strategy Group in March 2017 as set out at Appendix B)
• The Nolan Principles (as set out at Appendix B)
ELHCP Principles
Participation: Representation and ownership from health and social care organisations (‘The Parties’), local people and lay members to clearly demonstrate collaborative and representative decision making
Collaboration: All Parties will work collaboratively to deliver the overall EL STP strategy, in the best interests of the wider system and local people
Engagement: Local people will be engaged and involved in the ELHCP governance to ensure their views and feedback are considered in the decision making processes. This engagement should operate at 2 levels; individual level and organisational level (i.e. via patient representative forums and other local community groups)
Accountability: Define clear accountabilities, delegation procedures, voting arrangements and streamlined governance structures to support continuous progress and timely decision making. Delegation of work to the groups with the relevant expertise and authority to deliver it
THCCG Governing Body Meeting 10th May 2017 Part I 109 Autonomy: Recognise the autonomy of the Parties (health and social care partners) of the ELHCP Partnership. Operate in a manner that is compliant with legal duties and responsibilities of each constituent organisation and the NHS and Local Authorities as a whole (e.g. legal responsibility for consultation on service changes). Ensure alignment with the local organisations’ governance and decision making processes recognising statutory and democratic procedures
Subsidiarity: Ensure subsidiarity so that decisions are taken at the most local level possible, and decisions are only taken at a system level where there is a clear rationale and benefit for doing so
Professional Leadership: Demonstrate strong professional leadership and involvement from clinicians and social care to ensure that decisions have a robust case for change and senior level support
Accessibility: Ensure complete transparency in all decision making to support the development of mutual trust and openness between organisations. Provide the necessary assurance to system partners on key decisions. Collaborative working and information sharing between working groups to ensure consistency.
Good Governance: Recognise that good system level governance will require robust planning and horizon scanning to ensure that proposals are presented to the statutory organisations in a timely way, that align with their local governance and decision making processes. However, where necessary local organisations will try to be flexible to support the system level governance.
6. Governance structure
The current proposed governance structure for the ELHCP Partnership is included in Appendix A.
This appendix also includes draft summary terms of reference for the key governance groups in this structure, which will be refined further by the groups.
7. Voting rights and process
Voting rights and processes will be defined in relevant terms of reference.
8. Major system changes The key system level decisions that will fall under the scope of the ELHCP Partnership arrangements are outlined below. This list will be updated from time to time to reflect the latest set of EL system level decisions:
• Approval of the EL STP
• Budget for the EL STP programme
• System level financial strategy and system control total
• Whipps Cross Hospital re-development strategy
THCCG Governing Body Meeting 10th May 2017 Part I 110 • Changes to King George Hospital Emergency Department
• The relevant elements of the East London Mental Health strategy
• The relevant elements of the East London Primary Care strategy
• East London system level estates plan
• The approach to specialised commissioning for the East London sector
• Risk pooling principles and financial arrangements
• Delegation in place to allow Tower Hamlets CCG Remuneration Committee to approve Very Senior Management posts on behalf of all the other ELHCP CCGs.
• Decisions about capital allocations
PART 2 – MISCELLANEOUS LEGAL PROVISIONS
9. Liability
This Partnership Agreement describes arrangements for aligned decision making of the Parties which they agree is necessary to achieve the objectives in Clause 3.
Parties agree that the governance bodies set up under this Partnership Agreement do not have any authority to make binding decisions on behalf of the Parties and that each Party (and not the governance bodies) will retain liability for the actions of the relevant Party.
10. Duration of the Partnership Agreement
This Partnership Agreement replaces shadow arrangement and takes effect from 1 April 2017.
The Parties expect the duration of the Partnership Agreement to be for the period of 2017-2021 in line with the duration of the STP or otherwise until its termination in accordance with Clause 14.
11. Effect of the Partnership Agreement
This Partnership Agreement does not and is not intended to give rise to legally binding commitments between the Parties.
The Partnership Agreement does not and is not intended to affect each Party's individual accountability as an independent organisation.
Despite the lack of legal obligation imposed by this Partnership Agreement, the Parties:
• Have given proper consideration to the terms set out in this Partnership Agreement; and • Agree to act in good faith to meet the requirements of this Partnership Agreement.
THCCG Governing Body Meeting 10th May 2017 Part I 111
12. Subsidiarity
The Parties acknowledge and respect the importance of subsidiarity.
The Parties agree for the need for many decisions to be made as close as possible to the people affected by them.
13. Dispute resolution process
All Parties will make every effort to work collaboratively in the best interests of the East London system, and to avoid disputes. Should disputes arise the parties will follow the agreed dispute resolution process to resolve the disputes as quickly as possible and to minimise impact on delivery.
Individual Party’s concerns should be raised in the first instance with the Independent Chair of the ELHCP Partnership Board. This should be in writing clearly stating the basis of the concerns, including where applicable the concerns and the rationale behind the dispute.
The Independent Chair will endeavour to find an informal resolution to the dispute through discussion and mediation. Where agreement cannot be reached using informal resolution processes the Independent Chair will propose a formal resolution process, which may involve reference to national guidance and best practice.
14. Termination
Each Party may terminate its participation in this Partnership Agreement by giving the other Parties no less than 30 days’ notice in writing.
The Independent Chair will endeavour to find an informal resolution to the dispute through discussion and mediation. Where agreement cannot be reached using informal resolution processes the Independent Chair will propose a formal resolution process, which may involve reference to national guidance and best Practice. Parties may terminate the Partnership Agreement with the written agreement of all of the Parties.
15. Law
This Partnership Agreement will be governed by the laws of England and the courts of England will have exclusive jurisdiction.
16. Review process
This Partnership Agreement will be reviewed and updated from time to time to enable good practice governance to be recognised and built upon to identify and address areas for development.
17. Code of conduct
THCCG Governing Body Meeting 10th May 2017 Part I 112 The Finance Strategy Group has agreed ELHCP principles which are listed in Appendix B.
The Committee on Standards in Public Life (Nolan Committee) has set out seven principles of public life which it believes should apply to all in public service. The seven Nolan principles are listed in Appendix B.
The Parties are asked to adopt these above principles as the basis for collaborative working across the partnership arrangements.
18. Amendment
Parties agree that this Partnership Agreement may be varied only with the written agreement of all of the Parties. Such amendments will be included in an addendum/appendix to this Partnership Agreement.
Appendices
Appendix A – Governance Appendix B – Principles Appendix C – Roles Appendix D – Sign off by the Parties
THCCG Governing Body Meeting 10th May 2017 Part I 113 Appendix A.1 Governance Structure for the East London Health and Care Partnership
Governance structure
CCG Governing Provider Trust Local Authority Regulators Bodies (x7) Boards (x5) Cabinets (x8) NHS E NHS I CQC
Local Accountable Care Systems BHR Integrated Care Hackney Transformation WEL / TST Board Partnership Board Programme Board
ELHCP Mayors and ELHCP Social Care & Leaders Advisory Group ELHCP Partnership Board Public Health Group Political advisory Independent Chair Social care and public leadership health leadership Strategic direction and ELHCP programme leadership ELHCP Clinical Senate Community Group System wide engagement Clinical leadership and and assurance assurance ELHCP Executive Group ELHCP ELHCP Finance Assurance Group Operational direction, Strategy Group Independent assurance delivery and assurance Oversight and assurance and scrutiny of finance strategy
Project Steering Groups established as required to deliver plans
THCCG Governing Body Meeting 10th May 2017 Part I 114 Appendix A.2 Draft Terms of Reference for ELHCP Governance Groups
A 2.1 Draft Terms for Reference for the ELHCP Partnership Board
Purpose
• To provide strategic direction to the ELHCP STP programme (based on the decisions by the statutory organisations) • To oversee and assure the delivery of all elements of the ELHCP STP Plan • To address / resolve escalated system-level risks and issues • To generate effective partnership working and a sense of common purpose between the system partners • To provide oversight and assurance of the funding for the ELHCP STP programme • To approve initiatives/frameworks/tests/plans/collaborative commissioning/standards
Membership
• 1 x Independent chair • 1 x ELHCP STP Executive Lead • 1 x Chief Executive of Barts Health NHS Trust • 1 x Chief Executive of the Homerton University Hospital Foundation Trust • 1 x Chief Executive of Barking, Havering and Redbridge University Hospital NHS Trust • 1 x Chief Executive of East London Foundation Trust • 1 x Chief Executive of North East London Foundation Trust • Nominated Representative/s of East London Commissioners (CCGs) • 1 x Chair of Local Workforce Action Board[1] • 2 x Co-Chairs of the Clinical Senate • 1 x Acute Sector Clinician[2] • 1 x Mental Health Sector Clinician2 • 2 x Nominated representative from the Community Group • 1 x Local Authority Chief Executive representative from Barking, Havering, Redbridge area • 1 x Local Authority Chief Executive representative from City and Hackney area • 1 x Local Authority Chief Executive representative from Tower Hamlets, Waltham Forest, Newham area • 1 x Representative from the Mayors and Leaders Advisory Group • 1 x Representative from a Director of The Social Care and Public Health Group
Additional Attendees / Advisory
• Representatives of GP federations • 1 x HealthWatch observer • 1 x representative from the ELHCP Finance Strategy Group • 1 x NHS England representative (regulator) • 1 x NHS Improvement representative (regulator) • 1 x NHS England Specialised Commissioning representative • 1 x Local Authority representative for prevention commissioning • 1 x Health Education England representative • 1 x UCLP
[1] The chair of the Local Workforce Action Board (LWAB) will be represented as an accountable office of one of the Parties [2] Endorsed by the ELHCP Clinical Senate
THCCG Governing Body Meeting 10th May 2017 Part I 115
Quorum
At least three quarters of the membership of the ELHCP Partnership Board, including:
• An Independent Chair (or an agreed deputy) • 1 x acute trust representative • 1 x mental health trust representative • 1 x CCG representative • 1 x Clinical Senate representative • 1 x Local Authority representative • 1 x Community Council representative
Voting arrangements
This is a unitary board, where motions will be passed by a majority vote, where a majority is defined as at least three quarters of the votes cast.
In advance of any vote all voting members must declare any potential conflicts of interest. The Independent Chair will decide on whether any potential conflict of interest should preclude a member from voting on a particular issue.
Reporting
This ELHCP Partnership Board reports and is accountable to the statutory organisations in the ELHCP system
Frequency
Monthly. Alternative month seminar meeting.
Under exceptional circumstances extra ordinary meetings of the ELHCP Partnership Board may be arranged.
Requests for extraordinary board meetings must be raised to the Independent Chair for consideration.
THCCG Governing Body Meeting 10th May 2017 Part I 116 A.2.2 Draft Terms for Reference for East London Health and Care Partnership (ELHCP) Executive Group
Purpose
• Provide operational direction and assurance to the delivery of the STP plan, ensuring it provides high quality, sustainable integrated care for the people of East London (EL) • Provide a forum for the Executive Group to identify and appraise solutions and options for addressing the major system-wide service, quality and financial challenges. Ensure a pipeline and forward plan/work programme of to take forward solutions. • Provide oversight and assurance to the key governance groups in the ELHCP governance that report into the Executive Group, reviewing quality, operational delivery, transformation, performance and financial management. • Hold Senior Responsible Officers (SROs) to account for the development and delivery of the STP delivery plans, addressing the service, quality and financial challenges • Ensure opportunities for bidding for transformational funding are maximised and provide oversight to bid. • Provide oversight and assurance to the Finance Strategy Group in developing the financial strategy • Assure the collective delivery of Quality, Innovation, Productivity and Prevention (QIPP)/Cost Improvement Programme (CIP) across the system, providing oversight to the three system delivery Boards. • Drive the delivery of the EL STP programme at pace • Manage risk and mitigation plans, escalating key risks and issues to the East London Health and Care Partnership (ELHCP)Board • Oversee the development of a programme of organisational development (at system level) to support the strengthening of the ELHCP and the delivery of the STP • Identify the key messages and communications required to enable local people and staff in EL to understand the ambitions and impacts of the STP on health and care services and outcomes • Ensure adequate resource is available to support the ELHC STP programme of work, including providing oversight to the sourcing of support external to EL from other parts of the wider system, e.g. Healthy London Partnership, NHS England/Improvement resources. • Analyse the gap in the system
Membership
• 1 x ELHCP STP Executive Lead(Chair) • 1 x ELHCP STP Finance Lead • 1 x Chief Executive, Barking, Havering and Redbridge University Hospitals NHS Trust • 1 x Chief Executive, Homerton University Hospital Foundation Trust • 1 x Chief Executive, Barts Health NHS Trust • 1 x Chief Executive, East London NHS Foundation Trust • 1 x Chief Executive, North East London NHS Foundation Trust • 1 x Chief Executive, London Borough of Waltham Forest, ELHCP LA Lead & representing the Waltham Forest and East London (WEL) system • 1 x Chief Executive, London Borough of Hackney, representing the City and Hackney system • 1 x Chief Executive, London Borough of Havering, representing the Barking, Redbridge and Havering system • 1 x Chief Officer, Barking, Havering and Redbridge CCGs • 1 x Chief Officer, Newham CCG • 1 x Chief Officer, Tower Hamlets CCG • 1 x Chief Officer, City and Hackney CCG • 1 x Chief Officer, Waltham Forest CCG
THCCG Governing Body Meeting 10th May 2017 Part I 117 • 1 x BHR & WELC POD Director, North East London and Anglia Commissioning Support Unit • 1 x ELHCP STP Programme Director • 1 x ELHCP STP Director of Communications • 1 x ELHCP STP Director of Provider Collaboration • 1 x representative from the Clinical Senate
Reporting
Reports and is accountable to the ELHC Partnership Board
The following groups report to the Executive Group:
Operating Planning Group Finance and Activity Group Transformation Steering Group (TSG) (N.B. The steering groups associated with the 8 delivery plan work streams report into the TSG e.g. Local Workforce Action Board, Digital etc.) The delivery Boards for the three systems: City & Hackney, WEL, BHR
Frequency
Monthly
Quorum
Chair of the group or the delegated member to represent the chair. 2 x Chief Executives of provider trusts 3 x Chief Officers of CCGs 1 x Chief Executive of LA 3 x ELHCP Directors
Deputies Where members of the group are unable to attend a specific meeting, deputies with executive level accountabilities may be substituted.
Standing Items
Reports from:
Operating Delivery Group Finance and Activity Group Transformation Steering Group (N.B. The steering groups associated with the 8 delivery plan work streams report into the TSG e.g. Local Workforce Action Board, Digital etc.) The delivery Boards for the three systems: City & Hackney, WEL, BHR Items as required on: communications and engagement, OD, governance
THCCG Governing Body Meeting 10th May 2017 Part I 118 A.2.3 Terms for Reference for ELHCP Clinical Senate
Purpose To develop the clinical strategy that will deliver the requirements set out in the East London Sustainability and Transformation Plan, considering the three main areas that the STP addresses: o The health and wellbeing gap o The care and quality gap o The financial gap Not only addressing current issues but addressing needs beyond the horizon of the 5-Year Forward View To ensure that this strategy reduces the variation in care with the aim of giving every resident of East London access to the same standard of care and chances of good health and good healthcare outcomes; it being understood that local delivery systems will vary in structure and function The Clinical Senate will look for cost-effective solutions that free up resource to be directed to appropriate priority areas Their advice should support the development of appropriate commissioning and contractual arrangements To ensure that quality and safety of care is properly considered in its work and recommendations and provide relevant assurance especially around reconfiguration and service redesign To oversee arrangements for measuring the access to and quality of care on a systematic basis across key results areas to enable benchmarking Discuss options for changes to services, making joint recommendations to the Boards of the various NHS Organisations across East London, both commissioner & provider; To monitor system issues or vulnerable services To work together to identify system solutions To design and recommend clinical change to the Transformation Steering Group for initiative work-up
Principles To be ambitious for the population we serve and act as their advocates To be a collaborative coalition of professionals who can think, advocate and advice beyond the walls of our individual organisations to support this common purpose, in so doing gaining understanding of the whole care pathway Provide a forum where collective knowledge on clinical issues and strategic options for reconfiguration and transformation can be shared and discussed Provide a mechanism for increased participation and advice from clinicians and other professionals in strategic direction setting in East London Thus being able to lead transformational change across the whole care pathway To attend regularly, contribute regularly and be encouraged and supported to do so and to build a powerful, authoritative, collaborative body To be focused, use our time wisely and complete our business effectively Seek and commission expert advice from within East London and beyond as necessary and look to learn from successes here and elsewhere To commit to develop as leaders and visibly support the development of clinical leadership among the wider body of clinicians in East London To demonstrate that we can deliver recommendations for transformational change to build confidence in our capability
THCCG Governing Body Meeting 10th May 2017 Part I 119
Membership
Co-chair, Appointed from CCG Chairs below
Co-chair, Appointed from Medical Directors below
CCG Chair, City & Hackney CCG
CCG Chair, Tower Hamlets CCG
CCG Chair, Newham CCG
CCG Chair, Waltham Forest CCG
CCG Chair, Havering CCG
CCG Chair Barking and Dagenham CCG
CCG Chair, Redbridge CCG
Medical Director, Barts Health NHS Trust
Medical Director, Homerton University Hospital Foundation Trust (HUH)
Medical Director Barking, Havering and Redbridge University Hospital NHS Trust (BHRUT)
Medical Director, East London Foundation Trust (ELFT)
Deputy Medical Director North East London Foundation Trust (NELFT)
NHS England Medical Director for North East London
NHS England Medical Director for Specialised Commissioning London
Director of Nursing, Barts Health NHS Trust
Director of Nursing, HUH
Director of Nursing, BHRUT
Director of Nursing, ELFT
Director of Nursing, NELFT
A GP provider lead – nominee to be agreed by GP Federations
A Director of Adult Social Services
Director of Public Health, Newham STP PH Lead
SRO, Transformation Programme ELHCP STP
STP and Accountable Officer BHR CCGs
Queen Mary University London Representative
UCL Partners
CAG Medical Directors Barts Health Hospital Sites (N=3)
Nurse Directors Barts Health Hospital sites (N=3)
THCCG Governing Body Meeting 10th May 2017 Part I 120
Decision Making & Quorum
Quorum: At least 1 Co-chair 2 CCG Chairs and 2 Provider Directors (Medical or Nursing), SRO (or their representatives), and ensuring all three of the local areas are represented
Administration and Handling of Meetings
The ELHCP STP PMO will be responsible for providing administrative support to the meeting and for circulating agenda and papers at least seven days in advance of the meeting taking place.
Frequency, conduct and reporting of Meetings
There should be an annual planned work programme that sets out the priorities based on the Sustainability and Transformation Plan that is agreed with the STP Programme Board. Meetings should be held 2-monthly to synchronise with the STP Board. In alternate months the Clinical Senate should meet to discuss key clinical issues related to other STP programmes, for political awareness and horizon scanning and to support its development The Chair and the SRO for Transformation supported by any other Clinical Senate Members present, will present findings and recommendations to the STP programme board so that accountable officers can consider and enact them as individual organisations and in the collaborative systems emerging in north eat London Each paper presented should have clear rationale in regard to the above and clearly set out what decisions are required A clear annual work programme based on transformation programme with clear links to STP deliverables; this should include “quick wins” Ensure appropriate interaction and alignment with other work programmes the particularly the Workforce Programme through specific papers but through regular updates and attendance which could be scheduled into the work programme The clinical senate should continuously reflect on its effectiveness and could briefly review this at the end of each meeting and could use local resources such as the Staff College to support this Action notes from each meeting will be taken and approved at the subsequent meeting. Action notes will be forwarded to the Integrated Care Coalition (ICC), Transforming Services Together Board (TSTB) and Hackney Health and Social Care Transformation Board.
Resources
Members of the Clinical Senate will be supported in their attendance and work by their individual organisations and these roles are not additionally remunerated Administrative and analytic support will be provided by the STP Programme and through its PMO. The Co-chairs are expected to commit one day a month each to the programme, again resourced by
THCCG Governing Body Meeting 10th May 2017 Part I 121 their organisation
Accountability/Governance
The clinical Senate is accountable to the East London Health and Care Partnership Board.
THCCG Governing Body Meeting 10th May 2017 Part I 122 A.2.4 Terms for Reference for Social Care and Public Health Group
Purpose
• To provide professional leadership and assurance in social care and public health • ToR to be confirmed by the Group in 2017.
Membership • Directors of Public Health • Directors of Social Care • Other TBC
Quorum
To be confirmed
Reporting
Advisory to ELHCP Partnership Board.
The Group will provide a social care and public health view on all issues before these are presented to the ELHCP Partnership Board (and these meetings will be scheduled to enable this flow of business).
Frequency
To be confirmed
THCCG Governing Body Meeting 10th May 2017 Part I 123 A.2. 5 Draft Terms for Reference for ELHCP Finance Strategy Group
Terms for Reference for ELHCP Finance Strategy Group
Purpose
• To lead the development of the ELHCP integrated financial strategy • To provide strategic direction on the approach to achieving the overall system control total making recommendations to the ELHCP Board for onward recommendation to partner governing bodies/boards. • To oversee and make recommendations on the allocation of the Sustainability and Transformation Funding including Estates and Technology Transformation funding • To manage the central CCG risk pool and other matters as requested by the STP Board
Membership
• 1 x ELHCP STP Independent Chair • 1 x ELHCP STP Executive SRO • 1 x ELHCP STP Finance Lead • 5 x Trust Directors of Finance • 3 x CCG representatives • 2 x Audit Chair • 1 x NHSE London Finance Director • 1 x NHSI representative • 3 x nominated Local Authority Director of Finance
Reporting
Reports and is accountable to the ELHCP Partnership Board
Frequency
Bi-monthly / quarterly
THCCG Governing Body Meeting 10th May 2017 Part I 124 A.2.6 Draft Terms for Reference for the ELHCP Community Group
Purpose:
The Community Group is established as a subgroup of the East London Health and Care Partnership. Representing key partners and stakeholders, community (patient and public involvement groups) and the Voluntary Community Social Enterprises sector, its purpose is to act as a reference group to the Partnership – helping it to develop strategies, plans and activities and recommending the most effective ways for it to communicate and engage with its target audiences.
The Group will be formed of key organisations and individuals, who through their pooled knowledge, skills and expertise of the east London health and care landscape, can bring a unique perspective on the changes that may be needed in order to achieve the Partnership’s goal of helping the people of east London live happy, healthy and independent lives.
In its capacity, the Group will have the scope to contribute to decisions taken at Board or Executive level, through Group member representation at the Board and any other relevant committees or groups.
Aims:
1. To collaborate with the wider Partnership (i.e. Board, other committees and member organisations) acting as a reference group for the development of strategies, plans and activities; 2. To recommend the most appropriate ways in which the Partnership should seek to engage, involve, consult and collaborate with local people; 3. To support effective Partnership communications and engagement activity, especially through the Group members’ existing channels; 4. To support the Partnership’s STP delivery plans and priorities
The STP delivery plans are: Delivery plan 1 - Promote prevention and personal and psychological wellbeing in all we do; Delivery plan 2 - Promote independence and enable access to care close to home; Delivery plan 3 - Ensure accessible quality acute services ; Delivery plan 4 - Provider Productivity; Delivery plan 5 - Estates Infrastructure; Delivery plan 6 - Specialised Commissioning; Delivery plan 7 - Workforce; Delivery plan 8 - Digital Enablement
Objectives:
An initial objective of the Group will be to review and agree the purpose, proposed structure and ways of working. This will also be reviewed and agreed on an annual basis.
More broadly, and once the Group is formally established, its longer terms objectives as a reference group and communications and engagement network are outlined below.
1. Devise an effective working model for the Group to engage with the wider Partnership; 2. Ensure the interests of the organisations and groups/bodies the Group represents are epitomised; 3. Work closely with the Partnership’s communication and engagement leads to ensure information and communication/ engagement activity and inputs are well designed and effective, adhere to best practice, and reach intended audiences; 4. Contribute to policy development through the creation of time limited reference groups, which considering how specific goals and challenges of the STP can best be met, taking information and views from external groups.
THCCG Governing Body Meeting 10th May 2017 Part I 125 Accountability and Reporting Arrangements:
The Group is accountable to the Partnership Board.
The Group will have two nominated representatives at every Partnership Board; however, there may be occasions where representation from more than two Group members is required, for example, to present/update on a specific piece of work.
The Board will nominate one representative (other than the Group representative) to attend Group meetings. Equally, a nominated representative from one of the other committees may be required to attend Group meetings.
Membership: The proposed membership takes account of the various patient/public groups, voluntary, community and third sector organisations, specialist charities, education, business and professional representatives (such as the Police). Each organisation is invited to put forward two members that will represent them at the Community Group. Members should be at a senior level within their organisations, and have a comprehensive understanding of the health and social care agenda, at a local, regional and national level.
The full Group will be expected to meet at least twice a year. Outside of the formal Annual General Meeting type meetings, there is an expectation that relevant members will meet to deliver or support more focused pieces of work, including undertaking equalities impact assessments e.g. around Prevention.
The membership has been grouped within their relevant sector.
1. Patient/public groups 2. Voluntary/third 3. Community group sector/specialist orgs Healthwatch Age UK Faith Groups Patient Advisory Board Stroke Association Patient Participation Diabetes UK Networks Cancer Research UK Macmillan Cancer British Heart Foundation Mind Alzheimer’s Society Community Waltham Forest 4. Education 5. Business 6. Professional/other Queen Mary University Chambers of Commerce London Ambulance Service Youth Parliament East London Business Police University of East London Alliance Fire Service Local Colleges Canary Wharf Group Local Medical Committee Local Schools City of London Local Pharmacy Committee Local Opticians Staff-side Representatives/Unions Independent Influencers Foundation Trust Council/s Equalities Group/s
THCCG Governing Body Meeting 10th May 2017 Part I 126
Nomination and the Role of the Chair, Vice Chair and Sub-Group Leaders: The Community Group must nominate a chair and vice chair. It will ultimately be for the Group to decide the process for doing this; however a suggestion could be through a ballot process.
The Group might also want to nominate two chairs; one representing the patient voice and the second, representing the professional, statutory and business organisations. These are essentially the two overarching and distinct membership groups of the Group. They might comprise both a chair and vice chair.
The Chair/s or vice chair/s represent the Group at Programme Board level, and as such represent the interests and consensus view of the Group.
Sub-group leaders will be selected by members for discreet, targeted pieces of work. They will be responsible for leading the delivery for a specific project, and will feed back to the Programme Board and the wider Group on the outcomes/outputs of their work.
Quorum:
While the Group is not a formal decision making body, and more of a reference group, it is suggested there be a quorum for meetings of the whole Group – namely 50% membership, including at least the Chair or Vice Chair.
Frequency of Meetings:
It is suggested the Group will meet twice a year unless otherwise agreed. Any sub-groups of the Group may meet more often as appropriate.
Authority:
The Group is authorised to investigate any activity within its terms of reference. It is authorised to seek and may secure the information it requires from any Partnership organisation and all employees are directed to co-operate with any request made by the Group.
Monitoring Effectiveness:
In so far as is required, in order to support the continual improvement of the Group will complete an annual self-assessment of the effectiveness of the Partnership; present a report to each Partnership Board meeting; and undertake an annual review of the terms of reference for the Group, reaffirming its purpose and objectives. This Group will review the results of the assessment of its effectiveness and adjust its terms of reference accordingly.
Review of Terms of Reference:
The terms of reference will be reviewed annually and sent to the Board for ratification.
Additional:
The Partnership communications and engagement team will coordinate and provide administrative support to the principal meetings of the Group. However, any sub-groups of the Group may need to nominate one of its members (on a rotational or static basis) to coordinate and administer its own activities.
THCCG Governing Body Meeting 10th May 2017 Part I 127 The Group will have access to the East London Health and Care Partnership’s dedicated online resource – the Briefing Room – and will be able to use all available materials for their communication and engagement activity. Members of the Group will be able to submit content to the Briefing Room but would need to adhere to the site’s editorial style and protocol and seek approval from the Partnership communications and engagement.
A small budget may be available from the East London Health and Care Partnership for the facilitation of meetings.
THCCG Governing Body Meeting 10th May 2017 Part I 128 A.2.7 Draft Terms for Reference for ELHCP Assurance Group
Purpose
• To provide independent challenge and assurance to the ELHCP STP Board on the STP Plan and its delivery. • To provide independent assurance to the constituent organisations within the ELHCP STP about the objectivity and transparency of the STP Plan and its delivery.
Membership
NHS Trust audit chairs (5 members). CCG audit chairs (7 members, currently 4). Local Authority audit chairs (7 members).
Reporting
To the ELHCP STP Board. To the Boards, Governing Bodies and Councils of the constituent organisations within the ELHCP STP. This would be through the audit chair of each organisation or other arrangements to be determined locally.
Remit
Assess the effectiveness of the Board Assurance Framework established by the ELHCP STP, including commenting as necessary on developing governance and accountability arrangements. Assess compliance with the Memorandum of Understanding (MoU) agreed by the ELHCP STP. Assess the adequacy of the arrangements established to account for the funds available to the ELHCP STP from the NHSE and constituent organisations. Ensure that there are effective arrangements in place for the external and internal audit of the resources available to the STP. Assess the arrangements established by the ELHCP STP to secure economy, efficiency and effectiveness in the use of resources. Assess the effectiveness of the arrangements established to manage conflicts of interests that might arise.
The Group may, as necessary, request the attendance of any ELHCP STP officer or Board member to a `meeting of the Group to seek explanations about the issues under consideration.
Frequency
At least four times a year.
Quorum
A minimum of three members, including at least one audit chair from an NHS Trust, a CCG and a local authority.
Resources
ELHCP STP officers to provide support and advice to the Group as requested.
THCCG Governing Body Meeting 10th May 2017 Part I 129 A.2.8 Terms for Reference for Mayors and Leaders Advisory Group
Purpose
• To provide a forum to represent the views of political leaders in East London on the ELHCP Partnership • To provide feedback to the ELHCP Partnership Board on elements of the plan • To provide a forum for political engagement on the EL STP
Membership • Leader or nominated representative of London Borough of Waltham Forest1 • Mayor or nominated representative of London Borough of Hackney1 • Chair of Policy & Resources Committee or representative of City of London Corporation1 • Mayor or nominated representative of London Borough of Tower Hamlets1 • Mayor or nominated representative of London Borough of Newham1 • Leader or nominated representative of London Borough of Barking and Dagenham1 • Leader or nominated representative of London Borough of Havering1 • Leader or nominated representative of London Borough of Redbridge1 • Independent EL STP Chair
Reporting
Advisory to the ELHCP Partnership Board
Frequency
Quarterly
1 To be nominated by the respective local authority
THCCG Governing Body Meeting 10th May 2017 Part I 130 Appendix B – Principles
In addition to the ELHCP Principles in Section 5, the Parties have adopted the following:
• ELHCP Financial Principles (agreed by the Finance Strategy Group in March 2017)
• The Nolan Principles
B.1. ELHCP Finance Principles
The following principles were approved by the Finance Strategy Group in March 2017:
All members of the ELHCP Partnership pledge the following:
B.1.1 System Control:
Commitment to delivering a system control total.
B.1.2 Openness and transparency:
Openness and transparency, with all parties agreeing to share information.
B.1.3 Shared objectives:
A shared objective of mutual support. Joint and shared accountability for system income & expenditure (I&E) between providers and commissioners and shared mutual responsibility and accountability for the control of operational expenditure.
B.1.4 Accountability:
That providers and commissioners are equally accountable for planning and managing the delivery of care in a way that meets demand and delivers constitutional standards.
B.1.5 Clinical strategy:
That commissioning, service planning and transformation must be based on a clinical strategy that is constrained within a determined financial envelope.
B.1.6 Incentives:
Current payment systems do not incentivise delivery of improved outcomes. Changes to the reimbursement of patient pathways is needed to incentivise whole system efficiency and effectiveness and improved outcomes delivered through better system integration.
B.1.7 Transformation Programme:
A clinical transformation programme must be jointly owned by providers and commissioners. It must be operationalised and delivered by provider clinicians and operational professionals and they must be properly resourced, incentivised and held to account for delivery.
B.1.8 Compensation:
Where key strategic decisions may be in the best interests of the patient but may have a differential impact on individual organisations, the beneficiaries of any change must fairly compensate the losing entity.
THCCG Governing Body Meeting 10th May 2017 Part I 131 B.1.9 Transitional support:
Transitional support must enable acute providers to deal with stranded costs associated with moving to new models of care.
B.1.10 Prevention:
Prevention and upstream investment need to be prioritised to enable our residents to lead healthier lives.
B.2 The Seven Nolan Principles
B.2.1 Selflessness: Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.
B.2.2 Integrity: Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.
B.2.3 Objectivity: In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.
B.2.4 Accountability: Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.
B.2.5 Openness: Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.
B.2.6 Honesty: Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.
B.2.7 Leadership: Holders of public office should promote and support these principles by leadership and example.
THCCG Governing Body Meeting 10th May 2017 Part I 132 Appendix C – Roles of the governance bodies
1. Partnership Board
The ELHCP Partnership Board will:
a) approve the EL STP; b) review and update the EL STP, when necessary; c) prepare a EL STP programme plan, which will: convert the high level EL STP into individual projects; prioritise the projects taking into the account, for example, the following: benefits - which projects are "low hanging fruit', which can be implemented quickly and simply to achieve a material benefit and which projects will lead to the greatest benefits; funding - which projects do not require funding, which projects do require funding, but the funding can be procured and which projects require funding and the funding will not be available at this stage; dependencies - which projects have dependencies upon the implementation of other projects; complexity – which projects are complex and might be better implemented once the Parties have more experience of working together; allocate projects to different phases, starting with phase 1; offer an initial view as to which Parties may be interested in each relevant project or whose services may be affected by the project e.g. if the project affects acute care; communicate the programme plan and the reasoning behind it clearly to the Parties;
d) prepare a communication plan, which will generate effective partnership working and a sense of common purpose between the Parties; e) circulate "Lessons Learned" reports from the ELHCP Project Boards, with its comments.
2. ELHCP Clinical Senate/ ELHCP Finance Strategy Group/ ELHCP Community Group/ ELHCP Assurance Group
The ELHCP Clinical Senate/ ELHCP Finance Strategy Group/ ELHCP Community Group/ ELHCP Assurance Group will: a) provide advice to the EL STP on all matters referred to in Paragraph 1; and b) on request, provide advice to the EL STP Project Boards.
THCCG Governing Body Meeting 10th May 2017 Part I 133 Appendix D – Sign Off by the Parties
Through signing this East London Health and Care Partnership Agreement the Parties listed below will:
Agree to the objectives in this document and work collaboratively to achieve these Agree to the partnership principles and processes outlined in this document Recognise the partnership structure outlined in this document for the ELHCP and support this locally
The signatories to this Partnership Agreement should be properly authorised to represent their respect organisations in entering into the commitments outlined in this document.
Signed on behalf of: Signature: Name: Title: Date: Barking and Dagenham CCG Barts Health NHS Trust
Barking, Havering and Redbridge University Hospitals NHS Trust City and Hackney CCG
City of London Corporation East London NHS Foundation Trust Havering CCG London Borough of Barking and Dagenham London Borough of Hackney London Borough of Havering London Borough of Newham London Borough of Redbridge London Borough of Tower Hamlets London Borough of Waltham Forest Newham CCG North East London NHS Foundation Trust The Homerton University Hospital NHS Foundation Trust Tower Hamlets CCG Redbridge CCG Waltham Forest CCG
ENDS
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NHS Tower Hamlets Clinical Commissioning Group Finance, Performance and Quality Meeting
Part I – Performance and Quality
Date & Time: Wednesday 22 February 2017, 13:30 – 15:00
Venue: TH CCG, 2nd Floor Meeting Room, Alderney Building, Mile End Hospital, London E1 4DG
Chair: Tan Van Dal (TV), NHS TH CCG Governing Body Member and Secondary Care Consultant
Attendees: Alison Glynn (AG), Associate Director of Provider Performance (WELC POD), NEL CSU Archna Mathur (AM), Director of Performance and Quality, NHS TH CCG Jackie Brown (JB), Interim Chief Finance Officer, NHS TH CCG Judith Lewsey (JL), Designated Nurse for Safeguarding Children and LAC, NHS TH CCG Pacifique Kimonyo (PK), Performance Manager and Quality, NHS TH CCG Nyasha Mapuranga (NM), Consortium Mental Health Quality Manager, NHS TH CCG Sandra Moore (SM), Deputy Director of Performance and Quality, NHS TH CCG Selina Bailey (SB), Performance and Quality Business Manager, NHS TH CCG (Minute Taker) Simon Hall (SH), Acting Chief Officer, NHS TH CCG
Apologies: Deane Kennett (DK), Director of Contracts, NEL CSU Josh Potter (JP), Acting Director of Integrated Commissioning, NHS TH CCG Mariette Davis (MD), Lay Member for Governance, NHS TH CCG
Agenda items 1. Welcome and introductions TV
TV welcomed all to the meeting and noted the apologies.
2. Conflicts of Interest TV
None were declared.
3. Review of minutes and action log TV
The previous minutes were approved and agreed as an accurate record. The action log was reviewed and updated. Acute Services
4. Barts Health Month 10 AG / Review of performance and quality report and existing escalations on red areas for SM Barts Health SM presented the Barts Health quality report for January 2017. The following exceptions were
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highlighted.
Friends and Family Test (FFT) Response Rate The FFT response rates remain low with ED remaining the lowest at 3% in January 2017 compared to 1% in December 2016 and below the target of 20%. The current response rates for FFT and Real Time Patient Feedback (RTPF) are the lowest nationally. BH continue to work on improvement on response rates.
MSA There were 27 breaches in January 2017 compared to 24 breaches in December 2016 for BH. The Royal London continues to contribute the highest volume of MSA breaches; of the 27 breaches in January 2017, 26 were at the Royal London site. All the breaches occurred in critical care at RLH, mainly due to ward beds being unavailable for patients who are ready to be moved from the critical care ward. The lack of beds is typically a result of patient flow issues which lead to high bed occupancy in the ward areas. The remainder of the sites achieved compliance, with zero MSA breaches in December 2016.
Safer Staffing The following wards/clinical areas fell below the national rate of 80% fill rate for RN/Ms and Care Staff in January 2017:
13C Vascular and Surgery 8D Neonatal 8F Day Barkantine.
Stat Man Training Safeguarding Children Level 2 Performance is improving but for RLH it remains below the 85% contract KPI. BH: 86.7% in January 2017compared to 85% in December 2016. RLH: 84.7% in January 2017 compared to 81.4% in December 2016.
Safeguarding Children Level 3 This remains below the contractual KPI for both BH and RLH but is showing an improvement. BH: 83.7% in January 2017 compared to 81.3% in December 81% in November. RLH: 81.6% in January 2017 compared to 77.5% in December.
Safeguarding Adults Level 2 This remains consistently below the contractual KPI of 85% for BH and RLH. BH: 67.9% in January 2017 compared to 73% in December. RLH: 65.8% in January 2017 compared to 66% in December.
HCAIs BH reported 6 HCAIs in February compared to 9 in January 2017. The YTD total is 66. The year- end target is 82. RLH reporting 1 in February compared to 3 in January 2017. The YTD total is 23. The year-end target is 34.
In 2015-16 the year-end total for BH C Diff was 87 against a year-end target of 82. The 2016-17
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year-end is 24% lower.
Never Events BH are reporting a YTD total of 12 never events for 2016-17 contractual year. An additional never event was reported at Newham Hospital on March 09 2017 – wrong site surgery.
The Never Event action plan is a standing item on the CQRM agenda. The Never Event action planned was reviewed at CQRM on 15 March 2017. It was agreed not be closed. A discussion will place with the WEL Quality Leads to agree next steps.
Serious Incidents The BH backlog of overdue incidents was 33 in January 2017 this remains the same in the February 2017 backlog. The RLH backlog is 6 with WX having the highest number of backlog at 20. The investigations of SIs should occur within 60 working days and a failure to meet this is a poor quality experience for those patients (and/ or their relatives) affected by the incident
Datix backlog The datix backlog is currently at 50. The RLH site team have improved the datix position significantly from over 800. The datix backlog is monitored at the monthly RLH CQRM.
Complaints The RLH performance remains below target of 80% with 44% in January 2017 compared to 47.2% in December 2016. Since November 2016 there has consistently been a greater number of complaints opened than closed. Although this has not affected performance, which continues to average 50% closed within 25 days, it has caused a rise in the volume of complaints being handled. Additionally February2017 saw a spike in the number of complaints received which has further contributed to a rise in volume. This is typical for February annually and coincides with an increase in hospital pressures over the winter months of December and January.
End of Life Care The Trust has changed its complaints database (Datix) to enable improved identification of complaints relating to EoLC. The trial of the tagging process commenced in February 2017 and has already demonstrated the ability to extract more reliable data. In February 2017 there were 4 complaints that affected patients receiving end of life care.
Duty of Candour Duty of candour continues to be below the compliance standard of 100% for BH however in January 2017 RLH met the 100% standard. For BH the level of achievement was 69% in January 2017 compared to 54.3% in December 2016. 5. Barts Health Staff Survey SM
SM presented the 2016 Barts Health Staff Survey to FPQ. The following exceptions were highlighted.
Key Finding 1 “Staff recommendation of the organisation as a place to work or receive treatment”. The Trust have improved overall on this since the 2015 survey.
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Key Finding 2 The overall indicator of staff engagement for Barts Health NHS Trust. The Trust's score of 3.78 was below (worse than) average when compared with trusts of a similar type. However the scores on each of the dimensions have improved since the 2015 survey.
The Top Ranking Scores of note for which Barts Health NHS Trust compares most favourably with other combined acute and community trusts in England (* above the national average). KF6. Percentage of staff reporting good communication between senior management and staff* KF32. Effective use of patient / service user feedback* KF2. Staff satisfaction with the quality of work and care they are able to deliver*
The Bottom Ranking Score of note for which Barts Health NHS Trust compares least favourably with other combined acute and community trusts in England. It is suggested that these areas might be seen as a starting point for local action to improve as an employer. KF26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months
The Key Findings of note where staff experiences have improved at Barts Health NHS Trust since the 2015 survey.
This is a positive local result. However, when compared with other combined acute and community trusts in England, the score for Key Finding KF10 - Support from immediate managers - is worse than average. KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents KF14. Staff satisfaction with resourcing and support 6. Barts Health CQUINs 2016-17 Forecast Position SM
SM presented a paper to FPQ to forecast year end achievement for 2016-17 CQUINs. The forecast is based on Q1, Q2 and Q3 provisional achievements. The Q4 forecast is based on the best possible outcome for the Trust, and therefore takes into account the previous three quarters. The current year-end forecast based on the rationale provided stands at 70.30%.
The identification of Sepsis CQUIN ED Treatment: Timely identification and treatment for sepsis in emergency departments (applies to adults and child patients arriving via ED or by direct emergency admission to any other unit or acute ward). The Trust self-reported achievement for this CQUIN in Q2 and 3 is not achieved. Therefore based on the self-assessment by the Trust of non-achievement; the forecast for this indicator at Q4 will also be not achieved.
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ED Screening: Timely identification and treatment for sepsis in emergency departments (applies to adults and child patients arriving via ED or by direct emergency admission to any other unit or acute ward). The Trust self-reported achievement for this CQUIN in Q2 and 3 is not achieved. Therefore no payment for Q2 and Q3. The forecast based on Trust self-assessed achievement year to date for Q4 will also continue to be not achieved.
Inpatient Treatment: Timely identification and treatment for sepsis in acute inpatient settings (applies to adults and child patients who are acute hospital inpatients). The Trust self-assessed as partial achievement, as only the Royal London site had submitted evidence. The Royal London partially achieved hence the 1.67%, as the sliding scale for achievement was used. The narrative in Q3 suggests that sepsis nurses will be recruited in April 2017 and this suggests the other sites will not achieve for Q4 also.
Mental Health Services
7. Mental Health Performance and Quality Month 10 NM
NM presented the East London Foundation Trust Quality Report for January 2017. The following national standards and exceptions were highlighted: National Standards Dementia Diagnosis Rate The estimated diagnosis rate trajectory is 66%. In January 2017 the trajectory was 84.21%. Within the WELC CCG’s, Tower Hamlets is the only CCG meetings its planned target of 73%.
IAPT Access Rate The quarterly target for IAPT Access Rate is 3.75% and the cumulative target 7.5%. In Q2, 3.77% service users accessed treatment, which is above the quarterly target. This was an improvement from Q1, however even though there is achievement in Q2, Q1’s performance has impacted on the cumulative performance. ELFT achieved 7.4% of the cumulative target which failed to meet the expected 7.5%.
IAPT Recovery Rate The IAPT Recovery Rate target is 50%. In Q2, 48.6% service users were reported as having recovered, below the 50% target. Local data, not yet published, shows Q3 has met the target. Due to the decline in figures for the local data on recovery rates, a recovery plan has been agreed with Compass which they are monitoring the recovery rate figures every week. The CCG receives a monthly dashboard. Exceptions PTS Waiting Times The target percentage of PTS service users waiting less than 18 weeks from referral to commencement is 95%. In Q3 the borough achieved 100% compliance against this KPI. This is an improvement from Q1 and Q2. The CCG set a local target of 11 weeks from referral to treatment which the borough has been meeting however it has now been highlighted that services users are
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now waiting more than 11 weeks for their second appointment.
RAID Waiting Times The A&E performance was 92.5% in December 2016 and 92.2% in January 2017. ELFT reported that there were 19 A&E breaches out of 243 attendances received by the service. The breaches were due to a range of reasons including:
• Identification of out of area beds. • Late referrals from general A&E. • Complex and lengthy multiple assessments which might involve multiple agencies. • Delays in doctor attendances: dealing with Mile End emergencies.
The indicator is being monitored at CQRM where ELFT report. Changes to this indicator in April 2017 are expected to show an improvement.
Transforming Care The average length of stay is more than twelve months based on two patients. One patient is affecting the average length of stay. Patient 1 was admitted to MEH on 27 February 2014. His period of hospitalisation has included two extended periods of Section 17 leave from 27 April 2015 to 29 June 2015 and between 22 February 2016 and 19 October 2016 with weekly reviews on the ward. The patient was diagnosed with a Learning Disability in October 2016 and therefore only known to be part of the Transforming Care cohort from this time.
CPA Employment The CPA Employment status for adults target is 97%. In January 2017, the target reached was 95.2% performance by the borough, below the required target. This is the second month this KPI has not been achieved. All three boroughs are struggling to meet this KPI. Tower Hamlets borough has achieved this KPI four times in 2016-17 whilst City & Hackney have only achieved it once and Newham have never achieved it.
CPA accommodation The CPA Accommodation Status target 97%. In Q2, the performance target reached was 95.1% by the borough below the required target. This is the second consecutive month that KPI has not been achieved. All three borough are struggling to meet this KPI. Tower Hamlets has only achieved this KPI 3 times in 2016-17.
8. ELFT CQUINS 2016-17 NM
NM presented the ELFT CQUINS for 2016-17 which was reviewed by the committee. ELFT have met the national and local CQUINS in 2016-17.
9. ELFT Health Staff Survey
NM presented the 2016 ELFT Health Staff Survey to the committee.
Summary of Findings
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Top 5 Ranking scores Percentage of staff reporting good communication between senior management and staff: Quality of non-mandatory training, learning or development. Staff recommendation of the organisation as a place to work or receive treatment. Percentage of staff able to contribute towards improvements at work Staff satisfaction with the quality of work and care they are able to deliver ELFT is highly rated and staff are engaged compared to other similar ranked Trusts.
Bottom 5 Ranking scores Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months Percentage of staff experiencing discrimination at work in the last 12 months Percentage of staff experiencing physical violence from staff in last 12 months Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion
Violence reduction is a high priority for ELFT and is being reported and reviewed at CQRM. Action: NM to raise the ELFT Staff Survey finding of the 4% of staff experiencing physical violence from staff in last 12 months at the Consortium on 18 April 2017.
Primary Care
10. GP Service Alerts PK
PK gave an overview on the GP Service Alerts and Barts Health and CCG ‘You said/we did’.
There were 22 service alerts raised in January 2017, with Obstetrics/Maternity being the main service the GPs complained about.
The top five reasons for GP complaints are: 1. Referrals 2. Access Issues 3. Unsafe discharge 4. Results and Treatment 5. Request to provide tests not accessible to GPs.
QIR Response Template does not provide information to identify the patient complaint The Performance and Quality Manager amended the QIR response template to include NHS number and D.O.B. On the 09 March 2017 the template was shared with the Barts Health Complaints Team for circulation.
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Maternity Related Alerts Barts Health are in the process of moving to an NHS.net mail account in order to address the issues with e-Faxes for Maternity related alerts. However, this is being rolled out across the Trust and is taking some time. The Performance and Quality Manager has chased the service on when this will be implemented.
The CCG Early Years Transformation Manager is seeking GPs’ feedback on review of the antenatal pathway. Feedback forms will be circulated in the coming weeks. The CCG want to gain an understanding on GPs’ perceptions of how antenatal pathways should be delivered across Tower Hamlets.
There was maternity themed CQRM in February 2017. The site leadership team were able to provide answers to the following key lines of enquiries including :
GP service alerts highlight several areas of poor communication with general practice and GPs obtaining test results in a timely manner.
Service alerts highlighting discharge summaries are of poor quality. Either the information is incorrect or there is little or no information provided.
The CCG has received information that women are having difficulty calling the antenatal clinic. We have also used three mystery shoppers who have experienced the same problem.
The next Maternity themed CQRM is scheduled in May 2017. The CCG will again review issues relating to the performance and quality of care provided by the service in detail and escalate key issues raised by GPs. Action: Maternity related service alerts to be added to the next Maternity CQRM agenda in May 2017.
Foot Health Services asking GPs to prescribe antibiotics Historically, the Foot Health Service has not prescribed antibiotics as there are no clinicians within the service who are qualified to prescribe. In instances where antibiotics have been required, the patient would be referred back to the GP. The Service Manager will explore the possibility of identifying and training staff for prescribing and discuss this further with the CHS General Manager and Associate Director of Nursing for Community & Therapies.
Request to provide tests not accessible to GPs e.g. MRIs The RLH Governance team are to complete and circulate definitive list of tests that GPs can access.
There is a wider issue of the five year forward view and having a contact person within the RLH to deal with GP related issues and has been raised with Caroline Alexander, Alastair Chesser and Jackie Sullivan. Action: SH/AM to raise at TST the issue of having a contact person within the RLH to deal with GP related issues. 11. Primary Care Complaint Report PK
PK presented the Primary Care Complaint Report. The purpose of this report to thematically analyse
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the complaints received by NHS England regarding the Primary Care service across Tower Hamlets since July 2016.
TH CCG currently act as co-commissioners for Primary Care. Regular meetings have now been scheduled to enable CCG and NHSE colleagues to meet and discuss key issues facing GP practices. This opportunity has allowed the CCG to work closely with the local NHS England teams in decisions about primary care services. This collaborative working has resulted in the CCG gaining access to a wider range of information that was previously only held by NHS England. The NHS England Complaint Team have shared with the Performance and Quality Manager the number of complaints received from patients in Tower Hamlets from July 2016 onwards. There are now also monthly updates and thematically analysis on the complaints they received. The complaints data will be included in the Primary Care Quality Dashboard and quarterly complaints report will be presented to the Primary Care Commissioning Committee.
NHSE received 46 complaints between July to December 2016 for TH CCG, in comparison to Newham CCG who had 53 and Waltham Forest who had 39. The main themes of complaints for TH CCG include communication/attitude of staff, clinical issues and practice management.
Communication/Attitude This category covers complaints relating to staff being dismissive/lacking empathy, manner/tone used to speak to patients, as well as issues relating to availability of information (oral or written). The top five practices include: 1. Harford Health Centre 2. Harley Grove Medical Centre – PMS 3. St Stephens Health Centre 4. City Wellbeing Practice 5. Island Medical Centre
Complaints Relating to Clinical Care Complaints that fall under this category include issues relating to delay in care as well as medication errors. The top five practices include: 1. The Mission Practice 2. Chrisp Street Health Centre 3. The Spitalfields Practice 4. Ruston Street Clinic 5. Harley Grove Medical Centre – PMS
Complaints Relating to Practice/Surgery Management This category covers complaints relating to access issues as well as de-registration concerns. The top five practices include: 1. XX Place
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2. Dockland Medical Centre 3. Harley Grove Medical Centre – PMS 4. Jubilee Street Practice 5. St Katherine’s Dock
Action: SH will recommend the Primary Care Complaint Report to be discussed at the Locality’s Board meeting at the Primary Care Commissioning Committee.
The committee feedback on the good work gone into the Primary Care Report. 12. Primary Care Dashboard PK
PK presented the Primary Care Dashboard. The Primary Care Commissioning and Performance and Quality colleagues have been working collaboratively to review and strengthen the approach taken to improve quality of care provided by GP practices in Tower Hamlets. Part of this project has been developing a comprehensive quality dashboard. The dashboard was developed by a task and finish group supported by the Primary Care Clinical lead and comprised of: • Performance and Quality Manager for Primary Care • Primary Care Commissioning Manager • Primary Care Analyst • IT Change Facilitator
The team developed a dashboard which aims to analyse the quality of care for GP practices against three main domains: 1. Safety 2. Clinical Effectiveness 3. Patient Experience
The Primary Care Dashboard will be used to monitor quality metrics such as: • CQC performance • Complaints • Safeguarding • Serious Incidents • Medicine Management • Friends and Family Test • GP Patient Survey • Intelligence from the Primarycare web tool.
The dashboard will be updated quarterly by the Primary Care Commissioning Manager and the Performance and Quality Manager and will be reviewed quarterly at the Primary Care Commissioning Committee. Alongside the dashboard, the Performance and Quality Manager is working on developing the Primary Care Performance Framework which will describe what actions are to be taken to improve GP Practice performance regarding intelligence revealed by the dashboard. The Committee remarked on the excellent work that has gone into the Primary Care Dashboard. Residential & Nursing Homes
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13. Peter Shore CQC Report PK
PK presented the CQC Report on the Peter Shore Court Care Home.
The CQC carried out an inspection at Peter Shore on 18 November 2016. The finalised report was published on 27 February 2017. The report highlighted areas in which the care home had improved with regards to performance following the previous CQC inspection report published on 07 October 2015. The Care Home Overall Rating is Require Improvement, with good in Caring and Responsive domains.
Areas that require improvement are risk management – risk assessments not in place, updating of the care records, communication with carers - not being kept up to date and governance.
The Local Authority Contract Monitoring Officer and the CCG Performance and Quality Manager will collaborate to continuously support the service improve the quality of care offered to patients and have requested a CQC action plan. 14. Nursing and Residential Homes QA Visit Framework
PK gave a verbal update on the Nursing and Residential Homes QA Visit Framework. Going forward there will be a multi-disciplinary approach to QA visits to nursing and residential homes. The multi-disciplinary team (MDT) with include the Performance and Quality Manager, LBTH Adults Safeguarding Lead, a Clinical Lead and LBTH Monitoring Officer. The MDT will co-ordinate QA visits, complete a comprehensive report and an action plan after each visit. The action plan will be owned by the Performance and Quality Manager and the LBTH Monitoring Officer who will ensure the actions are completed.
AM remarked this is a good model and was discussed at SAB. Safeguarding
15. Adults Safeguarding SM
The committee reviewed Adults Safeguarding and no exceptions were noted.
For Information
16. CRG Report March 2017 SM RLH CQRM Agenda March 2017 Noted for information.
17. FPQ Membership, ToRs and Governing Body Lead SH
Due to lack of time this was not discussed. Action: AM, SM and Richard Quinton to meet and review the FPQ ToRs and send recommendations to TV and MD via email.
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18. AOB All
None raised.
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Finance, Performance and Quality Action Log
Action Action # Lead Due date Outcome / update Status
25.01.17 – Moved to 22 February 2017. BH CQUIN Achievement 25 January Nov#2 SM SM to share the CQUIN forecast position at next 2017 22.02.17 - Moved to 22 March 2017. FPQ meeting. 17.03.17 – Closed on the agenda.
25.01.17 – JP to follow up with CK. SH to raise at STP. 22.03.17 – ELFT believe with the new A&E standards coiming into effect in Mental Health Performance and Quality 25 January April 2017, they will be able to stop the Nov#3 RAID CK 2017 clock which should reduce the 4-hour CK to provide update on actions taking place to 26 April 2017 breaches. improve performance for the RAID service. AG has requested Frank Coathorpe to investigate the RAID standards. NM to provide an update at the next FPQ.
GP Service Alerts 16.03.17 - PK spoke with the PK to discuss with Transformation Managers Transformation Managers and Feb#1 and Service Leads to ensure that GPs are PK 22 March 2017 Service Leads who confirmed notified about rejected referrals with 24 hours in notification for rejected referrals within order to re-refer the patient in order to avoid 24 hours further delay.
BAF reviewed. Need to identify new BAF governing body lead for FPQ. Feb#2 BAF to be reviewed and updated to include all SM 22 March 2017 the new strategic risks across the organisation 22.03.17 – To be discussed with and escalated to SH. ToRs.
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ELFT Health Staff Survey NM to raise the ELFT Staff Survey finding of the March#1 4% of staff experiencing physical violence from NM 26 April 2017 staff in last 12 months at the Consortium on 18 April 2017.
GP Service Alerts March#2 Maternity related service alerts to be added to SM 26 April 2017 the next Maternity CQRM agenda in May 2017.
GP Service Alerts March#3 SH/AM to raise at TST the issue of having a SH/AM 26 April 2017 contact person within the RLH to deal with GP related issues.
Primary Care Complaint Report SH will recommend the Primary Care Complaint March#4 Report to be discussed at the Locality’s Board SH 26 April 2017 meeting at the Primary Care Commissioning Committee. FPQ Membership, ToRs and Governing Body Lead March#5 AM, SM and Richard Quinton to meet and review AM 26 April 2017 the FPQ ToRs and send recommendations to TV and MD via email.
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NHS Tower Hamlets Clinical Commissioning Group Finance Performance and Quality Meeting
Part II – Finance
Date and Time: Wednesday 22nd March 2017, 15:00 – 16:30
Venue: MEH, Alderney Building, 2nd Floor Meeting Room
Mariette Davis (MD) Chair Lay Member for Governance NHS TH CCG Richard Quinton (RQ) Finance Adviser NHS THCCG Troy Hinds (TH) Finance Manager NHS THCCG Deane Kennett (DK) Assistant Director of Contracts NEL CSU Dennise Friday (DF) Finance Business Manager NHS TH CCG Jackie Brown (JB) Interim Chief Finance Officer NHS THCCG Jim Dodds (JD) NEL CSU Finance NELCSU Moira Coughlan (MC) Joint Head of Medicines Management NHS THCCG Sandra Moore (SM) Deputy Director of Performance and Quality NHS THCCG Shuma Begum (SB) Contracts Manager NHS THCCG Tan Van Dal (TVD) Secondary Care Consultant Governing Body NHS TH CCG Member Archna Mathur (AM) Director of Performance and Quality NHS TH CCG Kelly Samuel‐Welsh (KSW) Finance Administrator NHS THCCG Raana Ali (RA) Joint Head of Medicine Management NHS THCCG Carrie Kilpatrick (KP) Director of Mental Health and Joint NHS THCCG Commissioning Mba Chujor (MB) Transformation Officer NHS THCCG
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Minutes
19. Welcome and introductions MD
MD welcomed all to the meeting.
20. Conflicts of Interest MD
As per CCG conflicts of interest register, none further were declared in relation to specific items on the agenda. 21. Review of Minutes and Action Log MD
ACTION: The quoracy to be reviewed. AM, RQ and SM to discuss and make suggestions of any changes proposed to Mariette.
February minutes were recorded as a true and accurate record of the meeting. 22. CCG Finance Report Month 11 RQ
RQ provided an update on the CCG Finance Report for Month 11 (February 2017) and a forecast for the year. At month 11 the CCG is reporting a year to date surplus of £10.9m and forecasting a full year surplus of £11.942m, in line with the CCG’s Financial Plan. However, commissioning reserves and Non‐recurrent in year measures are required to offset pressures on contract activity, particularly in the acute sector and co‐commissioning areas, in order to achieve the targeted 2016/17 position. The acute position at Month 11 is reporting a year to date over performance position of £7.2m with a forecast over performance position of £7.9m by year end. This is mainly attributable to the over performance at Barts Health, reporting a year to date over performance of £4.5m and forecast of £4.9m, however, the forecast is now in line with the recently agreed year end deal and so has been fixed. Other areas of overspend relate to BMI, Guy’s and LAS.
23. QIPP Report Month 11 RQ
RQ provided an update on the Month 11 QIPP report. The QIPP report shows a year to date under achievement of £229k against the revised plan, with a projected full year under achievement of £327k against the plan, attributed to the delayed start date of the new CHS contract. The following points were discussed: Reserves have been fully utilised for this year. There is an overspend in the running costs of the Finance Department ACTION: The over spend of the running costs of the Finance Department to be reviewed. RQ will
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report back at the May FPQ meeting and also provide a 2017/18 budget presentation.
24. Finance and Activity DK/JD
DK provided an update on the Finance and Activity report for Month 11. The CCG is forecasting a full year surplus of £11.9m which is in line with its financial plan for 2016/17. Within this forecast, acute is reporting an £7.9m overspend, with the main driver being Barts, which is £4.9m overspent. Barts Health (Acute): The key drivers of over performance continue to be attributed to Outpatients Procedures, Outpatient Attendances, Non‐Elective, Critical Care, Day Case and Elective, and High Cost Drugs. A year‐end settlement has been reached with Barts Health, the final value being based on the agreed claims and metrics projected forward for the full year. For Tower Hamlets CCG, the agreed position is £146m, which will result in an over spend of £5.2m against the contractual plan of £141m. There is a £1.9m over performance across Associate Acute contracts, with Guy’s, BMI, UCLH, Royal Free, GOSH and Homerton accounting for the majority of this. Across the Associate Providers, Maternity is the greatest driver of over performance Tower Hamlets LAS performance in January was 69.4% for Cat A (incidents reached within 8 minutes) against a target of 75%. Pan London Cat A performance was below trajectory and target (75%) at 62.3%. The quality of the ambulance service has been analysed. Although they are in special measures there have been no major incidents recorded. Barts Health CHS, DNA rates were significantly below threshold (7.5%) at 6.2% during December. GPOOH have not reported any gaps in service during the last reporting period ELFT Mental Health, overall performance remains stable with the provider performing well across the majority of contractual requirements. Where performance is under plan, recovery plans are in place and trajectories are being closely monitored. Continuing Health Care is reporting a FOT over spend of £157k at month 10 due to a provision included in the projection for the estimated costs of Tower Hamlets share of the joint care packages. There is a shift in maternity services as Barts are reporting a slight underspend contributing to an over spend on associates. The opening of the new birthing unit should result in an improvement. . Acute Contract Review: JD provided a summary on the Acute Contracts. The month 11 report focuses on the level of activity at Guys, sources of referral to local providers, Outpatient Procedures and High Cost Drugs.
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The following points were discussed:
Tower Hamlets is forecasting an overspend of £7.9m, which has improved by £0.2m. The Barts Health forecast is reflective of the year end deal of £5.2m. Associates and other acute providers are £2.7m over plan, showing an adverse movement of £0.2m. The key drivers of over performance at Barts are:
Outpatient Procedures £2.0m overspend. This has remained largely unchanged and is the net of agreed counting and coding related claims. Outpatient Attendances £1.9m overspend. This was previously reported at £1.3m and relates to first attendances, driven by Gastroenterology, General Medicine, Dermatology, Interventional Radiology and Hepatology Non Elective £2.0m overspend. This has increased in the month by £0.2m after a £0.4m increase last month Critical Care £1.5m overspend. This has increased by £0.2m, mainly the result of higher activity rather than complexity. Both the number of patients and the length of stay are up compared to last month. Day cases and electives have improved within the month. Another major driver was high cost drugs which increased mid last year. This could be attributable to drugs which were added to the NICE guidance.
The associates over spend is mainly driven by Guys at £0.5m, attributed to maternity. The following continue to be the key drivers of the forecast over performance. o UCLH £0.3m o Royal Free £0.2m o Homerton £0.2m o GOSH £0.2m o BMI £67k o NCA £96k BMI £67k and NCA £96k were the key drivers of an adverse movement of £0.2m in the month.
ACTION: JD will speak to colleagues in regards to complexities v quality at procedure level and how this impacts on the length of stay and also the impact of readmissions. ACTION: JD will look at PROMs (Patient Reported Outcomes) etc. (non‐electives) and feedback at the next FPQ meeting. ACTION: JD to do some analysis work on capacity and trends. The increase in CC associated within TH over the last couple of years is different to other CCGs and this is under investigation. JD looked at organs supported around maternity related CC which is higher than other providers. JD to provide analysis on other CCGs’ performance on CC and feedback at the next FPQ.
Medicines Management
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RA presented the medicines management report. The Tower Hamlets Prescribing Total for 16/17 is £31,556,740. The position for Month 11 shows that the annual projected forecast is £31,521,608, therefore forecasting an underspend of £35,132. “Specials” is showing additional savings of £38.5K. The Specials pharmacist continues to monitor Specials prescribing at a practice level, and provides advice and support, where needed. YTD figures for ScriptSwitch shows that it’s delivering additional savings of £222k. Oral Nutritional Supplements (ONS) includes adult and paediatric feeds. YTD figures for ONS is showing a cost pressure of £37K. The dietetic team have been reviewing patients at practices and providing support to aid clinically appropriate and cost effective ONS prescribing. The dieticians are continuing to address the increase seen in ONS spend, attributed to an increase in tube feeds and also a large volume prescribed on a few prescriptions. STP programmes are being developed in terms of Medicine Management looking at biosimilars with Barts (working across the footprint). A total of 7 initiatives are being worked on. Referrals JD tabled his slide on referral activity. There has been a reduction in consultant to consultant referrals. A referral tool has been developed which acts like a database with an enquiry screen where you can look at activity by speciality and CCG. Gastro 1st attendances, is generally reflected in the overspend. Some movements are due to Barts coding i.e. general surgery versus breast surgery. Some referrals may not have been recorded previously. i.e. clinical physiology. Referral patterns can be revisited. There are currently 2 sources of referral data, NELIE and MARs data and referrals by provider.
ACTION: JD ‐ Identify and report at the May FPQ the patterns in referrals and include as an agenda item.
Date of next meeting: April 26th, 13:30 – 15:00 (Part II – 14:30 – 15:00) THCCG, 2nd Floor Meeting Room, Alderney Building, Mile End Hospital, London E1 4DG
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Primary Care Commissioning Committee Minutes
Date: 28th March 2017
Time: 3.30-5.30pm
Venue: Room 7, Education Centre, Burdett House, Mile End Hospital, E1 4DG
Chair: Julia Slay
Voting Julia Slay Lead for Patient and Public Involvement NHS TH Members: (Chair) CCG Simon Hall Acting Chief Officer NHS TH CCG Maggie Buckell Registered Nurse Member – Primary Care GB NHS TH Board Lead CCG Andrea Antoine Deputy Chief Finance Officer NHS THCCG Mariette Davis Lay Member (Governance) NHS TH CCG Tan Vandal Secondary Care Representative NHS TH CCG
Non-Voting Virginia Patania Urgent Care Representative NHS TH Members: CCG Karen Bollan Healthwatch Representative Healthwatch Jackie Applebee LMC Representative LMC Alison Goodlad Head of Primary Care NHS England Nicola Hagdrup GP Representative GP Provider
In attendance: Chima Olugh Primary Care Commissioning Manager NHS TH CCG Jenny Cooke Deputy Director of Primary Care NHS TH CCG Angela Williams Administrator (Minute Taker) NHS TH CCG Pacifique Quality and Performance Manager NHS TH Kimonyo CCG Angela Ezimora- Assistant Head of Primary Care NHS West England
Apologies: None Noted
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ACTION LOG SUMMARY
Agenda Action Due RAG rating Lead item no. date #November 1 Planning Guidance – Implications for April Added to forward CO General Practice should be added to the 2017 plan will be on the forward planner as a regular agenda item agenda for alternate meetings from now on #November 2 Discussion to be had between Medicines May CO/MC/ Management and Primary Care regarding 2017 AG prescription safety. Alison Goodlad to ensure how dentistry prescribing is dealt with and report back to the committee
Item no. Item name Lead
1. General Business
1.2 Welcome Introduction and Apologies JS The chair welcomed everyone to the committee meeting and introductions were made around the room.
1.3 Declarations of Interest JS None noted
1.4 Minutes of Part I of the meeting 31st January 2017 JS The minutes were agreed as accurate.
2. Finance AA
The Month 11 Report was presented to the committee. There was a reported overspend of 412k. The report highlighted that there had been additional funds received to support the increased premises costs throughout 2017/18. Jenny Cooke advised that there had been some QIPP delivery associated with the challenge of business rates against the council. However, this was predominately associated with prior years and would not significantly benefit the CCG’s financial position in 2016/17.
3. Commissioning and Contracting CO
3.1 PMS Review Chima Olugh provided an update on progress against the PMS Review. A PMS-wide meeting was held and all practices advised of the process agreed at the last primary care committee. Practices had also had individual visits to have the opportunity to understand what the PMS review would mean to them.
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Following this process there were two further areas for decision required by the committee. Firstly, processes to support practices that may want to switch to a GMS contract and secondly the operational processes in place to manage the transitional funding. Decision 1: Converting to a GMS contract. Jenny Cooke provided an overview of the rationale for allowing practices to convert to GMS contracts, both from the perspective of individual practices and from a transactional/contracting perspective. The Primary Care Committee approved the process that would allow PMS practices to convert to GMS contract, with transitional support, within a time-limited window. However, the committee recommended that a full quarter is allowed between practices confirming moving to a GMS contract and the implementation of the new contract. The Primary Care team will update the process and send this to the PMS practices for consideration. NHS England representatives noted that whilst they would not ordinarily support practices moving to a GMS contract with transitional funding, they did confirm that Tower Hamlets CCG were able to follow the process approved by the committee. Decision 2: PMS finance operational processes: Jenny Cooke provided an overview of the financial operational processes to manage the PMS transitional funding, including the management of in-year list size changes. The Primary Care Committee approved the financial operational processes. Maggie Buckell asked how the GPs felt about this review process. Jackie Applebee replied that many were understandably worried, particularly about their substantive posts and that they were losing money that was generally used for staffing.
3.2 NIS/QOF Update JC
Jenny Cooke presented a brief update on NIS and QOF for 2017/18. The final specifications were agreed by the LMC-subgroup and these have been issued to practices. The feedback from practices and networks has been generally very positive. The GP Care Group will manage the contract and the Chair recently wrote to all practices to advise them of this. Nicola Hagrup commented that this had been well received so far. On local QOF, 28 practices had signed up in total, with a number of practices fully signed up to the local offer. Thanks were noted for Jo Sheldon, Primary Care Commissioning Manager, who has worked tirelessly on this piece of work to ensure it was delivered on-time and to a high standard.
3.3 Building Resilience in General Practice Programme JC
Jenny Cooke presented a paper highlighting the progress made over the last three months in the delivery of this programme. There are 25 practices signed up, along with the GP Out of Hours Service. The coaches have been hired and matched to practices, the QI training has begun and the data software has been installed into practices. Maggie Buckell asked if the coaches were NHS or external professionals. Virginia Patania responded that they had a wide range of backgrounds, from local GPs to those from the corporate / banking sector. Virginia added that the STP are very interested in replicating this work across North East London and are looking at a range of options at the North East London Partnership for Quality Improvement. Virginia also noted that additional funding had been secured from NHS England to roll out collaboratives. This would be a mechanism for bringing together practices that are working on the same area, e.g. access, Funding was secured in February with Vanguard money, who were very supportive of the programme. Simon Hall indicated that there needs to be continued conversation between the CCG and the GP Care Group about their role in the programme.
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3.4 GP Forward View Update CO
Chima Olugh provided an update on local areas of development and funding associated with the GP Forward View. The highlights included: - Confirmation of funding for extended access in 2017/18
- Training for reception and clerical staff was underway with a programme of work that has been commissioned across Newham, Waltham Forest and Tower Hamlets
Virginia asked when we would have access to the Medical Assistant training and funding. Chima explained that a pilot was underway in Hackney and Newham and we’d take the outputs of this to inform a local plan. Simon Hall and Nicola Hagrup expressed the need to work closely with CEPN on this.
3.5 GP Summit JC
Jenny Cooke updated the committee on the GP summit that has been planned with a small group for the Practice Managers Forum, GP Care Group and Network Managers. The event will be held in April and is support peoples’ understanding of what is happening in Primary Care, build relationships, and give people a sense of ownership and control. Around 250 people working in General Practice were due to attend.
4. Quality and Performance
4.1 CQC Update PK
Pacifique Kimonyo’s presented the CQC paper that went into further detail on the two practices in Tower Hamlets rated as inadequate, East One Health and Harford Health Centre. Pacifique marked Harford’s engagement in the CQC processes and their consistent efforts to improve. Virginia Patania expressed concern on the sustainability of practice improvement if it was dependent on the on-going visits of the team.
5.0 Governance
5.1 BAF CO
The updated BAF was presented. The committee was assured by the mitigations in place.
5.2 Forward Plan CO
The forward plan was approved.
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Minutes of the Executive Committee
Date: 21st March 2017
Time: 1.30-3.30pm
Venue: Jane Milligan’s Office, 2nd Floor, Alderney Building, Mile End Hospital, E1 4DG
Chair: Simon Hall, Acting Chief Officer
Present: Simon Hall, Acting Chief Officer THCCG Josh Potter, Acting Director of Integrated Commissioning THCCG Archna Mathur, Director Performance and Quality THCCG Isabel Hodkinson, Principal Clinical Lead THCCG Victoria-Tzortziou-Brown, Principal Clinical Lead THCCG Ellie Hobart, Deputy Director of Corporate Affairs THCCG Jackie Brown, Interim Chief of Finance THCCG
Apologies: Somen Banerjee Director of Public Health – LBTH Justin Phillips, Corporate Governance Manager THCCG
In attendance:
ACTION LOG SUMMARY
Agenda Action Due RAG rating Lead item no. date 1.3 Request equalities data from the CSU 18/417 JP 2.1 Prescribing budget details for the QIPP plan to be 18/4/17 JP/MC checked by Moira with Josh in context of the Rightcare figure
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2.1 Check the accuracy of the figure for the walk in centre 18/4/17 IH/MC 2.2 Feed back to LBTH our representative for the MARAC 18/4/17 EH Implementation Group 2.3 Discussion paper on Capitation to be produced for the 4/4/17 KB/IH THT Board (4th April)
2.3 Contact Programme Leads to discuss the pilot 18/4/17 IH capitation opportunities 2.4 Governance team to contact Clinical Leads, and 18/4/17 EH propose how we take forward at next Executive Meeting 2.8 A presentation on CHS Implementation to be put 18/4/17 JP together for the GB Seminar on 5th April 2.9 Take forward the business case for CHC/Joint 18/4/17 AM Packages Review, ensuring it is in line with our revised interim policy
Item no. Item name Lead
1.3 Minutes of the Previous Meeting and Action Log SH
The minutes of the last meeting were agreed as accurate. Actions reviewed as follows:-
Justin Phillips is currently looking into receiving the equalities data for the CCG.
Josh has now sent Isabel and Victoria the requested information regarding Integrated Care.
Preferred attendance days for Clinical Leads is being collated, so we can make a decision about whether we move all clinical meetings to Wednesdays or just the Governing Body in public meetings.
2.0 Operations
2.1 Practice Prescribing Budget
Isabel presented the Practice Prescribing Budget paper and explained that this was a continuation of the current work, and that it is the third year in a row with a 70/30 split. It was noted that the walk in centre figure seemed to be high and Isabel confirmed that she will find out whether this is correct. As money is challenging in this coming year it was agreed that we should look to review the prescribing budget without losing quality. It was noted that the prescribing budget is not in the current QIPP plan and that Deloitte had identified prescribing as a potential QIPP looking at our Rightcare data. ACTION:
Prescribing budget details for the QIPP plan to be checked by Moira with Josh in context of the Rightcare figure
Check the accuracy of the walk in figure.
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2.2 Community MARAC Implementation Group
Ellie explained that Tower Hamlets Council have been assessing their anti-social behavior policies and in this respect have requested that we put forward a representative for the MARAC implementation Group. It was agreed that the approach for this should be through THT with Edwin from THT attending the meetings and Denise Radley feeding back updates through the THT Board ACTION:
Ellie to feed back to LBTH our representative for the MARAC Implementation Group.
2.3 Capitation Workstream
Isabel led a discussion to try to clarify what the aims of the capitation workstream now are. The Capitation Sub Group is meant to report to the THT Systems Group but this hasn’t happened as effectively as it might. It was agreed that we need to reframe this work, getting greater ownership across the whole health economy. For us to move more effectively towards any capitation solution there will need to be an agreed approach at a WEL/STP level. Katie Brennan and Louise Phillips are working on a paper for the THT Board, and our ACS development meeting, that will clarify why, what and how with respect to this worksteam. ACTION:
Discussion paper on Capitation to be produced for the THT Board (4th April)
Isabel to contact Programme Leads to discuss the pilot capitation opportunities
2.4 4th April Clinical Commissioning Forum Agenda and Forward Planner
The decision was made for the April Clinical Commissioning Forum to not go ahead as we are instead holding the GP Summit in April. The next meeting in May will be a joint presentation with Tracey Cannell leading which will include the THT development. It was also confirmed that for the forward planner we have scheduled the following: June-Outcomes framework which we shall call understanding our population and August - Commissioning Intentions and JSNA process. The move of clinical meetings to Wednesdays from Tuesdays was discussed, and it was agreed to review Clinical Lead’s availability. It was noted that to achieve the synergy across the NEL CCG’s it was only necessary to move public Governing Body Meetings. ACTION:
Governance team to contact Clinical Leads, and propose how we take forward at next Executive Meeting
2.5 THT Development Update
The first sub boards will be in April with joint chairing arrangements rather than predominantly CCG. There will be a transitional period for the new THT Board arrangements to become active (until June 2017)
2.6 TST Update
There was a discussion about future positioning of TST in the context of STP, and accountable care developments. Simon Hall outlined that the need for a joint approach to Barts Health remained, but that this would be kept under review. The existing TST Programme needs to focus now firmly on delivery.
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2.7 29 March Joint WEL CCG Session
This has now been developed and Simon is meeting with the Chairs and Chief Officers to agree the final agenda.
2.8 GB Seminar 5th April 17
Ellie has blocked out some time to include CHS implementation which will include what we expect to be delivered in the CHS contract, the service model and service development plan, outcome within contract, contract structure, alliance management arrangements, along with the role of the Care Group and CCG. Josh will look at putting this information together. ACTION:
Josh to put together a presentation on CHS implementation
2.9 CHC/Joint Packages Review
In 2016/17 a project to review all joint care packages for adults was undertaken, funded via the Vanguard. Progress has been slower than expected as there were no agreed criteria in place, and it has taken longer than hoped to get many of the re-assessments undertaken. The business case proposed was for the short term continuation of the interim post, in order to finish the adults work and to make a start on the review of children’s joint care packages. This will include getting robust criteria jointly agreed between us and LBTH. The proposal has the support of the joint commissioning Executive and was supported by the Executive committee. ACTION:
Take forward the business case, ensuring it is in line with our revised interim policy
3. Governance
3.1 IG Update
It was confirmed that the CCG need a mobile working policy. Mandatory training at 92% so any outstanding courses please complete. We are using the OD session next week to hold mandatory training sessions. No SIRI level 2 IG incidents in 2016/17. Any contracts not managed by CSU please let Justin Phillips know by 31st March.
AOB
There are governance issues with the Discovery Board and agreement of £55,000 was agreed through the Joint Management Team, but this does not appear to have been reflected in budget setting discussions. Richard Quinton will check through with the Finance Team to make sure there are no similar agreements. Finally, huge thanks were given to Jackie Brown as this is her last Executive Committee she leaves the CCG on Friday.
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Enclosure
Paper
Minutes of Audit Committee Meeting
Tuesday 17th January 2017, 14.00 to 16.00 The Archive Library, Bancroft Road
1 General Business
Welcome, introductions and apologies
Present
Name Role Organisation
Mariette Davis (Chair) Governing Body Lay NHS THCCG Member - Governance Tan Vandal Governing Body Member - NHS THCCG Secondary Care Doctor Noah Curthoys Governing Body Lay NHS THCGG Member – Corporate Affairs
In attendance
Name Role Organisation
Henry Black Chief Finance Officer NHS THCCG John Elbake Internal Auditor RSM Justin Phillips Governance Manager NHS THCCG Jack Stapleton External Auditor KPMG Sophia Beckingham Governance Officer NHS THCCG (minutes) Neil Thomas Partner KPMG Andrea Antoine Deputy Chief Finance Officer NHS THCCG Gemma Higginson Counter Fraud NHS THCCG Josh Potter Director of Commissioning NHS THCCG
Apologies
Name Role Organisation
Simon Hall Acting Chief Officer NHS THCCG Jackie Brown Acting Chief Finance Officer NHS THCCG
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1.1 Welcome and introductions
Mariette Davis (MD) welcomed members and attendees to the meeting. Apologies were noted and MD declared the meeting as quorate.
1.2 Declarations of interest
There were no declarations of interest in relation to items on Part I of the agenda. However, it was noted that there is a Part II agenda item for which the auditors are directly conflicted in regards to internal auditor appointment procurement. This agenda item has not been shared with the Auditors and will be discussed under Part II without the auditors present.
1.3.1 Minutes and matters arising of previous meetings
The minutes for the 11th October 2017 Audit Committee were declared as accurate.
MD reviewed the Matters Arising from the previous January meeting. Justin Phillips (JP) informed the Audit Committee that the actions regarding PMO have been superseded by the work regarding Tower Hamlets Together, where the PMO office and transformation board will be merged with THT structure. JP informed the Audit Committee that the CCG’s Corporate Affairs team are encouraging all staff and office holders to complete their mandatory training including Information Governance. MD noted that there have been issues with the training platform and Ellie Hobart (EH) has been liaising with NEL CSU to remedy these issues.
JP informed the Audit Committee that changes to the Constitution have been paused in order to reflect the recent work being conducted explored regarding new models of working including ‘Accountable Care systems’.
2 External Audit
2.1 & 2.2 External Audit Progress Report and Annual Audit Plan
Neil Thomas (Partner, KPMG) presented the report, asking the Audit Committee to note the work KPMG had conducted since the last Audit Committee on 11 October 2016. KPMG have completed their planning for the 16/17 audit; produced a draft Audit Plan for 2016/17 and prepared a technical update which was presented for information.
NT outlined the work planned to be completed in time for the March Audit Committee which will include a review and evaluation of the control environment, as well as detailed testing to supplement that which KPMG will undertake at year end on the financial statements. This will include month 9 income and expenditure testing and testing over the significant audit opinion risks and confirmed logistics for the external audit final accounts visit with both the CCG and NEL CSU. Leads from KPMG have met with senior officers from the CCG to ensure that KPMG are kept informed of how the CCG is responding to the current challenges it faces including the delivery of the financial plan for 2016-17.
NT presented the progress report including the external audit plan and the technical update, noting that the paper sets out summary scope of work, timeline and areas of focus for the CCG and KPMG, informing the Committee that there are no new significant changes in
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accounting guidance in terms of reporting requirements and no significant change in deadlines for the CCG to take into account.
NT presented the key elements of the financial statements audit approach, and asked the Audit Committee to note detail in the report outlining changes to reporting including materiality, areas affecting financial statements in light of the STP and control totals and industry context and accounting guidance. NT noted that there are additional pressures on management within the healthcare system and these are taken into account when KPMG conduct their audits. It was noted that the second year of Primary Care Co-commissioning should result in a smoother process than previously and in terms of the KPMG scope, this should be managed through routine business. MD noted a discrepancy in the report, noting that on the Primary Care Co- commissioning Committee, the voting GP is independent and MD asked for this to be updated.
NT noted the effects that the STP process has had on the CCG, with the STP direction likely to influence future investments and impact financial resilience. Primary Care Co- Commissioning is an area of perceived continued vigilance for governance arrangements (especially in regard to Conflict of Interests) which the CCG needs to continue to assure itself. NT noted that the financial improvement plans in NHS Barts Health still present significant risks.
In light of the audit plan that had been presented, NT outlined the KPMG fees that would encompass the work, noting that KPGM are proposing a flat fee with an additional fee request for extra work. Work with the CCG will continue to agree this after confirmation of interim work.
Action:
. KPMG revise the note regarding the independent GP on the Primary Care Co- commissioning Committee.
Subject to the change in the report regarding the independent voting GP, the Audit Committee APPROVED the report.
2.4 External Audit Appointment
Henry Black (HB) notified the Audit Committee that the CCG appointed KPMG LLP as its local external auditor. The appointment is a collaboration between the Waltham Forest, East London and City (WEL) and North Central London (NCL) CCGs and the contract, valued at £636,750, will be split between the commissioning groups. The appointment will last for three years, beginning on 1 April 2017 and ending on 31 March 2020.
MD congratulated KPMG on their appointment and noted that the CCG looked forward to continue to work with them in the future.
The Audit Committee NOTED the appointment.
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3 Governance
3.1 Sustainability and Transformation Plan (STP) Governance Update
HB gave a verbal update to the Audit Committee regarding the Sustainability and Transformation Plan (STP) Governance, informing the committee that working groups had been conducting sessions in mind to inform the Memorandum of Understanding between CCGs and the STP. HB asked the Audit Committee to note that no formal decision making authority has been delegated from the CCGs to the STP, and the MOU is designed to describe a way of working for multiple organisations to come together and ensure they deliver the requirements being asked of them in the current healthcare climate, whilst also assuring and maintaining the statutory responsibilities of the CCGs involved. The MOU has been submitted to the THCCG Governing Body as part of the January Part I meeting which will allow Governing Body members to scrutinise the MOU and provide Jane Milligan (Executive Officer for NEL STP) recommendations.
The Audit Committee NOTED the verbal update.
3.2 Tower Hamlets Together (THT) Update
Josh Potter (JPO) presented the THT report in place of Simon Hall, who gave his apologies, noting that the pack was presented to the Tower Hamlets Together (THT) board in a bid to move the THT partners towards solving various issues which had presented themselves as a result of transformation clashes and duplication across the healthcare system in Tower Hamlets. JPO felt that it had become clear that in order to create the desired healthcare outcomes by multiple organisations across the borough, a single strategy needed to be developed. Many areas nationally were pursuing accountable care systems and THT and the CCG have explored this way of working as a way to drive improvements in health and social work.
JPO explained that work has begun during phase one to research the existing THT governance and contrast and compare to the CCGs governance procedures; this has resulted in conversations regarding the CCG working towards using the same PMO format as THT, in the hope that any future amalgamation of the CCG’s and THT’s PMO process is smoother. JPO explained that during phase two, the CCG can make further changes to their governance to align with other organisations locally – this could result in the abolishment of the transformation board and create a merged THT board with delegation granted by the CCG. This would result in transformation priorities to be delivered in one place which should improve the ease of contact negotiations and help the system become more efficient. JPO noted that there will be further governance implications that the CCG Governing Body will need to deliberate (including the delegation of authority), and acknowledged that the CCG Governing Body will need assurance that the THT board has the experience, transparency and effectiveness in order to carry out this delegated authority effectively.
Justin Phillips (JP) updated the Audit Committee regarding the governance implications that would need to be deliberated and what the CCG will need to do to resemble the proposed organigram. JP informed the Audit Committee that there is feeling that the current THT board composition resembles a meeting of execs as opposed to a full board; this evaluation has led to the suggestion that there should be an assessment of board composition (including membership and independency); review of the TOR, and effective and agreed systems to management of the conflict of interests that are likely to arise.
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JP informed the Audit Committee that the CCG SMT have opted to retain decisions in a committee within our local governance structure, with advisory clinical input from the THT board – this is likely to be the first step into the direction of accountable care. All directorates have been asked to review potential the governance implications in their areas; this has resulted in the possible creation of a new Finance Committee will be discussed by GB members in a future OD session. Matters of business that will be delegated to this committee will be the reviewing of decisions/recommendations made by the THT board and reviewing the medium and longer term financial planning of the CCG. By March, it is intended the Governing Body will be presented with the sign off for delegation to the new Finance Committee. MD queried if the new Finance Committee would supersede the Finance, Performance and Quality committee. JP explained that this would be an additional committee that will focus on medium term financial issues and the affordability of the decisions made by the THT board. HB elaborated further, explaining that the Transformation Board oversees the portfolio of investments and receives the business cases from various clinical boards. Currently, the transformation board has the dual function of checking affordability and clinical benefit – HB explained that this would be improved if reviewed in the provider/THT environment with the decision of affordability kept within the CCG. HB explained that THT cannot be decision makers using money of which they are not accountable for, resulting in the creation of the new Finance Committee.
MD requested that Simon Hall attends the next Audit Committee in order to provide an Accountable Care Governance update, regarding the governance implications that accountable care systems and THT developments will have on the CCG.
Action:
. SH to provide an Accountable Care Governance update at the next audit Committee.
The Audit Committee NOTED the update.
3.3 Board Assurance Framework
JP introduced the Board Assurance Framework, noting that the BAF was revised following discussions with respective Executive Lead committees and risk management leads during the months of November 2016 – January 2017.
JP noted that minor changes had been made to the controls and assurances within the BAF, noting in particular Risk 1.1 which relates to the position at the Royal London Hospital – their CQC rating has moved from ‘Special Measures’ to ‘Requires Improvement’. A quality summit is taking place in order to support the Royal London Hospital to move towards a better rating. Risk 1.3 was updated in light of successful recruitment to the posts of Safeguarding Nurse, therefore resulting in a reduced risk rating. Jackie Brown (JB) had reviewed the financial risks within the BAF, adding that there are additional gaps in the adverse financial position in Barts Health – JB also felt that the CCG needs a greater oversight over the work that TST is conducting.
JP felt that the CCG had moved forward with risk 4.2 regarding managing conflicts of interest, including the work the governance team have under taken to embed the new statutory guidelines. JP noted that an internal audit will take place regarding the CCG’s conflict of
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interest processes in the coming weeks, the result of which will be reported back to the March Audit Committee with recommendations.
NC noted that the BAF was much improved and MD thanked the governance team for their work on the BAF.
The Audit Committee NOTED the BAF.
3.4 Conflicts of Interest
JP introduced an update on Conflicts of Interest within the CCG, noting that the governance team have been working to embed the new guidelines and polices introduced by NHSE and THCCG in the recent months. The policies were ratified by the Governing Body after extensive staff, committee and auditor engagement. Conflicts of Interest will be a standing agenda item on the Audit Committee agenda.
JP introduced a current potential conflict regarding a Victoria Tzortziou Brown who is the CCG clinical lead for MSK. VTB is also working within the MSK service as a clinician conducting several sessions per week. It was explained that a potential conflict arises as this GB member also sits on the Service Performance Review. The Committee advised Victoria Tzortziou Brown to step down from this role on the SPR.
JP informed the Audit Committee that the conflict of interest submissions for quarterly reviews to NHSE had been completed. The annual submission to NHSE requires a more comprehensive review of processes, of which JP will bring back to Audit Committee for scrutiny before NHSE publish their findings on My NHS.
The Audit Committee NOTED the Conflict of Interest Update.
3.5 London Digital Mental Wellbeing Pilot Programme
JPO presented the London Digital Mental Health Wellbeing Pilot Programme report, giving an overview of the intended outcomes and current funding model.
JPO explained that due to the adaptive way that the service has evolved, this has resulted in an unspecific service specification - this can result in difficulties in procurement as procurement takes place in small pieces as the projects adapts and grows to the needs identified. JPO noted that a stakeholder event is taking place in February, consisting on the CCGs and Councils who are involved in the project. JPO explained that the CCG will look at longer term procurement during autumn 2017 and update on project and plan going forward at this time.
NC queried data protection issues due to the collation of intelligence based on people’s internet usage and possible holding of such data with a provider. JPO acknowledged this, stating that he had been advised that the data is not individualised and that no trackers of PID involved – the collation of data works on a broad level for the population. JPO assured the Audit Committee there is a tight working group who view data protection issues as a key area of focus and work to ensure patient confidentiality.
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MD queried if the service would fuel demand due to easier access to services. JPO explained that the work is preventative and the working group will look at tracking the self-referrals to IAPT services to ensure that levels are maintained. It is possible that this service could increase referrals but decrease the strain on services in other areas. JPO explained that ELFT have supported the initial scoping and many organisations have shown interest.
The Audit Committee NOTED the update.
3.6 Audit Chairs’ Report to the Governing Body
JP commented that the draft report should have been drafted by the interim Governance Managers. MD confirmed that no such report had been written during the interim time period. JP confirmed he would produce a draft report for the following Audit Committee.
4 Internal Audit
4.1 Progress Reports
John Elbake (JE) introduced the RSM progress report, summarising the updates on the work carried out and progress in delivery against the CCG IA plan. JE informed the Audit Committee that RSM have issued three final reports relating to Procurement and Contracting with Partial Assurance, Primary Care Delegated Commissioning and Contract Management with Partial Assurance and Budget Setting, Budgetary Control and Financial Reporting with Substantial Assurance.
MD noted the partial insurance for recent audits and expressed disappointment. JE explained that robust processes do exist within the CCG but that changes in governance management has affected the consistency of which governance processes are applied. JE noted that the CCG has updated processes to reflect gaps identified in the reports.
MD queried what mitigations are now in place to prevent errors on the waiver register and asked for assurance that payment was not made incorrectly. JP stated that the correct waiver was signed off by the CFO and therefore there was no overspend and new controls are in place to help mitigate human error and noted the work that has been done to improve the waiver process.
MD noted that procurement working group has been disbanded which has affected the oversight of the waiver register and the procurement tracker. Simon Hall has asked for this to be agenda item for SMT in order to discuss appropriate ownership and ensure the trackers are having airtime at a committee of the board.
JE informed the Audit Committee that the internal audit plan/three year strategy plan is in progression and JE has met with Andrea Antoine (AA) to address topics and issues for inclusion. MD noted that it was key to have a governance review, especially in light of changes in THT and the new committees. JP noted that a few months are needed to tidy existing governance procedures after a lengthy period during which TH had had interim governance managers and AA noted that June would be a good month for this to take place. JE will present the Audit Plan in March to the Audit Committee for approval.
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JE presented the CSU Quality and Performance 2016/17 update. MD queried the ownership of liaison between the CCG and the CSU - AA outlined the CSU contracting arrangements with the CCG, noting that she is the finance lead for the CSU service level agreements. During the last SMT AA took a service specification regarding the CSU and is now working to align these to the requirements that each directorate need. MD felt that it was important for the Audit Committee to see an update on the deliverables of the CSU and the depth and quality of the service that the CCG is receiving.
Action:
. AA to update on the deliverables of the CSU and the depth and quality of the service that the CCG is receiving.
The Audit Committee NOTED the report.
4.2 LCFS Update
GH informed that the Audit Committee that there are currently no counter fraud issues that the Audit Committee needed to have sight of.
The Audit Committee NOTED the LCFS report.
5 Finance
5.1 Annual Reports and Accounts Process 2016/17
The committee reviewed and noted the timelines for the annual accounts and process for 2016/17, including the arrangement of meetings with Jane Milligan and Henry Black sign-off.
Action:
. JP/SB to arrange May Audit Committee meetings.
5.2 Strategic Finance Update
HB gave a verbal update regarding the year end positon, stating that the CCG has a requirement to set aside a 1% surplus in uncommitted in reserves and the CCG are on track to deliver.
Multiple discussions are being held at STP level to cover the Barking, Havering and Redbridge financial position and what measures can be taken to bring financial balance the system. A paper will be presented at the next Governing Body meeting regarding the detail of the future financial outlook and the Barking, Havering and Redbridge (BHR) financial position.
NC queried what risks this will have against THCCGs surpluses and if the surpluses will be removed permanently. HB explained that this is not the case – given the climate the CCG is in with future risk share the likelihood is that the surplus will not be used to support another organisation directly.
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5.3 PAYE Guidance – Interims in the NHS
HB introduced the update regarding the IR35 PAYE Guidance in light of Jackie Brown’s apologies. HB outlined the changes that are due to be implemented by HMRC in April 2017. The CCG have written to its current interims noting this and have informed them that they will be required to join an agency or alternatively sign a fixed term contract with the CCG. There is a possibility that the CCG will be liable for more tax and the finance team have worked to mitigate this via the new Interim Policy and the communications to interim workers. Budget holders within the CCG have also been asked to review their team members in light of the new implications of the HMRC guidance.
HB stated that another change in the guidance that is also applicable to the CCG is the change to the business case process for interims that is required to be sent to NHSE. If an interim stands to earn above £600 pounds per day, approval will need to be sought from the CCG’s local DCO. If the interim stands to earn over £800 pounds per day, then approval must be given by David Slegg and over £900 PPD approval required by Paul Simon. HB assured the Audit Committee that risks had been effectively mitigated and the CCG will be fully compliant with the guidelines issued.
The Audit Committee NOTED the update.
5.4 Waivers
HB presented the waivers report (Oct 2016 – Jan 2017). MD highlighted that there were various waivers for the Vanguard project and queried the reasoning behind this. HB explained that THCCG act as intermediary between Vanguard and NHSE and the CCG holds the Vanguard monies as such. As this money is pre-awarded and is not THCCG money, it cannot be used for procurement, nor can any Vanguard invoices be paid with a PO process. Due to the stringent THCCG procurement policies, this means that Vanguard can only be paid via a waiver and therefore appear on the report, although they are not ‘true waivers’ paid from the CCG allocation.
MD requested an update at a future Audit Committee in order to further review the intricacies of the use of waivering quotation exercise and tendering processes.
The Audit Committee NOTED the update and the new waiver form.
Actions:
. CFO to update in the next Audit Committee in order to further explain the intricacies of the use of waivers for Vanguard monies and other procurement issues.
7 AOB
No AOB to note.
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Tower Hamlets CCG Transformation Board Tuesday 11th April 2017 12.30 – 14.30pm 2nd Floor CCG Meeting Room, Alderney Building MEH, E1 4DG
Julia Slay (JS) ‐ Chair, Isabel Hodkinson (IH), Judith Littlejohn (JL), Victoria Tzortziou‐Brown (VTB), Rachel Attendees Perry (RP), Maggie Buckell (MB), Josh Potter (JP), Noah Curthoys (NC), Tracey Price (TP) Dennise Radley (DR), Somen Banerjee, Sam Everington (SE), Simon Hall (SH) Anwar Miah (AM), Andrea Apologies Antoine (AA) Archna Mathur (AM) and Finbarr Hanna (FH)
Minutes: No Item Lead 1 Welcome, introductions and apologies. JS Introductions were made and apologies noted.
2 Declarations of Interest All No new declarations were made.
3 Review of Previous Minutes / Actions All The previous minutes were reviewed and accepted.
4 Financial recovery/additional QIPP programme It was stated that there was an £8.188m deficit in the QIPP budget which has been reduced to £1.1m following an extensive review. Following discussion with relevant teams, the remaining budget deficit has been allocated out against areas where it felt additional savings could be made. There is a need for the budget to breakeven and achieve a surplus. It was noted that in 2016/17 a surplus was achieved. The budget has been signed off and it was noted important that the budget remains balanced as reserves will not be available. Strong control mechanisms are in place to ensure the budget does not go into deficit. No funding will be agreed unless the budget has been identified and cost implications are clear.
5 Development of CI/QIPP schemes for 2017/18 (March OP submission) JP stated there is a £20m QIPP programme to achieve and explained the additional QIPP opportunities identified. The group were invited to feedback on the areas identified and how clinical leadership can be developed in the schemes. The schemes have been categorised into different areas: Technical: E.g. savings on tariff costs/ elective care thresholds; Running costs: E.g. savings due to delays in recruitment; Budget review: E.g. may or may not have budget allocated; Transformation/ pathway development: E.g. bringing forward existing plans such as delivery of the urgent care re‐design programme. In other areas new pathway re‐design work has been identified including ophthalmology and ENT; Policy changes
There are a number of schemes where savings have been identified and figures have been risk adjusted to ensure deliverability. There are some schemes that have not been included in the 2017/18 QIPP but with further development these schemes could deliver savings in 2018/19.
Discussions have taken place with the council regarding jointly managed schemes. It is likely that there further discussion will need to take place at the Health and Wellbeing Board and Overview and Scrutiny Committee.
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It was noted that there will be a cost pressure with increased registration of patients in primary care. This is taking into account demographic growth and initiatives to increase GP registration. The primary care allocation is fixed and takes approximately 18 months to register an increase in national statistics. It was noted that contingency funding might be required for both primary care and acute services.
The next steps are for SMT leads to be identified and project plans to be amended or developed through the relevant programme board structure. Any variations to contract will need to be approved. There will be a rolling programme throughout the year to review and identify new opportunities.
For decision – complex adults programme 6 Dressing optimisation scheme outline business case Angela Fernandes and Raana Ali presented the outline business case for dressing optimisation with a request to provide an uplift to the contract with Accelerate CIC.
Since 2011 Tower Hamlets CCG have commissioned a Dressings Optimisation Scheme (DOS) from Accelerate CIC. Under the scheme, the service takes ownership and responsibility for dressings in Tower Hamlets to ensure effective use of resources in the management and prevention of wounds and chronic oedema. The scheme aims to: Reduce the waste of unused dressings; Provide quicker access to dressings; Standardise practice including that of infection control Improve patient care; Making significant financial savings.
Ordinarily this budget would sit with the prescribing team and the CCG would absorb the full impact of any overspend. Currently, Accelerate CIC assumes responsibility for this prescribing spend for this highly specialist area of wounds and chronic oedema.
The contract includes a gain share arrangement for this service. Under this arrangement the first £20,000 of any savings go to Accelerate CIC to cover their management of this arrangement. Thereafter any savings are split 50:50 between Accelerate and the commissioner. Accelerate bears the risk of any overspend.
The budget for the service has not been increased for a number of years and Accelerate have highlighted concerns that they cannot continue to provide the service within the existing budget. For 2016/17 the budget is currently overspent. It has therefore been requested that:
The overall budget for the service is increased by £54,300; The contract is amended so that the first £30,000 of savings go to the provider to cover increased management costs (£10,000 increase as previously set at £20,000 – this is included in the total request of £54,300); The risk is amended so that the risk is shared 50:50 between provider and commissioner going forward; A formal budget review process is put in place for 2017/18 and the reminder of the contract term.
It was noted that Accelerate have recently entered an arrangement with City & Hackney although the details are unknown. There were some questions raised concerning this. Other points noted at the meeting include:
This important service with the provider taking responsibility in using and managing dressings. The structure of the contract to be reviewed to factor in growth and efficiencies year on year The role and interface with Community Nursing and this scheme was discussed. It was noted important not to de‐skill or change the responsibilities of Community Nursing
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It agreed beneficial to link this scheme with the CHS Alliance Board.
AGREED: The Transformation Board agreed to the investment request of £54,300 but not to the proposed changes in the risk share arrangements (i.e. the risk is not to be shared 50:50 between the provider and commissioner if costs escalate above the agreed budget).
7 TH CCG / THT governance alignment A discussion took place on plans to align the governance of TH CCG and THT to a single PMO arrangement. Work has been undertaken on commissioning intentions and the constitution with further work to be done looking at the governance arrangements. Programme boards are meeting to develop shared understanding on how schemes will be delivered. There will be a single line of reporting and monitoring to the THT board from July 2017. The council have been involved with discussions and final programme structure is being agreed with the providers. The Transformation Board will cease once the new joint board commences in July. Any CCG investments will be approved by the new strategic finance and investment committee.
ACTION: It was agreed that Louise Phillips would circulate an update on the arrangements for the new THT board including terms of reference and membership.
8 Highlight Reports – For Information All The highlight reports were noted.
9 AOB All No additional items were raised.
Date of next meeting: 9th May 2017 at 12.30 – 14.30 hours, 2nd floor CCG meeting room MEH
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