AGENDA NHS Leeds CCG Governing Body Meeting

Date: Wednesday 25 November 2020 Time: 14:00 – 17:00 Venue: Microsoft Teams

Please note: agenda timings are approximate Item Description Lead Paper Time GB Welcome and Apologies Chair N 14:00 20/82 Purpose: To record apologies for absence and confirm the meeting is quorate.

GB Declarations of Interest Chair Y 20/83 Purpose: To record any Declarations of Interest relating to items on the agenda:

a) Financial Interest Where an individual may get direct financial benefit from the consequences of a decision they are involved in making;

b) Non-Financial professional interest Where an individual may obtain a non-financial professional benefit from the consequences of a decision they are involved in making;

c) Non-financial personal interest Where an individual may benefit personally in ways that are not directly linked to their professional career and do not give rise to a direct financial benefit, because of the decisions they are involved in making; and

d) Indirect Interests Where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making.

GB Questions from Members of the Public Chair N 14:05 20/84 Purpose: To receive questions from members of the public

GB Minutes of the Governing Body Meeting and the Annual Chair Y 14:10 20/85 General Meeting held on 23 September 2020

Purpose: To receive the minutes for approval

GB Matters Arising Chair N 20/86

Item Description Lead Paper Time Purpose: To consider any matters arising that are not considered elsewhere on the agenda

GB Action Log Chair Y 20/87 Purpose: To review the outstanding actions

CHIEF EXECUTIVE’S REPORT GB Chief Executive’s Report Tim Ryley Y 14:20 20/88 Purpose: To receive a report from the Chief Executive, including an update on the current position relating to COVID- 19

GB Winter Planning & Impact of Covid-19 Helen Lewis Y 14:40 20/89 Purpose: To receive an update on the current position

GB Financial Update Visseh Pejhan- Y 15:00 20/90 Sykes a) Financial Plan for 20-21

Purpose: To receive an update on the current financial plan

b) Financial Position – Month 7

Purpose: To receive the finance report for information

RISK GB Corporate Risk Register Sabrina Y 15:20 20/91 Armstrong Purpose: To receive the corporate risks for review

GB Governing Body Assurance Framework Sabrina Y 20/92 Armstrong Purpose: To receive the Governing Body Assurance Framework for review

BREAK FOR 5 MINUTES STRATEGY GB People & OD Strategy Refresh Sabrina Y 15:40 20/93 Armstrong Purpose: To receive an update and approve the updated version

COMMITTEE CHAIRS SUMMARIES GB Primary Care Commissioning Committee – 7 October Sam Senior Y 15:55 20/94 2020

Purpose: To receive the summary for information and assurance

GB Remuneration & Nomination Committee – 14 October Sam Senior Y 20/95 2020

Item Description Lead Paper Time Purpose: To receive the summary for information and assurance

GB a) Audit Committee – 18 November 2020 Cheryl Hobson Y 20/96 Purpose: To receive the summary for information and assurance and approve the recommendations

b) Auditor Panel – 18 November 2020

Purpose: To receive the summary for information and assurance and approve the recommendations

GB Quality & Performance Committee – 11 November 2020 Phil Ayres Y 20/97 Purpose: To receive the summary for information and assurance COMMISSIONING & FINANCE GB Integrated Quality & Performance Report Helen Lewis Y 16:10 20/98 Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee

GOVERNANCE GB Policy Approval 20/99 a) Conflicts of Interest and Standards of Business Sabrina Y 16:20 Conduct Policies Armstrong

Purpose: To receive the policies for approval

b) Pharmaceutical and Related Industries Joint Working Simon Stockill Policy Presented by Sally Bower Purpose: To receive the policies for approval

GB Forward Work Programme 2020/21 Chair Y 16:30 20/100 Purpose: To receive the forward work programme for 2020/21

GB Any Other Business Chair N 20/101 Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest" Confidential Section - Held in private GB Confidential Minutes of the Governing Body held on 23 Chair Y 16:35 20/102 September 2020

Purpose: To receive the minutes for approval

GB Ratification of Lay Member Appointment Chair N 16:40 20/103

Item Description Lead Paper Time Purpose: To ratify the lay member appointment

GB Recommendations from Remuneration & Nomination Y 16:50 20/104 Committee

a) Recommendation from Remuneration & Chair Nomination Committee – Non-Executive

b) Recommendation from Remuneration & Nomination Committee – Executive Sam Senior

Purpose: To approve the recommendation from the Remuneration & Nomination Committee

Dates of Future Meetings:  27 January 2021  24 March 2021 ITEMS FOR INFORMATION IFI1. Minutes of the West Yorkshire & Harrogate Joint Chair Y N/A Committee – 20 July 2020

Purpose: To receive the minutes for information IFI2. Summary of Key Decisions – West Yorkshire & Harrogate Chair Y N/A Joint Committee – 6 October 2020

Purpose: To receive the key decisions for information

NHS Leeds CCG Governing Body Meeting - 25 November 2020 Declarations of Interest Title Name Job Title Role Practice B Declared Interest- (Name of the organisation and Type of Interest Is the interest Interest From Interest Until Action Taken to Mitigate Risk (where applicable) Code nature of business) direct or (Practice indirect? Only) Angela Collins Lay Member for Patient and Governing Body Member N/A Nil Declaration Public Participation Dr Ben Browning Member Representative Governing Body Member B86020 GP Partner at Lofthouse Surgery Financial Interests Direct 01/02/2019 01/04/2020 Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Shareholder in Leodis Care Ltd (now dormant) Financial Interests Direct 01/01/2011 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Member of Leodis Care LLP (Shell Company) Financial Interests Direct 01/01/2011 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Spouse is a Salaried GP Indirect Interests Indirect 01/01/2019 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Spouse is city-wide lead for Disability Services (NHS Indirect Interests Indirect 01/01/2015 Ongoing Declare any potential or perceived conflict of Leeds CCG) interest at relevant meetings/workshops

Cheryl Hobson Lay member, Audit & Governing Body Member N/A Member of South Yorkshire Joint Independent Audit Financial Interests Direct 01/12/2019 Ongoing Declare interest in any relevant agenda items Conflicts of Interest Committee for the Office of the Police and Crime and absent as appropriate Commissioner Cheryl Hobson Lay member, Audit & Governing Body Member N/A Contracted to provide online tutoring for HFMA on Financial Interests Direct 01/02/2019 Ongoing Declare interest in any relevant agenda items Conflicts of Interest Post Graduate Leadership and Financial Management and absent as appropriate qualifications Cheryl Hobson Lay member, Audit & Governing Body Member N/A Deputy Chair and Board Member, Chair of Finance and Non-Financial Personal Interests Direct 01/12/2018 Ongoing Declare interest in any relevant agenda items Conflicts of Interest Resources Committee and Member of Audit and absent as appropriate Committee for Wellspring Academy Trust which has academies across Yorkshire and the Humber including in Leeds. Voluntary, unremunerated role.

Cheryl Hobson Lay member, Audit & Governing Body Member N/A Sibling is a Non-Executive Director at Barnsley Hospital Indirect Interests Indirect 04/11/2020 Ongoing Declare interest in any relevant agenda items Conflicts of Interest NHS FT and also contracted to provide interim and absent as appropriate financial support to Connect Healthcare Rotherham CIC Helen Lewis Interim Director of Acute Governing Body Member N/A Trustee, Leeds Jewish Welfare Board Non-Financial Personal Interests Direct 01/12/2017 Up to 9 year Declare any potential or perceived conflict of and Specialised term interest at relevant meetings/workshops Commissioning. Dr Jason Broch Clinical Chair Governing Body Member B86022 Partner at Oakwood Lane Medical Practice Financial Interests Direct 01/01/2006 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Director Jemjo Healthcare Ltd Financial Interests Direct 01/05/2007 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Spouse business Airtight International Ltd Indirect Interests Indirect 10/05/2012 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Spouse business Nails 17 Ltd Indirect Interests Indirect 10/05/2012 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Director Leeds Jewish free school Non-Financial Personal Interests Direct 16/01/2014 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Director/trustee Brodetsky Primary School Foundation Non-Financial Personal Interests Direct 17/06/2014 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Chair of Governor's Brodetsky Primary School Non-Financial Personal Interests Direct 01/09/2012 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Founding Fellow of the Faculty of Clinical Informatics Non-Financial Professional Interests Direct 01/05/2018 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Gartner UK - Clinical Advisor Financial Interests Direct 01/06/2018 01/05/2020 Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Calibre Care Partners Ltd OLMP is a member of this GP Financial Interests Direct 01/06/2018 Ongoing Declare any potential conflict/interest at federation, which is part of Leeds GP Confederation relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Shareholder / Director Chapeloak Services Ltd Financial Interests Direct 01/01/2019 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Leeds Acupuncture Clinic - father's and brother's Indirect Interests Indirect 10/05/2012 Ongoing Declare any potential conflict/interest at business relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Clinical Lead - Yorkshire & Humber Local Health & Care Financial Interests Direct 01/11/2018 Ongoing Declare any potential conflict/interest at record Exemplar, inc membership of NHSE Clinical relevant Governing Body/Committee Advisory Group meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Clinical Chair role, NHS Leeds CCG Financial Interests Direct 01/07/2020 Ongoing Was Assistant Clinical Chair between 1/4/2018-1/7/2020 Joanne Harding Executive Director of Governing Body Member N/A Joint Chair of the NHSCC National Nurses Forum Non-Financial Professional Interests Direct 01/07/2019 Ongoing Declare any conflict of interest at relevant Quality and meetings/workshops. Safety/Governing Body Nurse Dr Julianne Lyons GP Member Representative Governing Body Member B86110 GP Partner at Leeds Student Medical Practice Financial Interests Direct 01/01/2016 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Leeds Local Medical Committee Member Financial Interests Direct 01/09/2013 31/03/2020 Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse is a Director of Leeds Haematology Ltd Indirect Interests Indirect 01/05/2013 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse is a trustee of UK Myeloma Forum Indirect Interests Indirect 01/01/2013 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse is an employee of the University of Leeds Indirect Interests Indirect 01/01/2015 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 GP lead for Leeds Primary Care Workforce and Training Financial Interests Direct 01/05/2018 Ongoing Declare any potential conflict of interest at Hub Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse has an honorary contract with Leeds Teaching Indirect Interests Indirect 01/01/2015 Ongoing Declare any potential conflict of interest at Hospitals NHS Trust Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Shareholder of Leeds West Primary Care Limited Financial Interests Direct 01/10/2015 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 I am a member of LSMP and The Light PCN Financial Interests Direct 01/07/2019 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Daughter employee of Leeds Primary Care Workforce Indirect Interests Indirect 01/07/2019 Ongoing Declare any potential or perceived conflict of and Training Hub interest at relevant meetings/workshops.

Dr Keith Miller GP Member Representative Governing Body Member B86109 Spouse - Advanced Nurse Practitioner, LTHT Financial Interests Indirect 01/01/2008 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 *Expired* Financial Interests Direct 01/01/2010 31/08/2020 Declare any potential conflict of interest at GP Partner at Kirkstall Lane Medical Centre Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86033 GP Partner at Crossley Street Surgery Financial Interests Direct 01/09/2020 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 *Expired* Financial Interests Direct 20/05/2020 31/08/2020 Declare any potential conflict of interest at Temporary ad hoc role as Project Lead for Care Homes Governing Body/Board, sub committees and for Woodsley and Holt Park PCNs relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 NHS Leeds Clinical Commissioning Group – Member Financial Interests Direct 01/01/2018 Ongoing Declare any potential conflict of interest at Representative Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 Member of GP Confederation Non-Financial Professional Interests Direct 01/01/2018 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Phil Ayres Secondary Care Consultant Governing Body Member N/A Personal friendship with the Chief Executive of Leeds Indirect Interests Indirect 27/11/2019 Ongoing The action required to manage any conflicts and Chair of the Quality and Community Healthcare of interest will be agreed with the Chair of Pewrformance Committee the relevant meeting. In relation to the Quality and Performance Committee which I chair, the Deputy chair will be asked to agree any required actions. No confidential/sensitive information to be shared or discussed with the LCH Chief Executive.

Phil Ayres Governing Body Member Governing Body Member N/A I have personal friendships with GP of the Rawdon Indirect Interests Indirect 01/01/2017 Ongoing Maintain awareness of potential influence Surgery over decisions I may take as independent practitioner. Abide by GMC code of conduct. Declare this interest at relevantmeetings.

Sabrina Armstrong Director of Organisational Governing Body Member N/A Personal friendship with a non-executive director of Non-Financial Personal Interests Direct 01/05/2019 Ongoing Declare any potential or perceived conflict of Effectiveness Leeds Community Healthcare NHS Trust. interest at relevant meetings/workshops.

Sabrina Armstrong Director of Organisational Governing Body Member N/A Close friend works as Director of System Capability and Indirect Interests Indirect 01/01/2014 Ongoing Declare any potential or perceived conflict of Effectiveness Operations at NHS England. interest at relevant meetings/workshops.

Sabrina Armstrong Director of Organisational Governing Body Member N/A Pool member with NHS Interim Management and Non-Financial Professional Interests Direct 01/01/2014 Ongoing Declare any potential or perceived conflict of Effectiveness Support (NHS IMAS). interest at relevant meetings/workshops.

Samantha Ramsey Corporate Governance Band 8d and above or N/A Close friend works as an Advanced Health Indirect Interests Indirect 01/01/2014 Ongoing Declare any potential or perceived conflict of Manager Employee Decision Maker Improvement Specialist (Public Health) interest at relevant meetings/workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Lay Member for Primary Care Bassetlaw CCG Financial Interests Direct 01/09/2013 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Lay Representative National School of Healthcare Financial Interests Direct 01/05/2016 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning Science interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Lay Advisor Health Education England (West Midlands) Financial Interests Direct 01/05/2016 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Patient and Public Panel Member - National Institute Financial Interests Direct 01/04/2017 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning Health Research interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A *Expired* Non-Financial Personal Interests Direct 01/05/2013 18/05/2020 Declare any potential or perceived conflict of Care Co-Commissioning Chairperson - Brampton United Junior Football Club interest at relevant meetings/ workshops (S63 6BB) Sam Senior Lay Member for Primary Governing Body Member N/A *Expired* Non-Financial Professional Interests Direct 29/05/2019 10/08/2020 Declare any potential or perceived conflict of Care Co-Commissioning Independent Lay Member to Rotherham Federation interest at relevant meetings/ workshops Connect Healthcare Sam Senior Lay Member for Primary Governing Body Member N/A Volunteer for CortonWood Miners Welfare Scheme Non-Financial Personal Interests Direct 15/10/2019 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning (registered charity) interest at relevant meetings/ workshops

Dr Simon Stockill Medical Director Governing Body Member N/A Partner at Sleights and Sandsend Medical Practice, Financial Interests Direct 01/04/2016 Ongoing Declare any conflict or perceived conflict Whitby (Hambleton, Richmondshire & Whitby CCG) within context of any relevant meeting or project work Dr Simon Stockill Medical Director Governing Body Member N/A GP Appraiser, NHS England (Yorkshire & Humber) Financial Interests Direct 01/12/2013 Ongoing Declare any conflict or perceived conflict within context of any relevant meeting or project work Dr Simon Stockill Medical Director Governing Body Member N/A Clinical Lead for Quality Improvement, Royal College of Financial Interests Direct 01/09/2016 Ongoing Declare any conflict or perceived conflict GPs within context of any relevant meeting or project work Dr Simon Stockill Medical Director Governing Body Member N/A Clinical Director, Whitby Coast & Moors Primary Care Financial Interests Direct 01/07/2019 Ongoing Declare any conflict or perceived conflict Network within context of any relevant meeting or project work Tim Ryley Chief Executive Officer Governing Body Member N/A Spouse to carry out LeDeR reviews for the CCG which Indirect Interests Indirect 31/07/2020 Ongoing Exclude self from all conversations to do with is a financial benefit to her. LeDeR except pure performance in terms of numbers. Declare at any relevant meetings

Visseh Pejhan-Sykes Chief Finance Officer Governing Body Member N/A Niece works for CCG as Digital Communications Officer Indirect Interests Indirect 11/12/2017 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Draft Minutes NHS Leeds CCG – Governing Body Meeting Wednesday 23 September 2020 1.00pm – 4.00pm Microsoft Teams Virtual Meeting

Members Initials Role Present Apologies Dr Jason Broch (Chair) JB Clinical Chair  Dr Phil Ayres PA Secondary Care Specialist Doctor  Dr Ben Browning BB Member Representative  Angela Collins AC Lay Member – Patient & Public Involvement  Jo Harding JH Executive Director of Quality and Nursing  Dr Julianne Lyons JL Member Representative  Dr Keith Miller KM Member Representative  Visseh Pejhan-Sykes VPS Executive Director of Finance  Tim Ryley TR Chief Executive  Samantha Senior (Deputy SS Lay Member – Primary Care Co-  Chair) Commissioning Dr Simon Stockill SSt Medical Director  Additional Attendees Sabrina Armstrong SA Director of Organisational Effectiveness  Victoria Eaton VE Director of Public Health  HL Interim Director of Acute & Specialist  Helen Lewis Commissioning Laura Parsons LP Head of Corporate Governance & Risk  Sam Ramsey SR Corporate Governance Manager  RH  Rachel Howitt Head of Clinical Governance (item GB 20/61) BP  Dr Bryan Power Clinical Lead (item GB 20/65) JT  John Tatton Associate Director of Planning (item GB 20/66)

Members of public/staff observing - 0

No. Agenda Item Action GB Welcome and Apologies

20/55 JB welcomed everyone to the virtual Governing Body meeting.

No. Agenda Item Action

Apologies had been received from Phil Ayres and Sabrina Armstrong. The Chair confirmed the meeting was quorate.

GB Declarations of interest 20/56 Members were asked to raise any declarations of interest in relation to

agenda items.

No declarations were raised.

GB Questions from Members of the Public 20/57 No questions had been received.

GB Minutes from Previous Meetings 20/58 JB presented the minutes from the NHS Leeds Governing Body 22 July 2020 for approval.

The Governing Body: (a) approved the minutes of the NHS Leeds Governing Body held on 22 July 2020.

GB Matters Arising 20/59 There were no matters arising.

GB Action Log 20/60 The Governing Body reviewed the action log and noted that all actions were complete. The Council of Members meeting, in relation to action 20/40 was due to take place on 30 September 2020.

GB Patient Voice 20/61 The Governing Body received a presentation which provided detail of patient experience by those who use the Special Allocation Service (SAS) in Leeds. Members were informed that the service was a GP practice for registered patients in Leeds who have been asked to leave their own (usual) GP practice due to unsafe or inappropriate behaviour. It was acknowledged that this was not something that was used frequently and there were strict criteria and thresholds that must be reached in order for it to happen.

Two patient stories were presented, which outlined the difficult and complex reasons for removal, and highlighted the importance of safety, but that it was a difficult balance to meet. The importance of patient experience was recognised and the impact on patients. The stories provided important feedback that they had not understood what was happening at the time and explanations hadn’t been provided. Feedback had also been provided that once removed, patients had difficulties accessing and registering with the SAS.

No. Agenda Item Action Further engagement work had also been undertaken with other groups and services that supported patients who used the service. The overall responses had been positive and were satisfied with the care and support received. Following the engagement and feedback received, a patient information leaflet had been developed for practices to use to ensure there was not a gap between the removal and registration with the new service. In addition to this, a summary flow chart was being developed to support staff in understanding the policy. Further improvements were being considered and what could be learnt from the feedback provided. It was acknowledged that the changes may be small, but were significant.

Members recognised the importance of the service and that it provided continued service for those patients identified. It was also highlighted that it was important to consider the staff members affected within practices. A suggestion was made to link to the zero tolerance policy to indicate concerns about safety.

Members recognised the actions that had been taken as a result of the patient experience and highlighted the importance of using engagement to inform the decision making process.

Patient Experience & Complaints Annual Report The Patient Experience and Complaints Annual Report was presented for information. Members noted that the report had been discussed in detail at the Quality & Performance Committee and they had agreed full assurance that there were robust processes in place for the patient experience function in the CCG.

GB Chief Executive Report 20/62 An overview of the current Covid-19 situation was provided and it was acknowledged that it was a fast paced situation and that winter and reset was extremely challenging. As a city, Leeds had 88.3 per 100k people identified with Covid-19 and there had been a notable increase in hospital admissions. It was acknowledged that there would be a knock on consequence to the stabilisation and reset and as an organisation there was a need to consider how to manage the challenging targets and continue to support the health of the population.

The Director of Public Health provided a detailed overview of the situation in Leeds in relation to Covid-19. It was acknowledged that it was challenging to have a high rate of infection; however this reflected the national position. The highest proportion of cases was in the younger adults’ age group; however Leeds was seeing a rise across all ages.

Members were informed that the Health Inequalities framework would be launched and recognised the importance of the piece of work, but also the challenges in relation to investment discussions as a result of the knock on consequences of the wider challenges faced. The impact of Covid had been

No. Agenda Item Action considered alongside the launch of the framework and the subsequent impact on inequalities in relation to the restrictions made in light of Covid.

The Communications & Engagement report had been included and members were asked to receive the information as assurance that the CCG was delivering its statutory duties to ensure public involvement and consultation.

A query was raised in relation to the expectations from NHS England, where we currently are and where we predict to be in terms of the response to the pandemic as well as resuming elective activity. It was acknowledged that the impact of Covid-19 had affected the services undertaking elective surgery and if the situation deteriorated further, it would not be possible to deliver the targets set. It was noted that the situation was different for the second wave as the first wave resulted in the cancellation of all elective activity and services. Members recognised the hard work that was ongoing and the virtual work taking place. The system was prioritising clinically and maximising elective activity and would continue to do so whilst possible.

The Medical Director provided an overview of the current position within general practice and it was highlighted that there was increased demand with 11 practices reporting level 2, however it was manageable. There was a proactive system in place in terms of managing demand, as it was highlighted that contact levels in primary care were as high and now exceeding the levels pre Covid-19. The Primary Care Silver group were considering the BAME population and workforce to understand which practices had higher numbers and prioritising the business continuity plans within those practices. The response and support from the GP Confederation and Primary Care Commissioning teams to general practice was commended.

In relation to staff testing, members were informed that this had been extended to include symptomatic children of staff. Although there was further work to be done in terms of testing, it was acknowledged that the demand was being managed well.

Members were informed that in relation to care homes, the Silver and Bronze care home groups were actively meeting and considered intelligence form all care homes via the capacity tracker. There were good relationships with care homes and care home managers sat on the Silver and Bronze groups. It was recognised that test and trace continued to be a challenge; however the position in care homes was stable due to the hard work and systems that had been put into place. Members were informed that the care home Silver group had agreed to consider support to the wider social care sector and the home care sector. It was noted that in relation to the national guidance on care home visiting, a local approach was being considered in order for the decision to be taken on an individual basis to have a more ethical approach.

The Governing Body:

No. Agenda Item Action a) noted the contents of the CEO Report; and; b) received the communications and engagement update as assurance that the CCG is delivering its statutory duties to ensure public involvement and consultation.

GB Corporate Risk Register 20/63 The Corporate Risk Register was presented. Members were informed that there were two corporate (red) risks on the operational risk register. This was an increase from 1 to 2 red risks. Risk 548, Statutory Financial Duties had increased due to national planning principles not being received and the uncertainty in relation to current projections. It was noted that the risk would be reviewed and updated once the guidance had been received.

Members were informed that the risk relating to Information Security following the penetration testing would be lowered by March 2021 once the action plan had been implemented.

The high amber risk in relation to Shaping our Future was discussed and the potential impact on staff given the current circumstances and remote working.

The Governing Body: a) reviewed the corporate risks; b) reviewed the high scoring amber risk aligned to the Governing Body; and c) agreed that the controls and actions were effective and assurances were sufficiently robust.

GB Governing Body Assurance Framework 20/64 The Governing Body Assurance Framework (GBAF) was presented and it was noted that this had been reviewed and risk descriptions had been updated following feedback from the previous meeting.

It was noted that no scores had been changed, and additional controls had been added where required. Members were informed that a deep dive of Risk 4 (failure to overcome local and national workforce shortages) had been presented to the Audit Committee on 16 September 2020 and the Committee had been assured regarding the governance arrangements.

The Chief Executive highlighted the impact of Covid on service delivery and that this could increase the risk level to the organisation. It was noted that the position was changing rapidly in Leeds and there was a timing issue with the paperwork but it was important to note the increasing risk.

The Governing Body: a) reviewed the Governing Body Assurance Framework; b) considered the controls and assurances; and c) noted the review and assurance processes.

No. Agenda Item Action

GB Covid-19 impact on provision of health services for non Covid 20/65 conditions BP presented with the key findings from the work stream ‘Covid 19 – Impact on the Provision of Healthcare services on non-covid conditions’. The work was undertaken to understand the healthcare of those whose care had been negatively impacted by the arrangements made to meet Covid-19 demands.

Members were informed that a multi-agency steering group had been set up

to shape and lead the work, including a strong clinical representation and representation from Healthwatch to ensure the patients were at the forefront. A hypothesis led approach was taken in developing the recommendations. There were 74 recommendations made through the hypothesis with 5 cross cutting themes. It was noted that the report had been divided into themes, quick wins and successes and the work would be taken forward through existing forums and partnerships.

Members found the report useful and comprehensive. A query was raised in relation to a focus on the increase in domestic violence and it was acknowledged that further work could be undertaken through the

recommendations to ensure this was included. The challenge of the timing of data was recognised within the timescales that the report had been produced.

A further query was raised in relation to more detail of the inclusion of care JH homes within the report and recommendations. Members were assured that there was detailed work ongoing within the care home scheme in practices and the report considered the frail population as a whole. It was agreed that the report would link directly with the health inequalities framework to identify the needs of those in care homes as a population cohort.

In relation to the cross cutting themes, a question was asked as to whether there were any implications for the CCG’s strategic commitments and whether these would require adapting. Members were assured that the work supported the development of the left shift blue print and Shaping our Future.

A query was raised in relation to whether the lessons learnt were being used in the current second wave and it was confirmed that the report had been discussed at the Stabilisation and Reset group and would be taken through individual forums and proactive work was already being undertaken in both primary care and through the Silver Care Home group.

The Governing Body expressed thanks to all those involved and highlighted the quality of the report and the effort that had been put into developing this piece of work. Members agreed that the report should be shared widely to promote the work that had been undertaken and that it was reflective of a good position in Leeds.

No. Agenda Item Action The Governing Body:

a) approved the Covid19 – impact on provision of health services for non-COVID Conditions report; and b) noted the recommendations within the report.

GB NHS Leeds CCG Green Plan 20/66 JT presented the NHS Leeds CCG Green Plan. The Governing Body was informed that NHS Organisations were required to publish a Green Plan that articulated their commitment to achieving national climate change/carbon reduction priorities along with the key actions that would be taken to ensure delivery.

Members were informed of three areas that would be measured - reducing the CCG’s direct impact on carbon, pollution and waste; commissioned services and a role in supporting sustainability; and partnership working. It was noted that the carbon reduction had been significant over the last 6 months due to Covid-19 and the number of staff working from home.

It was acknowledged that work was ongoing with partners in relation to the estates across the city and the wider role that the CCG had. Conversations were ongoing in relation to a system headquarters and how partners plan to work in the future. The need to invest in technology to maximise use when working from home was highlighted.

NHS Leeds CCG was described as small as an organisation in terms of carbon footprint, however there was a role in terms of commissioning services that could be utilised.

The role of digital and technology was discussed and the importance of the Leeds Informatics Board to consider the priorities across the city in terms of technology.

The Governing Body:

a) agreed the focus of the NHS Leeds CCG Green Plan; and b) approved the publication of the plan.

GB Committee Chair’s Summary – Primary Care Commissioning Committee 20/67 – 5 August 2020 Members were informed that the Committee had approved the branch closure at Adel following a robust discussion. Members had been assured that proper engagement had been completed and this had been reviewed and analysed.

The Governing Body: a) received the report.

No. Agenda Item Action GB Committee Chair’s Summary – Remuneration & Nomination Committee 20/68 – 29 July 2020 The report was presented and members were asked to note the further work that would be undertaken on the Workforce Race Equality Standard (WRES) and would be presented to a future Remuneration and Nomination Committee meeting.

The Governing Body: a) received the report.

GB Committee Chair’s Summary – Audit Committee – 16 September 2020 20/69 Members were informed that the Committee had received a deep dive of Risk 4 of the Governing Body Assurance Framework (relating to local and national workforce shortages) and were assured by the work that was being undertaken.

The Committee had noted the limited assurance in relation to penetration testing and an update would be provided with a more detailed discussion at the November Audit Committee. An update had been received from internal audit and it was noted that further resource would be allocated to considering personal health budgets.

The Governing Body: a) received the report.

GB Committee Chair’s Summary – Quality & Performance Committee – 09 20/70 September 2020 The Governing Body received the report for information and the focus on annual reports at the Committee was highlighted.

The Governing Body: a) received the report.

GB Integrated Quality & Performance Committee 20/71 The Governing Body received an overview of current performance levels and noted the sustained activity in primary care in relation to learning disability assessments. Members were informed that cancer performance measures were back up to 95% for 2 week waits and it was acknowledged that the IQPR does not always reflect the targets that are being worked on.

A query was raised in relation to the Continuing Healthcare assessment backlog and the actions taken to address this. Members were assured that work was ongoing and as of 1 September, new patients had to be assessed within 6 weeks. It was noted that the performance target would be included in the next version of the IQPR in order to inform Governing Body members of the position.

No. Agenda Item Action The Governing Body: a) received and reviewed the IQPR dashboards; discussed the information, and noted the current areas of underperformance and mitigating action.

GB Finance Update 20/72 The finance update was presented to members and it was noted that in line with the previous regime, retrospective top ups would be provided to bring organisations to breakeven where appropriate. Members were informed that there had been no increase to service changes as part of developments of commissioning and the commissioning budgets were currently unclear.

It was acknowledged that there was no financial issue for the first half of the financial year.

The Governing Body: a) considered the Month 5 financial position.

GB 2020-21 Operational Financial Planning and Annual Budgets Update 20/73 The Governing Body was informed of the basis of the budget setting, and once further detail was known, it would return to the Governing Body. It was recognised that the position had changed since the report had been submitted as allocations had been received.

Members were informed that growth money planned in terms of new investments would be given to the ICS to oversee as a lump sum. Ordinarily the CCG would receive growth monies to spend on activity increase and investments; however the total figure would now be given to the ICS.

Conversations were ongoing with partners across the system and there was an assumption that any activity taken with independent providers would be paid centrally through a national contract. VPS highlighted ambiguity in terms of winter for hospices and the third sector. It was recognised that there were still large details to clarify.

Members discussed the affordability of activity within the acute sector and the risks associated with not doing so. It was highlighted that Leeds were considering the impacts and costs and consequences across the system. The increase in mental health demand was also recognised.

It was acknowledged that the risks were smaller than £30million and EMT would consider and present a sensible proposal to a future meeting once further work had been undertaken on the allocations. Members recognised the challenges, noted the position and welcomed the opportunity to inform thinking.

It was highlighted that discussion and decisions should take place in the public domain where possible but the Governing Body was mindful of

No. Agenda Item Action restrictions in terms of time and national direction. The Executive Management Team would focus on the needs of the population of Leeds and negotiate the best position for Leeds as a whole.

The Governing Body expressed thanks to the Chief Finance Officer for the ongoing hard work in relation to the financial position.

The Governing Body: a) noted the current position with the CCG financial plan for 2020-21; b) noted potential exposure to an anticipated financial risk (deficit) of c£30m for September to March 2021; and c) discussed and agreed that EMT would consider and present a sensible proposal to a future Governing Body meeting.

GB Any Qualified Provider Update Report 20/74 Members were informed that following the decision made in May 2020 at the Governing Body to offer direct financial support to AQP providers considered to be of local strategic importance for the recovery of services across the city, further guidance had been released. The Finance team had reviewed the position, considered the PPN 04/20 (Procurement Policy Note – Recovery and Transition from COVID-19) and proposed to continue the arrangement to the end of the financial year.

The Governing Body reaffirmed the decision taken to continue the revised contracting arrangements with providers beyond 31st October 2020, as per PPN 04/20 based on the current financial regime and pending the issue of updated financial planning guidance.

The Governing Body: a) noted the contents of this update report; and b) reaffirmed the decision taken in May 2020 to continue the revised contracting arrangements with providers beyond 31st October 2020, as per PPN 04/20 based on the current financial regime and pending the issue of updated financial planning guidance.

GB Governing Body Effectiveness 20/75 JB presented the report and it was highlighted that work had begun in terms of the recommendations from the survey and actions from the independent review of the Audit Committee.

It was acknowledged that there was a recommendation that the Audit Committee receives information in relation to all procurement waivers, rather than just those above the procurement thresholds. This would require an

amendment to the Committee’s terms of reference, Procurement Policy and Operational Scheme of Delegation. The Governing approved these amendments in line with the Constitution.

The Chair highlighted the importance of ensuring that the Governing Body

No. Agenda Item Action has leadership that was representative of the people of Leeds and that this was high on the agenda of the CCG.

The PWC report and actions, and the feedback from the internal effectiveness review would be considered with the new Audit Committee Chair once in post.

The Governing Body: a) received the report; b) considered the issues raised; and c) approved the minor amendments to the Audit Committee Terms of Reference, Procurement Policy and Operational Scheme of Delegation to confirm that all procurement waivers will be presented to the Audit Committee.

GB Forward Work Programme 2020/21 20/76 The Governing Body’s work programme was presented for information.

The Governing Body: a) received the forward work programme.

GB Any Other Business 20/77 No other business was raised.

The Governing Body resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

Date of next meeting: 25 November 2020

Approved and signed by:

Dr Jason Broch, Clinical Chair, NHS Leeds CCG

Date:

Minutes NHS Leeds CCG – Annual General Meeting (AGM) Wednesday 23 September 2020 16:15 – 17:30 Live Event, MS Teams (Virtual)

Attendees Initials Role Present Apologies Dr Jason Broch JB Clinical Chair  Tim Ryley TR Chief Executive Officer  Dr Ben Browning BB Member Representative  Angela Collins AC Lay Member – Patient & Public Involvement  Jo Harding JH Director of Nursing & Quality  Dr Julianne Lyons JL Member Representative  Dr Keith Miller KM Member Representative  Visseh Pejhan-Sykes VPS Chief Finance Officer  Samantha Senior SS Lay Member – Primary Care Co- 

Commissioning Dr Simon Stockill SSt Medical Director  HL Interim Director of Acute & Specialist  Helen Lewis Commissioning Dr Sarah Forbes SF Associate Medical Director  Victoria Eaton VE Director of Public Health  Sabrina Armstrong SA Director of Organisational Effectiveness  Dr Bryan Power BP Clinical Lead for Long Term Conditions  Becky Barwick RB Head of System Integration  Laura Parsons LP Head of Corporate Governance & Risk  Sam Ramsey SR Corporate Governance Manager  Cheryl Lee (minutes) CL Corporate Governance Officer  Members of the public/staff members observing – 21

Item. Notes Action Welcome & Introductions 1

Item. Notes Action Jason Broch (JB), Chair welcomed everyone to the meeting. JB thanked his predecessor, Gordon Sinclair for his time in the role of Clinical Chair. JB reflected on the previous year and sent thanks and well wishes to members of staff and lay members who had moved on to new roles or retired. Ian Cameron, previous Director of Public Health was thanked for his time and commitment and Victoria Eaton was welcomed to the role.

2 Review of Achievements 2019-2020

Tim Ryley (TR) provided an overview of NHS Leeds CCG for the previous year and highlighted key achievements for the year. These included:

Leeds mental wellbeing service launched in November 2019  5 year contract, worth up to £76m including new investment of up to £20m  Follows significant review of primary care mental health services for common mental ill health conditions  Gives people access to services depending on their needs such as Improving access to psychological therapies (IAPT), primary care mental health liaison and perinatal mental health support

Over £4.5 million investment to support GP practices with link workers  Investment in social prescribing makes a positive difference  Single citywide service run by community and voluntary organisations led by Community Links  Example: Foundry Lane Surgery in Seacroft: refers patients to 8 week art therapy course to help those experiencing a range of emotions including anger, low mood, depression or anxiety.

Leeds Cancer Programme  City-wide partnership strategy; core team embedded in the CCG  Leeds Teledermatology service for suspected skin cancer patients  Last year, 8,927 two week-wait skin referrals received by LTHT; 5,798 patients (65%) appointed to a Teledermatology Triage Clinic; all patients appointed to triage assessed within48 working hours

Key challenges were identified as:

Coronavirus • Struck in the last quarter of 2019-2020 • Rapidly developed new ways of working to provide safe care • Changes to how the CCG works

System / winter pressures • NHS experiences pressures every year; winter less challenging but pressure remains constant throughout the year

Item. Notes Action • System-wide initiatives to reduce delayed transfers of care taking effect; more to do to improve patient experience and outcomes • Good progress made on system flow

System integration (both challenge and success) • Leeds ‘Place’ • West Yorkshire and Harrogate Integrated Care Partnership

TR detailed the positive responses to the challenges faced including the adoption of new ways of working, improved technology, virtual meetings, system wide initiatives and the ever developing integrated and collaborative working across organisations.

3 Financial Review 2019-20

Visseh Pejhan-Sykes (VPS) presented a review of the finances of NHS Leeds CCG. VPS stated that the Leeds economy is worth £69 billion and 4 out of 5 NHS national offices are based here in Leeds including NHS England and NHS Digital. 196,000 people were employed within health and science in the public sector. VPS reported on how the CCG had spent the allocated funds:  £1.316 billion received  Half of this is spent on hospital care  Quarter is spent in primary care including prescribing  15% spent on Community Care and Care Homes  12% spent on Mental Health services  2% other areas

VPS presented the running costs of the CCG:  CCG – £17million allocation, of which £13 billion spent with the balance transferred to patient care.  From 2021, CCG running costs allocation will be reduced to £15 million, all underspend will be transferred to health services.

Key Financial Achievements: • Financial Balance – despite emerging pressures from COVID in March • High audit assurance – financial systems • Leeds Mental Health and Well Being Service • Keeping the NHS Operating during COVID

4 Adoption of Annual Report and Accounts 2019-20

JB presented the Annual Report and Accounts 2019-20 for adoption.

5 Covid-19

 Impact on the city

Item. Notes Action Victoria Eaton (VE) provided an overview of the current cases of Covid-19 in Leeds. VE explained there had been steep rises during late summer and September which is earlier than had been anticipated. The highest rates of infection were in 18-34 year olds but VE acknowledged that all age groups are seeing rising numbers of infection. VE discussed the impact being felt now along with the ongoing impact across the city including mental health, economic impacts and the interrupted care of chronic conditions.

 Impact on health services Bryan Power (BP) presented on a study carried out around Covid19 – impact on provision of health services for non-COVID Conditions, which had been commissioned by Health and Social Care Gold Command.

BP shared that people had rapidly adapted to new ways of accessing healthcare. By focussing on inequalities, specific areas were identified with a focus on deprived areas.

75 hypotheses and recommendations along with cross cutting themes were identified and being taken forward. Clear consistent communications was identified as being a key factor.

 Stabilisation and Reset (StAR) Sarah Forbes (SF), Associate Medical Director presented an overview of the stabilisation and reset plan.

SF explained the benefit and strength in partnership working and the group members included those from community healthcare, hospitals, mental health trusts, Social Care, Public Health along with the third sector and peoples’ voices represented.

SF stated that capturing peoples’ voices had been invaluable and that one focus had been on ensuring service delivery along with improving the lives of the poorest the fastest.

6 Look Forward – Health Inequalities Framework

Becky Barwick (BB) shared a video around improving the health of the poorest the fastest. This included the 5 intended outcomes;

1 – People will live longer and have healthier lives; 2 – People will live full, active and independent lives; 3 - People’s quality of life will be improved by access to quality services; 4 - People will be actively involved in their health and their care; 5 – People will live in healthy, safe and sustainable communities.

BB introduced the Health Inequalities Framework which was signed off in May.

Item. Notes Action BB shared the ‘strategy to action’ for 2020-21.

7 Questions & Answers

Attendees were invited to pose questions to the CCG’s Governing Body:

1. “Do you know where the transmission of Covid-19 is occurring for it to be rising amongst all age groups?”

Information is gathered both from NHS Test and Trace and local contact tracing activities. This enables trends to be identified along with specific places. The main trend for transmission in Leeds has been found to be socialising, both in private households and hospitality venues. This particularly escalated in mid-August. The levels of transmission have been shown to be much lower in organised settings such as schools and workplaces.

2. “Are funding cuts to the CCG for administration fuelling CCG mergers in West Yorkshire and Harrogate?”

The position in West Yorkshire is for CCGs to be closely aligned to our local communities at city level. Although financial challenges with administration costs in some areas may have led to mergers, this is not the case for Leeds CCG or Bradford. The ambition and intent remains to have close links with the Local Authority.

3. “Do you have an action plan to address a 3rd and 4th wave?”

The work carried out by the group Bryan Power led is driving some of the thinking around the third wave, particularly around the management of chronic conditions. Work is already underway to ensure a more integrated, holistic approach is adopted.

The 4th wave will be around the economic impact as well as the mental health and well-being.

The biggest challenge for mental well-being is where the NHS will distribute the money, either for targeting elective mental health and the backlog that has been created or to target the increase that is anticipated in the coming months and years. The CCG is committed to not only meet the mental health investment standard but to go faster where we are able to. A mental health plan is developing city-wide with a strategy board meeting and including all partners in the city. In terms of the economic impact, the CCG will be an active player in the commissioning of services to support the health inequalities agenda and to mitigate wherever possible the economic wave. We will also be driving

Item. Notes Action innovation working with the universities and the business sector to boost that part of the economy. An example of this in new Leeds hospital buildings.

4. “As you will be aware, the CCG’s combined prescribing costs for stoma and continence appliances is one of the highest nationally. Many CCGs are advancing plans to centralise services with the aims of improving patient experience, ensuring patients have an annual review with a nurse specialist and containing costs. Do you have any plans to look into this area? And if so, who will be leading on this?”

NHS Leeds CCG have invested in the past two years in clinical nurse specialists, who working as integral members of the Community Continence and Colorectal service, undertake reviews and clinical assessment of patients who are catheterised and who require stoma review. This has significantly increased the numbers of people who are now living without catheters as a result of successful trials without catheter. Stoma care patients are being reviewed and the appropriate products prescribed reducing accessories and product use in addition to promoting clinically effective stoma care. These reviews take place as clinically indicated and at a minimum annually following recent investment in nursing staff (Nurses are CCG funded rather than sponsored by one of the stoma companies.)

5. “Given the emerging evidence around Childhood Adverse Experiences (ACEs) and the cross-cutting health impacts generating from them – many of which will have been compounded by Covid19. Combined with the increasingly robustly evidenced needs of sexual violence victims across the lifespan - evidenced by the Independent Inquiry Child Sexual Abuse (IICSA) and the recent Police & Crime Commissioners review of 3rd sector specialist sexual violence services in West Yorkshire. What plans do the Board have for supporting the gaps in Leeds 3rd sector specialist sexual violence services funding for children, young people and adults, female and male - as we emerge into a post Covid19 environment?”

The NHS Leeds health and the care system recognise the profound and lifelong impact that Adverse Childhood Experiences (ACEs) can have. We share a commitment to identify and support children who are experiencing, or adults who have experienced these. Earlier this year, the Leeds Health & Well-being Board signed off the new all age Mental Health Strategy and one of the key priorities within this strategy is to ensure existing and new services provide trauma informed care. In taking this forward we recognise the importance of working with those who are experiencing, or who are survivors of ACEs, in developing our support and services. We ensure that children are at the centre of any development of support and services; for example Leeds CCG funds the MindMate Ambassadors (who are young people with lived experience and often have had experience of ACEs), as well as working closely with the children in care council in the city. Leeds

Item. Notes Action CCG also funds the Visible Project, which is survivor led group, who campaign for better outcomes for adult survivors of child sexual abuse. In addition, NHS Leeds CCG have worked with NHS providers in terms of developing quality standards relating to developing trauma informed care services and we plan expand this work to other providers and sectors. There is also a dedicated work-stream in the city where health, social care and education partners are working together to join up the support and service offer, as well as developing a programme to encourage a trauma informed approach in school settings.

As a system, we recognise there is more to do but are well placed to make good progress in this area over the next few years. In response to your specific query about supporting the gaps in Leeds 3rd sector funding for specialist sexual violence services, we are not currently in a position to make any firm commitments around any funding in any areas. The CCG has no clarity yet at all about its allocations from NHS England for next year, or the national mandated expectations that will come with them. We fully recognise the pressures this sector is under and are in ongoing dialogue with Forum Central and other 3rd sector partners and with LCC colleagues. We recognise that the pressures in the Council budgets will bring additional pressures to the City’s resources. Within the available resources Leeds CCG is committed to addressing gaps within the 3rd sector, which will be informed by our recently developed health inequalities framework and CCG strategic plan. We recognise that as a system, we need to shift resources to preventative and early intervention services and 3rd sector have a crucial role in this. Survivors of sexual abuse are a priority group and as commissioners, we will ensure that future investments consider carefully the needs of this group and other vulnerable groups. Currently, commissioners are reviewing current 3rd sector provision relating to mental health support and city wide engagement is planned for November 2020. The findings from their engagement will also help to inform future investments and new models of care support. More details will shared on the CCG website.

6. “Can you tell us about prescribing physical activity in different localities in Leeds?”

The new Primary Care Healthy Living template for monitoring levels of physical activity and enabling quick electronic referral to Healthy Living services is planned to go live on 21st September 2020. This is the first time that Leeds Primary Care staff including GP’s will be able to refer patients directly to One You Leeds and Active Leeds for Physical Activity Opportunities. Active Leeds offer a range of physical activity behaviour change programmes, initiatives and interventions – including, for example, long term conditions, Leeds Girls Can, couch to 5km, bike rides and group walks. Active Leeds are accepting referrals from Healthcare Professionals, Healthy Living Services, Social Prescribing Teams, community groups and self-referrals via the online enquiry form, email or by phone. PH fund work

Item. Notes Action around Falls Prevention and a Strength and Balance Programme for Frailer Older People.

Active Leeds Team have also supported the place based approach outlined in the Director of Communities and Environments report of November 2017 and have Localities Officers working with the 6 x 1% priority communities identified in the report (the 4 areas outlined below plus Lincoln Green, Burmantofts and Richmond Hill and Clifton and Nowells, in Seacroft). Sport England funding has enabled a Get Set Leeds Local approach to PA in our 1% neighbourhoods, where a community chest pot is available to support local innovative projects. 55 staff across primary and secondary care have attended followed by HCAs, GPs and physiotherapists. The training supports professionals to look at the benefits of signposting and referring patients to physical activity opportunities as well as promoting opportunities in Leeds. We have recently developed, in response to Covid and more people wanting to be active at home, a set of webinars focused on increasing knowledge and awareness of the benefits of physical activities and signposting opportunities in the Leeds area.

A number of Leeds GP practices refer patients to Parkrun (opportunity to walk, run or volunteer). A survey of GP practices we did in 2018 looked at GP referrals into OYL/Active Leeds and Parkrun, which suggests 16% current signpost into parkrun. Leeds is also one of the areas in the UK with a 5K Your Way programme which links Cancer pathways into parkrun via primary and secondary care signposting. Walking Groups have also started from GP surgeries supported by Walk Leader training from Active Leeds. The Public Health contract reported 42 referrals from Health Services (GPs, Social Prescribing, Midwives, other Health professionals) in 19/20. All partners deliver a range of physical activity options. In WNW, Barca delivers yoga and walking groups. In ENE, Orion and Touchstone deliver a walking group, Zumba, gardening groups, swimming, pilates, yoga, Ramgarhia fitness. In the SE, Health For All and Hamara are able to offer a community gym, but also offer activities such as walking groups, exercise classes, gardening groups, swimming group, pilates, and Zumba.

Physical Activity Clinical champions training, run by Public Health England. The majority are nurses or trainee nurses,

7. “I am very disturbed to hear that NHSE have noted their intention to “streamline commissioning through a single ICS/STP approach” which will “typically lead to a single CCG across the system” and are requiring formal written applications to merge CCGs on 1 April 2021 to be submitted by 30 September 2020. When the CCGs were set up following the Health and Social Care Act 2012 a key argument for the change was that planning and commissioning health care would be put in the hands of local GPs who were said to be best placed to understand the needs of their

Item. Notes Action patients and neighbourhoods. We have already seen the 3 CCGs reduce to one with an inevitable loss of accountability. Now that Covid 19 is shedding a harsh light on gross inequalities between diverse populations, income groups and geographical areas, surely it is even more important that vital decisions regarding commissioning health and social care are taken at ground level by people who know Leeds well and are familiar not just with the challenges but with a string of good intentions and past local initiatives which have barely scratched through the rust on the issue. It also seems more important than ever to insist on championing and building local decision making and accountability as early Government decisions to bypass local public health and other bodies well placed to manage test and trace systems, PPE provision etc. in favour of putting resources into privatised, remote, often unaccountable and sadly inadequate providers has been fairly disastrous. Some time ago the West Yorkshire and Harrogate joint CCGs reassured us that they were not in favour of amalgamating CCGs across the ICS. I hope that this is still the case and would be grateful if you could clarify the position of Leeds CCG. Should there be any plans for further mergers I would like reassurance such plans would be widely publicised and subject to rigorous public consultation as required by the Health and Social Care Act and NHS (Clinical Commissioning Groups) Regulations 2012.”

The WYH joint CCGs are not in favour of amalgamating and that remains our position. Where there are areas we can work on together we will through the Joint Committee and this will be an open meeting at which the public can attend. Leeds CCG is committed to remaining as an independent CCG. Any mergers can only happen in two-ways. One as CCGs we decide to consider that, in which case I can give assurance that if we change our position then we will include public consultation. However, the second means is through changes in legislation or direction from NHS England. In those circumstances decisions on consultation will be outside the CCG’s control.

8. “While Public Health England has effectively been abolished and moved into a new organisation with a central role in dealing with pandemics, it is unclear who will pick up other important aspects of PHE including screening, vaccination, intelligence and health improvement. The whole thrust of NHS reorganisation is based on shift of services from hospital to community coupled with effective public health interventions that will lead to a reduction in demand for health care and reduce costs. What assessment has the CCG made of the implications of the abolition of PHE (in the current pandemic, likened to removing the wings from a malfunctioning aircraft in flight

Item. Notes Action in order to achieve a safe landing) in terms of achieving its strategic objectives?”

The CCG has limited engagement with Public Health England currently as most of our Public Health relationship is with those aspects commissioned or delivered with the Public Health Department in Leeds City Council. We continue to strengthen these relationships with an Integrated Commissioning framework and further joint posts. PHE is continuing to operate across its remit currently and once more detail of the future is understood we will review the position.

9. “The number of positive tests for coronavirus in Leeds is rising alarmingly. There has been an outbreak at Gregg’s distribution centre in Leeds, and recently the Food Standards Authority was investigating approximately 40 outbreaks in food factories around the country. In meat packing plants, infection has been attributed to cramped working conditions, background noise (which leads to shouting), and poor ventilation. Worryingly, similar compound risk situations might occur in other crowded, noisy, indoor environments, such as pubs, live music venues, gyms and schools. The German meat processing plant outbreak in which 1500 workers were infected was investigated very thoroughly, including with genetic finger printing of the virus isolated. This showed the outbreak was a super-spreader event in the plant and not related to spread in the community (as commonly assumed). Transmission of the virus occurred indoors over distances of 8 metres and more. Such outbreaks have demonstrated that current precautions for controlling spread of infection in workplaces are inadequate, and airborne transmission a much more significant problem than previously thought. UK experts have been calling for urgent recognition of the key role of ventilation in work places in preventing COVID-19. This issue is not yet reflected in government advice regarding reduction in risk of viral spread. How is the Governing body raising the importance of airborne viral transmission with its various partners, with a focus on effective ventilation to reduce risk of further outbreaks in schools and workplaces?”

From a national government perspective there are guidelines and restrictions in place that seek to reduce the potential of infection of airborne transmission. Social distancing and the rule of 6 is now a legal requirement in the hospitality sector along with a restriction on levels of music to prevent shouting and the need for excessively close talking. In addition new legislation announced on the 22nd September 2020 requires all staff working in the retail sector to wear face coverings. Government guidance targeted at businesses does make reference to the importance of providing as much ventilation in workplaces as is practically possible although it does not make this a legal requirement at present. From a Leeds perspective following outbreaks in food processing

Item. Notes Action plants across Europe and closer to home in Kirklees the Leeds Environmental Health Team contacted all food processors and manufacturers in Leeds to provide advice and support to ensure they were clear taking all necessary safeguards. This included the offer of visits and inspections by EHO’s and Infection Control Specialists. The offer was well received and taken up by many businesses. This has now been rolled out to other workplace settings including the hospitality sector and our universities and FE colleges. To date Leeds has seen approximately 15 outbreaks linked to workplace transmission and a rapid response allied to good relationships with businesses has meant that outbreaks have been quickly brought under control and further transmission prevented.

10. “Last year the CCG adopted commissioning guidance from NHS England based on recommendations to restrict access to 17 Evidence Based Interventions (17 EBI). A further consultation over an additional 31 procedures has now been completed and CCGs will at some point once again be asked to endorse recommendations made. I would therefore like to draw attention to a response to this consultation by the Patients Association (PA) which stated that the claim it was extensively consulted is false, that it was commissioned to undertake patient focus groups with a timetable that then made it impossible for findings to be fed back before the close of the consultation, and that the risk that these proposals may cause harm could have been reduced by engaging with patients and listening to their views. In addition the PA questioned why the whole consultation was focused on reducing NHS activity rather than how to benefit patients. In the light of this, when recommendations are made to the CCG over commissioning these 31 procedures, will the CCG look critically at these and endorse the concerns of patients with NHSE, as articulated by the PA? Furthermore, has the Governing body published data on changes in numbers of procedures and any adverse clinical consequences for patients following implementation of guidance on commissioning the 17 EBI?”

Thank you for drawing our attention to the Patients’ Association concern that patients were not fully consulted. The process that the Integrated Care System of West Yorkshire and Harrogate took with the first 17 was to review the extent to which they were a significant change from any existing local policies, and then to adopt these as an ICS in line with our approach to commissioning policies. We did ask about patient engagement for the first set as we felt it was sensible to rely on national engagement rather than incurring additional costs repeating such engagement locally. Given your feedback, it would be helpful to know whether the PA feedback could be made available to the ICS to consider before we discuss our local adoption of the further EBI list. It would be really helpful if you could arrange to share this or give us a contact.

Item. Notes Action

In terms of the 17 procedures, we have not published data to the governing body, though this has been shared in ICS Planned Care papers which I believe are publicly available. The data for April to February 19 to April to February 20 are below. (We have stopped at February because of the significant drop in elective activity in March due to Covid). We have not been alerted to any adverse clinical consequences to patients linked to this guidance. The key areas of patient concern were around the withdrawal of some of the spinal injections, particularly for patients who had received these over a number of years and found them to be beneficial. The biggest numbers of reductions were in shoulder decompression and in tonsillectomy.

11. “Charging ‘overseas visitors’ for NHS care is part of the hostile environment. The administrative costs are greater than the money raised, and adverse health effects on those large numbers of people with unsettled status now well documented. A recent report from the Institute for Public Policy Research states that: “The human impact of the hostile environment highlights that healthcare charges and data-sharing do not only pose risks to undocumented migrants; they also threaten to jeopardise broader public health objectives, including efforts to contain the transmission of COVID-19”. Will the CCG undertake to investigate the negative health impact of overseas visitors charging on both BAME communities and staff, and feed this back to the independent enquiry into the effects of COVID-19 on BAME staff and communities in West Yorkshire headed by Dame Donna Kinnair and commissioned by the Yorkshire and Harrogate Health and Care Partnership Board?”

The CCG recognises these concerns as do our partners within the city and

Item. Notes Action recognise that they are likely to further drive health inequalities. We are currently waiting for the publication of the report of Dame Donna Kinnair report and will take forward any findings arising from that.

12. “It has been a very disappointing year for the residents who live in Adel who after an extensive campaign lost their one and only surgery. How many more small surgeries going to be closed?”

Applications for branch surgery closures can be made by the practice who holds the contract at any time (as opposed to a CCG led process). There is a clear process which should be followed in considering any application as part of NHS England’s Policy and Guidance Manual (PGM) (Part B, Section 7.15.10). Specifically, the guidance sets out what commissioners should consider when deciding on branch closures. This includes:  financial viability  registered list size and patient demographics  condition, accessibility and compliance to required standards of the premises;  accessibility of the main surgery premises including transport implications;  the Commissioner’s strategic plans for the area;  other primary health care provision within the locality (including other providers and their current list provision, accessibility, dispensaries and rural issues);  dispensing implications (if a dispensing practice);  whether the contractor is currently in receipt of premises costs for the relevant premises;  other payment amendments;  possible co-location of services;  patient feedback;  any impact on groups protected by the Equality Act 2010 (for further detail see chapter 4 (General duties of NHS England);  the impact on health and health inequalities;

Both sites at Adel and Alwoodley are operated by the same practice and therefore the level of service should be consistent however recognising that the premises at Alwoodley are modern which meet current healthcare guidance relating to estate.

JB thanked attendees for their contributions to the meeting.

The AGM closed at 17:35

MINUTES ACTION LOG – GOVERNING BODY

ITEM ACTION ACTION: ACTION BY: COMPLETED/UPDATE NO: NO: 22 July 2020 20/40 1 Shaping our Future Operating Model LP/JB Complete. Recommendation that the CCG Membership (at the next opportunity) Council of Members meeting to take approves the changes in the voting members’ job titles in the CCG place on 30 September. Changes Constitution. will be presented for approval. 23 September 2020 20/65 1 Covid-19 impact on provision of health services for non Covid JH Complete. conditions Primary Care Colleagues are Members were assured that there was detailed work ongoing within working to establish the enhanced the care home scheme in practices and the report considered the frail health in care homes scheme as per population as a whole. It was agreed that the report would link directly the national requirements. The with the health inequalities framework to identify the needs of those in scope to apply a health inequalities care homes as a population cohort. lens in terms of is probably reasonably limited during this set up phase but we certainly have a long term ambition to implement proactive care based on need to all people living with frailty – focusing on maximising independence – wherever the person lives.

Agenda Item: GB 20/88 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25th November 2020

Title: Chief Executives Report

Lead Governing Body Member: Tim Ryley, Chief Tick as Category of Paper appropriate Executive () Report Author: Tim Ryley, Chief Executive Decision

Reviewed by EMT/Date: N/A Discussion 

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing 2. Reduce health inequalities across our city We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health 4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds 6. Create the conditions for health and care needs to be addressed around local neighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city. 2. Quality of commissioned care is compromised and does not reflect best practice. 3. Failure to achieve financial stability and sustainability. 4. Failure to overcome local and national workforce shortages. 5. Business continuity of health and care services disrupted as a result of a significant event. 6. Ineffective patient and public engagement and lack of transparency in translation of engagement into decisions. 7. Partners and Professionals do not support the CCG strategy. 8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans. 9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY:

The report provides an overview of the key areas of focus and provides updates on work to implement a number of key areas discussed by the Governing Body.

In particular, it sets out:

- The medium term implications of the Covid Pandemic and the likely medium-term financial pressures with an eye to implications on the level of risk and future planning priorities - The changing NHS landscape and implications for Leeds going forwards - The plans for management of EU Exit impact as the transition period ends - Development of the local Integrated Care Partnership - Implementation of Shaping Our Future - Addressing BAME inequalities and diversity within the CCG - First steps on implementing the CCG Health Inequalities Framework

RECOMMENDATION:

The Governing Body is asked to:

a) DISCUSS and NOTE the Chief Executive report; b) DISCUSS and NOTE the attached BAME Health Inequalities Report; and c) RECEIVE the communications and engagement update as assurance that the CCG is delivering its statutory duties to ensure public involvement and consultation.

Chief Executives Report:

1. INTRODUCTION

1.1 This report provides an overall context to the current work of the CCG including an element of Horizon Scanning. In doing so it is intended to give some context for further detailed reports and discussions. It also updates on key areas of work that have been set in motion by the Governing Body in recent months.

2. HORIZON SCANNING

2.1 Covid Implications

2.1.1 Governing Body members will note that the GBAF and the Risk Report indicate an increasing level of risk across all areas of the CCG business. Given the unprecedented scale of the pandemic it would be a surprise otherwise. It will also be clear in the IQPR that the system is not operating at a normal level of service.

2.1.2 There is the immediate pressure that presents considerable risks to access, clinical quality, finance and staffing. The demand on colleagues and resource constraints within the CCG and across our partners also limits our capacity to push forward other agendas at the pace we might have normally expected to.

2.1.3 Members of the Governing Body will also recall the report from Dr. Bryan Power on the medium and long-term implications of Wave 1 which will clearly now be exacerbated. These include: the implications on planned activity which is now scaled back increasing waiting lists; access to long-term condition management; the implications on mental health; and the impact of economic hardship in health especially health inequalities.

2.1.4 The CCG believes that the best way to minimise these impacts is to continue to share the risks across the city with our partners and to continue to engage with the public in Leeds. The shorter the time period that Wave 2 lasts the less the impact and equally the more service we can retain during this period the greater the mitigation. There are no intentions to stop services but reductions in the scale of the offer and delays in access are inevitable.

2.1.5 In the medium term the back-log of elective activity is likely to become the dominant feature of NHS planning for at least the next three years, potentially something akin to the focus in the early years of the 2000’s. This will have an impact on other areas of development.

2.1.6 The paper on the Covid response later on the agenda will detail more on the work being undertaken to manage the situation.

2.2 Finances

2.2.1 The financial challenges of this current period and how these are being managed will be detailed in the financial report later in the papers.

2.2.2 However, the Governing Body needs to be sighted on the potential implications of a number of changes in the financial position going forward and the implications on the CCG Strategy and previous commitments.

2.2.3 It is likely that the changes to the funding regime set out for the last six months of 20-21 will continue into the next financial year. This, with the planned care recovery noted above, will put considerable pressure on the CCG’s budget and thus our commissioning intentions. The attention given to cost reductions and efficiency across the city will be much higher than in previous years. The implications of reductions in Adult and Children’s Social care will also need to be played-in.

2.2.4 Work is underway on developing revised plans and budgets. The Governing Body will be discussing these in more detail over the next three months.

2.3 NHS Landscape

2.3.1 As Governing Body members will be aware there are on-going conversations at a national level between the NHS and DHSC on the future of the NHS and in particular commissioning and the strong possibility of legislation in the spring.

2.3.2 The clear picture emerging is that there will be a very strong emphasis on Integrated Care Partnerships at place, in line with our strategy. These will have a number of commissioning responsibilities. At the same time there will be a single strategic commissioner or similar at an ICS level.

2.3.3 Clearly the balance of decision making and the nature of this relationship will need working through.

2.3.4 The other strong message is that there is a desire that legislation removes barriers to evolving the right solutions for each area rather than prescribes the exact nature of all arrangements.

2.3.5 It is expected that guidance on the transitional nature of ICS will be published shortly and probably at some point in December there will be a consultation published on future legislative changes.

2.3.6 The CCG will continue to work closely with the ICS and fellow CCGs to set out our preferred options on how we evolve towards this new thinking, whilst at the same time strengthening the place based approach adopted through Shaping Our Future. These are set out in the work being done under Commissioning Futures. I intend to bring a report to the next CCG Governing Body on this and the revised Operating Model of the ICS in which the CCG is also involved.

2.3.7 It will be important too to develop a strong narrative for all CCG colleagues and as a Leeds partnership describing our approach. The CCG will continue to work across our partnerships and take forward the principles agreed in the last board development workshop.

2.4 EU Exit

2.4.1 The Emergency Preparedness leads in the City have updated their EU Exit planning assumptions and risks, as we get closer to December we may again face the end of the transition period without a trade agreement. The main risk areas identified locally remain medicines and equipment supply, and the risk to fuel supplies. Local organisation have confirmed that they are in a much stronger position now due to actions taken in Covid in respect of PPE supply, and recent centralised distribution models adopted for medicines in Covid-19 may mitigate some of the previously assessed supply risks.

2.4.2 A national NHSE/I Webinar hosted on 4th November 2020 gave detailed information on the ongoing national work and associated developments on a wide spectrum of areas including medicine supplies, clinical consumables, workforce, data, information governance, reciprocal healthcare, adult social care and primary care. There is now a much clearer picture on the mechanisms in place to mitigate identified risk, as well as clarity on channels to communicate up and down the structures. There continues to be strong messages not to stockpile, and to escalate through established routes.

2.4.3 The Leeds Health and Social Care Resilience Group is now meeting and the first half of it focusses on Leeds Health and Social Care EU Exit Planning and will comprise organisational updates and a review of key risks and an update from the Leeds City Council Executive Office. This format replaces the previous Leeds Health and Social Care EU Exit Task and Finish group that was led by Dr Ian Cameron as Director of Public Health; members welcome the supportive approach which enables a shared understanding of issues and risk. The CCG is committed to supporting delivery across the system, including obtaining assurance from Primary Care and contracted providers.

3. INTEGRATED CARE PARTNERSHIP (ICP) DEVELOPMENT

3.1 Progress and Next Steps

3.1.1 In the past two months further conversations have taken place across Leeds building on the already strong relationships to agree the next steps on developing an Integrated Care Partnership across the city. This has included a number of meetings of NHS Chief Executives with the Director of Adult Social Care and the Confederation Chief Executive; the wider city Partnership Executive Group and at the Health & Wellbeing Board. These have been supported and facilitated by CCG members of staff with advice from strategic partners.

3.1.2 The Chief Executive group has been formed to meet at least monthly to drive the agenda forward and agreed that in building a truly Integrated Care System we need to strengthen and accelerate four areas:

- Strengthen our shared vision and ambition by more sharply defining measurable goals. This will be supported by the work underway in the Left Shift Blue-Print.

- Create a single source of truth that drives decision making across the system, accelerating the creation of joined-up information systems and analysis

- Develop governance to hold the partnership together in development and in time as things move forward to create the underpinning governance for an integrated networked partnership

- Ensure that there is an engine room to drive the change building around the CCG plans for a Director of Business Integration with support from a remodeled Health Partnership Team

Each of these four has named city chief executives leading on it and reporting back accordingly. I have been asked by provider colleagues to chair the ICP development board.

3.2 Workforce

3.2.1 In September 2020, a permanent Director of Strategic Workforce and the Health and Care Academy (Kate O’Connell) was appointed on behalf of the city, to advance the full programme of work underpinning the Strategic Workforce Priorities, including effective alignment and integration with the city’s wider enabling strategies, and developing the Academy to realise its full potential.

3.2.2 The Strategic Workforce Priorities continue to provide a cohesive focus for Health and Care organisations across the city, but there is recognition of different challenges within different parts of the system, dissonance between governance requirements, and unique organisational pressures all of which can make alignment with system level priorities a challenge.

3.2.3 Workforce pressures in health and care are even greater than before, with the resourcing, safety and wellbeing of our current and future workforce under substantial strain.

3.2.4 The collective response to these disruptions has however stimulated innovation and an increase in pace of the Leeds Left Shift and person-centred care, prioritising digital transformation, workforce redesign, and cross-organisational working and learning.

3.2.5 This provides an impetus to progress key programmes of work advancing the introduction of new roles into the health and care system; rebalancing and enhancing our educational pathways; working with local communities to learn together and improve

opportunities; develop city-wide leadership and expertise; realise the value of digital, technical and data advances; and improve workforce mobility.

3.2.6 Progress on the shared workforce strategy has been challenging over the last year, with immediate staffing pressures often taking precedence over some of the longer term ambitions. Despite this, there have been some important system level achievements: - The successful expansion and diversity of nursing placement opportunities - The growth of System Leadership development across the city, stimulating cross- boundary working and innovation - Development of a Mental Health First Aid infrastructure to better support workforce wellbeing - The increasing impact of Springboard in career progression for women in health and care, specifically from minority communities - Launch of the first city cohort of Data Analyst Apprentices building workforce capacity and connectivity - The culture change programme Better Conversations has now reached over 100 organisations helping to unify a city-wide approach to working ‘with’ our citizens and patients - Completion of a successful pilot for new roles in GP practice providing essential learning for future workforce planning

3.2.7 As part of Shaping Our Future the CCG is looking to appoint a workforce planning individual to work closely with the Pathway Integration Teams and Primary Care to ensure that there is an end to end understanding of workforce changes and needs to support the city approach to workforce planning.

4. CCG DEVELOPMENT

4.1 Shaping Our Future - Staffing

4.1.1 We have now begun the post-filling activity in line with our Organisational Change policy and follow ACAS and CIPD best practice. At present, that is limited to Band 8C, 8D and VSM. We have appointed one of the three vacant Director posts, the Director of Pathway Integration, and a second is currently advertised on NHS Jobs, the Director of Population Health Planning. We are still in consultation with partners on the potential joint post of Director of Business System Integration, and anticipate this being agreed for advert by the end of November. In the meantime we have secured some interim support to cover aspects of the two current vacancies given the Covid challenges.

4.1.2 At the Governing Body level we have recruited to the vacant Lay Post for Audit and Conflicts of Interest and welcome Cheryl Hobson.

4.1.3 Directors have now had initial discussions with colleagues in the first tranche (VSM, Bands 8C and 8D) and will issue individual letters outlining next steps. We are including those senior staff embedded within the GP Confederation. In line with our policies, we

have reviewed current roles against those identified in the new structure and either ‘slotting in’ clear matches; assessing in ring-fenced ‘pools’; or identifying other options. We expect most of our people will transition into the new structure and are committed to avoiding compulsory redundancies.

4.1.4 We also plan to move quickly to resolve the position for Bands 2-4 where their roles are far less likely to change significantly in the new model other than a greater likelihood of matrix working, as will apply to all staff.

4.1.5 We are finalising our development offer to support colleagues which will begin with a programme from December commencing with Population Health Management; and Matrix-working. We will also launch a series of co-development design workshops in January.

4.2 Shaping Our Future – Organisational Development

4.2.1 Our Organisational Design plans include: - Finalising our new behaviours, ways of working (matrix and extreme teaming) and cultural change requirements - Designing the skeletal architecture (Directorates, Portfolio Holders and Business Units) required to enable the delivery of the new operating model - Agreeing resourcing envelopes for the Business Units - Agreeing an approach to resource management to ensure expertise from within BUs are deployed swiftly and effectively into virtual teams; and - Supporting briefing, consultation and activity to populate the teams and directorates.

5. BLACK LIVES MATTER AND BAME NETWORK

5.1 West Yorkshire Review on BAME Health Inequalities

5.1.1 The West Yorkshire Partnership (ICS) commissioned Dame Donna Kinnair to undertake a rapid review over the summer of the public sector approach to the commissioning and provision of services across West Yorkshire. The report was published in October and is attached for note, “Tackling health inequalities for Black, Asian and minority ethnic communities and colleagues - understanding impact, reducing inequalities, supporting recovery”

5.1.2 The Governing Body are asked to discuss and note the report and the implications for the CCG as commissioners. There is a close fit to the work we have already undertaken within the Health Inequalities Framework but with an additional lens.

5.1.3 In particular the key recommendations for commissioners are set out below:

 Ethnicity recording is 100% in all settings and that this data, coupled with local insight, is used across the Partnership to inform the design and delivery of care.

 Community representation, that reflects local population ethnicity, is visible throughout the planning process, including procurement of services.  Service access, uptake and outcomes by ethnicity are monitored to identify inequalities.  Ethnicity recording is 100% in all settings and that this data, coupled with local insight, is used across the Partnership to inform the design and delivery of care.  Clear local and Partnership arrangements for commissioning with the voluntary, community and social enterprise (VCSE) sector are in place.  Demonstrate that services are culturally competent and are contributing towards reducing inequalities identified.

5.2 CCG Response to West Yorkshire BAME Staff Action Plan

5.2.1 The Governing Body will recall that at the September meeting we signed-up to the West Yorkshire BAME Staff Action Plan following a presentation by Shak Rafiq and Kaysha Maynard. Our BAME network was already established but is now increasingly involved in key decision making. They are receiving training to enable them to be actively and meaningfully involved in all senior appointments, and members of the Network have been involved in all recent senior appointments.

5.2.2 In tandem with two other CCGs, we have commissioned Unconscious Bias training for all staff. It is and is due for delivery in December and will include a targeted offer for Governing Body members.

5.2.3 Some actions are still in progress including offering active representation at the WY&H BAME Review action planning group. All of our planned future actions are in line with those recommended by the review, but we are now looking at how we can spread these across the system to increase impact.

5.2.4 As the Chief Executive Officer, I met with the CCG BAME Network last month and we agreed a set of areas to focus on which are being built into our organisational development plan. These included:

- Further strengthening of the arrangements for BAME colleagues in the appointment processes - Building into my one-to-ones with directors a focus on their active support to Black, Asian and other heritage staff in their directorate - Ensure our processes for secondments and acting-up roles are as inclusive as our permanent recruitment process to create developmental opportunities - We will ensure that colleagues with Black, Asian and other heritages receive recognition as authors of work etc. - We will ensure colleagues from a variety of backgrounds are actively invited to influence our planning and design of services.

6. HEALTH INEQUALITIES UPDATE

6.1 The CCG launched its Health Inequalities Framework in September at the CCG Annual General Meeting, the Health & Wellbeing Board and through a week long set of articles in the Yorkshire Evening Post. We also announced a series of investments in this financial year that are aligned to the framework with a focus on the Voluntary Sector, Local Care Partnerships and Digital Inclusion. The challenging financial position has meant some minor scaling back on the scale of these.

6.2 We are now working to ensure that in setting our plans for the next financial year the principles set out in the Health Inequalities Framework are applied across all areas of our business and in line with the Commissioning elements of the West Yorkshire Black Lives Review described above. This includes further work to look at data in amore granular way.

7. SUMMARY

7.1 The NHS is in unchartered territory and the pressures on all aspects are significant. As a CCG it is important that we both support our colleagues to manage the very intense challenges of the pandemic in the current time-zone, whilst at the same-time maintain that strategic population and medium to long-term focus set out in our Strategic Plan. The report summarises the likely pressures on the system arising from the current challenges and indicates progress that we have made in key areas of our strategy in the past few months.

7.2 As ever Governing Body members are asked to note the Engagement Report which is attached. Maintaining a strong communications and engagement presence at times like this remains critical.

8. RECOMMENDATION

The Governing Body is asked to:

10 West Yorkshire and Harrogate Health and Care Partnership Review Report

Tackling health inequalities for Black, Asian and minority ethnic communities and colleagues

Understanding impact, reducing inequalities, supporting recovery

October 2020 01 Contents Foreword from the chair

03 Foreword of the review sessions 05 Introduction 09 Purpose of the review Despite historic events and the Everyone deserves the same stark reality of the compelling 11 The Review Panel opportunities to lead a healthy evidence before us, I like many life, no matter where they live or others want to know why people 13 Building on existing work who they are – their background, from BAME communities have been 14 Supporting Black, Asian and minority ethnic (BAME) whether they are wealthy or not. disproportionately affected by communities Difference should not lead to COVID-19 and continue, yet again, to disadvantage. be impacted by health inequalities and 15 Supporting BAME colleagues an unjust society. Furthermore, I want 19 Review themes to know what is happening to address Yet, evidence shows that people this symbol of social injustice. 20 Improving access to safe work for BAME people in from Black, Asian and minority ethnic West Yorkshire and Harrogate (BAME) communities continue to face Being involved in this important review 24 Ensuring the Partnership’s leadership is reflective of health inequalities, discrimination in has given me both the opportunity to communities the workplace and are more likely learn more about West Yorkshire and to develop and die as a result of a Harrogate’s cultural vibrancy, strong 28 Population planning – using information to make plethora of diseases, most recently diverse communities and identities, sure services meet different groups of people’s needs COVID-19. and to facilitate a much needed

conversation which builds on the 33 Reducing inequalities in mental health outcomes by Health inequalities we know exist have ethnicity work already well underway by the been further exacerbated by recent Partnership. There is much to be proud 38 Summary of recommendations events, namely the pandemic and of and it gives me genuine hope for economic recession. Whilst it may be current and future BAME generations. 42 Action plan uncomfortable for some, now, once 43 Closing comments again, we have the opportunity to act I am especially keen to ensure that with passion and conviction like never the review work carried out doesn’t 45 Supporting information before. sit as a report on a shelf, collecting 45 Contributors dust. I know this is absolutely not Closing these gaps which exist in all the intention. There is a genuine 48 References BAME communities remains the biggest commitment for real change and challenge we face, and essentially you only need to look at the themes one of the biggest of our life time. covered on page 19 to know this is This is one of the many reasons I the case. You can be reassured that was delighted to hear that West an action plan for implementation, Yorkshire and Harrogate Health and monitoring and evaluation is firmly Care Partnership (WY&H HCP) were underway. commissioning an independent review. Knowing that more must be done was >> an important step.

West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 3 BAME communities and colleagues, like everyone else, deserve to have the best start in life - to live a long and happy Introduction one in good health with fair access to education opportunities, a warm and loving home and an income sufficient Our Partnership and to meet their needs. And because population we understand that reducing health inequalities is about jobs that local West Yorkshire and Harrogate Health people can get, decent housing and and Care Partnership (WY&H HCP), is preventing people becoming isolated, the fourth largest Integrated Care Photo credit: Leeds Gypsy and it follows that we should recognise System in the country, covering a Traveller Exchange (also known that local places and communities have population of 2.7 million people. It as Leeds GATE) the most critical role to play in West covers six local places, Bradford district Yorkshire and Harrogate. and Craven; Calderdale, Harrogate, The 2011 census data shows Black Kirklees, Leeds and Wakefield. It is Asian and minority ethnic (BAME) The collective strength behind this made up of NHS organisations, councils, communities make up 20% of the report will give it the determined force Professor Dame Donna Kinnair Healthwatch, social enterprises, population of West Yorkshire and and the resources it needs around charities, community and voluntary Harrogate, around 490,000 people. key areas of work, such as addressing (Professor Dame Donna Kinnair is the organisations, which collectively Bradford has the highest proportion the wider determinants of mental Chief Executive and General Secretary employ over 100,000 colleagues. of BAME groups of people (31.2%) health for BAME communities, fairer of the Royal College of Nursing, a and Craven has the lowest (3.6%). career opportunities for colleagues, leading figure in national health and In 2019/20 the percentage of BAME addressing racism and indirect care policy.) The majority of work takes place children in school across West Yorkshire discrimination. locally in the six places where people ranged from around 6 in pupils in live. The Partnership only works across Bradford to around 2 in 10 pupils in I’m heartened by the work of the West Yorkshire and Harrogate where it Wakefield. There are approximately Watch Professor Dame review panel. It has been built and can add value, share good practice or 7,000 people from Gypsy, Roma and Donna Kinnair’s film here informed by an extensive amount of tackle difficult issues together. Traveller communities living across where she explains more insight, hard work, dedication and West Yorkshire. about her involvement. commitment from all involved. This includes the Partnership’s leadership, the West Yorkshire and Harrogate Percentage of Black, Asian and minority ethnic population groups by BAME Network, and the strength local authority area and overall across West Yorkshire and Harrogate of voluntary and community sector 25 partners – to name a few. I look All other forward to following the outcomes White 20 from the recommendations made here Mixed / multiple ethnic groups and most importantly hearing about the positive difference it has made to 15 Asian / Asian British people’s live. Total 10 Black / African / Caribbean / Black British 5 Other ethnic group 0

Leeds Craven Bradford Kirklees Harrogate Calderdale Wakefield

4 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 5 The Partnership has big ambitions As our awareness of the emergent Percentage of ethnic groups by local authority to tackle health inequalities and health inequalities that have been area and overall in West Yorkshire and Harrogate support BAME communities and brought into sharp focus by the colleagues. COVID-19 pandemic both broadens and 100 deepens, we believe it is vital to seize 90 White British this moment and build our knowledge 80 All other White You can read more about in this space. We will focus on taking decisive and clear action to make a 70 Mixed / multiple this in ‘Delivering better health and wellbeing for powerful and sustained impact on the 60 ethnic groups Asian / Asian British everyone: Our five year plan’. lives of the communities that we are 50 privileged to serve. Total 40 Black / African / Caribbean / Black 30 British 20 Other ethnic group 10 0

Leeds Craven Bradford Kirklees Harrogate Calderdale Wakefield

Better health and wellbeing for everyone: West Yorkshire and Harrogate has a Our five year plan long history of welcoming refugees EasyRead and asylum seekers. Obtaining current 1 numbers for these communities can be difficult and complex to understand with no overall figure at any one time. For more information visit Migration Yorkshire. “Our ambition is to have a Photo credit: Harrogate and District NHS The COVID-19 pandemic has more diverse leadership that Foundation Trust highlighted the impact of deep-seated better reflects the broad and long-standing health inequalities range of talent in West faced by BAME communities. What Yorkshire and Harrogate, Differences in the impact of causes these inequalities is the Photo credit: helping to ensure that Feel Good Factor, Leeds the pandemic by ethnicity subject of much debate but much the poor experiences in can be linked to the deeper impact the workplace that are The direct impacts of the pandemic of wider societal inequalities beyond particularly high for Black, can be seen by the number of people the operation of health and social Asian and minority ethnic diagnosed with the virus and the care services. These include broader (BAME) staff will become a number of deaths from COVID-19. environmental, social and economic thing of the past.” Analysis by Public Health England (PHE, factors that exert a profound June 2020) showed that the proportion ability to shape health outcomes for (West Yorkshire and Harrogate of cases testing positive for COVID-19 communities. Health and Care Partnership, varied by ethnicity. March 2020)

6 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 7 In England the highest diagnosis rates Higher rates of mortality were also of COVID-19 per 100,000 population seen for some ethnic groups compared were in Black ethnic groups of people to others. In comparison to previous Purpose of the review (486 per 100,000 in females and 649 years, all-cause death was almost four per 100,000 in males) and the lowest times higher than expected amongst The COVID-19 pandemic has Some issues are likely to affect were in people of White ethnic groups Black people in March-May 2020, affected every child, adult, family everyone living in an area and some (220 per 100,000 in females and 224 almost three times higher in Asian and community in West Yorkshire only specific groups of people. Other per 100,000 in males). It is important males and almost twice as high in and Harrogate, with some of issues are likely to be compounding to state that the differential impact White males. Among females, deaths the biggest impacts experienced and intersectional – such as people of COVID-19 on BAME communities is were almost three times higher in by the most economically experiencing oppression due to not specifically as a result of genetic this period in Black, mixed and other disadvantaged and those from concurrent racism, sexism and other vulnerability to the disease but largely females, and 2.4 times higher in Asian BAME communities. forms of prejudice or systemic as a result of forces that shape and females compared with 1.6 times deprivation. For example, a Black structure labour markets, housing and higher in White females. workplace cultures which culminate in lesbian woman will have different This review specifically aimed to needs and experiences to a Black an elevated risk profile for some BAME The causes of these inequalities are understand this impact on BAME heterosexual woman. These factors communities. often structurally located, multi- communities and staff. The aim further amplify the disadvantages faceted and intersecting in nature, was to review existing work, to experienced by some groups. Indirect impacts from COVID-19 arise for example gender. These might take explore if this work was sufficient to from the effects of various factors, the form of differences by ethnicity, address this impact and to identify Also, not everyone from one of these such as whether healthcare services are for example overcrowded living recommendations for action to reduce groups will identify with the term appropriate to the needs of different conditions (English Housing Survey, July this impact. BAME. We are mindful of the current groups, food or job insecurity, 2020), high risk occupations, existing work taking place called #BAMEover education, communities being together health conditions and differences in and will be keeping this in view as we in harmony, safety and access to safe the provision of appropriate health This review builds on the Partnership’s move forward. For the purpose of this spaces to be physically active. services that meet people’s needs. work so far and includes new themed review we have used the term BAME Working with communities allows areas of work (see page 19). This review and will explore the needs of some We have also observed inequalities in us to influence wider factors such as did not aim to address all issues related ethnic groups disproportionately the indirect impacts of COVID-19 by housing, employment, education, social to COVID-19 such as the restoration of affected. ethnicity from communities in West networks and the environment, which health and care services or increases in Yorkshire and Harrogate, for example, make a big difference to people’s waiting times. ‘39% of parents of children from BAME health. backgrounds said they worried about taking their children into healthcare You can read the Terms settings, compared to 31% of parents of Reference for the of White British children’ (Healthwatch Review here. Leeds, June 2020). In Halifax, ‘people are just not going out, there’s fear that if they go into hospital they We recognise that the term BAME has won’t come home again’ (Voluntary limitations. While this report uses the Community Organisation Manager, acronym BAME to describe people June 2020). from Black, Asian and minority ethnic backgrounds, we recognise that this You can read more examples Photo credit: grouping will include a number of of the impact of COVID-19 Keighley Healthy Living groups with different experiences, cultural backgrounds and health needs. Photo credit: on communities here. Born in Bradford

8 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 9 West Yorkshire and Harrogate has a diverse population which has a complex profile across the region as a The Review Panel whole and within the six local places. Therefore activity in this arena should Five initial independent review sessions The recommendations were required be locally-led and driven in order to were chaired by Professor Dame Donna to be ambitious and action focused address the nuances and differences Kinnair, Chief Executive and General so they could contribute towards a of each area and to have the greatest Secretary of the Royal College of reduction in health inequalities by impact. Nursing, a leading figure in national ethnicity for people living in West health and care policy. The review Yorkshire and Harrogate. Integral to this review is the impact panel included the Chair of West of interpersonal, institutional and Yorkshire and Harrogate Health and structural racism on inequalities Photo credit: Mid Yorkshire Hospitals NHS Trust Care Partnership Board, Cllr Tim Swift; in health outcomes for the BAME leaders of the executive team; public population. These refer to the range Photo: health specialists, doctors, members Cllr Tim Swift (MBE), of different issues people might Current events, such as COVID-19 of the West Yorkshire and Harrogate Chair of the West and the Black Lives Matter experience. For example, direct BAME Network and colleagues from Yorkshire and Harrogate Movement, have brought into focus experiences of racism from other the voluntary, community and social Health and Care inequalities in health outcomes that people, ways in which organisations enterprise (VCSE) sector. An advisory Partnership Board. disproportionately affect people from might act to exclude certain groups of group of VCSE representatives was people, and fundamental differences in BAME communities. This makes the established to support the inclusivity Launching the review, Councillor Tim life opportunities for different groups review carried out and the subsequent of the panel. You can listen to their Swift, Chair of the West Yorkshire of people. findings (see page 21) extremely podcast here which describes their and Harrogate Health and Care important if the Partnership is to journey through the process. Both the Partnership Board, said: Racism is experienced differently improve BAME people’s health and review panel and the VCSE group had and to different degrees by different ensure a fairer society for all living a wide diversity of voices including “We are in full agreement groups of people. The experiences of across the area. people from different ethnicities, that rapid action is needed to BAME communities and colleagues, sectoral backgrounds and ages. The understand and tackle deep- in and out of the workplace, differ sessions took place between July and seated and longstanding considerably. These factors were Watch this film narrated October 2020. health inequalities facing considered throughout the review by West Yorkshire and people. Although tackling wider and tackling these head on, however Harrogate young people The Review Panel first considered the inequalities cannot fall to us uncomfortable, is instrumental about their ambitions for a demographics of West Yorkshire and alone, we are in an ideal position to the success of this report’s fairer society for everyone. Harrogate in relation to ethnicity. The to both listen and lead, and have recommendations (see page 38). panel also received intelligence and a responsibility to demonstrate insight related to inequalities in health by our actions that we can be observed for specific ethnic groups and part of the solution. The excellent underlying factors that may contribute relationships we have with other towards these. The panel coupled this key players, including the West information on population need with Yorkshire Combined Authority information on Partnership work to and our local universities, mean date to formulate the four key themes we can ensure that action on (see page 19). reducing these inequalities becomes a major part of our Subsequently the panel received recovery plans.” intelligence and insight related to these themes to inform the review (July, 2020) recommendations.

10 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 11 Accountability Building on “With much to do we This reports sets out a series of are hopeful that we will recommendations to the leadership achieve better wellbeing for of the West Yorkshire and Harrogate existing work everyone by working with Health and Care Partnership. The community partnerships. This Partnership will develop an action plan involves recognising that in response to the recommendations. This review is built on local the relationship between The action plan will capture all the knowledge, insight and intelligence healthiness and ethnicity is information about the changes we as well as existing work carried out complex and ultimately a life are going to make as a system – it will by the Partnership. and death situation for many detail what we will do and why, who who are at an increased risk will be responsible for the changes, Photo: Members of West Yorkshire of contracting coronavirus and the timescales for delivery. and Harrogate Health and Care and sadly dying.” Partnership BAME Network. This action plan will be considered and West Yorkshire and Harrogate approved by the Partnership Board Health and Care Partnership in December 2020. The Partnership The intention is to share this report Board, June 2020 board will periodically review progress and action plan with the Government’s against these recommendations and Commission on ‘Race and Ethnic this information will be made available Disparities’ to influence nationally to the public on our website and wider what can be done to eradicate racial through our community networks. The and social inequality. It will also be action plan will be accompanied by a used to support national reviews, Recent Partnership insight includes: set of indicators to measure progress including the independent review into over time. the Government’s coronavirus response • COVID-19 feedback received from • A report produced in July 2020 and the NHS People Plan, which partners including West Yorkshire titled ‘Third Sector Resilience: Alongside the above, we aim to published its latest edition in July 2020. Healthwatch organisations, Before and during COVID-19’. This strengthen the role of the VCSE panel, Yorkshire Cancer Community, Sikh highlights the impact of COVID-19 which was set up to inform the review. Alliance Yorkshire, Carers UK and across the voluntary and community This panel will ensure progress is made Bradford Talking Media (August sector enterprise (VCSE), and makes on the recommendations and will 2020). This was specifically regarding various recommendations including support the Partnership to engage the impact of coronavirus on long term investment in the VCSE with communities who might not individual people and communities. and in volunteering; investment otherwise be aware of this work. This in training and developing people will be achieved through community • A rapid insight report developed and organisations, and better assets and influencers. We will also with the support of the Yorkshire connecting commissioning of health aim to strengthen the role of the & Humber Academic Health and care service delivery across West Yorkshire and Harrogate BAME Science Network (June 2020). West Yorkshire and Harrogate. network in delivering change. Recommendations included undertaking further investigations • A diversity of programmes across The aim is to complement and support into the experiences of BAME the Partnership which can link system-wide working at both a local communities and colleagues with the health of our BAME and West Yorkshire and Harrogate working across the Partnership. populations, including our carers level. This review does not replace local programme, maternity programme, place based work in Bradford district children and young people and Craven; Calderdale, Harrogate, Photo credit: programme and many more. Kirklees, Leeds and Wakefield. St Augustine’s Centre, Halifax

12 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 13 Supporting BAME Supporting BAME communities colleagues

The Partnership brings together Local place action and BAME West Yorkshire and In Halifax, The Women’s approaches to understand and address networks Harrogate BAME Network health inequalities across all its priority Activity Centre is a place for South Asian women over 50 programmes including mental health, Partner organisations across Bradford The West Yorkshire and Harrogate who are isolated or are widows of first learning disabilities, cancer and district and Craven; Calderdale, BAME network, recognising the generation migrants. It’s place where maternity care. We will also be looking Harrogate, Kirklees, Leeds and disproportionate impact of COVID-19 they can engage, make friends and get at our children and young people Wakefield have, or are, establishing on staff, has been working hard with involved in the community. Watch the workstreams to ensure the voice of a BAME colleagues network. These colleagues and leaders from across the film here. BAME children and young people networks form the West Yorkshire and Partnership to support our response to shape our work. Harrogate BAME Network, a network COVID-19. This involves: of chairs, BAME leaders and allies • BAME leadership development connected across the Partnership. For You can read more about what • Bespoke communications these programmes are doing example, Bradford Teaching Hospitals to address inequalities here. NHS Foundation Trust has involved • Bespoke health and wellbeing over 400 BAME colleagues across resources for colleagues its hospitals via webinars exploring • Involvement in shaping and concerns and challenges around In June 2020, over £500,000 of the contributing to research Health Inequalities Fund was allocated themes such as personal protective to VCSE organisations to help improve equipment, health and wellbeing and • Involvement in decision making outcomes for groups of people risk assessments. The Chair of the • A consistent approach to supporting disproportionately affected by the Trust’s Network is a member of the colleagues with risk assessments. impacts of COVID-19. Seven of the Photo credit: West Yorkshire and Harrogate BAME thirteen groups who were successful Feel Good Factor, Leeds Network. You can see other examples are focused on supporting BAME here for Mid Yorkshire Hospitals NHS BAME Network members communities, to improve health via Trust and Leeds City Council. talk about the origins, interventions such as vaccinations, Watch this film about the purpose, benefits and diabetes prevention and continuity of work of the Feel Good Factor, importance of the West care for maternity services. We also a health and wellbeing Yorkshire and Harrogate allocated a further £50,000 to The organisation based in the Health and Care Partnership Women’s Activity Centre to support heart of Chapletown Leeds. Photo: BAME Staff Network here. our work with diabetes. Please see Wasim Feroze, Leeds City Council BAME Network film opposite.

Photo credit: The Women’s Activity Centre, Halifax Photo: South West Yorkshire Partnership NHS Foundation Trust

14 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 15 This group has focused on using their collective lived experience and Listen to the Podcast here. “Building on the support knowledge to support action on: of the executive leadership • Recruitment, selection and session, colleagues explained ‘Can You Hear Me?’ succession planning the importance of visible role Episode 2: Carers • Talent, culture and organisational models, peer support, a safe development space to share experiences, ‘I think there’s a recognition and a forum to shape and now that the kind of ‘one size • Reporting on measurement and influence change across the fits all’ (approach) that typically impact Partnership, as well as what institutions like ours have, is • Influencing decision-making already exists within their just not sufficient. We have to organisations.” • Health inequalities. find a way of getting into a conversation with communities (Fatima Khan-Shah, West that says ‘what would good Yorkshire and Harrogate look like?’ said Dr Owen Photo: Dr Owen Williams (OBE) Health and Care Partnership, Williams (OBE), Chief Executive, Photo: Fatima Khan- Director for Unpaid Carers and Calderdale and Huddersfield Shah, member of Personalised Care) NHS Foundation Trust. West Yorkshire and Listen to the Podcast here. Harrogate Health and Care Partnership BAME Network Listen to the Podcast here. ‘Can You Hear Me?’ Episode 3: White Privilege

‘Can You Hear Me?’ ‘It’s not just about what we do A series of West Yorkshire and Episode 4: Workforce in our own organisations. We Harrogate Health and Care Listen to the Podcast here. have to carry it over into society Partnership Podcasts called ‘Can ‘My father’s work ethics were every single day’ said Wallace you hear me?’ was launched early to respect people – and some Sampson (OBE), Chief Executive, 2020, giving a voice to the diverse ‘Can You Hear Me?’ Episode 1: may feel they have to work Harrogate Borough Council. talent working to improve health and Everything you wanted to twice as hard’ said Kez Hayat, care for people in West Yorkshire know about coronavirus but Bradford Teaching Hospitals and Harrogate. The first episode were afraid to ask. NHS Foundation Trust. (launched on 14 May 2020) focused on the impact of COVID-19 on our BAME ‘This is about how we change population – this approach has been the way people view other seen as national good practice. people, view other people’s lives. It is about empathy… we want people to understand and then to empathise, and that’s what senior leaders need to actually start doing and thinking about now’ said Yvonne Coghill, Former Director for Workforce Race Equality Standard Implementation, NHS England. Photo: Photo: Kez Hayat, Bradford Teaching Wallace Sampson (OBE), CEO for Hospitals NHS Foundation Trust. Harrogate Borough Council

16 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 17 The Partnership’s System It is anticipated this will promote Leadership Development and embed systemic change Programme leading to increased accountability. 07 Review Developed and designed by BAME The Partnership’s System Leadership colleagues, it aims to recognise the Development Programme recognising talent of colleagues and give them the importance of building inclusive the missing leadership skills and themes leadership, has put in place various opportunities required to progress support packages with a focus on their career. The unique element of Through the review’s work original themes, understanding BAME issues and around the fellowship programme is that as how white leaders will be required to well as offering traditional taught such as population health inequalities and demonstrably use that insight to sessions on system leadership, it also workforce, the areas of work were refined create better outcomes and guarantees a career coach and works into four distinct themes, through panel experiences for BAME staff and in partnership with organisations to member contributions, initial review of identify stretch opportunities and communities. This includes the BAME the evidence and further discussion by the associated competencies. Recognising Fellowship Programme which is panel: all about developing future senior the responsibility organisations have in increasing the diversity of senior system leaders that reflect the • Improving access to safe work for BAME leadership, this programme works local populations. Development colleagues in West Yorkshire and Harrogate of competencies to form a pivotal collaboratively to achieve different element of judgement on performance outcomes. • Ensuring the Partnership’s leadership is is underway for those working through reflective of communities the programme and for those leaders • Population planning (using information supporting the stretch opportunities. The programme supports the Partnership’s ambition to increase the to make sure that services meet different number of BAME colleagues in senior groups’ needs) leadership and board level positions. • Reducing inequalities in mental health outcomes by ethnicity.

Photo credit: Leeds and York Partnership NHS Foundation Trust

18 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 19 This includes homeworking or The risk to our workforce is not temporarily working in non-patient only about catching COVID-19. The Improving access to safe work facing roles. It also aims to ensure lockdown has resulted in large colleagues feel confident requesting numbers of people with reduced for BAME people in West access to personal protective employment and earning potential, equipment. Managers are trying to totalling around 24% of the workforce. ensure that any extended change to Analysis by McKinsey (May 2020), Yorkshire and Harrogate normal working arrangements does shows that people with the lowest not disadvantage BAME colleagues incomes are most at risk of this at in the longer term that could be a around 44% for roles such as cleaners, What does the evidence consequence of the resulting limiting kitchen assistants and waiting staff. range of duties, visibility, exposure People working in part time roles, via The Partnership aims to reduce tell us? any disproportionate health or and access to career development an agency or on zero hours contracts, economic impact resulting from The Office of National Statistics (ONS) opportunities. are especially vulnerable to changes in COVID-19 for people working in data (May 2020), tells us that some their job situation. For example, the West Yorkshire and Harrogate. jobs have a higher risk of exposure to The increased risk to health is also NHS Workforce Race Equality Standard You can read the insight which the virus because of the need to work true for any occupation where there is and local council information shows was gathered for this section here. closely with others. This is especially true close contact with other people every that BAME colleagues don’t always in health and social care environments day; for example bus and taxi drivers, receive the same opportunities as where there is a likelihood of direct hairdressers and cleaners, and for their White colleagues with people working in factories, such as equivalent qualifications. Key lines of inquiry exposure because of the need for direct physical contact with others. food production and manufacturing. for review Wide ranging analysis highlighted in The ONS data (May 2020) highlights a higher proportion of Black, Asian and • Are occupations at highest risk of the Health Service Journal (May 2020), What further action to do shows the significantly higher risk ethnic minority people are working exposure to COVID-19 infection over- in these types of jobs. For example, we need to take? represented by BAME population to BAME health and care workers of catching COVID-19. 60% of healthcare Health Foundation analysis of the ONS It is clear from the review findings groups? This element of the report labour force survey (June 2019) shows includes both the impact on health colleagues who have died of COVID-19 that the Partnership must make are from a BAME background whereas in West Yorkshire and Harrogate, 23% concerted efforts to reach, inform and and also the economic impact on of food production, processing and people due to the lock down. they make up around 20% of the support colleagues most at risk in our overall NHS workforce. food sales involves BAME colleagues. communities. It is also imperative that • What have West Yorkshire and For some of these roles the underlying safety and wellbeing messages are Harrogate organisations and The West Yorkshire Association of risk cannot be fully mitigated by social understood by the high proportion of local places done to mitigate and Acute Trusts (WYAAT) and the Mental distancing measures or more general BAME people working in high risk roles. communicate risk? Health, Learning Disability and Autism advice and guidance. As well as It is important for their health, and that Collaborative have worked with HR increasing awareness for some roles it of their families and communities. colleagues and the BAME Networks may be necessary to increase physical to develop a consistent approach to protection to mitigate the increased risk assessment in the workplace. This health risk of the workers. covers all areas of risk including age, weight, pregnancy and underlying health conditions - as well as ethnicity. In response to the risk assessments a number of actions have been put in place for people.

20 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 21 Recommendations

Immediate action is needed to Channel support to the most The risk assessment process is only Communication with colleagues share information and reach those vulnerable colleagues as the job the first step. The Partnership and communities recognises hardest hit by COVID-19. It is important retention and self-employed support should aim to ensure that appropriate the impact of racism on people’s to shine a light on the people who schemes end. The aim is to provide actions are taken in each place to lives. It is important that particular are working in high risk roles which support for people in sectors most mitigate risk for all colleagues, where attention is given to the fact that haven’t been given a high profile in impacted by lockdown. This includes they don’t already exist. We recognise BAME communities are not of one the media in the same way that some the provision of retraining and reskilling that individual organisations hold homogenous ethnicity. areas of the NHS have been. This schemes for potential new roles in accountability for doing risk assessments includes colleagues working in social the future and the introduction of and protecting those most vulnerable to The review recommends amplifying care settings, in transport and food new short term working and training harm, and that work is ongoing across communications messages at a local service roles, and people working schemes for disproportionately affected the Partnership to do this. level whilst not making assumptions in factory environments. We will BAME young people and women. This about language or method. It is also work with organisations, such as The will include supporting people returning The review therefore recommends that important to consider the impact of West Yorkshire Combined Authority to work on reduced hours, helping all organisations engage with their racism and digital exclusion. to deliver co-designed ethnically them to maintain working knowledge BAME networks (setting one up if it This should take place through local appropriate advice and support for in their job while the economy recovers. doesn’t already exist) to seek assurance communication channels and VCSE people who are working in high risk Initiatives are needed to narrow the regarding the impact and effectiveness networks. Consideration should also be roles to mitigate risk to their health, educational attainment gap and raise of risk assessments, and ensure that given to the co-production of a West their families and communities. In aspirations, supporting people from the emotional load related to racism Yorkshire and Harrogate anti-racism and addition to this where advice will not BAME communities into employment. is considered in the risk assessments a myth busting campaign to combat be sufficient; action to mitigate the risk and resulting mitigating actions. Good COVID-19 racism. should be taken, such as the provision The review recommends strategic practice found in organisations and of personal protective equipment for partners, such as West Yorkshire networks will also be shared through people working in public-facing roles. Combined Authority ensures equality the BAME network of networks. of opportunities for BAME groups are Watch this film about The Partnership will ensure that this explicit in all economic development the South West Yorkshire recommendation is reflected in the and recovery plans, and that positive Partnership NHS Foundation Partnership’s People Plan (expected action such as the inclusion of specific Trust’s Black, Asian and January 2021) and progress is monitored plans to improve opportunities for minority ethnic staff network, through the West Yorkshire and BAME communities, and the promotion which is one of many local Harrogate People Board and the of schemes such as the government organisation networks. Partnership Board. KickStart Scheme to young BAME people, are prioritised.

This should also include wider work on apprenticeships, post-university employment, job creation and start up grants. The review also recommends that strategic partners ensure that COVID-19 related safe working practices are incorporated in any and all work done to ensure quality employment for the population of West Yorkshire and Harrogate.

22 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 23 The panel acknowledged the data reviewed relates to the previous year Ensuring the Partnership’s and some progress has been made since the publication of the local NHS leadership is reflective of Workforce Race Equality Standard data (2019). communities However organisation boards on the whole are not representative of the communities they serve and the We know from analysis by McKinsey process of change is glacial and uneven and Company (February 2020) that The Partnership aims to ensure across the NHS. Based on available “White privilege doesn’t having diverse representation in their leadership is reflective of data (local NHS Workforce Race mean or suggest that you senior decision making is critical to communities, within partner Equality Standard data 2019) Board have had an easy life. Nor truly understand and represent the organisations, and at a system representation varies from 0% to does it suggest you haven’t views and needs of the communities and board level. You can read the 28.6% across NHS organisations in earned your successes but served. Evidence from a McKinsey insight gathered to support this West Yorkshire and Harrogate. it does mean that your life work here. and Company report (January, 2020) hasn’t been harder because highlighted that diverse boards The panel recognised the important of the colour of your skin” can also lead to improving the role inclusive cultures and processes experiences of BAME workforces. play in the experience and progression Key lines of inquiry A diverse Board offers a breadth of of BAME people. Similarly, the The review also found the likelihood for review perspective and leadership styles that McGregor-Smith Review (2017) of being appointed from shortlisting improve collective decision-making. recommendations are wide-ranging for roles is over double for White • Are boards within the Partnership Our Partnership must strive to be in nature and ask that organisations people than for BAME colleagues ethnically representative of the truly representative of the focus on improving workplace cultures, in some of our organisations. The communities they serve? communities we serve. improve processes and systematically relative likelihood of entering formal • What are the barriers for colleagues support progression. disciplinary action is also greater in applying and being successful at for BAME colleagues and they are reaching this level? This review identified a number of less likely to access nonmandatory barriers for the progression of BAME training and continuous professional • What representation do BAME colleagues in our organisations, and development. All of these are colleagues have on key decision found that structural racism and white indicators of career success and role making forums? privilege play a part. Experiencing progression. More detailed information structural racism and micro aggressions on these findings can be found in the What does the evidence can have an extremely negative insight report here. tell us? impact on people and can falter their progression, for example everyday Insight from the experiences of verbal and nonverbal slights or snubs, the West Yorkshire and Harrogate Based on census data from 2011 which are frequently not intended to BAME network and review of Roger for West Yorkshire and Harrogate cause harm or hurt feelings, yet their Kline’s (2020) work highlights that residents, overall 19.6% are from a impact often does just that. recruitment and selection processes BAME background. Bradford has the are unfair, there is increased scrutiny highest proportion of BAME groups of performance rather than potential, at 31.2% and Craven has the lowest and that social exclusion impacts on at 3.6%. opportunities to network. Photo credit: Airedale NHS Foundation Trust

24 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 25 This offers the opportunity for a Recommendations career coach to tailor the development needs of BAME colleagues for career To increase the fairness and equity To reduce the disparity in progression and offers a variety of of access to roles, the review disciplinary and complaints stretch and secondment opportunities recommends that all organisational processes, the review recommends all across the Partnership. The review leaders develop and embed clear organisations across West Yorkshire acknowledged that whilst there leadership standards that ensure and Harrogate develop independent are pockets of good practice being we have inclusive workplaces. That panels with BAME representation to Photo credit: delivered against the system ambition, leaders pledge to personally uphold review cases of racial discrimination on Yorkshire Ambulance Service such as the increased representation these standards within their own people who access care and services as NHS Trust in some decision making forums organisations, starting with a review well as staff. and the BAME focused development of recruitment and selection processes; The panels should also be responsible It is helpful to note that work is already programme and work on bias and where process is not followed ensure for assuring all grievance and underway across the Partnership. A privilege training, there was some immediate action is taken to support disciplinary cases are reviewed recent call to action asked all the concern about the lack of progress in learning, reward success and sanction to ensure racism has not been a Partnership’s Chief Executives to other areas and this inquiry could serve poor performance. contributing factor prior to cases ensure representatives from the as a reminder of the previously agreed progressing through to formal BAME network are involved in the actions. This builds on the commitment made in disciplinary stages. recruitment and selection of senior March 2020 to deliver the recruitment leadership level appointments. This and retention recommendations made in the ‘Achieving our ambition to In addition, to eliminate was part of delivering the West discrimination, identify ways of Yorkshire and Harrogate BAME Network increase the diversity of our leadership’ paper written by the West Yorkshire providing independent support for recommendations in March 2020 where BAME people going through processes recommendations include making What further action do and Harrogate BAME network. It is also a fundamental area of focus for the and promote inclusion; panels should equality and diversity and unconscious we need to take? support organisations to undertake bias training mandatory across all NHS People Plan 2020, which highlights the importance of compassionate and root cause analysis of existing systems partnership organisations. There are There is still much work to do inclusive cultures that value our people and processes when managing examples of good practice where to implement the Partnership’s and create a sense of belonging with disciplinary and complaint cases. Care structural privilege and White privilege commitment to deliver the system a particular focus on tackling the should be taken to ensure the process discussions are now being built into ambition of a more diverse leadership discrimination that some staff face. for making complaints does not unconscious bias training packages. that better reflects the broad range of penalise people and complaints are Whilst evidence informs us that talent in West Yorkshire and Harrogate. The evidence found that the handled seriously. training alone does not make a huge This includes helping to ensure that the Partnership needs to provide difference to reducing disparity in poor experiences in the workplace that To ensure leadership is more development opportunities for experience, undertaking it alongside are particularly high for BAME staff representative of communities, all BAME staff working at every level all the other system ambitions will be will become a thing of the past. the review recommends that all more impactful. Systemic reviews of across organisations. Partnership organisations should our recruitment and wider employment actively seek out local, ethnically processes and policies are integral to Photo: The review recommends that a new representative talent through positive Sal Uka, Clinical shaping lasting change and delivering BAME mentorship framework is action and embed accountability Lead for West on our commitments by ensuring that developed. This will provide additional, by setting targets for recruitment Yorkshire flexible development opportunities inclusion and equality are built into the Association of and retention, particularly at senior for people across the Partnership fabric of our day-to-day operations. Acute Trusts levels. This should include talent and further enhance opportunities within partnership organisations A fellowship programme has also provided by the West Yorkshire and proactive engagement with been developed for BAME colleagues and Harrogate BAME Fellowship schools, colleges, universities and local as recommended by the BAME network Programme (see page 7) in the West communities for recruitment drives (please see page 7). Yorkshire and Harrogate System with planned engagement events. Leadership Programme.

26 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 27 What further action do Population planning - using we need to take?

Intelligence informed action information to make sure The Partnership should foster a culture of recording and understanding of services meet different groups ethnicity data in all sectors. This requires improvements in the quality of coding of ethnicity across all of our of people’s needs health and care settings. This data should feed into population health Photo credit: Feel Good Factor, Leeds management models to support decision making in relation to local need and prioritisation of care. Key lines of inquiry The Partnership has developed a for review combined impact assessment for large Data should be coupled with relevant scale service change. Equality impact local insight to complete the picture. To identify and embed approaches to assessments (EQIAs) are completed This includes meaningful engagement reduce health inequalities for specific locally for service changes or revised with communities to understand ethnic groups throughout population policies. It was felt that EQIAs were people’s needs, strengths and planning processes. Pressures on often undertaken without assurance experiences. funding may exacerbate inequalities that positive action would follow where limited resource is not aligned where disadvantage was identified. We should use intelligence to inform to local need. You can read the insight thinking as to where we have gathered to support this work here. Review members highlighted the the greatest opportunity to take Photo credit: preventative action to improve health Yorkshire Cancer Community importance of co-producing services Population planning moves us on from with communities and of sustainable outcomes for people - this includes the term commissioning to a whole funding models for the VCSE and a refugees, asylum seekers, and Gypsy, Traveller and Roma groups of people. system approach to; understanding What does the evidence clear commitment to a commissioning needs, designing pathways, procuring tell us? intention that is co-designed with services and evaluating impact to local VCSE partners. Work is ongoing ensure local need is met. It involves a within the Partnership regarding Effective planning of services starts partnership approach for a population ‘Commissioning Futures’. The review with understanding groups of people’s across a defined geography whether advised further opportunities must be ‘needs’. This requires access to data this is a local neighbourhood, a local sought to connect this work with the and insight. Intelligence related to authority area or an integrated care needs of BAME communities across the ethnicity is often not included in system, such as ours. Partnership and that high-level buy-in local, regional and national data should be secured. sets. Improvements have been made locally in the recoding of ethnicity in primary care. For example, in Leeds gaps in ‘unknown or not recorded’ data has reduced from 22% in 2013 Photo credit: to 6% in 2020. Recording of ethnicity Keighley data varies across the NHS Trusts in Healthy Living the Partnership, with completeness Photo credit: ranging from 86.4% to 99.3%. Leeds Irish Health and Homes

28 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 29 The intelligence we use should be This should include specific action, to a doctor following a night in A&E due captured and considered at relevant such as easy to understand language, to an attempted suicide. Her number population geographies within the procurement mechanisms and contract was passed to the Integrated Access to system, including in neighbourhoods security. Psychological Therapies Service with no working with the data Primary Care access to an interpreter or explanation Networks hold, in local places bringing Approaches to micro-commissioning to what was happening. intelligence together in partnership, (the process of identifying and and at a system level to inform the addressing needs at an individual In the same period of hospital care, work we do across the Partnership. level through creating additional mental health liaison team colleagues activities in local communities) used Language Line to support them We need to do more to triangulate of services should be supported, and stayed in contact to ensure they the data from relevant sources with underpinned by knowledge of need received the care needed. We need to Photo credit: learn from examples such as these to system-wide approach to intelligence at a neighbourhood level. Touchstone, Leeds to underpin this. We also need to improve the way we work. do more to resource and embed Approaches for consultation, To receive the best experience from It is also essential that we keep in view Population Health Management models engagement and coproduction the process we should go to places overseas visitor charging which is a across the Partnership to support the should be adapted as relevant to where people are, in settings that are national government policy in terms of effective use of data and insight in meet preferred methods and styles of accessible and, importantly, where health inequalities. understanding need. specific groups of people, where they people are most comfortable. We don’t exist already. also need to consider the impact of A key part of the pathway of care is Equal partners in participation in public involvement, personalised care planning. When population planning including the support which may be working with BAME communities, needed for the psychological impact of We should seek to shift the balance colleagues should consider the cultural, those sharing their experiences. of power towards those with the religious and communication needs of greatest knowledge of the needs of specific ethnic groups of people. Digital Accelerated improvements specific ethnic groups, i.e. the people inclusion should also be considered, in our communities. This involves Partnerships should come together including reducing barriers to access taking positive action to seek the views to understand inequalities in relation related to language, connectivity and of under-represented groups to ensure to access and use of health and care access to technology. Public facing the views sought for engagement services by ethnicity. roles, including receptionists, mental reflect the ethnic diversity of our health workers etc. should be reflective populations. This engagement should Positive action should be taken to of the ethnic diversity of communities, happen throughout the population Photo credit: mitigate the widening of inequalities. with culturally competent services being planning process, including the Keighley Healthy Living Options for delivering models for care, provided. development of co-design principles such as digital access or social prescribing with the Voluntary Community and The engagement we undertake needs offers, should consider the needs Social Enterprise (VCSE) and the to be fit for purpose for what we need for specific ethnic groups of people. community they serve. to deliver to improve people’s health. Equality impact assessment processes Being clear on the purpose of the need to reform to become a catalyst for The VCSE play a key role in this, as engagement, where the findings will change. Effective alternatives should they are agile and responsive to local be shared and to what extent it can be developed that have more direct community needs. An approach to influence change is essential. accountability aligned to improved service planning should be adopted, health outcomes for people. one that creates an equal playing field for all providers, including the You can see an example of this from Photo credit: VCSE, in the design and delivery of two experiences of care for one person Wakefield NHS Clinical services. who spoke only Farsi. They were referred Commissioning Group

30 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 31 Recommendations

Insight and Intelligence: Accelerated improvements include Reducing inequalities in Understanding the needs of continuous cycles of intelligence- different population groups and based service developments to mental health outcomes improved recording of ethnicity is make sure services are culturally shared to improve racial inequalities able and meet local need. We will for the decision makers across the work across the Partnership to by ethnicity Partnership. demonstrate the actions we have taken to reduce inequalities for This review recommends that ethnicity specific ethnic groups. The review recording is 100% in all settings and recommends monitoring service To explore inequalities in mental The Health Inequalities Prevention that data is visible in integrated access, uptake and outcomes by health for BAME communities, Pathway (HIPP) approach was used to intelligence models. ethnicity. Services should demonstrate in order to develop targeted understand the causes of inequality in how they are contributing towards approaches for improving mental health. This included three key The review also recommends that the reducing inequalities. This would mental health. You can read the issues: Partnership take system action for involve working with West insight gathered to support this 1. Are there inequalities in living specific groups requiring more focus, Yorkshire Association of Acute work here. conditions and risk factors that for example refugees, asylum seekers, Trusts, mental health providers, affect mental ill health? What can Roma, Gypsy and Traveller groups of Primary Care Networks and other be done to reduce this? people and to better understand the partner organisations to identify links between ethnicity and poverty. Key lines of inquiry 2. Are communities able to see a opportunities to reduce inequalities for review health professional and get a through service improvements. diagnosis? What can be done to Equal partners: Redressing the This review focused on the mental improve access to health care? balance of power towards those health needs of people from different 3. Is treatment and support for mental with the best knowledge of why BAME communities, including the illness high quality and appropriate? inequalities exist and the solutions of following groups of people who How can this be improved? how they can be addressed. experience particularly high levels of inequality: The review recommends community representation that reflects the • Men from Black or Black British diverse ethnicity of local areas, is backgrounds embedded throughout the population • Women from South Asian planning process; including in the backgrounds design, mobilisation, delivery and • People from Gypsy, Roma and evaluation of services. The review also Traveller communities recommends the VCSE are treated as equal partners with clear mechanisms • People who are asylum seekers or in place to enable this. refugees.

*It is important to note that within Photo credit: each of these groups, there are Yorkshire Ambulance Service NHS Trust Find out more about diverse communities with different involving people in service experiences, needs and strengths. >> delivery by watching this film about the Sikh Alliance Photo credit: Yorkshire and Sikh Elders Service. Sikh Elders Service, Touchstone

32 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 33 What does the evidence Evidence on rates of mental illness by People who are suffering from tell us? ethnicity is complex and mixed. Black mental ill health do not always get a men are three times more likely to diagnosis and the care that they need. The conditions of everyday life, such be diagnosed as having a psychotic Research has shown that depression as income, employment, housing condition than any other group and and anxiety in pregnancy was more and the local environment, have an there is evidence that Black women likely to be missed for women from impact on mental health. Experiences are more likely to have depression or Pakistani backgrounds in some areas of discrimination and racism are also anxiety (McManus et al 2016). (Prady et al 2016). People from Gypsy, likely to impact on people’s mental Roma and Traveller communities, and health. In West Yorkshire, people from Refugees and asylum seekers have asylum seekers and refugees, often BAME backgrounds are more likely to much higher rates of mental ill health find it very difficult to get the health live in the most deprived 10% of areas than the general population, and it care they need. For people with (West Yorkshire Combined Authority, has been estimated that over 30% English as an additional language, 2020). experience depression, and over making an appointment in the first 30% experience post-traumatic stress instance can be difficult. Other Photo credit: South West Yorkshire The Office of National Statistics disorder (Blackmore et al 2020). barriers include stigma, trust and Partnership NHS Foundation Trust (ONS) has shown that income levels concerns about discrimination, and vary by ethnicity, with people from lack of understanding of how the Bangladeshi backgrounds having the health care system works. After starting psychological therapies lowest median hourly pay. People for anxiety disorders and depression, from non-White backgrounds are more The Voluntary Community and completion rates are lower for people likely to be unemployed than people Social Enterprise (VCSE) sector and from Black, Asian or minority ethnic from a White background (ONS, 2019). individual people, such as teachers or backgrounds. For example, in West youth workers, provide considerable Yorkshire and Harrogate 46% of White There is some evidence that air support, for example to people who men complete treatment, compared pollution is linked to depression, have mild to moderate illness, or with 39% of Black/Black British anxiety and suicide, and we know that people who are waiting to receive men and 38% of men from mixed air quality is worse in areas with high appropriate health care. This puts backgrounds (IAPT 2019/20 figures). BAME populations. There are also pressure on these organisations and Issues raised include a lack of culturally differences in the use of greenspace individual people. The emotional appropriate services, including support by ethnicity, which is linked to both toll of providing support is high, in different languages. physical and mental health. with impacts on their wellbeing. This was illustrated to the Review Panel In West Yorkshire and Harrogate there (September, 2020) with examples put are many examples of innovative COVID-19 has had an unequal impact forward from VCSE organisations approaches and good practice to on BAME populations, including loss It can also be difficult to understand supporting refugees and asylum support the mental health of BAME of employment and income, increased differences locally, due to issues with seekers who help people with complex communities. This ranges from caring responsibilities and loss of data collection. For example, Gypsy, trauma to navigate the health and individual people and community support networks. There are likely to Roma and Traveller background care system. organisations, through to health care be ongoing mental health support information is rarely recorded, so providers, commissioners and mental needs, including for people who have inequalities in mental health for High quality of treatment and support health hospitals. Sharing learning from lost friends and family or been unwell people from these communities are is essential to help people to manage these across the area could help to with the virus. ‘invisible’. their conditions and recover. There reduce inequalities in mental health. is some evidence of differences by ethnicity. >>

34 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 35 Recommendations Some of the many examples of good practice in West Yorkshire: To address the disproportionate This also involves supporting evidence impact on the mental health of based reviews, evaluating services • In Bradford, a GP surgery had • In Leeds, the Black Health some BAME groups of people due and coordinating training. Capacity made great improvements in Initiative has funded a project to factors such as living conditions, should be identified to take this work access to health care for people to support black men in their good work, fair pay, education and forward aligned with the Mental from the Roma community after communities around mental ill environmental issues such as air Health, Learning Disability and Autism recruiting a staff member from an health issues. pollution. and Improving Population Health Eastern European background. • In Calderdale, Kirklees and Programmes. • In Calderdale, the Roshani project Wakefield, partners have This review recommends that we works with communities and worked with faith communities should work as a Partnership to address community organisations to to deliver mental health first the wider determinants of health that increase awareness of mental aid training for faith leaders. disproportionately affects people from BAME communities. This includes health issues and challenge stigma. Photo: economic and environmental factors Patrycja Bartosinska, through procurement, employment, Huddersfield skills development and collaborative volunteer action. This involves expanding What further action do anchor institution approaches using we need to take? procurement and employment opportunities to create community The VCSE sector and individual Whilst there are many examples of Evaluating whether services are wealth among BAME populations. A people in communities are good practice, inequalities in mental working for people from different strong focus on improving housing providing considerable support to health remain. There is a need for communities is essential. There are conditions for people from BAME those with mental ill health, and need targeted action on inequalities in living opportunities to share good practice communities through the emerging further support to be resilient enough conditions for people from BAME across West Yorkshire and Harrogate health and housing network. This to continue this role. communities. More work is needed to to improve access to health care and would involve working with partners ensure everyone can access the care treatment available for people from such as, West Yorkshire Combined The VCSE sector providing ongoing they need, including focussed work all BAME communities. Authority to improve equity in skills mental health support to these to engage with communities, reduce and development opportunity and communities should receive additional stigma and improve understanding of outcomes by ethnicity as part of the specialist emotional and practical services where it doesn’t already exist. renewed regional skills strategy. support to continue this work. This Better collection and use of data on could be through community provision mental health and ethnicity would We will develop system-level of specialist mental health care improve understanding of inequalities actions to identify and address in partnership with existing VCSE and help ensure progress is made. inequalities in mental health for BAME organisations or through improved communities. partnership work with primary care networks. This review recommends that the Partnership coordinate progress on reducing inequalities in mental Photo credit: health by ethnic group. This includes Ripaljeet from the Black Asian and identifying and sharing good practice, Minority Ethnic Dementia Service. facilitating collection of intelligence and insight, and reviewing local auditing arrangements.

36 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 37 Summary of 1 recommendations The Partnership should develop and embed 3 inclusive leadership standards which leaders All health and care organisations To improve access to safe pledge to personally in West Yorkshire and Harrogate work for Black, Asian and uphold within their should develop independent minority ethnic (BAME) organisations, starting discrimination panels with BAME people in West Yorkshire with recruitment and representation to review all cases of racial discrimination in and Harrogate, the review 3 selection processes. recommends that... disciplinary and complaints cases All West Yorkshire and Harrogate prior to progressing through to partner organisations should formal stages. engage with their BAME networks (setting one up if it doesn’t already exist) to seek assurance regarding the impact and effectiveness of risk assessments and the resulting actions - ensuring the impact of racism is fully considered and mitigated. 2 A West Yorkshire and Harrogate 1 System Leadership Programme Work with partners, such as is commissioned to develop a The West Yorkshire Combined BAME mentorship framework. Authority to deliver co-designed, ethically appropriate advice and support for people who are in high risk roles. This will help to mitigate risk to their health, To ensure the Partnership’s their families and communities. leadership is reflective of 4 communities, the review 4 The Partnership should recommends that... All organisations in West 2 support the co-production Yorkshire and Harrogate of an anti-racism campaign. should engage in positive Work with strategic partners, Recognising and appreciating action to actively seek such as West Yorkshire Combined that BAME people are not out local, ethnically Authority, to ensure equality of one homogenous population. representative talent with It is helpful to note that these opportunities for BAME groups Communications messages local recruitment targets recommendations build on in all economic development and should be amplified at a for senior level roles. knowledge, insight and intelligence recovery plans, including work on local level to consider the as well as existing work carried out apprenticeships, job creation and impact of racism and digital by the Partnership. You can read start up grants. exclusion. more in the main report.

38 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 39 Summary of 1 recommendations Work to address the determinants that lead continued... to ethnic inequalities in mental health. This includes 2 using procurement and 3 Community representation employment opportunities that reflects local population to create community wealth Support the voluntary, To use information ethnicity, is visible throughout among BAME populations, community and social to plan services to the planning process, including improving housing conditions enterprise sector to provide meet different groups procurement of services. for people and equity in skills ongoing mental health of people’s needs opportunities. support to Black, Asian through population and minority ethnicity planning. The review 4 communities. Colleagues from recommends that this sector should receive services are culturally Service access, uptake additional specialist emotional competent and are and outcomes by and practical support to contributing towards ethnicity are monitored continue this work. reducing inequalities to identify inequalities. identified... To reduce inequalities in mental health outcomes by ethnicity, the review recommends all West Yorkshire and Harrogate Partnership organisations...

1 5 Ethnicity recording is 100% in Demonstrate that services all settings and that this data, are culturally competent Please see full report coupled with local insight, is and are contributing 2 for more information used across the Partnership to towards reducing Work together to co-ordinate, on recommendations. inform the design and delivery inequalities identified. lead and measure progress of care. on reducing inequalities in mental health by ethnicity. This includes sharing good practice, 3 Watch the improving use of evidence and Clear local and Partnership Partnership’s film to coordinating training. arrangements for commissioning see why all the review with the voluntary, community recommendations are and social enterprise (VCSE) so important. sector are in place.

40 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 41 Our independent review has again repeated the facts about the Action plan Closing inequalities by ethnicity and has shown that BAME communities can be vulnerable to poorer health outcomes This reports sets out a series of The Partnership Board will periodically comments from for far too many reasons. There are key recommendations to the leadership review progress against the report factors that can increase inequalities of the West Yorkshire and Harrogate recommendations. This information will further such as intersectionality with Health and Care Partnership. The be made available to the public. The Rob Webster deprivation. In West Yorkshire and Partnership will develop an action plan action plan will be accompanied by a Harrogate around half a million people in response to the recommendations, set of indicators to measure progress West Yorkshire and Harrogate’s cultural are living in the 10% most deprived outlining roles and responsibilities and over time. vibrancy is borne from cities, towns, communities nationally; a clear picture aligning it to our People Plan. villages with strong diverse communities is that of a social gradient - the more Along with the above, we also aim and even stronger identities. As a deprived the place where you live, to strengthen the role for the VCSE Partnership we are extremely proud the higher the mortality rate and the This action plan will be considered panel, which was set up to inform the to work alongside and represent the shorter your life expectancy. and approved by the Partnership review. This will help ensure progress is 2.7million people living across the area. Board in December 2020, before being made on the recommendations. Their People from BAME backgrounds, like published here. role will be important in supporting The healthy life expectancy of people all people, experience a range of risks the Partnership to engage with living in some areas is below the to their health throughout their lives. communities who might not otherwise national average, and the inequalities These risks vary significantly depending During this time we will engage be aware of this work. This will be between communities are significant. on their ethnicity. For example, meaningfully with stakeholders in achieved through community assets Working together with communities is people from BAME backgrounds are developing the plan. and influencers. We will also aim to what motivates local health and care overrepresented in the most deprived strengthen the role of the regional partners to work as one partnership 10% of our population across West BAME network in implementing and together, putting the needs of people Yorkshire and Harrogate, and income delivering change. first. varies by ethnic group.

As set out in this review report The economic impact of COVID-19 (summary) West Yorkshire and has led to a recession which brings Harrogate Health and Care Partnership additional risks to the mental and has big ambitions to tackle health physical health of our population – all inequalities and support Black, Asian themes covered in this report. and minority ethnic (BAME) communities and staff. The COVID-19 pandemic has The report also shines a light on brought these issues into even sharper the economic benefits of the health focus, with inequalities seen in deaths and care system. We are creators of for specific ethnic groups. good jobs, have large capital schemes underway, lead innovation in med tech and digital work. These potential We will now act on the findings benefits for both the economy and for from this review, built on the dual local people must be secured as we foundations of good evidence and invest in health and care. the testimony of people with lived experience.

42 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 43 It is our time to step up, to better opportunity to thank all colleagues support staff, and to build a new involved in the Review Panel, including resilient workforce for the future which voluntary and community partners Supporting information is truly reflective of the communities who have given their time freely we serve with a leadership that has without hesitation to do what is A report summary is available in All information was accurate at the talent, which has often gone right for all communities across West British Sign Language, Easy Read and September 2020. Please note some unrecognised, and the commitment Yorkshire and Harrogate. My thanks audio version. It is also available in of the photos and film footage may from us all. also to Professor Dame Donna Kinnair community languages. have been produced pre-COVID-19. for her inspirational leadership in As we continue through the COVID-19 challenging us all to think differently, There is also a range of information pandemic, it will be important to to make change happen and giving on our website to support this rebuild and shape our local economy us the confidence we need to get on important report. This includes to meet the needs of all people – and move forward at pace without personal reflections from the review irrespective of social class, ethnicity or hesitation. panel members, voluntary and other factors. The Partnership sees that community sector partner case studies we have a role in tackling economic, We have the potential to make the and a series of short films. You can social and health inequalities barriers work of this review something unique also listen to a podcast from review to achieving long-term prosperity and and special. I’m reassured that this is panel members talking about their considerably reducing the impact on a significant step forward that will BAME communities and colleagues. be closely monitored as progress is personal experience as part of the made through our action plan with review process here. The voluntary Not all experiences are equal and our clear timescales for delivery. This will and community sector enterprise sub- current language does not account for amplify and extend the work already group (VCSE) review sub group also the different ways in which different underway. Above all, we now have an recorded a podcast which is here. ethnic minorities experience racism. opportunity to improve and to save Racism is experienced differently lives – it’s imperative we seize the and to different degrees by different moment to make something of value groups of people. It is unhelpful we can be proud of together. to suggest that BAME groups are in perfect racial solidarity - that all Thank you to contributors racism is the same and that all ‘BAME’ people have the same life experiences Review Panel Membership and values. The experiences of BAME communities and staff, in and out of • Professor Dame Donna Kinnair, • Brendan Brown, Chief Executive, the workplace, differ considerably and Rob Webster Chief Executive and General Airedale NHS Foundation Trust it is our role as a large health and care (CBE) Secretary, Royal College of Nursing and Senior Responsible Officer partnership to take this into account (Independent Chair) (SRO) for the WY&H HCP and make a positive difference to CEO Lead for West Yorkshire and • Dr Sohail Abbas, GP and Deputy Workforce Programme people’s lives with them. Harrogate Health and Care Partnership Clinical Chair at NHS Bradford • Marie Burnham, Independent (also known as an integrated care District and Craven Clinical Lay Chair of the WY&H HCP Joint I would personally like to thank system (ICS) and CEO for South West Commissioning Group (CCG) Committee of CCGs everyone for their hard work and Yorkshire Partnership NHS Trust and Chair of the West Yorkshire involvement in this report. This and Harrogate Health and Care includes the Partnership’s leadership Partnership (WY&H HCP) Health executive group, our People Board Watch this film here about Inequalities Network >> and of course the West Yorkshire and why the review is important, Harrogate BAME network. and for more information on I would like to also take the the recommendations and what is next.

44 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 45 Review Panel Membership continued... Voluntary and Community Sector Enterprise Sub-group Membership • Yvonne Coghill, Former Director of • Rachel Spencer-Henshall, Strategic Workforce Race Equality Standard at Director Corporate Strategy, • Jo Baker, Programme Director, • Heather Nelson, Chief Executive, NHS England Commissioning and Public Health , WY&H HCP Harnessing the Power of Black Health Initiative Kirklees Council • Hannah Davies, Chief Executive, Communities Programme • Portia Roberts-Popham, Chief Healthwatch Leeds • Richard Stubbs, Chief Executive, • Humayun Islam, Chief Executive, Executive Officer, Locorum Care • Stephen Featherstone, Co-opted Yorkshire & Humber Academic Health BEAP Community Partnership Services Ltd Science Network Member, WY&H HCP Health and • Dipika Kaushal, Chief Executive • Santokh Sidhu, (Harrogate voluntary Care Partnership Board • Cllr Tim Swift, Leader, Calderdale Officer, Voluntary Action Calderdale community sector representative) Council and Chair of the WY&H HCP • Fatima Khan-Shah, Programme • Javed Khan, Chief Executive Officer, • Sayed Ahmed from Pakistan and Health and Care Partnership Board Director, WY&H HCP Unpaid Carers CNet Bradford Kashmir Welfare Association and Personalised Care programme • Dr James Thomas, Clinical Chair, • Kaneez Khan, Local Coordinator • Hilary Thompson, Chair, Third Sector and member of the WY&H BAME NHS Bradford Districts and Craven (West Yorkshire), Near Neighbours Leaders Kirklees and SRO for the Network CCG, Co-Chair of the WY&H HCP • Corrina Lawrence, Chief Executive WY&H HCP Harnessing the Power of • Alison Lowe, Chief Executive, Clinical Forum and Joint SRO for the Officer, Feel Good Factor Communities Programme. Touchstone (voluntary and WY&H Improving Population Health community sector representative) Programme • Alison Lowe, Chief Executive, Touchstone • Dr Habib Naqvi, Interim Director for • Robin Tuddenham, Chief Executive, the NHS Workforce Race Equality Calderdale Council and Joint SRO for Standard at NHS England / NHS the WY&H HCP Improving Population Health Programme Improvement Report Contributors • Sara Robinson, Centre Lead, • Rob Webster, Chief Executive, South West Yorkshire Partnership NHS St Augustine’s (voluntary and • Pippa Bird, WY&H HCP, Specialist • Sayma Mirza, Senior Head of Foundation Trust and CEO Lead for community sector representative) Registrar in Public Health Collaboration, Act as One -System the WY&H HCP Transformation. Programme for • Wallace Sampson, Chief Executive, • Madi Hoskin, Programme Manager, • Dr Owen Williams, Chief Bradford District and Craven Harrogate Borough Council West Yorkshire Association of Executive, Calderdale and Acute Trusts • Yannish Naik, WY&H HCP Climate • Kim Shutler, Chief Executive, Huddersfield NHS Foundation Change Lead / Acting Consultant in The Cellar Trust (voluntary and Trust and Chair of the NHS England / Public Health community sector representative) NHS Improvement Health Inequalities • Sarah Smith, Consultant in Public Expert Advisory Group Health and Programme Director, • Professor John Wright, Director, WY&H HCP Improving Population Bradford Institute of Health Research. West Yorkshire and Harrogate Health and Care Health programme Partnership (WY&H HCP) Project Support Team • Heather McKnight, WY&H HCP • Lauren Phillips, Head of Programmes Programme Support for WY&H HCP. • Ian Holmes, Director, WY&H HCP • Pam Bhupal, Calderdale Council, • Jonathan Booker, WY&H HCP Regional Health Partnership Support. Senior Analyst • Karen Coleman, WY&H HCP Communications and Engagement Lead

46 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 47 Air Pollution Dec National Environmental, All Isobel References (Particulate Matter) 2019 Mental health Braithwaite, Exposure and Shuo Zhang, Associations with James Depression, Anxiety, Kirkbride, Bipolar, Psychosis David Osborn, Title Date Geography Subject Population Author and Suicide Risk: A Joseph Hayes group Systematic Review and Mental health and 2014 National Mental health All S. McManus, Meta-Analysis wellbeing in the NHS P. Health needs data Dec Leeds Palliative Care All Leeds Bebbington, update 2019: 2019 Palliative R. Jenkins, End of life care services Network T Brugha for adults in Leeds Diversity matters Feb National Workforce All Vivian Hunt, 2015 Dennis Layton Deaths of NHS staff April National Mortality All Tim Cook, and Sara from Covid-19 analysed 2020 Emira Prince Kursumovic, Simon Evaluation of ethnic May National Mental Black, Asian S. Prady, Lennane disparities in detection 2016 health, access and minority K Pickett, Gig workers among April International Covid-19, All Josephine of depression and of health ethnic E. Petherick, the hardest hit by 2020 Employment Moulds anxiety in primary care services communities S. Gilbody, coronavirus pandemic during the maternal (BAME) T. Croudace, period: combined D. Mason, Are some ethnic groups May National Covid-19, BAME Lucinda Platt analysis of routine and T, Sheldon, more vulnerable to 2020 Employment Ross Warwick cohort data J. Wright Covid-19 than others?

Assessing jobs at risk May National Employment, All Tera Allas, Race in the workplace: Feb National Workforce All Dept. of and the impact on 2020 Workforce Marc Canal The McGregor-Smith 2017 Business, people and places and Vivian Review Energy and Hunt Industrial strategy Covid-19 in-patient May Bradford Covid-19, BAME John Wright, hospital mortality by 2020 Ethnicity, Gillian Access and experiences 2018 Leeds Mental health BAME John Halsall ethnicity Mortality, Santorelli, of mental health crisis Gender Trevor care services in Leeds Sheldon, by black and minority Jane West, ethnic communities Chris Cartwright Delivering through Jan National Workforce All Vivian Hunt, diversity 2018 Sara Prince, Homelessness and May Leeds Homelessness, All Leeds City Sundiatu Rough Sleeping 2020 Rough Council: Dixon-Fyle Strategy 2019- 2022 Sleepers Housing and Lareina Options Yee The effects of the May National Covid-19 All Laura Social, Emotional and Oct Leeds Mental health All Children Charlotte coronavirus crisis on 2020 Employment Gardiner Mental Health Needs 2019 and young Hanson workers Hannah Assessment: children people Parminder Slaughter and young people from Grewal Black, Asian and ethnic Which occupations have May National Employment, All Office of minority communities the highest potential 2020 Workforce, National in Leeds exposure to the Economy Statistics coronavirus (COVID-19)? Covid-19 transport June West Covid-19, All West UK labour market June National Employment, All Office of survey 2020 Yorkshire Employment, Yorkshire 2019 Workforce National Travel Combined Statistics Authority

48 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 49 How Covid-19 is June National Mental health Children and Kooth Coronavirus Aug West Covid-19, All West affecting the mental 2020 Young engagement report for 2020 Yorkshire Voluntary, Yorkshire and health of young people people stabilisation and reset and Community Harrogate in the BAME community Harrogate Sector Health and Care Sikhs Covid-19 report June Yorkshire Covid-19 Sikhs Sikh Alliance Partnership 2020 Yorkshire Disparities in the Aug National Covid-19 BAME Prof. Kevin Stabilisation and Reset June West Covid-19 Workforce West risk and outcomes of 2020 Fenton Programme: Rapid 2020 Yorkshire Yorkshire and Covid-19 Insight Report and Harrogate Harrogate Health NHS England / Aug National Covid-19, All NHS England/ and Care Improvement 2020 Mental NHS Partnership Planning Guidance – health, Improvement Yorkshire Implementing Phase 3 Health & Humber of the NHS response to services Academic the COVID-19 pandemic Health Science Network Over-Exposed and Aug National Economy, BAME adult Zubaida Under-Protected: The 2020 Ethnicity and children Haque A review on how July National Health All Children Dept. of devastating impact Inequalities Laia Becares the health of babies 2020 inequalities Health and of Covid-19 on black Nick Treloar and young children Social Care and minority ethnic from disadvantaged Jo Churchill communities in Great backgrounds can be MP Britain improved Andrea Leadsom MP We are the NHS: the Aug National Covid-19, BAME NHS England/ Matt Hancock NHS People Plan 2020 Workforce, NHS MP 2020/21 Employment, Improvement Commission on Race July National Employment BAME Dr Tony Leadership and Ethnic Disparities 2020 Health, Sewell (Chair) Kickstart scheme Sept National Employment All Department Criminal 2020 for Work and Justice Pensions Covid-19 and Brexit: July National Covid-19, All Josh De Lyon Real-time updates on 2020 Brexit Swati Dhingra The prevalence of Sept National Mental health Refugees Rebecca business performance in mental illness in 2020 and asylum Blackmore, the United Kingdom refugees and asylum seekers Jaqueline English Housing Survey July National Housing All Ministry of seekers: A systematic Boyle, 2020 Housing, review and meta- Mina Fazel, Communities analysis Sanjeeva and Local Ranasinha, Government Kyle Gray, Grace Race disparities in July International Innovation BAME Eszter Czibor Fitzgerald, innovation 2020 Marie Misso, Melanie Third sector resilience July West Covid-19 All Voluntary Gibson-Helm in West Yorkshire and 2020 Yorkshire Action Leeds Harrogate: Before and and during Covid-19 Harrogate Action required Aug National Covid-19, BAME Dr Owen to tackle health 2020 Ethnicity Williams OBE inequalities in latest (Chair) phase of COVID-19 NHS England response and recovery and NHS Improvement

50 / West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield West Yorkshire and Harrogate is made up of Bradford district and Craven; Calderdale, Harrogate, Leeds, Kirklees and Wakefield / 51 For more information contact: 01924 317659

NHS Wakefield CCG White Rose House West Parade Wakefield WF1 1LT

[email protected] A Partnership made up of the NHS, local councils, care providers, Healthwatch, voluntary www.wyhpartnership.co.uk and community organisations and charities. @WYHpartnership

Publication date: October 2020

Communications and engagement report

Total Favourability: mentions: 34 24

Total How many number enquiries have been of media 5 responded 5 enquiries: to on time:

A selection of recent media stories:

We’ve issued 19 media releases in the past two months, covering a range of topics including coronavirus guidance, self-care, mental health and wellbeing, cancer and local good news stories:

Gruffalo themed flu clinic takes place at a local GP practice

Delight as CQC praises improvements at Leeds GP practice

Local NHS and Leeds City Council appoint their new Chief Digital Information Officer

Trailblazing Leeds GP shining a light on health inequalities and Black British history

Public urged to use the right NHS service this winter

NHS doctors look to tackle misinformation about coronavirus during a Facebook Live session

NHS in Leeds highlights the importance of hand hygiene on Global Handwashing Day 2020

Coronavirus: A guide for parents and carers

NHS in Leeds encourages children and young people to seek mental health support ahead of World Mental Health Day 2020

Mental health support for all

 You can find all our press releases on our website https://www.leedsccg.nhs.uk/news/

September

Most popular content

This post describing the importance of washing your hands to help stop the spread of Covid 19 (click on image to view the Facebook post).

The post received 268 reactions, reaching an audience of 74,929 and with 715 engagements.

To view the post please click on the image on the left

Covid-19 – during the last two months, our campaigns and communications activity has still largely focused on issues surrounding the pandemic and the city’s stabilisation and reset work, which is a partnership approach involving colleagues across the local healthcare system. We continue to support messages that promote appropriate use of healthcare services and actions people can take to reduce the rate of infections.

In September, we ran our first Facebook Live event with local doctors and public health experts to address coronavirus questions and misinformation. The video from the session has had just under 4,000 views.

AGM – we supported governance colleagues with this year’s virtual annual general meeting, including writing and publishing the CCG’s annual report and annual review.

City/regional meetings and representation – we continue to hold key roles as part of the West Yorkshire and Harrogate communications network and the Leeds citywide communications network.

Citywide work – we are continuing to provide communications support for the city digital team. We are also supporting communications around mental health, an area of significant concern because of the impact of Covid-19. In addition, we are working with colleagues across the city on the 2020-21 flu vaccination campaign.

Health inequalities – we worked with the Yorkshire Evening Post to launch our health inequality framework leading to a series of features highlighting the work of partner organisations in tackling health inequalities.

Internal communications – we have continued our regular (three times a week) briefings for primary care and CCG staff and support our chief executive with a monthly team briefs via Teams Live. For World Mental Health Day, we organised a virtual staff wellbeing event with a local mental health specialist.

Local campaigns – we continue to work with commissioners, clinical colleagues and our partners to develop campaigns in response to current issues, including Feel Better, our student health and wellbeing campaign, and continuing our work to highlight NHS services (#NHSHereForYou and #ReopeningSafely).

National campaigns – we continue to support national information and awareness campaigns, including Black History Month, World Mental Health Day and Global Handwashing Day.

Primary care communications – we have supported practices by providing patient-facing materials, social media advice and media relations guidance, including press releases to highlight good news stories. We continue to support the new primary care BAME network.

Website accessibility – we ensured out website met new public sector accessibility standards, ahead of the 23 September deadline.

Winter preparedness – with flu season and coronavirus likely to significantly affect health and care service capacity, we continue to work with colleagues across the city to ensure clear, consistent and effective communications help people access he right services at the right time as well as taking preventative action to keep themselves and others stay well.

Number Average open of e- bulletins rate * *We have temporarily (staff 144 changed the way we N/A and send out daily staff primary and primary care briefings and are care) currently unable to access open rates

Number of extranet users 725

Number of Average people 429 number registered on of users 267 Workplace by per week Facebook

Number Number of of live engagement consultations/ events / engagements activities 7

Number Number of people of people involved in 122 signed up to our events / patient & activities public network

Number of Number parliamentary of PQs N/A enquiries 0 responded to on time

As a result of the ongoing Covid-19 pandemic, no new engagements were started during September and October; however, members of our team are involved in several work groups. In addition, we continue to consider alternative approaches to patient and public involvement.

Mental health community commissioning review – the CCG commissioning team and Leeds City Council are reviewing third sector and community-based mental health services in Leeds. Our team, alongside two CCG volunteers, is supporting this work.

Children’s constipation – we had our first steering group meeting in October. We now are contacting families who may want to be involved and gathering insight.

Community neuro service review – the insight report has been completed, and a survey is now live, asking patients for thoughts on the current service. This will conclude in December when commissioners and providers will agree on options for the new service. Engagement will start February 2021.

Insight reviews – we completed an insight review for the Primary Care Pro-active Team into what people in the Lincoln Green area think about accessing health and care services, and are working on a similar review for the Belle Isle area.

Insight repository – we are supporting work in the CCG to explore the development of an Insight repository and grey literature library. These resources will enable us to collate and code patient insight so that we can use existing patient experience data to inform commissioning decisions in the city.

Primary care networks engagement – we are working with Leeds Voices and Cross Gates Primary Care Network to develop a pilot to strengthen patient participation groups (PPGs) to facilitate stronger links between practices and the local patient population.

Digitising engagement – the working group, of patient and public volunteers from the CCG Network, met in October to look at priorities and focus. This will enable us to develop an aim, objectives and outcomes for this project.

CCG volunteers – We held one virtual group catch-up sessions during this time, and are developing more opportunities for our volunteers to get involved online. We continue to provide mentoring to our volunteers via phone and video calls.

Patient Assurance Group (PAG) – no PAG meetings were held in September or October.

Patient participation groups (PPGs) – we have continued to support PPGs during this time, attending meetings and planning a virtual PPG event.

Winter preparation engagement – Leeds Voices are leading an engagement to understand the communication needs of key seldom-heard communities and coproduce essential winter/Covid-19 messages for those communities.

People’s Voices Group (PVG) – we continue to support the PVG and associated sub-groups. These include the Digital Inclusion, Big Leeds Chat, and Citywide Network subgroups.

Networked Data Lab – we are continuing to provide support and guidance to the Business Intelligence Team with the engagement aspects of their Networked Data Lab.

Co-Production Training – we ran a virtual session of our co-production training through Zoom in October. We hope to create a video resource of the session to share online.

Covid-19 – we will continue to support the Leeds system with clear and consistent communications.

Campaigns – we will be working with colleagues to develop new campaigns and communications plans around antimicrobial resistance, advance care planning, Brexit and mental health. We are also developing a harms minimization programme for people aged 60 and above to encourage people to stay active and socially, but not physically, connected.

We will be supporting the West Yorkshire and Harrogate Health and Care Partnership with several regional campaigns, including Positive Vibes (mental wellbeing), Islamophobia awareness, Healthy Hearts (cardiovascular disease awareness) and Looking out for our Neighbours (social isolation).

We will also be supporting national initiatives, including the new Help Us Help You campaign.

Internal communications – we will continue to look at new ways to engage staff working remotely via our internal communications channels

The mental health community service engagement plan is being developed.

Proactive engagement – the Cross Gates PCN engagement will begin in November.

Stabilisation and reset – we will continue to lead on communications around the Leeds healthcare system’s reset to the new ‘normal.’

Volunteers - we are holding a CCG volunteer refresher session in November, and hosting two safeguarding training sessions for the volunteers which have been developed by the CCG safeguarding team

Winter / Covid-19 pressures – the health and care system in Leeds is currently under significant pressure. We will be working with colleagues across the city to ensure clear, consistent and effective communications so that people understand how services may be affected and how they can help. As part of this work we will be developing an information booklet that will be posted to every home in Leeds.

If you wish to contact us, please use the details below:

NHS Leeds Clinical Commissioning Group Suites 2- 4, WIRA House, West Park Ring Road, Leeds LS16 6EB

Tel: 0113 843 5470 Email: [email protected] Website: www.leedsccg.nhs.uk Facebook: facebook.com/nhsleeds Twitter: @nhsleeds

If you have special communication needs or would like this information in another format or in a different language, please contact us or ask a carer or friend to contact us on 0113 8435457.

Agenda Item: GB 20/89 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020

Title: Update on Winter Planning and the Impacts of COVID-19

Lead Governing Body Member: Tick as Category of Paper appropriate Helen Lewis, Director of Pathway Integration () Report Author: Helen Lewis, Director of Pathway Integration Decision

Reviewed by EMT/Date: N/A Discussion

Reviewed by Committee/Date: N/A Information  Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities 

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city.  2. Quality of commissioned care is compromised and does not reflect best practice.  3. Failure to achieve financial stability and sustainability. 4. Failure to overcome local and national workforce shortages.  5. Business continuity of health and care services disrupted as a result of a significant event.  6. Ineffective patient and public engagement and lack of transparency in translation of engagement into decisions. 7. Partners and Professionals do not support the CCG strategy. 8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans. 9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY:

This paper outlines the preparations for winter and surge planning in light of the significant constraints on the system caused by COVID-19. It describes the way in which system partners are working together and the impact of the increase in COVID-19 patients during the second wave on further recovery of planned care.

NEXT STEPS:

Governing Body is asked to note the continued oversight of System Resilience through the city-wide Health and Care Silver and Gold command arrangements, and the ongoing reporting of risks and mitigation through Governing Body subcommittee structures.

RECOMMENDATION:

The Governing Body is asked to:

(a) NOTE the actions and processes within the system and the significant risks to ‘business as usual’ caused by the need to respond to the surge of patients with COVID-19.

1. SUMMARY

1.1 The purpose of this paper is to update on planning for Winter and surge in relation to COVID-19, usual winter demand, and flu. It also describes the key impacts of the second wave of COVID-19 on other parts of the NHS system.

2. BACKGROUND

2.1 In line with the NHSE approach, the CCG is taking an integrated approach to overseeing winter, Covid and EU Exit planning over the coming weeks and months. System partners have all identified their own key actions which include both phased additional capacity and actions to respond to expected seasonal demands, and triggered actions to be taken as demand increases through Covid or other demand factors such as a flu outbreak, or other winter related disease peaks. Clearly because of the very early and unexpectedly large surge in Covid cases, we have already gone beyond some of the expected surge plans, and are developing new plans on a weekly basis to cope with the unprecedented volume of cases and the complexity of the infection control implications of these patients.

2.2 Each provider in the City has their own comprehensive set of actions internally, and the system also has a number of cross-cutting task groups to ensure key areas of focus are addressed. The difference between this winter and others is that we have had a chance to test out some very extreme versions of stopping services and deploying staff, earlier in the year. This means that providers have refined their thinking, but also that their staff are in the main are trained and ready to redeploy when essential so the lead times to do this will be less, and the potential for doing so greater. All our providers are committed to trying to not cease the provision of whole services, but will adjust their service offers in line with available staffing and clinical need.

2.3 At the time of writing, it seems extremely likely that we face a prolonged period in which we will only be able to deliver scaled back versions of many services. However, many services have been able to alter the way in which they are provided, which means that they will be more able to continue in some form than they were in May. Some services were ceased altogether while risk assessment and new ways of working were introduced, and so can still continue safely this time.

2.4 The risks to the waiting times in both outpatient and elective services at LTHT, but more widely across all our providers are noted in the IQPR and the report from the Quality and Performance Committee. Depending on how long the current surge in cases continues, the numbers of people waiting for treatment and the length of that wait will both increase. However, the situation is better than in the first wave, in that most diagnostic services are continuing to operate, and we are back up to around 80% or more of the usual ‘pre pandemic’ operating levels. Cancer pathways and cancer diagnostics continue to be in place despite the major constraints, and the backlog of people waiting more than 62 and more than 104 days for Cancer Treatment is falling. Cancer referral rates are back up to and higher than pre-pandemic rates. All elective capacity is used for those most clinically urgent, but depending on the impact of the COVID admissions on critical care facilities, there may continue to be some delays even for this group.

2.5 Partners meet regularly to review operational situation and consider further mutual aid. The Health and Care Silver Group (also operating as System Reset Group) which consists of Chief Operating Officers and key partners oversees the System Operational Group, serves as the A&E Delivery Board and is also overseeing reset plans and the attempts by partners to maintain as much of the recovery as possible during the second wave. This group also oversees Communications to public and staff around system and service delivery during this period.

2.6 At time of writing there were 11 wards at LTHT occupied by patients with COVID-19. This is close to the maximum numbers of wards that can be used in this way, and has been created by swapping the use of existing wards rather than opening new ones. Space and staffing remain constraints to further expansion. While the Nightingale hospital remains a potential venue for further patients, there is no pool of additional staffing to open these beds. The system continues to try to maximise outflow from LTHT and prevention of admission for any patients who can be cared for safely in their own homes or in a community bed.

2.7 Primary Care is currently also facing increased demand with more practices reporting increasing levels of Opel 2 and 3. Very strong mutual aid arrangements have been put in place, to try to maximise continuity of service for patients with support from neighbouring practices. Additional funding has been identified to increase same day demand response over the winter period which includes a combination of PCN and practice based plans. New national funding and national guidance on how primary care should prioritise its workforce was received in mid-November, but this continues to be a moving position. The requirement to also create sufficient staffing to deliver the COVID-19 vaccine during the coming months will provide an extra set of challenges. Recruitment of suitable staff to be able to deliver these expanded requirements will be a key challenge.

3. PROPOSAL

3.1 The Governing Body is asked to note the wide range of actions under way within the City coordinated by the CCG in ensuring we maximise capacity to maintain both our acute/emergency responses to patients and as far as possible slow any deterioration in waiting times for planned care. We note the risks that proactive and elective care may suffer during the coming weeks, which may then further impact upon outcomes for patients and may further reinforce inequalities.

3.2 In light of all the work done earlier in the year on the impact of COVID on non-COVID conditions, the Governing Body is asked to be assured that all partners remain extremely mindful of this in their planning and delivery during this second wave. This has added to system pressures.

4. NEXT STEPS

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

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1 This section sets out in any statutory/legal/regulatory or contractual issues.

6. FINANCIAL IMPLICATIONS AND RISK

6.1 The financial position around meeting the costs of surge capacity is described elsewhere in the Board papers but remains a moving position as additional funds become identified (e.g. for primary care capacity, Winter funding for Mental health services etc.)

7. COMMUNICATIONS AND INVOLVEMENT

7.1 Public communications and stakeholder engagement remain critical at this period, because of the very fast moving nature of the local situation and frequent updates on national guidance. Balancing the messages between encouraging patients to seek help for their healthcare against the need to remind people the NHS is significantly under pressure remains a challenging tightrope.

8. WORKFORCE

8.1 Workforce is significantly constrained across the system due to the levels of COVID and the levels of self-isolation required after contacts. The implementation of staff testing in the next weeks may impact on this somewhat, though there are concerns that proactive staff testing may add to pressures if they identify high levels of asymptomatic staff who then cannot work. Registered staffing remains a major pressure area- recruitment of non- registered staff has been more encouraging.

9. EQUALITY IMPACT ASSESSMENT

9.1 No new EIA has been completed

10. ENVIRONMENTAL

10.1 No new environmental issues have been identified.

11. RECOMMENDATION

The Governing Body is asked to:

(a) NOTE the actions and processes within the system and the significant risks to ‘business as usual’ caused by the need to respond to the surge of patients with COVID-19.

Agenda Item: GB 20/90a FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25th November 2020

Title: 2020-21 Operational Financial Planning and Annual Budgets Update

Lead Governing Body Member: Visseh Pejhan- Tick as Category of Paper appropriate Sykes, Chief Finance Officer () Report Author: Judith Williams, Head of Corporate Reporting & Strategic Financial Decision  Planning Reviewed by EMT/Date: N/A Discussion  Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve  health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event 9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY: This paper provides an overview of the latest financial planning position for NHS Leeds Clinical Commissioning Group (CCG), and the context of the system within which it operates, both at a place based level, and the wider Integrated Care System (ICS). The latest planning submission to NHSEI reflects a deficit position for the CCG of £14.8m for the six months October 2020 to March 2021.

The forecast deficit position is net of a number of material risks and assumptions around the current position, including the anticipated receipt of additional allocations of c£20m (£11m retrospective COVID reimbursement allocation requested by the CCG for Aug/Sept still awaited, and £9m of retrospective drawdowns of resources from NHSE/I in M7-12 to cover spend for which resources are deemed to be held centrally to cover the costs of out of hospital capacity and place based initiatives that ensure we have sufficient bed base available to deal with COVID and non- COVID activity. Examples include the Hospital Discharge Programme and support for strategic Any Qualified Provider/local Independent Sector capacity to maximise patient activity throughput.

The forecast position also assumes the delivery of £2.4m of QIPP savings which we are in the process of identifying.

Leeds needs to ensure that across the NHS Organisations we are financially balanced in aggregate. There are risks across all NHS organisations within Leeds as well as significant pressures on social care at Leeds City Council, all of which will have service and financial implications.

Although the NHS financial regime for 2021-22 is yet to be published, the expectation is that it will follow the principles of the M7-12 2020-21 regime. This is expected to result in a reduction in allocations of c£50m for Leeds CCG. Both the Leeds Healthcare system and Leeds City Council are forecasting significant financial shortfalls going forwards, together with the uncertainty of increased ongoing costs associated with the pandemic. This emphasises the need for all organisations, at both place level and the wider regional level to work together to transform services to ensure financial sustainability across the system.

NEXT STEPS: Work will continue to identify efficiencies. And to develop a shared financial understanding across place and at system level We will continue to bring updates to Governing Body on planning

RECOMMENDATION:

The Governing Body is asked to:

(c) DISCUSS and RECOMMEND how the CCG should proceed in the remainder of 2020- 21 with balancing its statutory duties to provide care for the population of Leeds, progress with our health inequalities agenda and continue with service developments that have already commenced prior to Covid in the light of the changing financial position and the need to find significant efficiencies; and (d) DISCUSS and RECOMMEND the approach to be adopted to develop a cohesive plan for 2021-22 within the anticipated financial constraints, to ensure financial sustainability, and limit risk to services. With due consideration to the context of the Place and the wider Integrated Care System (ICS) and the associated requirements to work closely with other organisations both at a Leeds place based level and at the wider ICS level.

1. SUMMARY

1.1 This paper provides an overview of the latest financial planning position for NHS Leeds Clinical Commissioning Group, and the system context. 1.2 The Leeds health and social care system has been operating on revised national funding arrangements as a result of Covid and is subject to ongoing significant associated cost pressures. 1.3 The latest planning submission, for M7-12 reflects a forecast outturn deficit position of £14.8m. Leeds as a place has the opportunity to deliver a balanced position if support towards lost commercial income is received by local trusts. 1.4 The forecast deficit position is net of a number of material risks and assumptions around the current position, including the anticipated receipt of additional allocations of c£20m (£11m retrospective COVID reimbursement allocation requested by the CCG for Aug/Sept still awaited, and £9m of retrospective drawdowns of resources from NHSE/I in M7-12 to cover spend for which resources are deemed to be held centrally to cover the costs of out of hospital capacity and place based initiatives that ensure we have sufficient bed base available to deal with COVID and non- COVID activity. Examples include the Hospital Discharge Programme and support for strategic Any Qualified Provider/local Independent Sector capacity to maximise patient activity throughput. 1.5 The forecast position also assumes the delivery of £2.4m of QIPP savings which we are in the process of identifying. Budgets have been set on a full forecast spend basis, and work has started to identify the efficiencies required to reduce our deficit gap. 1.6 Leeds needs to ensure that across the NHS Organisations we are financially balanced in aggregate. There are risks across all NHS organisations within Leeds as well as significant pressures on social care at Leeds City Council, all of which will have service and financial implications. 1.7 A high level reconciliation of the flow of funds in and out of Leeds as a result of the COVID finance regime suggest that Leeds has ended up with a reduced level of resources as a Place. Therefore based on this assessment (and our deficit position which has emerged as a result of our allocation changes) our planned investments will now have to be stopped and in some areas, we will need to start to decommission services in order to remain within the revised and reduced allocation envelopes post these regime changes.

1.8 Although the NHS financial regime for 2021-22 is yet to be published, the expectation is that it will follow the principles of the M7-12 2020-21 regime. This is expected to result in a reduction in allocations of c£50m for Leeds CCG. Both the Leeds Healthcare system and Leeds City Council are forecasting significant financial shortfalls going forwards, together with the uncertainty of increased ongoing costs associated with the pandemic.

1.9 The Governing Body is asked to note the current position with the financial plan, which is a deficit of £14.8m, and the further risks inherent in that forecast position. The Governing Body is asked to approve the high level budgets for 2020-21, recognising the savings still to be found. 1.10 Specifically, the Governing Body is asked to recommend how the CCG should proceed with in the remainder of 2020-21with balancing its statutory duties to provide care for the

population of Leeds, progress with our health inequalities agenda and continue with service developments that have already commenced prior to Covid in the light of the changing financial position and the need to find significant efficiencies. 1.11 The Governing Body is also asked to discuss and recommend the approach to be adopted to develop a cohesive plan for 2021-22 within the anticipated financial constraints, to ensure financial sustainability, limit risk to services and progress the system Sustainability and Transformation Plan 2. BACKGROUND 2.1 The Leeds health and social care system has been operating on revised national funding arrangements as a result of Covid and is subject to ongoing significant associated costs pressures. For NHS organisations the revised funding arrangements have been broken down into two phases. 2.2 Phase 1 of the NHS revised financial regime applied from April to September 2020, and the aim was to ensure that NHS organisations retained a balanced position during this period operated through a ‘top up’ regime. Leeds Clinical Commissioning Group (CCG) are still awaiting confirmation of associated August and September retrospective allocation to the value of £11m and this remains a significant risk. 2.3 Phase 2 applies from October 2020 until the end of March 2021. The CCG has submitted an operational plan for these six months to the West Yorkshire and Harrogate Integrated Care System (ICS) on 16th October for a consolidated submission to NHSEI, and a more detailed organisational plan on the same basis to NHSEI on 22nd October 2020 (Appendix A). 2.4 The plan assumes that the retrospective allocation for August/September of £11.3m is received in full and so the position at the end of September 2020 is breakeven. Based on the reduced allocations for the CCG for October to March, plus a share of the ICS covid allocation for these months, the CCG plan reflects a deficit position of £14.8m for these six months. Included within this is an unidentified QIPP figure of £2.4m. 2.5 The financial plan meets the requirements of the Mental Health Investment Standard (MHIS) and the Better Care Fund. However note that within the calculation of the MHIS assumptions have had to be made around block contract values which have been nationally mandated and which do not match the original planned contract values, and have had to be pro-ratad back to previous year splits. 2.6 The CCG holds no reserves or contingency. 2.7 The retained historic cumulative surplus for the CCG continues to equate to £35.6m (3% of original allocation as opposed to national requirement of 1%). 2.8 The plan does not include planned spend on the Hospital Discharge Programme (HDP) (£3m for M7-12) or spend on strategic Any qualified Providers (AQP)/local Independent Sector (IS) above a baseline (£3.6m for M7-12) as per the guidance from NHSEI. And so in that sense the expenditure in the plan is understated. The intent is that the spend on these areas will show in month as an overspend and be matched by a retrospective allocation. The process around HDP is ongoing and clear, that for AQP/IS and the elective incentive scheme less so. 2.9 Block payments to NHS providers, based on nationally mandated figures, with minor changes in the second half of the year, are continuing. So of the £1.3bn allocation for the

CCG £828m is committed for NHS providers. Budgets within the ledger are currently based on a mismatch of M1-6 budgets per the national model (with a shortfall of £11.3m based on the M05/M06 retro allocation not received) and planned spend for M7-12. Assuming that the M05/M06 retro allocation is received, budgets would be adjusted and the full year budgets are shown in Appendix B. 2.10 A process of close working between commissioners, finance and planners has been followed to produce the M7-12 budgets. Note that the first six months element of the full year budgets is based on actual spend and an assumption that the M05/M06 retrospective allocation will be received. And that the NHS element is nationally mandated for the full year. Note that unidentified QIPP of £2.4m is within “other” and the deficit is out with this. The budgets include the full retrospective allocation for M1-6 which is £22.5m. Work is ongoing to identify potential efficiencies to contribute to the gap. 2.11 The CCG’s Executive Team and Governing Body are reviewing their investment plans for 20-21 (and beyond) that were designed to tackle our Health Inequalities agenda and for which significant headroom had been created in 19-20 in preparation for these investments 2.12 A high level reconciliation of the flow of funds in and out of Leeds as a result of the COVID finance regime suggest that Leeds has ended up with a reduced level of resources as a Place. Therefore based on this assessment (and our deficit position which has emerged as a result of our allocation changes) our planned investments will now have to be stopped and in some areas, we will need to start to decommission services in order to remain within the revised and reduced allocation envelopes post these regime changes.

2.13 The NHS financial regime for 2021-22 is yet to be published but funding is expected to follow the principles in the 2020-21 M7-12 regime. This is expected to result in a significant reduction in available funds and there will be a need for urgent work to be undertaken across the system to balance the desired investments and real efficiency savings required to put the Leeds healthcare system in a strong position if the CCG budget is reduced by the c£50m anticipated. 2.14 The Left Shift Blueprint programme should give a sense of potential efficiencies for 2021- 22, based on the current work to provide the top 3 priorities for each area. 3. PROPOSAL 3.1 The Governing Body is advised of the current position with the financial plan as per the plan submitted in late October to NHSE/I, which is a deficit of £14.8m, with further inherent risks (see risks section) 3.2 This plan will form the basis of high level and detailed budgets for the 2020- 2021 financial year. The budget levels will include inherent risks and rely on additional central resources whilst also recognizing the savings still to be found within the reported forecast position. 3.3 The Governing Body inevitably needs to balance its statutory duties to remain in financial balance while providing care for the population of Leeds, progressing with our health inequalities agenda and continuing with service developments that have already commenced prior to Covid. In the light of the changing financial position and the need to find significant efficiencies, some of our original planned initiatives will be delayed. 3.4 In order for the CCG to start to develop a cohesive plan for 2021-22 within the anticipated financial constraints, the Governing Body is asked to provide a steer around this balance in order to ensure financial sustainability, and limit risk to services, with due consideration to

the context of the wider system and the associated requirements to work closely with other organisations both at a Leeds place based level and at the wider ICS level 4. NEXT STEPS 4.1 Work will continue internally to identify potential efficiencies and any associated impact on services. There will also be ongoing work on both a place based and system basis to ensure that the there is a shared and cohesive financial understanding, and that the implications of decisions in one organization are understood and recognized across the system. 4.2 We will continue to bring updates to Governing Body on planning and budgets. 5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL 5.1 Not achieving balance is a breach of a statutory duty 6. FINANCIAL IMPLICATIONS AND RISK 6.1 Deficit of £14.8m, after assumptions of further resource allocations in 6.2 and 6.3, and assuming unidentified QIPP of £2.4m is found. Risk around the receipt of the anticipated retrospective allocation for Aug/Sept of £11.3m. 6.2 Anticipated further resource allocation of £8.8m in relation to national primary care allocations, Hospital Discharge Programme and national funding for strategically important local AQP/IS spend. 6.3 Unidentified QIPP of £2.4m to find as minimum, plus further requirement to contribute towards deficit 6.4 Leeds has the opportunity to deliver financial balance as a system if non recurrent support towards lost commercial income is received by local trusts. 6.5 Risks across Leeds as a place: 6.5.1 LTHT’s break even position relies not just on significant national support towards lost commercial income during the Pandemic but also on the continuation of their ambitious waste reduction programme which is progressing despite the challenges of COVID but is clearly also carrying more risk. 6.5.2 The Leeds and York Partnership FT position carries significant risks around the costs of out of area placements which is particularly challenging during the COVID Pandemic. 6.5.3 LCH are also facing fluctuating pressures to ensure out of hospital capacity and support is maintained during the current COVID waves with associated financial and service risks. 6.5.4 Whilst the Council has been significantly impacted by COVID its core funding has not been amended by government. However, in recognition of the pressures incurred by local authorities, in-year one-off grant funding has been received. Decisions being made now by the local authority will have implications for the health and care system going forward. 6.6 Further risks that are not quantifiable at this point include: 6.6.1 Any potential impact of Elective Incentive System, currently the status of this scheme and its impact is unclear, and relates to the whole system activity levels within the ICS, the NHS and non NHS sectors.

6.6.2 The impact of major Independent Sector contracts returning from national to local control. 6.6.3 The impact of Brexit on areas such as CCG prescribing. Prescribing spend has been very volatile to date, and the first four months spend from the NHS Business Services Authority this year is £3.5m higher than in 2019-20. This is due to drug switches and changes to recommended practice (NICE guidance), as well as price increases experienced over the past 7 months across a range of drugs. 6.7 The risk of increasing levels of Covid activity across the system could also impact on the position currently reported. 6.8 Implications for 2021-22 if the funding follows the principles in the 2020-21 M7-12 regime. 7. RECOMMENDATION The Governing Body is asked to:

(a) NOTE the current position with the CCG financial plan for 2020-21, which is a deficit of £14.8m with further risk on top of. The plan was approved by the Accountable Officer and Chief Finance Officer as per the authority previously delegated by Governing Body. EMT, the CCG Chair and Lay Members have been kept abreast of the reported position as it evolved, during the Integrated Care System submission process; (b) APPROVE the high level budgets for 2020-21, recognising the savings still to be found; (c) DISCUSS and RECOMMEND how the CCG should proceed in the remainder of 2020- 21 with balancing its statutory duties to provide care for the population of Leeds, progress with our health inequalities agenda and continue with service developments that have already commenced prior to Covid in the light of the changing financial position and the need to find significant efficiencies; and (d) DISCUSS and RECOMMEND the approach to be adopted to develop a cohesive plan for 2021-22 within the anticipated financial constraints, to ensure financial sustainability, and limit risk to services. With due consideration to the context of the Place and the wider Integrated Care System (ICS) and the associated requirements to work closely with other organisations both at a Leeds place based level and at the wider ICS level.

Appendix A Plan submission for October 2020 to March 2021(six months)

Revenue Resource Limit Total Plan 31/03/2021 Year Ending £'000 Total In-Year allocation 645,742

Expenditure Acute 314,802 Mental Health 86,527 Community 75,911 Continuing Care 28,177 Primary Care 81,569 Other Programme 2,913 Primary Care Co-Commissioning 63,393 Total Programme Costs 653,292 Running Costs 7,280 Contingency 0 Total Costs 660,572

Underspend/(Deficit) In-Year Movement (14,830) In-Year (RAG) 3 Net Risk/Headroom 2,176 Risk Adjusted Underspend/(Deficit) (12,654) Risk Adjusted Underspend/(Deficit) (RAG) 3 Underlying position - Underspend/ (Deficit) (14,830) Contingency 0 Notified Running Cost Allocation 7,690 Running Cost 7,280 Under / (Overspend) 410 Population Size (000) 889 Spend per head (£) 8

Efficiencies 2,400 % of Recurrent Notified Resource 0.4%

BALANCE SHEET memorandum - Movement on historic underspend/(deficit) Brought forward underspend/(deficit) 35,568 Underspend/(Deficit) M1 - M6 0 Underspend/(Deficit) M6 - M12 (14,830) Balance carried forward 20,738

Risk Adjusted Underspend/(Deficit) Cumulative 22,914

Appendix B 2020-21 Budgets based on plan submissions

2020-21 2020-21 2020-21 NHS Leeds CCG Total 2020-21 High Level Budgets NHS NON NHS Budget £'000 £'000 £'000 Programme Services Acute Services 596,696 29,481 626,177 Mental Health Services 116,651 52,687 169,338 Community Health Services 114,490 38,317 152,807 Continuing Care Services 63,826 63,826 Prescribing 134,378 134,378 Primary Care Services 33,028 33,028 Primary Care Co-Commissioning 125,854 125,854 Other 9,088 9,088

Total Programme Services 827,838 486,658 1,314,496

RUNNING COSTS 13,446 13,446

RESERVES 0

CONTINGENCY 0

CCG Net Expenditure 827,838 500,104 1,327,942

Allocations M1-6 M7-12 Total Programme 578,145 571,207 1,149,352 Primary care co commissioning 61,244 60,951 122,195 Running Costs 5,446 7,690 13,136 Base allocations 644,835 639,848 1,284,683 Retrospective allocation M1-4 11,203 11,203 Retrospective allocation M5/6 (currently under review at centre) 11,332 11,332 Share of ICS growth/covid pot 5,474 5,474 System Development Funding allocations 420 420 Non recurrent allocations 22,535 5,894 28,429 Total allocations at time of plan 667,370 645,742 1,313,112

Surplus/(deficit) -14,830

Agenda Item: GB 20/90b FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25th November 2020

Title: Finance Report for the seven months ended 31st October 2020

Reviewed by Committee/Date: N/A Information  Checked by Finance (Y/N/N/A - Date): Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event 9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY:

This report provides an update on the financial performance of NHS Leeds Clinical Commissioning Group for the seven months to 31st October 2020, compared to the amended allocations for this period.

Full year allocations have now been received. Baseline funding for the year, excluding retrospective allocation and other non-recurrent funding is £1,285m. This will have implications for planning for 2021-22 if the funding is on the same basis going forwards.

The latest planning submission, for the six months October 2020 to March 2021 reflects a deficit position of £14.8m for the CCG. Leeds has the opportunity to deliver financial balance as a system if non recurrent support towards lost commercial income is received by local trusts.

There are also a number of further material risks and assumptions around the current position, including receipt of additional allocations of c£20m. Of this £11.3m relates to retrospective allocation for August/September, still under review by NHSEI. £2m relates to anticipated primary care allocations. And £6.5m relates to funding for the Hospital Discharge Programme and support for strategic Any Qualified Provider/local Independent Sector activity. These latter costs are not currently within the forecast as per NHSEI guidance. The plan also includes unidentified QIPP of £2.4m, currently within other. Work is ongoing to identify efficiencies to cover this and potentially contribute towards improving the deficit position.

The year to date position includes HDP spend of £0.8m, and spend on AQP/local IS of £0.5m, these will show as an overspend as budget for these was taken out of the plan (full year effect of both £6.5m). The anticipation is that these will be funded as a retrospective allocation. The process around HDP is clear and ongoing, that around AQP/local IS less so. As a result, to comply with current guidance, the October HDP spend is included in the forecast £0.8m, however the AQP/local IS spend is not.

There is a small benefit relating to conditional system development funding for mental health, where spend was already in plan so receipt of allocations covers this (£155k). But this is offset by a retrospective element payable to Yorkshire Ambulance Service in relation to April 2020(£137k). Net impact is an improvement of £18k in the deficit position from £14,830k to £14,812k. Overspends by area mainly relate to variance as at end of September, which would be cleared if retrospective allocation for August/September was given.

NEXT STEPS:

Updates on the 2020-21financial position will continue to be presented to the Governing Body and/or Executive Management Team (EMT) on alternate months to ensure that the CCGs’ financial position is formally reported and reviewed each month under the CCGs’ governance arrangements.

RECOMMENDATION:

The Governing Body is asked to:

(a) CONSIDER the Month 7 financial position; and (b) DISCUSS, COMMENT and HIGHLIGHT ACTIONS required to progress and report to the next meeting of the Executive Management Team.

3 NHS Leeds Clinical Commissioning Group Finance Report for the Seven Months ended 31st October 2020

Page 1 Financial Performance Report 31st October 2020 At 31st October NHS Leeds Clinical Commissioning Group 2020 At Year End 2020-21 RAG RAG

CCG Expenditure does not exceed planned level Programme spend less than allocation Running costs spend less than allocation Delegated Co-commissioning less than allocation Planned Surplus in year QIPP Clear identification of risks against financial delivery & mitigations Delivery of Mental Health Investment Standard (MHIS) Better Payment Practice Code - to pay 95% of valid invoices by due date or within 30 days of receipt of a valid invoice, whichever is later Cash at bank balance within 1.25% of the monthly amount requested or £250k, whichever is greater

The current temporary financial regime means that most of the usual metrics are not achievable under these conditions, and so have not been RAG rated

Page 2 Overview 31st October 2020 This report provides an update on the financial performance of NHS Leeds Clinical Commissioning Group for the seven months to 31st October 2020, compared to the amended allocations for this period. Full year allocations have now been received. Baseline funding for the year, excluding retrospective allocation and other non recurrent funding is £1,285m. This will have implications for planning for 2021-22 if the funding is on the same basis going forwards.

There are also a number of further material risks and assumptions around the current position, including receipt of additional allocations of c£20m. Of this £11.3m relates to retrospective allocation for August/September, still under review by NHSEI. £2m relates to anticipated primary care allocations. And £6.5m relates to funding for the Hospital Discharge Programme and support for strategic Any Qualified Provider/local Independent Sector activity. These latter costs are not currently within the forecast as per NHSEI guidance. The plan also includes unidentifed QIPP of £2.4m, currently within other. Work is ongoing to identify efficiencies to cover this and potentially contribute towards improving the deficit position.

Page 3 Financial Position Summary 31st October 2020 Year to date as at 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group MEMO Covid 19 spend Revenue Expenditure 2020-21 Budget Actual Variance included in year Budget Forecast Variance to date actual Year to date as at 31st October 2020 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Programme Services Acute Services 363,210 364,811 1,601 625,572 624,816 -756 214 Mental Health Services 95,725 96,318 593 167,094 167,747 653 1,178 Community Health Services including Childrens Services 90,273 92,719 2,446 155,508 156,947 1,439 2,191 Continuing Care Services 37,244 42,464 5,221 61,300 65,262 3,962 7,238 Prescribing and Primary Care Services 96,007 99,767 3,761 164,194 168,457 4,263 4,247 Primary Care Co-Commissioning 72,510 73,101 592 125,337 125,965 628 0 Other 4,138 2,118 -2,020 4,826 6,429 1,603 133

Total Programme Services 759,106 771,300 12,194 1,303,831 1,315,623 11,792 15,200

RUNNING COSTS 7,091 7,381 290 13,157 13,500 343 26

CCG Net Expenditure - over/(under) spend 766,197 778,681 12,484 1,316,988 1,329,123 12,135 15,227

CCG planned deficit -2,472 2,472 -14,830 14,830 Position as stands - over/(under) spend 763,725 778,681 14,956 1,302,158 1,329,123 26,965 Claim for Oct for HDP and AQPs in ytd, HDP only in forecast 1,277 -1,277 821 -821 Retrospective allocation for Aug AND Sept under review 11,332 -11,332 11,332 -11,332

Position if retrospective allocation for Aug/Sept received 776,334 778,681 2,347 1,314,311 1,329,123 14,812

Page 4 Allocations 31st October 2020

NHS Leeds Clinical Commissioning Group Co- IN YEAR Programme Running Costs Allocations 2020-21 commissioning ALLOCATION £'000 £'000 £'000 £'000 Opening Baseline Allocation Apr to July 2020 385,430 3,631 40,829 429,890 Subtotal Month 3 Adjustments 2,596 267 0 2,863 Subtotal Month 4 Adjustments 1,637 76 0 1,713

Baseline Allocation Aug to Sep 2020 192,715 1,815 20,415 214,945 Retrospective allocation 5,839 88 700 6,627 Subtotal Month 5 Adjustments (incl baseline Aug/Sept) 198,554 1,903 21,115 221,572 Subtotal Month 6 Adjustments 0 0 0 0 Baseline for October 2020 to March 2021 571,207 7,690 60,951 639,848 STP Plan Transfer - System Covid distribution to other CCGs 5,474 5,474 CYPMH Green Paper 400 400 Tobacco Early Implementer Sites 20 20 Adult MH - Individual Placement Support (IPS) -(Conditional SDF) 142 142 Learning Disabilities Mortality Review Programme (LeDeR) (Conditional SDF) 13 13 Community/CETR - (Conditional SDF) 223 223 Subtotal Month 7 Adjustments (baseline Oct to March) 577,479 7,690 60,951 646,120 Closing Allocation 1,165,696 13,567 122,895 1,302,158

MEMO: Full Year Baseline Allocation 1,149,352 13,136 122,195 1,284,683

Month 07 allocations Allocations received in M07 are the baseline allocations for M7-12 (£639,848k), plus a share of the ICS covid allocation (£5.5k), and non recurrent amounts for specific areas under the umbrella of System Development Funding (SDF) (£798k)

Note that no retrospective allocation has been received at this point in respect of top up or covid reimbursement for M05 or M06. This is still under review by NHSE and an update is expected in late November. This is £11.3m for Leeds CCG

Page 5 Acute Services 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds Teaching Hospitals NHS Trust (LTHT) 280,786 280,786 481,347 481,347 Mid Yorkshire NHS Trust 16,987 16,987 29,121 29,121 Harrogate Foundation Trust 17,674 17,674 30,298 30,298 Bradford Foundation Trust 3,376 3,376 5,787 5,787 York Foundation Trust 1,456 1,456 2,496 2,496 Other NHS Trusts 1,825 1,825 2,834 2,834 Non contract Activity (NCAs) 1,443 1,443 2,207 2,207 Non NHS Acute 10,243 10,243 17,471 17,471 Unplanned Care 31,021 31,021 53,256 53,256 Acute Services: NHS Trusts & FTs budget per covid model 347,220 0 -347,220 595,588 0 -595,588 Acute Services: Other Providers budget per covid model 15,991 0 -15,991 29,984 0 -29,984 Total Acute Services 363,210 364,811 1,601 625,572 624,816 -756

There has been no material change to the Acute forecast in Month 7. The Acute spend continues to be based upon central block payments including NCA block payments made to NHS providers as per the Covid model and NHSE requirements.

The Planned Care (Non NHS Acute) Any Qualified Provider activity is increasing as expected. In Month 7 in line with the financial plan the forecast now includes £1.6M for Villa Care beds and £1.3M for Winter beds. Due to the current finance regime and how the plan had to be submitted, the forecast currently shows £3,560K less than our expected outturn position. The £3,560K is the amount we expect to claim national funding for against the Elective Incentive Scheme. The majority of independent sector (IS) contracts continue to be managed and funded nationally by NHSE (Spire, Nuffield, BMI and Yorkshire Clinic). The nationally funded contract for(IS) acute services is intended to remain in place until December 2020

In Unplanned Care the YAS contract forecast remains based upon central block payments. The forecast has however increased by £176K in month 7. This is due to a correction to the April block payment of £137K to bring it in line with the monthly spend from May onwards, the remaining increase of £39K is for spend against the Mental Health Investment Standard. The remaining spend is based largely upon West Yorkshire Urgent Care out of hours and Minor Injuries Units/Urgent Treatment Centres, and non NHS NCAs.

Page 6 Mental Health Services 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds and York Partnership Foundation Trust (LYPFT) 65,123 65,123 113,696 113,696 Tees Esk and Wear Valley NHS Foundation Trust (TEWV) 783 783 1,342 1,342 South West Yorkshire Partnership Foundation Trust 759 759 1,301 1,301 Bradford District Care NHS Foundation Trust 100 100 100 100 Mental Health NHS budget 0 0 0 0 Independent/Voluntary Sector/LCC/Other NHS 3,891 3,891 6,768 6,768 Learning Disabilities 19,219 19,219 32,977 32,977 Improving Access to Psychological Therapies (IAPT) 335 335 1,339 1,339 Mental Health Specialist Services 5,749 5,749 9,781 9,781 Mental Health Non Contract Activity (NCA) 213 213 220 220 Mental Health Other 147 147 223 223 Mental Health Services: NHS Trusts & FTs budget per covid model 67,773 0 -67,773 117,448 0 -117,448 Mental Health Services: Other Providers budget per covid model 27,951 0 -27,951 49,646 0 -49,646 Total Mental Health Services 95,725 96,318 593 167,094 167,747 653

The block payments to Leeds and York Partnership Foundation Trust have increased for months 7-12 increasing the 12 month forecast by £2.8m all reflected in months 7-12, increasing expenditure in the second half of the year. The other significant increase to forecast is the inclusion of the commissioning intention to clear the IAPT backlog of £1.07m again reflected in the second half of the year. There is a small reduction of £198k in the 12 month forecast for Rotherham Doncaster and South Humber NHS Foundation Trust (MH NCAS) and a reduction of £100k for Bradford District Care Trust, as the block payments to these providers have stopped from October as they are below the de-minimum payment limit.

Page 7 Community Health Services 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds Community Healthcare NHS Trust (LCH) 67,373 67,373 114,490 114,490 Community Reserves 0 0 0 0 Voluntary Sector/Local Authority (LA) 11,966 11,966 20,783 20,783 Community Beds 4,747 4,747 8,024 8,024 Hospices 3,435 3,435 5,881 5,881 Reablement 3,492 3,492 4,662 4,662 Safeguarding 441 441 761 761 Community Health Services: NHS Trusts & FTs budget per covid model 62,722 0 -62,722 110,007 0 -110,007 Community Health Services: Other Providers budget per covid model 27,551 0 -27,551 45,501 0 -45,501 Sub Total Community Health Services 90,273 91,454 1,182 155,508 154,602 -907 Children's Services excluding Continuing Care 1,265 1,265 2,346 2,346 Total Community Health Services including Childrens 90,273 92,719 2,446 155,508 156,947 1,439

Community Services The main change in the 12 month forecast is a reduction in the Leeds Community Healthcare NHS Trus block payment which reduces the 12 month forecast by £1,007k. In Voluntary Sector the 12 month forecast has increased with the inclusion in months 7-12 of £242k for the East Recovery Hub (part of the £3.5m Winter Beds), however there will be less expenditure in the second half of the year due to non-continuation of Covid expenditure of £334k at the Leeds Equipment Store which is in months 1-6 only. In Reablement there is no change to the 12 month total forecast however there is Covid expenditure in the first 6 months only of £1,855k which significantly reduces the amount to be paid in the second half of the year. No material change to any other area Children's Services The 12 month forecast has not changed materially from month 6. There will be slightly more expenditure in the second half of the year as the commissioning intention for the Family Drugs and Alcohol team at LCC will be paid

Page 8 Continuing Care Services 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Continuing Healthcare (CHC) 25,300 25,300 36,882 36,882 Continuing Healthcare Personal Health Budgets (PHBs) 8,507 8,507 14,597 14,597 Funded Nursing Care (FNC) 4,474 4,474 7,127 7,127 Children Continuing Care including PHBs 729 729 1,252 1,252 Continuing Healthcare - operational 1,457 1,669 212 2,222 2,723 501 Neuro-rehab 1,785 1,785 2,681 2,681 Continuing Care Services: NHS Trusts & FTs budget per covid model 113 0 -113 113 0 -113 Continuing Care Services: Other Providers budget per covid model 35,674 0 -35,674 58,966 0 -58,966 Total Continuing Care Services 37,244 42,464 5,221 61,300 65,262 3,962

Continuing Care Services: The CHC year to date has increased by £800k for Hospital Discharge Programme (HDP) Covid related costs as of month 7. As per NHSE guidance, any further spend for HDP from Nov to Mar has not been included in the forecast outturn.

Page 9 Prescribing and Primary Care Services 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Prescribing (budget as per covid model) 75,783 76,703 920 130,047 131,491 1,444 Ex centrally funded drugs 2,173 2,173 3,773 3,773 Oxygen contract 565 565 1,040 1,040 Primary Care Schemes 16,429 16,429 25,538 25,538 Clinical Leads 310 310 543 543 Primary Care - GP Information Technology (GP IT) 1,555 1,555 2,565 2,565 Out Of Hours 35 35 65 65 Medicines Optimisation NHSE Non Recurring Funded Projects 196 160 -36 196 196 0 Primary Care Services: NHS Trusts & FTs budget per covid model 374 0 -374 374 0 -374 Primary Care Services: Other Providers budget per covid model 18,057 0 -18,057 30,839 0 -30,839 Sub Total Prescribing and Primary Care Services 94,410 97,930 3,520 161,456 165,212 3,756 Prescribing Staff 1,009 920 -90 1,730 1,688 -43 Primary Care Staff 464 498 34 795 837 41 Confederation Staff and Delivery Costs 124 420 296 212 721 509 Sub Total GP Confederation 1,597 1,837 240 2,738 3,246 508 Total Prescribing & Primary Care Services 96,007 99,767 3,761 164,194 168,457 4,263

Prescribing (inc centrally funded drugs and out of hours): August 2020 data has now been received and the data shows a decrease compared to previous months . Year to date costs remain £4.1M more compared to previous year’s costs at the end of August 2019. The Prescribing forecast for the year is an estimated £7.4m overtrade against planned budgets and includes adverse impacts in relation to final 19/20 expenditure. The forecast assumes there will be increases in the next few months due to seasonal demand and continued effects due to Covid 19, the expected costs are estimated to be more in line with the higher April-July 2020 costs. Home Oxygen includes a year-end benefit and expenditure in relation to Covid 19. Primary Care: Forecast spend is anticipated to be in line with original plans, and includes additional expenditure relating to Covid 19. The position for the year shows the impact of schemes from the original plan, with a slight decrease for the year due to anticipated expenditure no longer materialising. GP IT: Overall spend for the remainder of the year is expected to continue at a similar level as Apr to October, with a reduction in Covid related spend. Staffing: Prescribing staffing underspends relates to vacancies. Primary Care Staff overspend relates to additional Covid 19 Costs GP Confederation: Budget set for embedded staff costs only. Forecast includes delivery costs which were planned to be funded from transformation.

Page 10 Primary Care Co-Commissioning 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 GMS 18,155 19,227 1,071 31,124 32,960 1,836 PMS 29,478 29,946 468 50,535 51,337 802 APMS 6,017 6,262 246 10,146 10,735 590 Premises cost reimbursements 8,882 8,975 93 15,226 15,385 159 Other premises costs 587 498 -90 1,006 853 -153 Enhanced Services 1,589 1,888 299 2,664 3,236 572 QOF 5,741 6,100 359 9,841 10,457 616 Other GP Services(inc PCO) 2,060 85 -1,976 4,795 793 -4,002 Reserves 0 121 121 0 208 208 Total Primary Care Co-Commissioning 72,510 73,101 592 125,337 125,965 628

Co-Commissioning expenditure is expected to remain in-line with the original pre Covid planned expenditure. This would have included transferring £1.8m budget from primary care budgets to cover the equitable funding scheme as in previous years.

Page 11 Other Services 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Total Other Services 4,138 2,118 -2,020 4,826 6,429 1,603

Year to date underspend relates to the fact that M1-6 budget includes a significant amount set per the national model to cover PTS/111, but the costs are wrapped up in acute spend. This has been adjusted for in M7-12 and would be corrected for M1-6 if retrospective allocation is given and CCG is able to amend budgets for that period.

Forecast overspend reflects that a negative budget for unidentifed QIPP of £2.4m in M7-12 has been set here. Schemes are currently being worked up across different areas to provide efficiences in future months.

Page 12 Running Costs 31st October 2020

Year To Date Annual NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Pay, set on establishment, as per original allocation 5,850 5,559 -291 10,029 9,651 -377 Non Pay/Income, set as per original allocation 2,538 1,822 -715 5,351 3,849 -1,502 Defund/negative budget to match covid model -1,297 0 1,297 -2,223 0 2,223 Total Running Costs (incl retrospective allocation) 7,091 7,381 290 13,157 13,500 343

Additional allocation has been provided for the remander of the financial year in line with anticipated spend. However, the £290k overspend for Aug and Sep is still under review by NHSEI as part of retrospective allocation, and forecast outturn including this is now £343k overspent. Current vacancies and an underspend on non pay would have shown an underspend against pre Covid 19 original NHS England notified budget allocation of £15.380m.

Page 13 Consolidated Statement of Financial Position 31st October 2020 31st October 31st March 2020 2020 £'000 £'000 Current Assets Trade & Other Receivables 78,198 7,882 Cash & Cash Equivalents 464 315 Total Current Assets 78,662 8,197 Total Assets 78,662 8,197

Current Liabilities Trade & Other Payables: (56,946) (58,903) Borrowings 0 0 Provisions (392) (538) Total Current Liabilities (57,338) (59,441)

Total Assets less Current Liabilities 21,324 (51,244) Non-current Liabilities Provisions (6,530) (5,650) Total Non-current Liabilities (6,530) (5,650)

Total Assets Employed 14,794 (56,894) Financed by Taxpayers’ Equity General Fund 14,794 (56,894) Total Taxpayers’ Equity 14,794 (56,894)

The significant movement of total assets employed is mainly due to measures taken to support the temporary financial regime to ensure NHS Providers have certainty regarding cash inflows in response to Covid-19; notably the nationally mandated NHS block monthly payments in advance from April onwards (£68.9m per month).

Page 14

Agenda Item: GB 20/91 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020

Title: Corporate Risk Register (Operational Risks)

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Author: Anne Ellis, Risk Manager Decision

Reviewed by EMT/Date: 28 October 2020 Discussion  Reviewed by Committee/Date:  Quality and Performance Committee 11 Information November 2020 Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city.  2. Quality of commissioned care is compromised and does not reflect best practice.  3. Failure to achieve financial stability and sustainability. 4. Failure to overcome local and national workforce shortages.  5. Business continuity of health and care services disrupted as a result of a significant event.  6. Ineffective patient and public engagement and lack of transparency in translation of  engagement into decisions. 7. Partners and Professionals do not support the CCG strategy.  8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans.  9. Inadequate system infrastructure to support the CCG’s plans. 

EXECUTIVE SUMMARY:

1. The CCG uses Datix as an internal risk management system which enables operational risks to be recorded and managed by all members of staff. Risks are aligned to the appropriate CCG committee for overview and scrutiny.

2. The risks are included on the CCG operational risk register and reviewed within individual directorates on a regular basis. In line with the Risk Management Strategy, the Executive Management Team (EMT) and relevant CCG Committees receive and review the operational risks rated as high amber (12) and above. The CCG Governing Body receives the corporate risk register (all red operational risks scored at 15 and above) for review at each meeting, supported by the CCG committee chair updates.

Summary Table Current Previous (Sept 20) Total Risks 68 66 Red Risks 15+ 5 2 Amber 12+ 10 9 Accepted Risks 25 26 New Risks 2 7 Closed Risks 0 1

Accepted Risks 3. There are currently 68 active risks on the CCG risk register, 25 of these risks are categorised as ‘Accepted’ risks. This means that the current level of risk is deemed acceptable. Accepted risks are risks that are at, or below, the target risk score (approved by the responsible Director) or are green on the risk matrix (score <6). These risks are reviewed by management at least on an annual basis or when the CCG becomes aware of a change to the risk. High amber (12) or red risks are unlikely to be accepted and will continue to be reported to the relevant Committee and Governing Body.

Corporate Risks 4. There has been an increase from 2 to 5 red risks, the following changes have taken place:

a. R732 – Risk of Harm post Covid-19 (Planned Care and Mental Health): the risk has increased from 12 to 20. The likelihood of harm is now certain for some patients waiting for treatment, with an impact of a significant reduction in health outcomes and / or life expectancy. b. R729 – Risk of Harm post Covid-19 (Primary Care): the risk has increased from 12 to 16. The impact of the mitigating actions in relation to capacity and workforce on the changing situation is unknown and therefore the current score has been aligned with the unmitigated score. c. R707 – System Flow: the risk has increased from 12 to 16. The risk is more challenging to manage due to the more complex Infection Prevention Control (IPC) requirements needed to manage Covid-19 related demand. 2

A summary of the corporate risks is provided in the table below but further detail, including controls, actions and assurances, can be seen in Appendix 1.

Risk Rating

Current Position

Risk ID Risk

Current

Risk Title Risk

July

Sept

Changes to to Changes

Target Date Target Date Target Target Score Target

Risk score increased from 12 to 20. The likelihood of harm is now certain for patients waiting for treatment, with risk of a

significant reduction in health outcomes

19 (Planned (Planned 19

- and / or life expectancy.

Recovery has been progressing well over

the summer, however, given the surge in

post Covid 20 12 9 0 Covid-19 cases, the recovery will be 732 impacted and it is expected that backlogs

will increase further. Detail of the impact of 31/03/2021

Covid-19 has been included in appendix 1.

during and during

Care and Mental Health) Mental and Care Phase 3 action plans in place; these will be reviewed at each monthly planned care meeting. Due date set to 31/3/21 as

Risk of Risk harm review is ongoing. Work is ongoing to understand and challenge national assumptions in relation

to the Phase 3 Covid-19 financial regime and associated allocations; challenge regarding flaws in way the allocations have been derived nationally. Work is ongoing with WY&H ICS to balance the 16 16 4 4 0

548 ICS position. Work is ongoing across

Leeds place to mitigate Leeds system 31/10/2021 shortfall. Work is ongoing in Leeds CCG to reduce non-committed commissioning Statutory Financial Duties Financial Statutory intentions, investments and other spend. All non-committed expenditure suspended until further notice.

Risk score increased from 12 to 16. The risk is more challenging to manage due to the more complex IPC requirements needed to manage Covid-19 related demand.

The Winter Resilience Plan refresh is

ongoing, and includes planned Covid-19 16 12 12 8 0

707 specific winter responses and trigger 2/8/2021

System Flow System actions to enact as a result of surges in demand.

StaR Group formalised as Silver response and providing escalation forum from pressures identified at Bronze. The risk has been reviewed and the score

increased to 16. The impact score has 19 19

- been increased due to the increasing rate of Covid-19 cases, patients waiting for elective surgery needing to manage their

symptoms for longer and the impact of this

post Covid on the quality of life. The impact of the

mitigating actions in relation to capacity 16 12 9 0

729 and workforce on the changing situation is

unknown and therefore the current score

rimary Care) rimary

31/03/2021

during and during

( has been aligned with the unmitigated score.

There is limited funding available to

support practices with staff absences and Risk of Risk harm therefore impacting further on the backlog.

The risk score remains red, mitigating

actions are recorded in the Penetration

Test action plan. The action plan is risk rated and implementation is overseen by 15 15 15 9 0

721 the Business Intelligence, Information

Maturity Governance and Information Technology 01/03/2021 Assurance Committee.

Information Security Security Information

Risks Aligned to the Governing Body 5. There are 14 risks aligned to the Governing Body. These relate to Finance, Procurement and the Shaping Our Future programme. Six of these 14 risks are categorised as ‘Accepted’ risks.

Current Previous (Sept 20) Total Risks 14 14 Red Risks 15+ 1 1 Amber 12+ 1 1 Accepted Risks 6 6 New Risks 0 1 Closed Risks 0 0

6. Of the remaining eight risks aligned to the Governing Body, there is currently one red corporate risk and one high amber risk. The red corporate risk is summarised above at paragraph 4 (R548: Statutory Financial Duties) ; the high amber risk is summarised below, but further detail of the risks, including controls and assurances, can be seen in Appendix 1.

Risk Rating

Current Position

Risk ID Risk

Current

Risk Title Risk

July

Sept

Changes to to Changes

Target Date Target Date Target Target Score Target

Risk score remains at 12 due to:

 The impact on current remote

working arrangements and general

levels of staff anxiety during Covid- –

19. This is key to considerations in

the way in which the SOF programme

has been re-started and delivered

12 12 12 6 /2020 0

remotely. 719

 The publication of the operating 31/12

Impact on Staff Impact on model makes the programme real to

staff and could increase the likelihood Shaping Our Future Future Our Shaping of some staff leaving.

Additional controls and actions have been identified and added to Datix.

Covid-19 Risks

7. Risks and issues specifically relating to COVID-19 continue to be logged within task groups, and are escalated by exception through the command structure via SitReps. Strategic risks and red risks are reported to Gold Command by exception.

8. All operational risks continue to be monitored where they are impacted by the outbreak. 5

NEXT STEPS:

 All operational risks will be reviewed as per the bi-monthly cycle in accordance with the CCG risk management strategy and presented to the assigned committee for review. The Corporate Risk Register and high amber risks aligned to the Governing Body will be presented to the CCG Governing Body at each meeting.  Risks arising from the COVID-19 outbreak will continue to be monitored and escalated by exception via the command structure.

RECOMMENDATION:

The Governing Body is asked to:

(a) REVIEW the five corporate risks; (b) REVIEW the high scoring amber risk aligned to the Governing Body; and, for each risk; (c) CONSIDER whether the controls, actions are effective and whether assurances are sufficiently robust; and (d) AGREE any further actions required to manage the risks to the target level set.

6 Unmitigated Risk Score Current Risk Score Target Risk Score

ID Description Controls Assurance Gaps in controls Gaps in assurance Please provide details Actions

Title

Rating Rating Rating

Opened

Director

Manager

Covid-19?

Likelihood Likelihood Likelihood

Committee Committee

Responsible

Review date

Accountable

Consequence Consequence Consequence Consequence

or or as a result of

Expected date to

Is the risk affected reach targetreach grading Corporate Risks Number of patients waiting over 18 weeks for First Outpatient Appointment totalled 18,440 in September (down on previous months), but higher than pre-Covid-19 levels (8,800 in March). Outpatient activity during September was 90% (with majority of Stabilisation and reset group formed. contacts non-face-to-face). There is a risk that recovery will now be impacted due to There is a risk of harm due to 1) Patients not Work has also been undertaken to identify and prioritise the highest risk growing Covid-19 cases within LTHT and staff absence due to illness/isolation and presenting with symptoms due to Covid-19 patients. caring requirements; i.e. children. The number of patients waiting over 18 weeks is fears/concerns, including some urgent Planned Care team have worked to coordinate recovery plans with our likely to increase during November, as first week in November will mark 18 weeks presentations/referrals 2) Routine referral routes local AQP providers; i.e. backlog at LTHT worked through tackling longest since services were reinstated in June. into hospital settings being stopped from approx. waiters/urgent cases first for ophthalmology, ENT and gastro/endoscopy. 26th March through to June 2020, and 3) The Working with LTHT to track/manage backlog utilising NHSE Sourced IS 35,700 patients are waiting long than 3 months for an appointment, which is a backlog generated in terms of patients waiting for a contracts. Waiting times/progress monitored via Planned Care significant risk particularly in the area of ophthalmology, where there is a risk of diagnostic, first outpatient appointment, follow-up Close working with Cancer Alliance to manage cancer backlog and PTL. programme board with LTHT and IS/LTHT weekly meetings. harm relating to sight loss. In the specialty of ophthalmology, 7964 patients are or surgery - all resulting in potentially increased Currently working with LTHT to write to all patients waiting longer than 18 The Commissioning team is working closely with quality Implementation of actions identified from currently waiting longer than 3 months for a follow-up appointment with 915 morbidity, mortality and widening of health weeks with advise re pain management and how they might manage colleagues to identify and address themes arising from

732 20 20 Phase 3 letter Yes ophthalmology patients also waiting over 18 weeks for a first outpatient Phase 3 Action Plan 9 Major Major inequalities. While Mental Health services in the Major symptoms whilst waiting for an appointment. incidents reported on Datix and from soft intelligence.

appointment. Meetings are taking place with LTHT to agree a joint approach to

Moderate

07/08/2020 15/10/2020 31/03/2021 main remained open, some of our more specialist Helen Lewis Focused work across pathways undertaken for LTCs via Diabetes, Close monitoring of mental health demand through Lewis, Helen recovery with AQP/CLODN members. services were closed while staff were redeployed, Respiratory and CVD Steering Groups, with recommendations reviewed by fortnightly system calls and some of our services have been delivered in our Leeds LTCs programme board. 13,700 patients are currently awaiting a diagnostic at LTHT; diagnostic capacity at Might at occur some time. non face to face ways that may have been less Mental health partners working together to see how they can further LTHT is currently at 82% of pre-Covid-19 levels due to social distancing; which is a

accessible. There is therefore some evidence of Quality and Performance Committee expand capacity using 3rd sector partners and new ways of working, and a

great achievement. Patients waiting longer than 52 weeks totalled 1606 at the end of Expected to inoccur most circumstances. increased demand both linked to reduced services Expected to inoccur most circumstances. focus on primary care MH offers to help preventative approaches as far as September, in the specialities of urology, colorectal, adult spines, paediatric urology but also due to increased pressure on mental possible. and dentistry. Urgent referral rates have returned to pre-Covid-19 levels; with the health conditions during lockdown. Reviewing Mental Health Issues at System Rest Group, involving all cancer 2ww referral rate exceeding pre-Covid-19 levels at 104%. The rate of other partners 'urgent' referrals is at 77%; this requires attention.

Risk ofduring harm and post-Covid-19 (Planned19 and MentalCare Health) Referrals into mental health services are also increasing.

There is a risk of overspend; due to unforeseen National planning principles still to be Work is ongoing to understand and challenge national assumptions in relation to the financial pressures; resulting in failing to achieve received. Phase 3 Covid-19 financial regime and associated allocations; challenge regarding Work is ongoing to understand and challenge statutory financial duties e.g. Planned Surplus, Budget Control & Reporting Audited accounts COVID phase 3 financial regime and financial flaws in way the allocations have been derived nationally. Work is ongoing with national assumptions in relation to the Phase 3 548 Running Cost/Programme Expenditure limits, Cash 20 Contingency / Reserves Policies and Procedures 16 allocations to be notified beyond month 4, Yes WY&H ICS to balance the ICS position. Work is ongoing across Leeds place to 4

Covid-19 financial regime and associated

Major Major Major

Limit (MCD) Major also some funding being directed to ICS as mitigate Leeds system shortfall. Work is ongoing in Leeds CCG to reduce non-

R Reynolds

08/10/2020 31/10/2021 27/11/2015 allocations

opposed to direct to CCG. committed commissioning intentions, investments and other spend. All non- Governing Governing Body

committed expenditure suspended until further notice.

Statutory Financial Statutory Duties

in exceptional circumstances

Expected to inoccur most circumstances.

Will inoccur probably most circumstances.

Visseh Pejhan-Sykes - Chief Financial Officer Do notDo expect to happen. only Can imagine happening Winter review programme will identify learning from existing surge/escalation There is a risk that the Leeds system will deliver plans - including the positives from sub-optimal care and patient experience due to an Leeds System Resilience Plan - Associated Delivery Action Plans System Resilience Operational Group interventions as a result from Covid-19 that StaR Group formalised as Silver Response and inability to respond / coordinate response to a Leeds System Dashboard Integrated Commissioning Executive would be beneficial to continue. Covid-19 has added another dimension to winter planning; some services are providing escalation forum for pressures surge in demand, resulting in poor patient quality Predictive System Capacity & Demand Modelling Partnership Executive Group Winter review programme ongoing; adapting their capacity and service models according to national guidance. identified at Bronze. and experience, failed constitutional targets and System Agreed Escalation Processes and Mutual Aid Governing Body completed initial phases of reviewing winter Positives from the initial response such as greater use of technical solutions such as 707 reputational risk. 20 5 Year Commissioning Plans IQPR to Q&P Committee 16 Yes 4

online consultations are being introduced where possible. Winter Resilience Plan refresh ongoing to Major Major Major Major 19/20, evaluated learning from Covid-19

West Yorkshire Integrated Care System Development Covid-19 Gold Command Minor

sometime

01/08/2019 13/10/2020 02/08/2021 Helen Lewis The risk more challenging to manage due to the more complex IPC requirements include planned Covid-19 specific winter

System Flow System response, and currently triangulating system This encompasses patients presenting urgently, System Pressures & OPEL reporting Covid-19 Silver / Stabilisation And Reset winter plans. needed to manage Covid-19 related demand. responses an trigger actions to enact as a result admission avoidance activity, treatment in the Taylor-Tate, Debra Winter Review and Evaluation Programme Covid-19 Bronze Commands Learning from the Covid-19 response to of surges in demand. hospital and smooth discharge arrangements and system pressures is also being captured by capacity for those admitted.

Quality and Performance Committee EPRR review.

Expected to inoccur most circumstances.

Will inoccur probably most circumstances. Not expected but conceivable. Could occur

At the height of the pandemic / lockdown, routine work in primary was paused in line with the national direction to cope with Covid-19 activity. As services begin to open Amendments to national GP contract to re-prioritise work including a re- Lack of certainty on flu cohort / vaccine There is a risk of harm to patients given the backlog Continue to use PQI to monitor progress up and services are re-started, there is understandably a backlog of work such as LTC focus of the Quality and Outcomes Framework availability Assurance in the provision of of work post COVID-19 due to pauses on QOF, QIS, Alignment of some contract measures to support a focus in reviews, cervical screening which needs to be covered. Ongoing review of flu plans and performance. National commitment to reduce unnecessary bureaucracy to focus on Impact of a potential 2nd peak vaccine to 50-64 cohort given screening, referrals, patients not presenting with key areas i.e. QoF / flu 729 16 clinical care 16 Limited funding available to support national message regarding Yes 9

symptoms and challenges faced with “reset” Continued engagement of CDs, PMs and LMC to respond to The impact score has been increased due to the increasing rate of Covid-19 cases, Ongoing review of key indicators including Major Major

Major Major Local amendments proposed to re-focus QIS to support clinical capacity practices with staff absences and therefore vaccine availability

Moderate

13/10/2020 31/03/2021

16/07/2020 resulting in increase morbidity and mortality and feedback and address any concerns patients waiting for elective surgery needing to manage their symptoms for longer cytology, LD and SMI.

(Primary (Primary Care) circumstances. circumstances. utilisation of EA activity to support capacity creating further backlog

widen health inequalities. Turner, Mrs Kirsty and the impact of this on the quality of life. The impact of the mitigating actions in

relation to capacity and workforce on the changing situation is unknown and

Might at occur some time. Will inoccur probably most

Will inoccur probably most therefore the current score has been aligned with the unmitigated score.

Dr Simon Stockill Simon -Dr Medical Director

Risk of duringHarm and post Covid-19 Primary Care Commissioning Care Committee Primary

Engagement with LCC on Full patching Engagement with LCC on Third party Penetration Test action plan in place, risk rated patching (Ivanti) and overseen by the BIGIT Committee. Upgrade affected server estate to eradicate LCC are arranging for licences that the CCG will There is a risk of malicious file types gaining entry SMBv1 & .Net require for Ivanti to allow us to keep third party into the enterprise and taking hold as a result of: Network (RAS) hardening activities applications patched. - Outdated software Microsoft patching on Desktop and Servers is provided by LCC Assessment of Protective monitoring and Applocker installation to reduce unmanaged - SMBv1 Enabled Anti-virus is installed on all desktop and server estate implementation of controls applications on desktop and address out of - Poor Password Culture NHSMail is a centrally controlled ingress Updated password protocol - support desktop applications. - System misconfigurations Redcentric firewall has been installed on the internet boundary; not yet As a result of Covid-19 there have been delays in creating and implementing an communications and testing of passwords Network (RAS) hardening activities. - Authentication Mechanisms fully configured action plan to resolve critical and high risk vulnerabilities. In addition as a result of Windows 10 roll out and standardisation Update configuration of desktop and server 721 Resulting in: 20 Windows ATP(Advanced Threat Prevention) is installed on all Windows 10 15 Yes an increase in scam emails, text messaging, there is a higher likelihood of a cyber 6

Major Major Applocker installation to reduce unmanaged estate, including, but not limited to: SMB signing,

- Loss of data devices breach.

Moderate Moderate

09/10/2020 31/05/2021 30/01/2020 applications on desktop and address out of denied anonymous logons and unique

- Access to data Symantec Endpoint Protection (SEPP) in installed on all Windows 7 devices Audit Committee

Stephens, Nichola support desktop applications community strings. - Integrity of data System Event Management installed for Solarwinds to improve monitoring Update configuration of desktop and server Disabling of the SMBv1 - The total removal of - Access to network. position Information MaturitySecurity estate, including, but not limited to: SMB this issue is reliant on the migration away from In addition could result in failure of the DSPT,

signing, denied anonymous logons and the aging hardware in Yeadon. There is a plan in Expected to inoccur most circumstances. resulting in Data flows from NHSD and other Expected to inoccur most circumstances.

Visseh Pejhan-Sykes - Chief Financial Officer unique community strings place for migrating our file structure from this organisations being restricted. Segregate Active Directory from LCH platform and onto the Microsoft Azure tenancy Move from HTTP to HTTPs to secure during Dec 2020/Jan 2021 Not expected but conceivable. Could sometime occur internet facing services Segregate Active Directory from LCH.

Governing Body High Amber Risk Weekly updates about the programme in the CCG staff bulletin All staff invited to participate in staff information sessions before Christmas Questions and Answers section produced for the extranet. Clear message re no planned Targeted conversations with key staff, individually and as part of wider SLT compulsory redundancies development Names of members of the Shaping Our Future Honest conversations regarding opportunities and implications of new Delivery Group circulated to enable people to There is a risk of key CCG staff leaving the Staff may not disclose their staffing structures and requirements Reports to EMT have conversations with members of this group organisation due to the uncertainty created by the concerns or intentions to leave Communication Plan - Communication and engagement with all staff so Staff survey results Capacity to fill roles / loss of knowledge as required 719 Shaping Our Future Programme; resulting in 16 12 until they secure roles outside Yes Programme was paused in April, now restarted. 6

that they are clear on the rationale for change and the potential Staff absence reports Implementation approach to be shared with SOF Major Major

inability to deliver core services and to support the CCG Minor

Moderate

Scott, John

12/10/2020 31/12/2020 22/01/2020 implications. delivery group to understand impact on staff and transformation. Governing Governing Body OD planning and support key part of the programme - resource allocated how we can respond to this.

from within partners and CCG lead. Regular meetings with Staff Side and Might at occur some time. commitment to work transparently with them as

Shaping Our Future Shaping Future Our - Impact on Staff the programme progresses. Will inoccur probably most circumstances. Will inoccur probably most circumstances. Confirmation provided by TR that bands 2-4 would be mapped into role, and that band 5 is being reviewed at present Sabrina Armstrong, ofDirector Sabrina Organisational Effectiveness Process to allow targeted unfreezing of recruitment of key roles has begun.

Agenda Item: GB 20/92 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020

Title: Governing Body Assurance Framework (Risks to the Strategic Commitments)

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Author: Anne Ellis, Risk Manager Decision

Reviewed by EMT/ Date: 04 November 2020 Discussion  Reviewed by Committee/Date: N/A Information

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city.  2. Quality of commissioned care is compromised and does not reflect best practice.  3. Failure to achieve financial stability and sustainability.  4. Failure to overcome local and national workforce shortages.  5. Business continuity of health and care services disrupted as a result of a significant event.  6. Ineffective patient and public engagement and lack of transparency in translation of  engagement into decisions. 7. Partners and Professionals do not support the CCG strategy.  8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans.  9. Inadequate system infrastructure to support the CCG’s plans. 

EXECUTIVE SUMMARY:

1. The Governing Body Assurance Framework (GBAF) provides a structure and process that enables the CCG to focus on the principal (strategic) risks to achieving its strategic commitments and be assured that adequate controls are operating to reduce these risks to acceptable levels (the risk appetite).

2. The GBAF format enables the Governing Body to review each of the risks, analyse the controls and assurances, clearly identify any gaps and the actions needed to address them. The graph illustrates the movement of the risk score throughout the year in relation to the target risk score. The target risk score is the total impact of risk the CCG is prepared to accept in pursuit of its strategic commitments and has been agreed for each risk, based on the risk appetite.

3. As part of the review cycle, each of the principal risks has been reviewed and updated by the director leads. Updates made since the previous version are highlighted in bold italics.

4. All risks are currently operating above the agreed risk appetite. Mitigating actions have been identified and once implemented; the risk level should reduce to the level of risk appetite the CCG has agreed to tolerate.

5. The Executive Management Team and Governing Body receive the GBAF bi-monthly. The risks aligned to the Governing Body Committees are also reported to the relevant Committee bi-monthly in the risk report.

6. The Risk Management Strategy includes a review of the assurances provided by the GBAF. The review is designed to provide assurance to the Audit Committee that the CCG can place reliance on the assurances provided by the GBAF. The strategy states that principal risks outside risk appetite will be reviewed in detail at least once a year to assess the adequacy and completeness of the assurances. The Audit Committee will receive Risk 8: Constraints on CCG organisational effectiveness impacts the delivery of the CCG’s plans at the next Audit Committee meeting (18 November 2020). The Governing Body will receive assurance from the Audit Committee Chair in relation to the GBAF assurance paper as part of the Audit Committee Chairs summary.

7. As stated in the paragraph above, the strategy states that principal risks outside risk appetite will be reviewed in detail (deep dive) at least once a year to assess the adequacy and completeness of the assurances. As a result of the impact of the Covid- 19 pandemic on the principal risks, and all principal risks currently being outside risk appetite, the number of principal risks having a deep dive review at each Audit Committee would need to be increased to enable all risks to be reviewed during the year. The Governing Body is requested to consider operating outside the strategy during 2020/21 by postponing some deep dive reviews outside risk appetite and to continue to present one risk at each Audit Committee meeting. This is due to the current demands on the executive team in responding to the pandemic leading to reduced capacity of Directors to undertake a deep dive of all risks outside appetite by the end of 2020/21.

NEXT STEPS:

The Governing Body will continue to review the GBAF at each meeting and directors will continually monitor and update their risks accordingly.

Deep dive reviews of principal risks outside risk appetite will continue to be presented to the Audit Committee.

RECOMMENDATION:

The Governing Body is asked to:

(a) REVIEW the Governing Body Assurance Framework; (b) CONSIDER whether the controls and assurances are sufficiently robust; (c) AGREE any further actions required to manage the risks to the target set; (d) NOTE the review and assurance processes; and (e) APPROVE the postponement of some deep dive reviews of risks outside risk appetite and to continue to present one risk at each Audit Committee meeting.

Appendix 1 Governing Body Assurance Framework (GBAF) 2020/2021

Introduction

The Governing Body Assurance Framework (GBAF) sets out how the CCG will manage the principal risks to delivering the strategic commitments. The GBAF enables the Governing Body to corporately assure itself (gain confidence, based on evidence). The framework aligns principal risks with the commitments, and highlights key controls and assurances.

Where gaps are identified, or key controls and assurances are insufficient to reduce the risk of non-delivery to acceptable levels (within the CCG risk appetite), action needs to be taken. Planned actions will enable the Governing Body to monitor progress in addressing gaps or weaknesses and to ensure that resources are allocated appropriately.

Governing Body responsibility for the GBAF

It is for the Governing Body to:  Establish strategic commitments.  Identify the principal risks that threaten the achievement of these aims.  Identify and evaluate the design of key controls intended to manage these principal risks.  Set out the arrangements for obtaining assurance on the effectiveness of key controls across all areas of principal risk.  Evaluate the assurance across all areas of principal risk.  Identify positive assurances and areas where there are gaps in controls and / or assurances  Put in place plans to take corrective action where gaps have been identified in relation to principal risks.  Maintain dynamic risk management arrangements including a well-founded risk register.

Assurance

The Executive Management Team and Governing Body receive the GBAF bi-monthly. The risks aligned to the Governing Body Committees are also reported to the relevant Committee bi-monthly in the risk report. The Audit Committee annual work plan will ensure that principal risks outside risk appetite are reviewed in detail at least once a year, to assess the adequacy and completeness of the assurances, the Governing Body will receive a copy of the assurance provided to the Audit Committee.

The GBAF provides the basis for the preparation of a fair and representative Annual Governance Statement. It is the subject of annual review by both Internal and External Audit.

CCG Commitments:

We will focus our resources to: . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city

We will work with our partners and the people of Leeds to: . Support a greater focus on the wider determinants of health . Increase their confidence to manage their own health and well-being . Achieve better integrated care for the population of Leeds . Create the conditions for health and care needs to be addressed around local neighbourhoods

CCG Risk Appetite Statement

NHS Leeds CCG recognises that the long-term health of its population depends upon the delivery of its strategic ambitions and its relationships with its service providers, staff, public and partners. As such, NHS Leeds CCG will not accept risks that have a material adverse impact on quality of healthcare, health inequalities or life expectancy.

NHS Leeds CCG has a greater appetite to take considered risks in relation to opportunities where positive gains can be anticipated such as clinical and contractual innovation, where necessary, testing the constraints of the regulatory environment.

Summary of Principal Risks

Risk Title Risk Current Target Key changes since last review Ref Appetite Score Score 1 Failure to deliver the CCG Averse 20 12 No change to the current score, however investment plans are on hold pending review of CCG financial position. commitment to reduce health Depending on the outcome of the review of finances the risk score may be increased. inequalities across our city. 2 Quality of commissioned care is Averse 16 6 The risk score has increased from 8 to 16 due to the risk that the demands of Covid-19 on our providers and compromised and does not reflect primary care will put the quality of care of non Covid-19 patients at risk due to reduced access to services. There best practice is also a risk that some reporting and responding of quality measures will be paused again due to a second wave of Covid-19. i.e. complaints , CQUINS and other quality indicators. As such the consequence score has increased to 4 (major). 3 Failure to achieve financial stability Cautious 16 8 By month 6 the CCG would normally expect this risk to start to reduce, however risk levels for 2020-21 are very and sustainability. high following the publication of revised allocations in September that have significantly reduced the Leeds CCG’s resources in 2020-21. In particular in relation to our Commissioning intentions and progress towards our health Inequalities agenda. For months 1-4 the finance regime nationally was to ensure all organisations remained in financial balance. The CCG has yet to receive assurances that it will also be in balance from months 5 and 6 before entering the months 7-12 planning process with all the risks described above.

Following the allocations changes the Leeds system financial performance for 2021-22 in particular is predicated on the delivery of a significant QIPP/CIP programme; that needs to be initiated quickly in 2020-21. 4 Failure to overcome local and national Averse 9 6 No change to the current score. workforce shortages This risk was subject of a Deep Dive Assurance at the Audit Committee on 16 September 2020.

5 Business continuity of health and care Averse 20 15 No change to the current score. services disrupted as a result of a The CCG is embedding learning identified by both the Covid-19 Incident Coordination Centre evaluation, and the significant event Winter 19/20 review. 6 Ineffective patient and public Averse 8 4 The risk score has been reduced from 12 to 8. engagement and lack of transparency Commissioning projects were paused during the pandemic therefore there was a lack of engagement. The risk in translation of engagement into score was increased to recognise that some changes were made in response to the pandemic. Temporary decisions. changes are permitted under regulation 23(2) of the s.244 Regulations in the interests of protecting the health of patients and staff. If it is proposed that a temporary change is to be made permanent as business as usual, the expectation is that engagement or consultation should occur. As services are restarting, where appropriate, there are a number of projects in the planning stages that have already factored in a requirement for patient and public insight and involvement therefore the risk score can be reduced. 7 Partners and Professionals do not Open 12 8 No change to the current score. support the CCG strategy New action added relating to a review of Membership Engagement and Clinical Leadership in the CCG. 8 Constraints on CCG organisational Medium 12 6 No change to current score. effectiveness impacts the delivery of New action added in relation to the development of internal assurance process around delivery of outcomes the CCG’s plans. identified under the Left Shift Blueprint work and through commissioning intentions. Internal assurance through the Executive Management Team meetings. 9 Inadequate system infrastructure to Medium 16 8 No change since the last review. support the CCG’s plans. Actions are ongoing.

Risk 1: Statutory Duties: There is a risk of widening or not reducing the health inequality gap; Reduce inequalities in access to services and outcomes achieved.

Due to not effectively targeting available resources and addressing wider determinants of health in Promote the integration of health services and provision of health services integrated with partnership; provision of health related and social care services, where this would improve quality of services or reduce inequalities. Resulting in failure to deliver the CCG commitment to reduce health inequalities across our city. Promote innovation in the provision of health services. Risk Appetite: The CCG has an averse risk appetite for health inequalities; this means that the CCG is not Lead Director/risk owner: Helen Lewis- Director of Pathway Integration prepared to take risks in this area. Committee with oversight: Quality and Performance Committee Date last reviewed: October 2020 Risk Rating (consequence x likelihood) Rationale for current risk score: Current score: 20 Current The current risk score is assessed as 20 due to the heightened likelihood of health inequalities increasing 4 x 5 = 20 10 Score supported by evidence from the most recent Public Health Annual Report that identified increased Target score (2020/21): 0 inequalities across the city, with more people living in the 10% most deprived wards. In addition it is llikely 3 x 4 = 12 Target that COVID-19 has significantly increased the inequalities gap. Score Commissioned services and programmes may not currently always be designed in a way which meets the needs of groups who have poorer access to services, particularly preventive, proactive and primary care services and need to be reviewed in light of emerging evidence. This could result in an increase in health inequalities with some patients receiving sub-optimal care and potentially poor patient experience outcomes.

Rationale for target score: The CCG has an averse risk appetite for health inequalities and a legal duty to reduce inequalities in the population in terms of both access to services and health outcomes. This is a key strategic aim the CCG’s Strategic Plan in line with the Health and Wellbeing ambition that the Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest. The target score is assessed at 12 to reflect the current position and the challenge faced by the CCG in reducing the risk during 2020/21. The aim is to reduce both the likelihood and impact, but recognise that it will not be possible to reduce below 12 by the end of 2020/21 due to the impact of COVID-19.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):

 CCG Strategic plan is grounded in the Health and Wellbeing Strategy and reflects the city Joint Action Owner Due by Strategic Needs Assessment (JSNA) & local health needs with a clear focus on reducing health Investment plans for Q3 confirmed and now Helen Lewis (Becky Plans inequalities. being implemented Barwick) currently on  CCG is an active member of the Health and Wellbeing Board and other partnership hold arrangements, e.g. Partnership Executive Group, Leeds Health and Care Plan pending

 CCG Health Inequalities Framework – This is now signed off and moving to implementation. review of This describes how the CCG will use its £1.3bn resource to drive the changes needed to CCG realise the aim of reducing health inequalities. It also sets out how the CCG will use its financial position as a major statutory body to influence the wider determinants of health and our position partners in ways which more positively impact on the inequalities faced by the poorest people Actively reviewing further opportunities to Helen Lewis (all October 20 in the city. redirect resources to target on areas of greater heads of for April 21  Action at programme / project level – there is already significant work underway which is need for commissioning in 21/22 commissioning) targeted at reducing health inequalities, including: Work with BI and service evaluation to identify Frank Wood December 20 . Services for marginalised groups including sex workers, homeless people, gypsies and appropriate measures travellers, ex-offenders, etc. Review and response to all national guidance Helen Lewis (Becky Quarter 3 . ‘Equalised’ weighted funding for General Practice and greater focus on health inequalities on areas relating to inequalities in Phase 3 Barwick) . New IAPT (Leeds Mental Wellbeing) service has targets built in which direct the providers to ensure effective access for people from BAME communities and people living in deprived Leeds . Community midwifery teams aligned to areas of greater deprivation, working closely with children centres and health visiting teams . Work on disproportionate representation of Black men in Mental Health act admissions  Memorandum of Understanding in place between Leeds CCGs and Leeds City Council to 3

deliver Public Health Healthcare Advisory Service (PHHCAS) with action plan.  CCG commitment to Population Health Management approach will enable providers to work together at very local levels (through LCPs) to shape services around needs.  Commissioning for value programme now established to understand how commissioning investments impact on finance, quality and health outcomes.).  Joint data analysis team in place across Local Authority and CCG.  Each Commissioning lead reviewing actions to reduce health inequalities within their own areas as part of the work on the Left Shift Blueprint  Data consistently broken down into ‘deprived Leeds’, all Leeds to help identify areas with biggest gaps  Starting work to look at the underrepresentation of some communities in proactive mental health services Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Further work needed to be able to provide more timely data because of very significant lags in  Process measures being developed which clearly identify data on a Leeds/deprived national datasets Leeds/PCN basis to identify variation to drive actions to address these  Further work needed to evaluate within marginal groups where data is not available at granular  All commissioning intention/business cases and Blueprint plans reviewed to ensure sufficiently enough levels to evidence impact through routine data sets and will require proxy measures focused on the needs of most deprived/BAME communities/vulnerable groups as relevant to Link to Risk Register (operational risks): specific areas of work 305: Compliance with the Equality Act 2010 Public Sector Equality Duty (6) 688: Utilising patient experience data to inform commissioning decisions (6) Independent Assurance 695: Learning Disabilities Mortality Review Programme (LeDeR) (12) There are a number of external reporting mechanisms which will be used to build the CCG’s reporting framework, including:- Public Health England Local Authority Health Profiles Public Health Annual Report Local Authority Quarterly Report

Risk 2: Statutory Duties: There is a risk that the quality of commissioned care is compromised, and does not reflect best practice; Secure improvement in the quality of services and outcomes for patients, with particular regard to clinical effectiveness, safety and patient experience. Due to inadequate quality assurance and improvement processes, in both commissioning and delivery of care; Promote the integration of health services and provision of health services integrated with Resulting in failure to deliver the CCG’s strategic commitment to focus resources to deliver better outcomes for provision of health related and social care services, where this would improve quality of people’s health and well-being. services or reduce inequalities.

Risk Appetite: The CCG has an averse risk appetite for service quality; this means that the CCG is not prepared to Lead Director/risk owner: Jo Harding – Executive Director of Quality and Nursing take risks in this area. Committee with oversight: Quality and Performance Committee Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) Whilst the CCG has in place quality standards, and measures quality outcomes via a range of methods Current score: 20 Current and processes to assure the quality of care we commission for our patients. The risk score has 24 x 4 = 816 10 Score increased from 8 to 16 due to the risk that the demands of Covid-19 on our providers and primary Target score: 0 care will put the quality of care of non Covid-19 patients at risk due to reduced access to 2 x 3 = 6 Target services. There is also a risk that some reporting and responding of quality measures will be Score paused again due to a second wave of Covid-19. i.e. complaints , CQUINS and other quality indicators. As such the consequence score has increased to 4 (major).

Rationale for target score: A target score of six has been applied to this risk as the CCG aims to minimise the likelihood and consequence of the risk occurring. However it is recognised that it is not possible to eradicate risk to quality and safety completely and as such the target likelihood due to error is 3 (possible) and the target consequence remains 2 (minor). Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  The CCG has multiple team and work streams that encompass all the elements of monitoring and assurance of quality including patient safety, patient experience, effectiveness (clinical Action Owner Due by outcomes) and safeguarding. Review of AQP quality assurance process to completed Deputy Director of Complete  Various assurance methods and improvement strategies are used in collaboration with all and presented to the Quality and Performance Nursing and providers. This includes intelligence from our IQPR, quality visits, regulatory feedback and Committee in September 2020. Quality compliance with national standards and contractual requirements. This also includes integrated Embed Patient Experience further in the initial stages of Head of Patient January 2021 processes with local authority in relation to the monitoring and improvement quality in care the commissioning cycle to strengthen and inform Safety and homes. Unable to conduct quality visits at this time due to Covid-19 developments focused on patients’ experience of care. Experience  The WY&H QEIA tool, used across the ICS and adopted by the CCG, is utilised to ensure all Lead colleagues across the city to consider a new Director of Nursing March 2021 quality and equality impacts are considered in all service changes and vision and approach to QA and QI with a strong and Quality commissioning/decommissioning decisions. emphasis on mutual accountability  The CCG is leading the local implementation of the NHS England Early Adopter Programme Host commissioner assurance arrangements for Head of Quality December 2020 with LTHT for new Patient Safety Incident Response Framework and planning ongoing for people with LD and autism to be presented at Q&P rollout to all providers. Progress with implementation delayed in LTHT currently due to once agreed with LYPFT Covid-19  The CCG leads a Patient Experience Collaborative to ensure robust mechanisms for utilising all Patient Experience in commissioning decisions. This involves wider system partners and will feed into the city wide PE strategy.  The CCG has developed population health management work programmes to ensure quality lens is applied to the commissioning and delivery of care with specific reference to vulnerable groups and health inequalities. Quality outcomes as part of the left shift blueprint work are currently being worked up and will link in with the SOF work around outcomes for populations  CCG is working towards embedding the new liberty protection safeguards (MCA/DoLS). The judicial process needed for implementation of LPS is delayed needing to an increased risk as the current DOLs process has significant backlogs.  The CCG is currently working towards the implementation of the host commissioner assurance arrangements for people in LD and autism who reside in locked rehabilitation to ensure in particular patients who are placed out of area receive a safe and quality service

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Lack of joined up city wide approach to patient experience  Joint Clinical Quality Review Groups (CQRG) and Primary Care Quality Surveillance  Lack of city wide approach to quality assurance and improvement across the city  Review and monitor key quality, clinical governance and safeguarding (adults and children) requirements and standards, performance information, expectations and performance requesting and monitoring remedial action plans where required. The approach of CQRG has Link to Risk Register (operational risks): changed to encompass assurance against increased risk of Covid-19 732: Risk of Harm During and Post Covid-19 (Planned Care and Mental Health) (20)  West Yorkshire Quality Surveillance Group (QSG) and Quality Leads Meeting (QLM) 729: Risk of Harm During and Post Covid-19 (Primary Care) (16)  oversight of quality / sharing of intelligence and actions 723: Deprivation of Liberty (12)  Contract Management Board 726: Post Covid-19 backlog of Local Resolution and assessments (12)  update briefings from Providers identifying key areas of concern/under performance and actions 695: Learning Disabilities Mortality Review Programme LeDeR (12)  Quality and Performance Committee review of quality: 697: Care Home Medicine Management (9)  Integrated Quality and Performance Report, providers under enhanced surveillance, patient 664: Community Care Beds – Medicine Review (9) experience, incident management, updates around Covid-19 and impact on non Covid-19 660: Delivery of high quality primary care services (9) services discussed at the committee 28: Learning from medication related incidents (9)  Robust governance structure in place within the CCG provides assurance on the quality of services to Governing Body  Safeguarding annual declaration for care homes and private hospitals  Qualitative and quantitative monitoring of LeDeR reviews  GP Safeguarding Standards Framework to monitor SG performance of primary care SG  CCG is implementing the host commissioner framework for learning disabilities/autism in in patient settings

Independent Assurance  CQC inspection programme – reports/action plans monitored via provider quality meetings  New emergency inspection framework for CQC inspections implemented due to Covid-19.  New IPC targeted inspection framework launched and has included care homes and health care settings across Leeds.  Internal audits – 2018/19 High assurance of Individual Funding Requests and Patient Experience, Significant assurance of Personal Health Budgets, Safeguarding, Continuing Healthcare and Performance Reporting. 2019/20 High assurance of Incident Management, Significant assurance of Contract Management and the Mental Capacity Act

Risk 3: Statutory Duties: There is a risk of failure to achieve financial stability and sustainability for the Leeds health and care system; Fulfil the financial duties.

Due to increasing demands on the system, and / or failure of financial controls;

Resulting in a breach of financial duties and an adverse impact on delivery of the CCG commitments. Risk Appetite: Given the statutory nature of financial duties of the CCG, the CCG has a cautious risk appetite for financial Lead Director/risk owner: Visseh Pejhan-Sykes – Chief Finance Officer efficiency; this means the CCG will accept a low level of risk in this area. Committee with oversight: Governing Body Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) . Risk levels for 2020-21 are very high following the publication of revised allocations in September that have 20 Current significantly reduced the Leeds CCG’s resources in 20-21- in particular in relation to our Commissioning intentions and progress towards our health Inequalities agenda Current score: 10 Score 4 x 4 = 16 0 . Failure to achieve financial stability could normally lead to a breach in our statutory duties and have an adverse effect on our Target score: Target local population. This risk relates to both 20-21 and 21-22 financial years – although some mitigations have been Score identified non-recurrently for 20-21. 4 x 2 = 8 . Following the allocations changes the Leeds system financial performance for 21-22 in particular is predicated on the delivery of a significant QIPP/CIP programme, that needs to be initiated quickly in 20-21 . The system is heavily reliant on financial delivery at Place level and the CCG will be relying on LTHT to achieve a surplus to cover some elements of the CCG’s deficit in 20-21. The CCG will need to address its potential shortfall in 20-21 via QIPP schemes to be identified and put in train to start 21-22 with a break even plan. . For months 1-4 the finance regime nationally was to ensure all organisations remained in financial balance. . The CCG has yet to receive assurances that it will also be in balance from months 5 and 6 before entering the months 7-12 planning process with all the risks described above. Rationale for target score: The consequences of failing our financial duties will always be high from a patient care perspective so our ideal target score would be to retain the likelihood levels at 2 and below to manage the risks. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Revised financial policies and budgetary control framework produced in May 2020 to reflect new finance regime introduced in March 2020 to combat the COVID 19 Pandemic – shared Action Owner Due by with Audit Committee and Governing Body. Internal Audit has reviewed and compared Financial plans submission to NHSE/I at the end of Governing NSHE/I response expected in early with peers. October 2020 with major caveats including the Body November  Revised allocations received for 20-21 in September 2020 and led to a deficit position for assumption of significant revenue national the CCG resources drawdowns leading to adjustments  Regular CFO meetings across Leeds & West Yorkshire and the CCG have led to the potential between the CCG and LTHT to achieve financial for Leeds as a system balancing its finances but with some significant risks and caveats. balance across Leeds. The CCG has also developed a RAG rated list of QIPP opportunities for 20-21 and in Continuing to work closely across Leeds NHS and Governing Attend daily / weekly informal and preparation for 21-22 financial planning. Leeds City Council, West Yorkshire and the Body formal forums and keep abreast of all  Monthly budget reports will be issued from November once the CCG plans have been Reginal NHSE/I Team to clarify rules around deadlines for financial reporting, accepted by NHSE/I in November and positions will be discussed at budget holder meetings. finances and centrally held funds during the resource allocations and informing COVID financial regime. the centre throughout the next 6 months. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Health and social care economy nationally (including in Leeds) is severely financially challenged as a result of the  Monthly finance reports to EMT, Audit Committee and Governing Body identifying any COVID-19 Pandemic. Over the course of the year, some resources have been allocated to cover major gaps but current financial risks. the position for the second half of the year looks very precarious.  Escalation of exception reports to EMT and to Governing Body, and in the current year  Within the context of the West Yorkshire Integrated Care System (ICS), we are able to aim for a balance plan for 20- to the WY system and the regional NHSE/I team. 21 at each Place level but only after some major assumptions around national financial support for a number of  Procurement Programme monitoring and delivery reporting. technical and successful applications by CCGs and Trusts against centrally held pots for specific areas of  Lead commissioner monthly forecasts.  Financial impacts of primary care commissioning appear to be less significant at current stage spend. of planning.  Post COVID there will be significant pressures on the systems to ‘catch up’ on backlog elective activity and Independent Assurance maximise capacity and at the same time as having significantly restricted resources . The need to find  Budgetary and governance control systems for identifying and controlling financial risks – innovative ways to delivery care therefore is fundamental and urgent ranked high assurance by the Internal Auditors again as we enter 2020-21. Link to Risk Register (operational risks):  NHSE assurance meetings have resulted in the Leadership of the CCG across all areas being 548: Statutory Financial Duties (16) 551: Fraud and 708: National Shortage of Capital (8) Corruption (9) rated Green.

Risk 4: Statutory Duties: There is a risk of an inability to attract, develop and retain people to work in the Leeds health and care system; Secure improvement in the quality of services and outcomes for patients, with particular regard to clinical effectiveness, safety and patient experience. Due to our failure to overcome local and national workforce shortages; Have regard to the need to promote education and training of current or future health service Resulting in failure to deliver the CCG commitment to deliver better outcomes for people’s health and well-being. staff.

Risk Appetite: The CCG has an averse risk appetite for service quality; this means that the CCG is not prepared to Lead Director/risk owner: Jo Harding – Executive Director of Quality and Nursing take risks in this area. Committee with oversight: Quality and Performance Committee Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) Ensuring we have the workforce to deliver a sustainable health and care today and a workforce to deliver a Current score: 20 Current transformed health and care for tomorrow is hugely complex. Leeds needs to ensure that this is being 3 x 3 = 9 10 Score addressed at city-wide levels within the context of workforce challenges across the system. We know there Target score: 0 are gaps in required workforce now and the potential for more due to the halt in international recruitment as 3 x 2 = 6 Target a result of the pandemic. Score The National People Plan has just been published. The Leeds system will need to take account of its requirements locally. As a result the likelihood score is assessed as 3 (possible).

Rationale for target score: The changing nature of healthcare delivery and the introduction of new models of care require an adaptive, agile and integrated system. Keeping abreast of workforce requirements and planning for future skills and competencies will be challenging. There are likely to be workforce shortages as a consequence. As a result the actions detailed below are designed to reduce the likelihood from 3 (possible) to 2 (unlikely).

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Leaders of main health and care organisations have come together with commissioning and care leaders across the city as the Partnership Executive Group (PEG). This group aims to Action Owner Due by ensure coherence of strategy and approach across the city, and delivery of the goals set out in the Health and Wellbeing Strategy. This includes our approach to Workforce in the City. The LOWSB to review the Leeds ‘One Jo Harding as the Complete  Governance for Leeds Workforce programme has been reviewed and the new Leeds One Workforce’ vision statement and the 7 shared CCG representative Workforce Strategic Board (LOWSB) was established to replace the former arrangements and priorities in light of the pandemic and agree a on the LOWSB

their first quarterly meeting was held in November 2019. The purpose of the LOWSB is: to clear strategy for successful delivery. ensure that the Leeds based health and care workforce is fit for now and the future.

 7 Shared Workforce Priorities have been developed and agreed by the LOWSB. Seek to better understand the role and vision of Jo Harding as the October  The Leeds Health and Care Academy (LHCA) is funded by and works with all partners in the the Academy in delivering the ‘Leeds One CCG representative 2020 city. LOWSB works with the LHCA to bring together planning, coordination, resource and Workforce’ ambition statement on the LOWSB December delivery of learning and development for staff working in health and care in the city, to meet the Due date extended as the LOWSB does not 2020 citywide workforce challenge. LHCA work programme directly links to the strategic workforce meet until middle of November priorities.

 Primary Care Workforce sub-group and action plan is in place – TOR and membership has The LOWSB to consider the requirement for a Jo Harding as the October been reviewed to ensure alignment with Strategic workforce priorities and PCN workforce workforce needs analysis to better understand CCG representative 2020 challenges and links to the wider system. Workforce action plans being developed at PCN level the systems priorities in light of the pandemic. on the LOWSB December which supports the new GP contract setting out the new roles developing within general Due date extended as the LOWSB does not 2020 practice and the funding to support these roles e.g. care navigation; Rotational Paramedic; role meet until middle of November of occupational therapists in primary care pilot; shared roles across a number of practices and many more.  Leeds actively participates in the national and regional West Yorkshire and Harrogate ICS Workforce Groups and workforce activity is linked/mapped against regional workforce plan.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek):  The LOWSB provides assurance to the Health and Wellbeing Board and reporting to PEG on  There is a lack of understanding to develop, agree and establish a baseline of accurate workforce the delivery and impact of the workforce priorities in respect of its own plan, leading on the data across the whole Leeds Health and Care System to identify workforce gaps in existing and new workforce requirements outlined in the strategic drivers of the city through including the Leeds roles in order to model the future workforce requirements short/medium/long term. Health and Wellbeing Strategy, Leeds Health and Care Plan, Children & Young People’s Plan,  Workforce Programme of work and action plans to feed into a Leeds One Workforce Strategy has Inclusive Growth Strategy and tackling Climate Change. been delayed due to the impact of COVID-19. Next business as usual meeting due 14 July 2020. Additional Comments:  Leeds accepts the associated workforce risks and that workload and capacity has been negatively Leeds Health and Care System risk owner: Dr Sara Munro – Chief Executive of LYPFT impacted by COVID-19 and the new challenges that changed the focus of our system led work. She is the Senior Responsible Officer for Leeds Health and Care Academy and Workforce – Chair of  Former Director left the post in September 2019 LHCA and Workforce have appointed a Director Leeds One Workforce Strategic Board (LOWSB) and a Member of Partnership Executive Group and they join the team September 2020. (PEG).  The establishment of the Leeds GP Confederation brings new opportunity to engage with primary care ‘at scale’ and develop workforce initiatives for general practice across the city. This is yet to be realised. Link to Risk Register (operational risks): 651: General Practice Workforce (12)

Risk 5: Statutory Duties: There is a risk to business continuity of health and care services disrupted on a major scale; To take appropriate steps to ensure that the CCG is properly prepared to deal with emergencies that might affect it. Due to the demands of a significant event (including predictable surge); Category 2 responder (Civil Contingencies Act 2004) Resulting in a failure to deliver the CCG commitments to: Secure improvement in the quality of services and outcomes for patients, with particular regard  Deliver better outcomes for people’s health and well-being; and to clinical effectiveness, safety and patient experience.  Reduce health inequalities across our city.

Risk Appetite: The CCG has an averse risk appetite for service quality and performance; this means that the CCG Lead Director/risk owner: Helen Lewis – Director of Pathway Integration is not prepared to take risks in this area. Committee with oversight: Quality and Performance Committee Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) This risk relates to the CCG working with partners to mitigate the impact and to support recovery of the Current score: 20 Current delivery of healthcare services to the Leeds population as a result of a significant event. A significant event 4 x 5 = 20 10 Score can be a ‘rising tide’ or a one off event e.g. epidemic, adverse weather therefore the mitigations and plans Target score (2020/21): 0 are wide ranging across all organisations across the Leeds Health and Care system. Our current score with 3 x 5 = 15 Target regards to a significant event remains high given the ongoing presence of COVID-19 pandemic, and Score uncertainties around the trade terms for leaving the EU.

Rationale for target score: Based on experience during the COVID-19 period, we will try to work towards a moderate impact over the next 9 months. However, while, the CCG aims to minimise the impact of a significant event on healthcare services we have found that we are unable to fully and rapidly mitigate the impact of an ongoing pandemic risk in the way which we had originally considered for significant but shorter term risks. We have evidenced significant system ability to mitigate the impact on the health of the population, but without the ability to avoid adverse consequences which are likely to impact for many years. For example, elective waiting times will definitely rise over the next year, impacting on the health of our population and their experience, despite our best mitigations. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?): CCG Controls  Engagement at West Yorkshire level with local resilience forum and West Yorkshire urgent care Action Owner Due by meetings EU Exit preparedness: Steering group, self- Debra Taylor Paused  Training for key senior managers JESIP Training, On call training assessment, action plan, and liaison across system Tate  Counter Terrorism and Organisational Security Awareness delivered to all staff and with NHS as directed  CCG Business Continuity Plan  CCG Incident Response Plan with Action Cards EU Exit agreed. Steering group no longer meeting  On call systems in all providers plus the CCG, linking to NHS England (NHSE) and region at but remains in place and able to stand up as times of pressure required as the negotiations in 2020 progress.  EPRR Compliance and Action Plan Command and Control structure in place to Tim Ryley Ongoing  Winter plans in place, includes primary care and public health / Comms actions coordinate system responses and maximise use of  Embedding learning identified by both the Covid-19 Incident Coordination Centre staff resources to minimise health impacts evaluation, and the Winter 19/20 review Coordinated approach to reset and stabilisation to Helen Lewis Ongoing ensure ongoing focus on prioritisation so that System Controls restarted services pay particular attention to areas  System wide Surge and escalation plans in place and tested through exercises, and populations of greatest deprivation  Business continuity plans in place for providers as part of NHS contract, including General 2020/21 NHSE Emergency Preparedness Debra Taylor Ongoing practices. Resilience and Response process and Tate  Emergency Preparedness Resilience and Response (EPRR) Compliance and Action Plan for Compliance has been adjusted in recognition of NHS organisations ongoing operational demands.

 Operational delivery meetings at LTHT and weekly Operational Winter Group Existing CCG Incident Response plans will be  Leeds resilience plan and Forums in place reviewed and developed going forward to  Leeds Safety Advisory Group (SAG) to discuss the Health and Safety issues relating to an include CCG outbreak and pandemic structure event and offer professional guidance and plans following the Covid-19 ICC evaluation 10  System Resilience Assurance Board and in line with the outstanding EPRR 2019/20

 System and regional meetings. Local Health Resilience Partnership (LHRP). Health and Social action Care Resilience Group.  Health Protection Board Update training needs analysis and create a Debra Taylor- March 2021 (to be  EPRR framework for NHS organisations includes clear roles and responsibilities for system testing and evaluation schedule in response to Tate informed by the wide response the three yearly External Audit review of CCG new CCG  Clear roles and responsibilities for outbreak planning (NHSE, CCG, LA) BC arrangements Operating Model)  Leeds Outbreak Plan and Outbreak Roles and Responsibilities.

 Command and control structure in place to coordinate the city’s response to Covid-19

Recommendations from the Internal Audit of Debra Taylor- Ongoing. the CCGs response to Wave One of Covid-19 to Tate Recommendations be reviewed and reflected upon. still in draft form.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  None identified  Assurance from providers on EPRR compliance, and business continuity plans..  Regular testing of the CCG Business Continuity Plan  Annual self-assessment against EPRR – goes to Governing Body  Outputs from real or tested scenarios and learning – reports and action plans produced e.g. Link to Risk Register (operational risks): winter reviews. 650: CCG Business Continuity (6)  Oversight Group in place to ensure mutual aid to areas of greatest clinical needs 706: Emergency Preparedness Resilience and Response (8)  Coordinated ICS response to ensure prioritisation of staff and capacity for most urgent cases 729: Risk of Harm During and Post Covid-19 (Primary Care) (16)  Planned care boards and other boards overseeing impacts on routine care to ensure shared 732: Risk of Harm During and Post Covid-19 (Planned Care and Mental Health) (20) understanding of ongoing risks 721: Information Security Maturity (15)  Ongoing feedback from Healthwatch to help identify areas requiring greatest mitigation 707: System Flow (16) Independent Assurance 690: EU Exit (12) NHSE complete an annual CCG assurance assessment through quarterly reviews.  Internal Audit review undertaken on EPRR and Business Continuity  NHSE Review of EPRR response during COVID-19

Risk 6: Statutory Duties: There is a risk of commissioning services that do not meet population needs; Involve the public in the planning of, and proposed changes to, commissioning arrangements.

Due to ineffective engagement with patients and public and lack of transparency in translation of engagement Promote the integration of health services and provision of health services integrated with outcomes into decisions; provision of health related and social care services, where this would improve quality of services or reduce inequalities. Resulting in failure to deliver the CCG’s strategic commitment to work with our partners and the people of Leeds to: Provide patient choice.  Support a greater focus on the wider determinants of health  Increase their confidence to manage their own health and well-being Promote innovation in the provision of health services.  Achieve better integrated care for the population of Leeds  Create the conditions for health and care needs to be addressed around local neighbourhoods Risk Appetite: The CCG has an averse risk appetite for public engagement; this means that the CCG is not Lead Director/risk owner: Sabrina Armstrong – Director of Organisational Effectiveness prepared to take risks in this area. Committee with oversight: Governing Body Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) All appropriate controls are in place to plan and deliver effective patient and public involvement (PPI). Current score: 20 Current However the consequence of these controls failing has the potential to result in challenge and ultimate 4 x 2 = 8 10 Score referral by Scrutiny board to judicial review. This would impact on the CCG’s reputation as well as delaying Target score: 0 any proposed changes. 4 x 1 = 4 Target Score Commissioning projects were paused during the pandemic therefore there was a lack of engagement. The risk score was increased to recognise that some changes were made in response to the pandemic. Temporary changes are permitted under regulation 23(2) of the s.244 Regulations in the interests of protecting the health of patients and staff. If it is proposed that a temporary change is to be made permanent as business as usual, the expectation is that engagement or consultation should occur. As services are restarting, where appropriate, there are a number of projects in the planning stages that have already factored in a requirement for patient and public insight and involvement therefore the risk score can be reduced.

In March 2020 the CCG published an extensive insight report and engagement about changing the way people accessed hospital outpatient services, which includes support for greater use of technology, and therefore supports some of the changes already made. The CCG is now about to undertake a similar review and engagement into changes to primary care services.

The CCG has contingency to move to facilitated online engagement and work with Leeds Voices to engage with people through their volunteer programme.

Feedback from an in-depth deliberative event which took place in March 2020 now ensures that the commissioning, contracting and procurement teams act in accordance with the expressed priorities that patients have on patient choice, which is reflected in our procurement policies and service specifications.

Rationale for target score: A target score of 4 reflects an averse risk appetite. It would not be possible to reduce the risk to a score lower than 4. This is due to the potential consequence of a control failure supplemented by circumstances outside our control. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Volunteer panel in place (PAG): Remit to provide assurance around engagement and/or consultation plans. Action Owner Due by  Significant and major engagement/consultation plans taken to Scrutiny Board for discussion Ensure communications or engagement team Strategy and Ongoing and approval to proceed. reps co-opted onto appropriate commissioning Commissioning steering groups to ensure the patient voice is teams  CCG has a full complement of staff in place to support engagement activity. heard.  Communications and engagement incorporated into Left Shift Blueprint /Commissioning for Communications and Value (CfV) process. Engagement Team 12

 The engagement plan template includes the Equality and Quality Impact Assessment to identify Further enhance our approach to engagement Communications and Ongoing impact on protected characteristics and discrete communities. and involvement activity beyond our statutory Engagement Team  Contract with Voluntary Action Leeds (VAL) to support CCG engagement work across as wide duties. Our focus will be on proactive, ongoing conversations with communities and individuals a reach as possible, and also to undertake broad asset-based engagement in harder to to build a foundation of evidence that supports reach/engage communities. VAL is continuing to recruit to their volunteer Health Champions. commissioning plans for health outcomes.  CCG has a lead role in continuing to develop the citywide engagement hub which includes The website is currently being audited to Communications Complete engagement colleagues from provider teams. ensure it meets national mandated accessibility team  CCG works closely with Healthwatch as part of the People’s Voice network. standards  CCG community network continues to grow. Engagement team working more closely with Communications and Ongoing patient experience and complaints team to Engagement Team  Bi-monthly communications and engagement reports published and shared triangulate feedback and ensure robust  CCG undertakes regular engagement with GP patient and public groups. processes in place.  Deliberative events are independently facilitated, analysed and reported on.  Formal consultation and engagement processes are independently analysed and reported on.  Equality and Diversity lead works with engagement team to ensure all aspects of protected characteristics are covered in line with the Equality Act 2010.  There is a greater focus on collecting, analysing and using existing insight from patients and the public in planning Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Need to ensure feedback from engagement is joined up with insight and intelligence from patient  Evaluation reports written and provided to commissioning teams to incorporate in their plans experience reports and monitoring of contract delivery. and influence service change.  Reports published on the CCG website and shared with members of the public who expressed an interest for further detail: ‘You said, we did’. Link to Risk Register (operational risks):  Regular liaison with, and attendance as appropriate at, Scrutiny Board to support 305: Compliance with the Equality Act Public Sector Duty (6) commissioning colleagues.  Annual PPI review published in July 2019  Monthly VAL contract meetings and VAL KPIs reviewed quarterly. Independent Assurance  ‘Amber’ assessment rating for PPI from NHS England in 2018/19 (latest rating).  Internal stakeholder engagement audit October / November 2018; this has been rated High Assurance (highest rating).  NHS Leeds CCG invited by NHS England to present examples of good practice to Amber rated CCGs at a North of England workshop on Improvement and Assessment Framework (IAF) for engagement and community involvement.

Risk 7: Statutory Duties: There is a risk to the development and implementation of the CCG strategy; Co-operate with relevant local authorities.

Due to failure to enable partners and professionals to work with and support the CCG Co-operate with other NHS bodies.

Resulting in failure to deliver the CCG’s strategic commitment to work with our partners and the people of Leeds to: Promote the integration of health services and provision of health services integrated with provision of health related and social care services, where this would improve quality of  Support a greater focus on the wider determinants of health services or reduce inequalities.  Increase their confidence to manage their own health and well-being Promote innovation in the provision of health services.  Achieve better integrated care for the population of Leeds  Create the conditions for health and care needs to be addressed around local neighbourhoods Risk Appetite: The CCG has an open risk appetite for partnership working; this means the CCG is willing to Lead Director/risk owner: consider a higher level of risk in this area. Simon Stockill – Medical Director (Professionals) Tim Ryley – Chief Executive (Partners) Committee with oversight: Governing Body/Primary Care Commissioning Committee Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) There has been a long period of partnership development and through the COVID-19 response this has Current score: 20 Current deepened further. There are a wide range of controls in place to maintain this level of commitment. 3 x 4 = 12 10 Score Target score: 0 Rationale for target score: Target 2 x 4 = 8 The CCG is open to taking a managed risk that, partners and professionals do not support the development Score and implementation of the CCG strategy, to take the opportunity to further integrate care. The CCG recognises that to proceed in delivering greater integration, there is a fine balance in ensuring partners and professionals are on board and will need to take a more significant level of risk in order to do this. The higher level of risk will be mitigated through the targeted engagement and work with partners and professionals and the risk that partners and professionals do not work with the CCG will continue to be monitored on the integration journey.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  A wide range of partnership multi-agency, multi-professional boards and task groups are in place at all levels across the city where issues can be addressed (PEG, ICE, SRAB, Action Owner Due by

Programme Boards, Clinical senate, HWB, HWB Board-to-Board, Refresh of the city-wide governance with Tim Ryley March 2021 partners  The Chief Executive meets at least monthly with each of his equivalent and there are regular Further develop the coordination depth and Review Exec-to-Exec meetings Tim Ryley  A range of joint city-wide capabilities in digital, workforce and estates range of joint core city functions March 2021  New contracting approaches are in place to encourage greater partnership working Develop a CCG and city-wide approach to Tim Ryley Dec 2020 working with West Yorkshire ICS  Commissioning teams develop new models of care with partners and always with clinical Review of Membership Engagement and Simon Stockill Dec 2020 leadership Clinical Leadership in the CCG  All levels of staff heavily involved in West Yorkshire & Harrogate Partnership  Wide range of clinical leadership in all areas of change

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Develop a local replacement for the 360 review to gain feedback from partners.  Commissioning for Value monthly EMT meetings to review progress on key plans  Outcomes to monitor progress on Leeds level integration  Progress in key areas of improvement where partnership necessary for example TCP, IAPT, Waiting Lists Independent Assurance Link to Risk Register (operational risks):  Internal Audit Partnership Review 655: Member engagement (12)  CCG Annual Leadership Rating which includes reflection on partnerships 718: Shaping Our Future Stakeholder Engagement (9)

Risk 8: Statutory Duties: There is a risk of the effectiveness of the CCG being constrained; To carry out functions effectively, efficiently and economically.

Due to internal weaknesses and external threats, for example, capacity, structure, business intelligence and cybercrime;

Resulting in failure to deliver the CCG’s strategic commitments, which are:

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  ‘Shaping Our Future’ established to transform the way the CCG operates to better enable the achievement of the CCG’s strategic commitments to deliver improved population outcomes, Action Owner Due by reduce inequalities and greater provider integration. Green Plan in terms of climate change and Sabrina Armstrong September  NHS England has introduced the People Plan for which we have a programme of activity carbon reduction, planned to go to Governing 2020 to implement to meet our local needs. Body in September 2020.  Returning Stronger programme of work to identify better ways of working to improve Complete. Due outcomes. to be published  Annual reviews of Governing Body and Committee effectiveness as well as ongoing review to shortly and ensure continuing effectiveness (e.g. Quality & Performance Committee, Audit Committee). implementation  Comprehensive Risk Management Strategy approved by Governing Body and implementation to begin. is overseen by Risk Manager. Development of internal assurance process Sabrina Armstrong January 2021  Cyber Essentials Assurance roadmap supported by a detailed IT, IG and BI delivery plan for around delivery of outcomes identified under the Left Shift Blueprint work and the CCG and areas in Primary Care the CCG supports. through commissioning intentions. Internal  BI, IG and IT Committee providing assurance on all aspects of IT, IG and BI to the Audit assurance through the Executive Committee. Management Team meetings.  Increasing leadership capability re analytics infrastructure support to Commissioning and all Stage One Shaping Our Future – redesigning Sabrina Armstrong March 2021 other functions of the CCG. the CCG  Development of a Leadership Behaviour Framework for, initially, our senior staff to Establish Outcomes based contract the Covid- Visseh Pejhan- April 2021 support our new ways of working as part of the Shaping our Future programme of work. 19 finance regime is expected to continue Sykes April 2022 until April 2022. 15

 Introduction of a range of development opportunities to enhance and develop new Regular formal reporting of the CCG’s delivery Visseh Pejhan- Ongoing capabilities. plan progress (BI, IT, IG) to the Audit Sykes  Enhancement of our Health and Wellbeing support for staff to support new ways of Committee/ EMT / GB working. Reducing further our operational reliance on Governing Body Mid 2022  Supporting the development of a BAME Network and engaging members in key premises as a CCG decisions across the CCG, including senior appointments, to ensure the CCG is an inclusive employer.  Reducing reliance on physical premises to develop more agile working capability for the CCG in preparation for its System Integrator function in particular.  NHS Digital has stepped up nationally to reduce cyber risk for all NHS organisations by providing a single NHS Cloud tenancy nationally and contracts with Microsoft for all O365 products including security related options.  Risk assessments carried out on all staff during pandemic phase to ensure that health and wellbeing is being supported effectively and changes to working patterns and locations are being assessed and supported as appropriate. Where a risk is identified, action (including redeployment) will be considered to ensure staff can continue to work in a safe environment. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Impact of climate change on CCG effectiveness  Staff survey results.  Assurance to the Governing Body on CCG workforce issues  Cohesive commissioning decisions with high assurance and regular review and affirmation of  Organisation structured around Strategic Commissioning and System Integration capabilities. progress against strategic objectives supported and informed by robust support systems.  New, long term population-level outcomes based contracts established.  Remuneration and Nominations Committee receives assurance on workforce issues  CCG’s Business Intelligence reporting and Analytics has been identified as a key areas for through quarterly reports and regular updates on such as the Gender Pay Gap and development on both the CCG ad the city wide footprint Workforce Race Equality Action Plan.

Link to Risk Register (operational risks): Independent Assurance 650: CCG Business Continuity (6)  All internal audits undertaken during 2019/20 were rated as ‘significant’ or ‘high’ assurance. 305: Compliance with the Equality Act 2010 Public Sector Equality Duty (6) Head of Internal Audit Opinion provided significant assurance that there is a generally sound 578: Cyber Security (12) system of internal control. 721: Information Security Maturity (15)  CCG rated as ‘outstanding’ under the NHS Oversight Framework. 718: Shaping Our Future Stakeholder Engagement (9)  NHS Digital Audit, Self-Assessed annual Toolkit review of CCG’s BI, IT and IG processes and 719: Shaping Our Future Impact on Staff (12) controls plus annual Internal Audit review of toolkit 731: Legal claims/challenges to decisions (8)  Key outcome metrics and national / local tracking of delivery trajectory confirming positive 730: Authentication Vulnerability with MS Teams (12) impact on reducing health inequalities in line with CCG aspirations. 733: Home Working – Staff Physical Health (9)  Quarterly Place assurance meeting with NHS E/I. 734: Home Working – Managing Remotely (9)

Risk 9: Statutory Duties: There is a risk to delivery of the CCG strategy; Promote innovation in the provision of health services.

Due to inadequate system infrastructure to support plans, such as, estates and or digital provision; Secure improvement in the quality of services and outcomes for patients, with particular regard to clinical effectiveness, safety and patient experience. Resulting in failure to deliver the CCG’s strategic commitments, which are:

We will focus our resources to: . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city We will work with our partners and the people of Leeds to: . Support a greater focus on the wider determinants of health . Increase their confidence to manage their own health and well-being . Achieve better integrated care for the population of Leeds . Create the conditions for health and care needs to be addressed around local neighbourhoods. Risk Appetite: The CCG has a medium risk appetite towards enablers (digital and estates); this means the CCG Lead Director/risk owner: Visseh Pejhan-Sykes – Chief Finance Officer will accept a medium level of risk In this area. Committee with oversight: Governing Body/Primary Care Commissioning Committee Date last reviewed: October 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) Three critical non-workforce related support areas have been identified as Estates, Technology and Intelligence. Post Current score: 20 Current COVID, the weightings assigned to Estates and Technology respectively may alter depending on the nature of service delivery, but the data intelligence on which the system should rely on when making decisions remains of the highest 4 x 4 = 16 10 Score Target score: 0 importance. Without access to all three in the right measure, service delivery across the system will be highly 4 x 2 = 8 Target challenging or potentially less than optimally relevant. As Estates costs tend to be high with associated flexibilities Score being lower, the COVID era has highlighted the benefits of transferring reliance on premises to technology where practical in terms of mode of delivery of care – as new developments emerge this will increasingly become the case and Leeds is well equipped to be at the forefront of new ways of working. Our ability to deliver high quality intelligence is currently in the development stages. We currently have a significant backlog maintenance challenge for NHS premises – mainly in the Acute sector – and in some pockets in Primary Care. Rationale for target score: Ideally, our commissioning functions would have access to and rely more heavily on infrastructure and support functions such as IT, Cyber and Analytics to more effectively commission using sophisticated actuarial analytics to inform decisions. If this were the case the consequences of unavailability would be higher as would the benefits of access to this capability when available and working well. Our ideal score would be high reliance but low likelihood of failure due to well maintained and supported infrastructure. Treasury funding made available to LTHT to replace the Leeds General Infirmary will significantly eradicate the City’s NHS backlog maintenance and quality of care delivery issues in Secondary care. We are expecting an accelerated trajectory to the rebuilding of the LGI over the next 5 years. Critical next steps are the approval of the Outline Business Case and proceeding to Full Business Case and procurement processes. Ensuring that the new buildings are affordable to the Leeds System is also an important aspect of the planning process next steps. Business Intelligence development roadmap and leadership are in the process of being put in place.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  System review of COVID learning to reduce reliance on estates and to increase our full potential in terms of use of Technology. Action Owner Due by  NHS Digital developments around N365 and a common single cloud tenancy for the NHS has significantly Leadership role in reviewing, seizing and Governing Body Late 2020 improved cyber security for the NHS to build its technological service delivery platforms on. embedding change post COVID to ensure that

 New Director Portfolios to increase leadership focus on business intelligence and separation of Digital transformation of service delivery resulting from the COVID era is retained and adopted sustainably by leadership from Analytics to give the space and time to both agendas the Leeds system.  CCG’s roadmap to cyber assurance compliance and Business Intelligence capability developed and Set up Programme of delivery for Analytics support New Director for December phased for Audit review and feedback / assurances. to the CCG which is co-designed and owned by Business Intelligence 2021 SLT, Commissioners and the Wider System System wide Estates and Digital Strategy resets for Strategic Estates March 2021 the City post COVID Group (SEG) and Leeds Informatics Board (LIB) 17

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  IT infrastructure adequately developed across the Leeds and wider NHS system to provide a robust  BI – availability of and feedback from leadership and system leaders and stakeholders on impact and and relevant platform for analytics development and support infrastructure – needs more committed relevance of business intelligence as a timely and relevant tool for decision making. partnership working across both Health and Council.  System wide Estates (SEG) and Digital (LIB) strategic developments continue to address barriers to  Information Governance and other related governance and statutory arrangements support the optimal delivery of care. development of the ideal infrastructure and support systems.

Link to Risk Register (operational risks): Independent Assurance 707: System Flow (16)  Internal Audit Reviews of progress against plans for delivery 653: Primary Care Infrastructure (12)  Annual reports of progress from LIB and SEG to City wide forums such as PEG and the HWB Board 708: National Shortage of Capital (8)

Agenda Item: GB 20/93 FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020

Title: Position Statement: People and Organisational Development Strategy

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Authors: John Scott and Lara Parkinson, Decision former and current Head of People & OD Reviewed by EMT/Date: 11 November 2020 Discussion  Reviewed by Committee/Date: Workforce & Diversity Group on 10 November 2020; EMT on 11 Information  November 2020. Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing  2. Reduce health inequalities across our city  We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health  4. Increase their confidence to manage their own health and wellbeing  5. Achieve better integrated care for the population of Leeds  6. Create the conditions for health and care needs to be addressed around local  neighbourhoods Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city.  2. Quality of commissioned care is compromised and does not reflect best practice.  3. Failure to achieve financial stability and sustainability.  4. Failure to overcome local and national workforce shortages.  5. Business continuity of health and care services disrupted as a result of a significant event.  6. Ineffective patient and public engagement and lack of transparency in translation of  engagement into decisions. 7. Partners and Professionals do not support the CCG strategy.  8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans.  9. Inadequate system infrastructure to support the CCG’s plans. 

EXECUTIVE SUMMARY:

Leeds CCG’s People and Organisational Development (P&OD) Strategy 2018-21 was endorsed by the Governing Body in October 2018 and reviewed in January 2020. Despite a radically changing environment, the Strategy remains broadly fit for purpose. The Remuneration and Nominations Committee now has a programme to regularly review workforce data and specific diversity reports.

The impact of COVID-19 and lockdown has both challenged our capacity to maintain our support to people management but also shown our Strategy to be robust, flexible and adaptable.

The P&OD Strategy, through its six Ambitions and eight Themes, set out how the organisation should focus its People and OD activities in anticipation of changes in the wider system. As in the previous update, this report seeks to:

 Identify which key developments since the Strategy’s publication have been the most significant for the P&OD function  Describe the function’s response, and plans, around the impact of these developments  Provide an opportunity for the Governing Body to note these developments and consider ways in which the CCG can further capitalise on the opportunities they present  Provide assurance to the Governing Body that the steps being taken now and over the next 12 months will increase the organisation’s resilience and capacity for delivery and, where appropriate, development and transformation. In that respect, our response to the NHS People Plan and Promise will be pivotal.

NEXT STEPS:

Publication of the update and associated communication and engagement with our people and partners.

RECOMMENDATION:

The Governing Body is asked to:

(a) NOTE the continuing progress made during 2020; (b) COMMENT on the content of this report; and (c) ENDORSE and SUPPORT the plans described for 2021.

1. SUMMARY

1.1 This paper summarises progress during 2020 on the key elements of the P&OD Strategy and planned activity to ensure we embrace and embed the content and ambitions of the NHS People Plan and Promise.

2. BACKGROUND

2.1 The P&OD Strategy was written as a companion piece to the Leeds CCG Strategic Plan and so adopted the ambition of the Strategic Plan and echoed a Workforce Ambition to: ‘…attract and develop a flexible, dynamic and responsive group who can lead and support the health and care system to achieve this ambition.’

2.2 An Action Plan listed tasks and initiatives that would support the eight themes. These have been reviewed regularly and are summarised at Annex A. The RAG rating in January suggested that we had established a strong basis but needed to place greater emphasis on wider leadership development and the broader talent agenda.

2.3 Developments that have impacted on the Strategy during 2020

2.3.1 2020 has been a year like no other most of us have experienced. It has presented many challenges and potential barriers and severely tested the different elements of emotional intelligence of all our people. But equally it has resulted in an explosion of new ways of working and an increase in innovation. Some of the issues, benefits and implications to be drawn from the experience include:

 Agile working and redeployment. In the early stages of the pandemic, we swiftly gathered information about our people’s skills, personal circumstances and availability so that people might be deployed to priority areas within the CCG and the wider system. This activity has highlighted the flexibility and commitment across the organisation and sets a template for the second wave and subsequent remote management and matrix- working in the future. It also flagged a need for up-to-date information on our people and their skills.

 Homeworking. Since March 2020 the CCG has effectively operated as a predominantly home-based organisation. This has tested, and largely found effective, our ability to adapt to online operation, in terms of keeping in touch, management meetings, decision making and recruitment and selection. This was facilitated by the immediate issue of laptops and, where requested, mobile phones to all staff and the introduction of MS Teams to enable online conversations.

Although we have re-opened WIRA House on a limited basis, it seems unlikely that we will return fully to our previous office-based operations as they were. We have conducted a Returning Stronger survey that seeks to identify some of the positive outcomes driven by the pandemic. The impact of COVID-19 and the changed working environment will also be addressed in this year’s Staff Survey, currently underway.

 Health and Wellbeing. A direct impact of remote working was an increased call for practical and emotional support. Our established Occupational Health, counselling and wellbeing offer was enhanced by an online 24/7 Employee Assistance Programme, renewed publicity for our Health and Wellbeing Group (HWG), our Mental Health First Aiders and the Freedom to Speak Up Guardians.

We also established, initially, daily written updates to all staff including supportive messages from the Chief Executive and Directors; ‘Kitchen Chat’ e-drop in sessions. A DSE (Display Screen Equipment) Assessment also gauged colleagues’ comfort and safety in working from home and, as a result, additional equipment issued for home use.

 Black Lives Matter and disproportionate impact of COVID-19. Like the rest of the NHS and the Integrated Care System (ICS), we have begun to systematically review all our people processes and are proactively involving colleagues from the BAME (Black, Asian and Minority Ethnic) network in key decision-making including senior level appointments. A comprehensive COVID-19 risk assessment was completed for all CCG staff and actions taken to limit risk. This and the DSE review will be repeated periodically and when circumstances change.

 Further development of our diversity and inclusion offer. The BAME network has proved very successful and perhaps offers a template for developing further support to staff facing particular challenges (for example: staff with disabilities, premature birth, caring responsibilities and historical abuse). We continue to source support and adapt our policies and working practices. We have recently, for example, carried out a staff survey in relation to disabilities with the aim of understanding some of the challenges colleagues across the CCG experience and to explore the interest in developing a Disability and Wellbeing Network. Analysis of the responses to the survey is currently underway.

 The NHS People Plan. The NHS People plan has provided all NHS organisations with a clear set of actions that we must undertake to embody the behaviours set out in the People Promise. Many of the actions were already underway by means of our HWG, our Workforce Race Equality Standard (WRES) action plan and the P&OD Strategy action plan. This includes making our recruitment processes more inclusive, increased promotion of the physical and mental health and wellbeing of our staff and continuing to offer learning and development opportunities to increase the capability of our staff. These action plans are being brought together to provide clear oversight of the further interventions needed to be developed by the team.

 Shaping Our Future. We paused briefly on this programme trailed in January, during the first wave of the pandemic, but have now entered the post-filling phase to support the new operating model and organisational structure. This has included development work on capability requirements and a Leadership Behaviour Framework which we have begun to socialise with our senior managers.

 Social Partnership Forum. We now have effective engagement and consultation arrangements in place with our Staff Side colleagues including a regular Forum.

3. PROPOSAL

3.1 What is planned to prepare the CCG for future developments?

3.1.1 Our future plans will be largely dictated by the fulfilment of Shaping Our Future. Delayed by COVID-19, we remain committed to introducing the new working arrangements required to deliver the new operating model from the start of 2021-22. The people ambitions include:

a. Greater partnership working and integration with our partners with wider use of shared posts and management, and more extensive matrix working along extreme teaming principles.

b. A clear deployment model within the CCG to enable agile resourcing and working.

c. Building on the Leadership Behaviour Framework and rolling these values out through the organisation.

d. A greater understanding of the capabilities of our people and what gaps exist to fulfil current and emerging organisational and system needs.

e. Further development of coaching, mentoring and learning including workshops, secondment and shadowing opportunities and the offer of Executive Coaching;

f. Continued engagement with Culture Change initiatives at national, place and local levels. Ensuring we remain fully informed and involved in developments around Inclusive and Compassionate Leadership and embedding those principles into all our activities, processes and practices.

g. An unremitting commitment to addressing inequality across the organisation and, in particular, representation at senior levels in the CCG.

4. NEXT STEPS

4.1 The Strategy continues to reflect our broad direction of travel characterised by ever greater collaboration and partnership working across the system. We would normally see no reason for any significant reorientation of the Strategy – it has served us well.

4.2 However, the NHS People Plan and Promise offers an alternative framework to describe our intentions for how we engage and manage our people. We will want to track developments in its use by NHS England, NHS Improvement and our partners and may return to Governing Body with a further proposal during 2021.In the interim; we will continue to monitor progress and report via the Remuneration and Nominations Committee.

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1 The CCG has existing contractual relationships with providers of professional People and OD services that are necessary for the realisation of its strategic plans.

5.2 This report does not seek to change these so there are no additional statutory, legal, regulatory or contractual implications.

6. FINANCIAL IMPLICATIONS AND RISK

6.1 The contract for developing the new operating model for Shaping Our Future had a limited timescale and the costs were agreed as part of a rigorous tender process that met all necessary procurement and governance requirements. The additional in-house OD capacity set out in this report is provided through either secondment or temporary arrangements within existing budgets. Service arrangements, such as those via LTHT, give improved value for money through partnership working that enables the CCGs to shape those services within existing budgets.

6.2 The CCG has to be both resilient and agile in order to respond to the dynamic environment in which it operates, which in turn, requires responsivity and agility from our P&OD function. If that cannot deliver effective support, the risk is that it will fail to create the right conditions to enable the CCG to achieve its ambitions.

7. COMMUNICATIONS AND INVOLVEMENT

7.1 The original P&OD Strategy covered the period 2018 – 21. The communication and involvement activities around its review will include:

7.1.1 Assuming Governing Body agreement that it remains broadly fit for purpose, it will remain publicly available on the CCG’s website

7.1.2 A communications plan will be needed for the People Plan and, should this supersede the Strategy, that proposal will be presented to Governing Body.

7.1.3 Continued monitoring of Workforce and Diversity reports by the CCG’s Workforce and Diversity Group; Executive Management Team and the Remuneration and Nominations Committee.

7.1.4 Publication of this report and other supporting material on the CCG website and Extranet.

8. WORKFORCE

8.1 The plans set out in this report are designed to build the CCG’s capacity through, amongst other things, employee and leadership development. This will increase awareness of, and competence in ‘soft skills’ such as Coaching, which will support people to operate more confidently and effectively across a broader range of scenarios.

8.2 Better engagement through the staff survey, involvement, inclusion and development through appraisal, health and wellbeing through staff-led groups and collaborative working through active pursuit of partnership, will all work together to further attract, develop and retain a workforce that is more motivated, capable and engaged.

8.3 No negative workforce implications are anticipated, though the change to working arrangements will require sensitive handling.

9. EQUALITY IMPACT ASSESSMENT

9.1 The staff survey response rate of 80% for 2019 was encouraging, and in line with the national average completion rate for CCGs. This gives confidence that the results will provide a reliable baseline in terms of representation of staff opinions. We will need to do all we can to replicate that engagement for the 2020 survey.

9.2 Similarly the introduction of an improved and consistent appraisal system, and the encouragement for staff-led communications and groups, deliver tangible benefits for involvement, equality and staff voice.

10. ENVIRONMENTAL

10.1 There are no anticipated environmental issues, though the increased use of homeworking and other remote working will contribute to a reduction in the CCG’s carbon footprint.

11. RECOMMENDATION

The Governing Body is asked to:

(a) NOTE the continuing progress made during 2020; (b) COMMENT on the content of this report; and (c) ENDORSE and SUPPORT the plans described for 2021.

7 ANNEX A: PEOPLE & OD STRATEGY. ACTION PLAN SUMMARY STOCKTAKE

The diagram below describes the actions completed in the first two years of the strategy (in green) and indicates key activity for the coming 12 months (in red). The table that follows lists the activities as described in the Action Plan and uses a RAG rating to assess progress in each workstrand against the original plan.

Appraisal process Leadership Recruitment, Framework Selection and Onboarding

Learning opportunities People & OD Inclusion Senior Strategy Leadership Tier development

Health & Wellbeing Shaping Our Future - impact on OD Coaching offer

THEME ACTION

Resourcing 1 Apprenticeship Guidance, including a city-wide approach Complete Complete Review the promotion of alternative channels of recruitment i.e. LinkedIn, Resourcing 2 local communities, primary care, Leeds employers city-wide Superseded by link to Alternative method of recruitment i.e. alternative to NHS Jobs and internal LTHT. Will explore Resourcing 3 administration (E-track) alternatives Resourcing 4 Offer broader induction including an understanding of commissioning Complete process, teams and impacts on each other. Including Biographies, structure charts and extranet information Resourcing 5 Standardised approach to recruitment Complete Resourcing 6 Recruitment toolkit for managers, including a suite of values based interview Some work, but still a questions for recruitment need Resourcing 7 Understanding and collating internal pools of resources, skills and SoF leading to better capabilities internally understanding Resourcing 8 Review recruitment and promotion practices to make sure New that staffing reflects the diversity of the community, and regional and national labour markets Resourcing 9 Explore greater use of jointly-funded posts New Resourcing 10 Explore organisations commitment to flexible working for all including roll New out of carers passport Talent 1 Review appraisal process, including a talent matrix approach, train people Complete appropriately in the appraisal process Talent 2 Scope the meaning of the skills gap analysis and agree approach/timeframe Work begun as part of SoF post-filling activity Talent 3 Formalising the CCG's approach for access to mentoring, Planned as part of coaching offer Talent 4 Consider adopting the Citywide network approach, that is used for coaching Complete to support mentoring Talent 5 Using data from workforce planning, identify 'at risk' roles and agree a Emerging issue from SoF, succession planning approach to address the gap (including Clinical but needs more targeted Leadership) work Talent 6 Review previous approaches to Governing Body development and work New Chair has embarked with Corporate Governance team to identify future approach on review Engagement 1 Revisit previous communications survey outcomes, temperature check, Complete engagement thermometer and take appropriate action (eg refresh team brief, workplace launch etc) Engagement 2 Development a schedule of Staff Away Days inform content and implement Complete Engagement 3 Evaluation and Review the Building Champions network Complete Engagement 4 Increase the Champions cohort Complete – two tranches Engagement 5 Suggestions Box and Bright Ideas, you said we did model Complete Engagement 6 Conduct Staff Survey Complete – 2019 done, 2020 in train Health & WB Clarify the accountability of the H&WB Group and publicise the role of the Complete 1 group and it's outcomes H&WB 2 Director level responsibility for H&WB and H&WB Champions Complete H&WB 3 Learning from other organisations where we can share good practice and Ad hoc learning so far shared arrangements i.e. WIRA Business Park, city-wide organisations, LCC, LTHT, etc. H&WB 4 Extranet page specific to H&WB Complete H&WB 5 Re-procurement of OH and counselling services (widening the offer/scope Complete. EAP added in of services i.e. MSK) 2020 H&WB 6 Promotion of H&WB at induction, manager training and as part of Complete organisational value H&WB 7 Link flexible work arrangements (and it's support) to induction and appraisal Partially addressed, though conversations. Explore extension to current flexible work patterns and still more to do in terms examples of best practice. of publicity, further development H&WB 8 Revise Special Leave Policy to include provision for voluntary work/time out Complete to improve H&WB and support corporate social responsibility Inclusion 1 WRES action plan actions published and reviewed annually Complete for 2019 and 2020 Inclusion 2 Review membership of all CCG formal meetings, to ensure protective Complete characteristics are considered (board diversity) Inclusion 3 Update self-assessment for disability confident standard for the single CCG Complete

Inclusion 4 Research development opportunities which target under- represented Under review, but no groups and share formal output, as yet Inclusion 5 Review protected characteristic data that is available as a check and Ongoing activity balance for all people related processes Inclusion 6 Developing Managers awareness of their responsibility to support any Ongoing. Unconscious reasonable adjustments for new starters and current employees Bias training due in 2020 Inclusion 7 Review Gender Pay Gap analysis and action plan New – Paused in 2020

Learning & Review appraisal process, train people appropriately in the appraisal process Complete Development L&D 2 Capture individual development needs from appraisal discussions and inform Complete learning & development needs for the organisation L&D 3 Capture organisational wide development need from directorates and Complete for 2019 inform the learning & development needs L&D 4 Statutory/Mandatory compliance, ongoing monitoring and maintenance of Complete. Compliance at the provision, transition from current arrangements i.e. impact of eMBED 90%+ contract end L&D 5 Link into wider Leeds resources i.e. training programmes, coaching etc.…, Ad hoc. Link to LTHT not Influencing and developing a portfolio fully actioned L&D 6 Support for existing coaches Complete L&D 7 Address the need for clear management of Learning and Development Discussions began with applications - consider broader approaches for CPD across the city Health & Care Academy but paused. Some alliance. L&D 8 Develop and implement a Management skills programme Manager as Coach delivered. Will pick up as part of SoF. Workforce Consider the validity of the development of a long term workforce plan that Greater focus on Planning & includes information about future alignment of work streams to other workforce planning, but Transition 1 organisations more to do. W P & T 2 Audit of current New Ways of Working arrangements, following its Overtaken by impact of implementation in April 2018 COVID-19. Still requires documentation W P & T 3 Agree an approach of aligning resources to support the work of the Paused whilst Academy Academy agrees approach W P & T 4 Scoping the approach to matrix management for discussion with EMT Key element of SoF, W P & T 5 Flexible deployment toolkit for managers including an examplar way of Due to be includedin working document development under SoF Leadership 1 Agree the approach on adopting the Healthcare Leadership Framework, Paused pending outcomes including use of 360 feedback of SoF Leadership 2 Develop the Management Development Programme Paused pending outcomes of SoF Leadership 3 Contribution to the Citywide development of system induction and Attending meetings. leadership approach System Leadership programme agreed and resource allocated Leadership 4 Review Temperature Check and Staff Survey results to understand current Partly completed. culture around trust and support. Dependant on outcomes agree an Awaiting 2020 results to appropriate plan compare trend analysis.

Agenda Item: GB 20/94 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020 Title: Chair’s Summary – Primary Care Commissioning Committee held on 7 October 2020 Lead Governing Body Member: Sam Tick as Senior, Lay Member & Chair – Primary Care Category of paper appropriate Commissioning Committee () Report Author: Cheryl Lee, Corporate Decision Governance Officer Discussion  Information Approved by Lead Governing Body Member (Y/N) Y EXECUTIVE SUMMARY: This report provides the NHS Leeds CCG Governing Body with a summary of items discussed and outcomes and risks identified at the Primary Care Commissioning Committee (PCCC) meeting held on 7 October 2020.

RECOMMENDATION: The Governing Body is asked to:

(a) RECEIVE the report.

Description of key items of business discussed and key outcomes 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the PCCC meeting held on 7 October 2020. Further information can be obtained by reference to the minutes of that meeting.

Chief Executive’s Update 2. Members were informed of the current Covid-19 position in Leeds which has seen numbers in the mid to high 200’s per 100,000 people. The highest levels of infection are strongly amongst the lower age groups but all age groups are affected across all parts of Leeds. It was recognised that the implications would be more severe if a growth was seen in the older population. Members were informed that hospital admissions had increased and a third ward had already been opened and amid the increasing pressure, it is likely that some aspects of elective surgery may have to be cancelled. It was highlighted that workforce and testing remained high in terms of potential additional pressure. The need to be aware of recognising the impact on mental health and well-being should further restrictions come into place was stressed, along with the importance of the flu vaccine.

3. A significant challenge was noted in terms of finances for both the CCG and the NHS as a whole. The budget allocation leaves NHS Leeds CCG with financial challenges for the latter half of this year and a lack of clarity on the primary care funding position.

4. Multiple challenges were noted –the rising cases of Covid-19, pressures on elective procedures, flu vaccinations and the significant financial challenges and uncertainty faced.

5. It was shared that the ‘shaping our future’ programme was not believed to have a significant impact on primary care resources or support. There have been changes in relation to GP contracts across Leeds whereby they are more widely integrated and aligned to broader outcomes.

6. A good example of the work and initiative being undertaken across Leeds was shared with the Committee; Wetherby surgery were arranging a mass flu vaccination drive-through event where 7000 patients would be vaccinated at one time.

Closure of Branch Surgery at Adel – Update 7. Members received an update on the branch closure at Adel. The landlord may decide to give notice to the pharmacy therefore options available to the pharmacy were shared. There may be implications for the pharmacy needs assessment (PNA) and include the need to work within existing pharmacy regulations. It was noted that positive steps had been taken in mobilising patient transportation solutions and that formal arrangements would be confirmed at the next Committee meeting.

Primary Care Networks 8. The Committee was informed that revised national guidance had been circulated on PCN and DES implementation.

9. The key focus would now be in relation to the investment and impact fund which is a points- based system in place to reward quality service and the additional role reimbursement scheme.

10. Challenges were noted with an identified forecast of workforce underspend of £680,000. Some of the PCN’s with the biggest underspends were from the most deprived areas which could then have a negative impact on health inequalities. It was acknowledged that there was also the possibility that the anticipated underspend may be even greater. It was confirmed that 60% of the funding was within the financial baseline and confirmation was awaited for the remaining 40%.

11. Further challenges were noted regarding the progress of estates and utilising space for newly recruited posts. Although clarity was needed about where the responsibility for that sits, a senior level estates member would be recruited within shaping our future.

Summary from the Primary Care Operational Group meetings in August and September 2020 12. The Committee was informed that Oakwood Surgery had now re-opened their list, meaning all lists across Leeds were open.

13. There had been a notable increase in the number of asylum seekers across Leeds with additional support being provided by York Street Practice.

14. Target training had taken place in September and had received positive feedback.

15. An action was agreed for a shared risk approach to be revisited as part of the wider system integration work.

Impact of Covid on Quality in Primary Care 16. Members received an update on the impact of Covid-19 in primary care, highlighting the findings of the work carried out by Dr Bryan Power. During the initial findings looking at March, April and May there was a significant decrease in access to appointments along with a change in how they are being accessed. There had been a marked decrease in LD health checks along with a decrease in cervical smears. Vaccination levels had continued without a significant drop. 100% of practices have provided assurance they are now offering face-face appointments and the number of appointments was now increasing to pre-Covid levels.

17. The Committee received assurance that all patient feedback received was followed up and shared.

18. Members recognised that the biggest challenge facing primary care was the ongoing pandemic and the knock-on impact on health and well-being but the overview of quality highlighted that support was in place.

19. Positive news was relayed to members that 100% of practices in Leeds are now rated as good or outstanding by the CQC.

CCG Enhanced care home scheme 2021/22 update 20. Members were updated on the 1-year agreement in place to support care homes whilst awaiting the national guidance update which has been delayed due to Covid-19. The enhanced health and care home scheme would move towards less duplication.

21. Data regarding frailty was shared and a stepped approach to this was discussed. The importance of member feedback was acknowledged in developing the scheme and the primary care team will be running a care home session to ensure the ongoing dialogue and meaningful engagement.

22. The Committee approved the direction of travel, but recognized that this was a complex area with significant work to be undertaken.

Primary Care Risk Report 23. Members noted there were eleven active risks aligned to the Committee rated at 12 and above. A new addition reported was the alignment to the Governing Body Assurance Framework.

24. Two high amber (12) risks were reported: R651: General Practice Workforce, and high amber risk; R729: Risk of Harm post Covid-19 (Primary Care). An action was agreed for discussions to take place in relation to the levels of risk due to the pandemic and imminent Brexit along with the financial challenges faced.

Primary Care Finance and Estates Update 25. Members were presented with the position reported at month 5. The time-lag in reporting was also noted. The Committee was informed of a budget overspend at month 5 – a continuation of the trend for months 1-4 with the gap relating mainly to Covid-19 costs having been refunded by NHSE to break even retrospectively in months 1-4 . We are still awaiting our refund for month 5.

26. Reports throughout 20-21 to PCC have highlighted consistently a forecast over spend for Primary Care Co-Commissioning Budgets due to the CCG’s inability to move £1.8M of budget from the core allocation to cover the equitable funding scheme in Primary Care under the emergency finance rules introduced by NHSE/I for the pandemic period. Based on our indicative allocation now received for the remainder of the financial, it is clear that we will not be able to close this gap over the remainder of the year and that this deficit will continue. The NHS Leeds CCG has also not received a further allocation for the Impact and Investment Fund currently being paid to PCNs each month but it is likely that a separate allocation will ensue over the next 6 months.

27. The prescribing budget is also subject to overspending, in part due to changes in drug prescribing recommendations resulting in more expensive regimes along with an increase in the prescription of Sertraline. The second factor in the budget overspend is the inability to pursue more cost-effective drugs due to the Covid-19 pandemic and restrictions.

28. Members were informed that an indicative budget allocation had now been provided for the remainder of 20-21. Our financial planning assumptions have led to a starting position of estimated overspend by the end of the year to be £25m. Assuming the reimbursement of costs from NHSE for Covid-19 in months 5 and 6 and also for related additional activity spend with independent sector providers for months 7-12, this deficit would be reduced to £15m. It was noted the CCG has been defunded £53min total against its original allocation for 20-21 with circa only half of planned spend (circa £25) with the Independent Sector having been taken on centrally as an offset. This is then main reason for the initial deficit position as highlighted above.

29. Leeds CCG is not alone in this position as many CCGs across Yorkshire, and the Country, are also finding themselves with deficits.

Strategies/Policies approved N/A

Items of positive assurance or issues to be raised with the NHS Leeds Governing Body N/A

Any additional comments N/A

Agenda Item: GB 20/95 FOI Exempt: N

NHS Leeds CCG Governing Body

Date of meeting: 25 November 2020 Title: Chair’s Summary of Remuneration & Nomination Committee Meeting held on 14 October 2020 Lead Governing Body Member: Sam Senior, Lay Tick as Member – Primary Care Co-Commissioning / Category of Paper appropriate Deputy Chair () Report Author: Laura Parsons, Head of Corporate Decision Governance & Risk Discussion  Information Approved by Lead Governing Body member (Y/N): Y EXECUTIVE SUMMARY: 1. This report provides the NHS Leeds CCG Governing Body with a summary of items discussed, outcomes and risks identified at the Remuneration & Nomination Committee meeting held on 14 October 2020.

RECOMMENDATION: The Governing Body is asked to: (a) RECEIVE the report.

Description of key items of business discussed 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Remuneration & Nomination Committee on 14 October 2020. Further information can be obtained by reference to the minutes of that meeting (subject to exemptions under the Freedom of Information Act).

Non Executive Posts – Succession Planning

2. The Committee noted that the terms of office for the three Member Representatives were due to end on 31 March 2021, therefore an election process would be undertaken in line with the Constitution. The Secondary Care Consultant had indicated that he would be retiring from 31 March 2021, therefore a recruitment process would be undertaken. Job descriptions were agreed for both roles.

VSM Pay

3. The Committee agreed to make recommendations to the Governing Body in relation to pay for some VSM staff, this is included in a separate item on today’s agenda (GB 20/104).

Quarterly Workforce Report

4. The Committee’s responsibilities now include oversight of workforce within the CCG. The quarterly report was presented which provided detail on the current workforce profile and benchmarked performance in key HR areas such as sickness and recruitment. The Committee was pleased to note that statutory and mandatory training levels have reached

90% in all areas. A query was raised in relation to staff turnover which was 12.32% on average over the last 12 months. This was in line with other CCGs and was not of concern. Turnover rates had reduced recently due to Covid-19. Assurance was provided that turnover levels would be assessed at directorate level to ensure there were no areas with unusually high rates, and any concerns would be reported to the Committee by exception.

Staff Survey – Update on Harassment Figures

5. The Committee received an update on the results reported as part of the Workforce Race Equality Standard (WRES) report. This identified harassment and bullying from colleagues as a significant issue. This will continue to be monitored and any further action will be informed by the 2020 staff survey results. There may be a decrease compared to last year as the majority of staff are now working from home.

Gender Pay Gap – Further Analysis

6. An update was provided further to the Committee’s request for a further comparison of the Gender Pay Gap, following the report which showed results of a mean difference of 29.4% and median difference of 15.7%. Due to COVID-19 priorities, NHS organisations were not required to report for 2019 and, as a consequence, few comparators were available.

7. The next report was due in the next few months and would therefore be presented to the next Remuneration & Nomination Committee meeting, in February 2021. It was agreed that this should include a review of each pay band.

Lay Member Reappointments

8. The Clinical Chair presented a proposal in relation to Lay Member reappointments. Further detail is included in a separate item on today’s agenda (GB 20/104).

Strategies/Policies approved Five policies have recently been agreed by Staff Side, and will be circulated to the Committee for approval by e-mail rather than delay approval until the next meeting in February.

Items of positive assurance or issues to be raised with the NHS Leeds CCG Governing Body In particular, the Committee wished to highlight the Gender Pay Gap and inform the Governing Body that further analysis would be presented to the next Remuneration & Nomination Committee (including an analysis by pay band), to inform any action required.

Items of discussion regarding Strategic Risks to the CCG This summary provides assurance in relation to strategic risk 8 (Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans). In particular, no concerns were reported as part of the quarterly workforce update, however the Committee will be considering more detailed analysis in relation to the Gender Pay Gap, and will continue to monitor harassment figures reported through the staff survey and agree actions as required.

Any other Comments N/A

Agenda Item: GB 20/96a FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020

Title: Chair’s Summary – Audit Committee meeting held on 18 November 2020

Lead Governing Body Member: Cheryl Hobson, Tick as Category of Paper appropriate Lay Member – Audit & Conflicts of Interest () Report Author: Anne Ellis, Risk Manager Decision  Discussion  Information  Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY: This report provides the NHS Leeds CCG Governing Body with a summary of items discussed and outcomes and risks identified at the Audit Committee meeting held on 18 November 2020.

RECOMMENDATION:

The Governing Body is asked to:

(a) RECEIVE the report; (b) APPROVE the minor changes to the Detailed Financial Policies; and (c) APPROVE the minor change to the Operational Scheme of Delegation;

Description of key items of business discussed and key outcomes 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Audit Committee held on 18 November 2020. Further information can be obtained by reference to the minutes of that meeting.

Finance

2. The Committee was provided with an update on the impact of the finance regime for 2020/21 on the ICS and the CCG financial position. The consolidated system financial plan was submitted to NHS England on 5 October 2020 with an accompanying letter setting out the planning assumptions and risks associated with the plan. The shortfall from the ICS system envelope considered at the last meeting of the System Oversight and Assurance Group was £72m. This included a Leeds CCG deficit of £13m; however this position was predicated on the system receiving significant further national funding which is so far indicated but not confirmed. The CCG has limited control over payments under the financial regime, the areas the CCG has control over include prescribing, Continuing Healthcare and investments relating to tackling health inequalities.

3. The Audit Committee noted that the Governing Body will receive an updated paper outlining the risks and proposed actions to manage the financial position in the ICS and in the CCG.

4. The members received an update on progress relating to VAT provisions and noted that the final outcomes were awaited.

Risk Management

5. The Committee received an update on the operation of the risk management arrangements and the current risk profile. There are 68 active risks on the CCG register, of which 25 are accepted risks. There are five corporate (red) risks reported, this is an increase from two. The increase is as a result of the impact of covid-19 increasing risks relating to the risk of harm to non-covid-19 patients and pressure on the system. The increased risk profile was also reflected in the Governing Body Assurance Framework (GBAF), in particular for the principal risks around health inequalities, quality of care and financial stability. The Committee was assured that risk management arrangements were operating in line with the CCG’s risk management strategy.

6. Members were presented with the report for the deep dive of GBAF risk 8: Constraints on CCG Organisational Effectiveness Impacts the Delivery of the CCG’s plans. The Committee received an update on the current position in relation to the risk and the impact of covid-19 on the CCG and the unknowns going forward. The Committee noted that there were additional pressures on all teams and the CCG was working towards reaching the target score but that this was unlikely to be met by the end of March 2021. The Committee was assured on the position and was clear on the challenges being faced.

7. The Committee received a further paper on the progress towards managing the cyber security risk, which is part of GBAF risk 8. The CCG has an action plan and governance in place to become compliant with Cyber Essentials Plus by 31 July 2021. The Committee was assured on the progress being made and the contribution that the actions will have on managing the overall organisational effectiveness risk.

Information Governance

8. The Committee was updated by the Data Protection Officer. Specific areas to highlight included the change in reporting format, which is now based on the Accountability Framework recently introduced by the Information Commissioner’s Office which is divided into 10 categories to aid demonstration of compliance with relevant legislation. The Committee was assured that overall the CCG is fulfilling a good level of compliance with legislation despite the current conditions. There had been some slippage in processing activities. Information asset registers and data flows are reviewed on a six monthly basis, however this year, due to Covid-19, this was relaxed to be completed annually. Reviews had started and aim to be completed by the end of November 2020.

Internal Audit

9. The Committee was presented with the Internal Audit Progress Report which detailed the

audits undertaken in 2020/21. Two final reports have been issued for: Covid-19 Business Continuity, Significant assurance was provided and Full assurance was provided for the Primary Care Commissioning and Contracting audit. Work was ongoing on six audits. Progress against the plan had been delayed due to Covid-19 and audit staff being redeployed in the first wave, Internal Audit assured the Committee that the audits required to inform the Head of Audit Opinion would be completed as planned but could not assure that the full plan would be delivered by the end of March 2021. The Committee agreed to include an item on the agenda for the January 2021meeting to review any impact on delivery of the audit plan.

10. The Committee was presented with an update on open internal audit recommendations. The Committee noted that the number of open recommendations was reducing and there was good engagement with Internal Audit in implementing recommendations.

Counter Fraud

11. The Committee received and considered the Counter Fraud Progress Report.

External Audit

12. The Committee received an update on planning for the External Audit of the 2020/21 accounts. A full plan would be brought to the Committee meeting in January 2021. External Audit was in the process of identifying the value for money (VFM) risks.

Governance

13. The Committee received assurance on the governance arrangements within the city for managing the pandemic.

14. The Committee was assured that all tender waivers have been approved in line with the CCG’s Procurement Policy.

15. The Committee received an update on progress against the PWC Audit Committee Effectiveness action plan.

Losses and Special Payments

16. There were no losses and special payments to report in the period since the last Audit Committee meeting in September 2020.

Strategies/Policies approved  The Committee approved the following Information Governance policies: o Information Governance and Framework policy o Data Security and Information Governance Training Strategy o Data Subject Information Rights Including Subject Access Requests Policy

 The Committee recommended minor changes to the following policies for approval by the Governing Body: o Managing Conflicts of Interest Policy o Standards of Business Conduct Policy o Detailed Financial Policies o Minor change to the Operational Scheme of Delegation in relation to the approval of tender waivers.

Items of positive assurance or issues to be raised with the NHS Leeds Governing Body The Audit Committee highlighted the following:  The impact of the finance regime for 2020/21 on the ICS and the CCG financial position;  Good assurance on the governance arrangements across the city to manage the pandemic;  The impact of Covid-19 on the CCG is a recurring theme across the Audit Committee agenda.

Any additional comments N/A

Agenda Item: GB 20/96b FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 25 November 2020

Title: Chair’s Summary – Auditor Panel meeting held on 18 November 2020

Lead Governing Body Member: Cheryl Hobson, Tick as Category of Paper appropriate Lay Member – Audit & Conflicts of Interest () Report Author: Anne Ellis, Risk Manager Decision  Discussion Information  Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY: This report provides the NHS Leeds CCG Governing Body with a summary of items discussed and outcomes and risks identified at the Auditor Panel meeting held on 18 November 2020.

RECOMMENDATION:

The Governing Body is asked to:

(a) RECEIVE the report; (b) APPROVE the Auditor Panel Terms of Reference.

Description of key items of business discussed and key outcomes 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Auditor Panel meeting held on 18 November 2020. Further information can be obtained by reference to the minutes of that meeting.

2. The Auditor Panel received an update on the joint external audit procurement exercise being undertaken with West Yorkshire CCGs. A procurement timetable is in place to award a contract to commence from 1 April 2021. The procurement is being led by Huddersfield CCG. Leeds CCG will be represented by Sam Jones, Senior Finance Manager.

3. The Panel received the Auditor Panel Terms of Reference and noted that there were no proposed amendments. The Panel recommended the terms of reference for approval by the Governing Body.

1 Agenda Item: GB 20/97 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 25 November 2020 Title: Chair’s Summary of Quality & Performance Committee Meeting held on 11 November 2020 Lead Board Member: Dr Phil Ayres, Chair – Tick as Quality & Performance Committee & Secondary Category of Paper appropriate Care Specialist Doctor () Report Author: Sam Ramsey, Interim Head of Decision Corporate Governance & Risk Discussion  Information Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY: 1. This report provides the NHS Leeds CCG Governing Body with a summary of items discussed at the Quality & Performance Committee meeting held on 11 November 2020.

RECOMMENDATION: The Governing Body is asked to: (a) RECEIVE the report. Description of key items of business discussed 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Quality & Performance Committee on 11 November 2020. Further information can be obtained by reference to the minutes of that meeting.

Integrated Quality & Performance Report (IQPR) 2. The Committee received the Integrated Quality & Performance Report. Members noted that many areas covered by the report; particularly in secondary care, were affected by the second wave of Covid infections in the City. Therefore, the report offered no assurance to the Committee due to key performance indicators not being in line with nationally set targets/trajectories and no reasonable mitigation for this with no identifiable action that could be taken to rectify issues.

3. It was acknowledged that in terms of numbers, particularly delays to treatment, there will be a degree of harm because of the second wave. Whilst the timescales for a recovery to normal activity levels remained uncertain, the residual risk of significant harm would remain until the waiting times had reduced to a more acceptable level. The committee accepted and agreed that there was little else that could have been foreseen or done to avoid this situation.

4. The Chair highlighted that the Governing Body should note that in relation to the level of no assurance, there were no additional actions that could have been taken to provide a higher level of assurance; the Committee recognised that the timeline to recovery was unknown.

5. It was acknowledged that the entire IQPR had been rated at a level of no assurance due to the level of unmet need but that there were areas of service that were still performing well. The Committee was informed that there was confidence in relation to cancer response times and diagnostics along with many elements of primary and community care (see below).

6. The Committee was informed that during phase 3, stabilisation and reset, national performance expectations were set and as a city LTHT had ben commended for their ambitious targets and had over performed. This had been highlighted by the Integrated Care System (ICS) who had provided positive feedback to Leeds.

7. The Committee was assured that across providers, a commitment had been made to continue services where possible, therefore it was noted that a better service had been maintained, however, not sufficient to prevent delayed waiting times.

8. In relation to Primary Care, the view was supported that during the second wave, routine services had been maintained. Locally, practices had been invested in to increase capacity and manage winter and the backlog. Positive news was detailed in terms of the ambitious targets that had been set for flu vaccinations and at the current position; 30 practices had met over 75% for the over 65 year old cohort.

9. The need to understand and find ways to support GPs, their teams and the wider PCNs in the delivery of a Covid 19 vaccination programme was expressed. Further pressures were expected on an already stretched workforce when the vaccine was rolled out. The Committee agreed to reflect to the Governing Body that there were concerns about levels of fatigue and that the expected vaccine programme would place the system under further stress.

10. The Committee acknowledged the rising demand within mental health and although there had been sustained activity levels based on last years’ prevalence; unmet need was almost certainly rising because of system pressures.

11. An update was provided to the Committee on the current situation of care homes in Leeds. It was noted that although there were a significant number of care homes with infections, procedures were well established with a number of support offers, including daily calls, regular bulletins and data from capacity trackers. PPE availability was noted to be good and staff absences were deemed manageable.

12. The Committee agreed the level of no assurance, recognised that the recovery path was currently unknown and accepted that all staff in the system were making every feasible effort in the face of mounting pressure.

Providers Under Enhanced Monitoring 13. The Committee received a summary of the providers that were currently under Routine+ Monitoring, Enhanced Monitoring and Formal Action and the actions being taken as a result.

14. Members were assured that surveillance had continued during Covid-19 and six homes had now been removed from the surveillance process due to the assurance gained. Relationships were ongoing between the CCG and Leeds City Council and meetings were taking place on a monthly basis to share intelligence.

15. Members agreed that they were fully assured of the process in place.

CCG Risk Register 16. The risk register was presented. It was noted that there had been a change to the risk profile and there had been an increase to two red risks, ‘Risk of Harm during and post Covid-19’ and ‘System Flow’. A further high amber risk has increased from 12 to 16 (red risk), relating to the risk of harm during and post Covid-19 in primary care (R729); this risk was aligned to the Primary Care Commissioning Committee.

17. Members acknowledged the risks linked to Covid-19 and the EU Exit. This was reflected in the risk profile in the Governing Body Assurance Framework risks aligned to the Committee.

CCG Emergency Planning Statement of Compliance 18. The CCG Emergency Planning Statement of Compliance report was presented. Members were informed that a different assurance process had taken place this year in which the Accountable Officer signed off the statement.

19. Members noted good practice and were assured that the correct process had been followed and returned to NHS England.

Individual Funding Request Annual Report 20. The Committee received the Individual Funding Request Annual Report. Differences were noted in approval rates between different areas of deprivation (fewer approvals in higher deprived areas). The Committee requested that further interrogation of the data be undertaken to explore possible explanations for this the variation. The ability of this report to describe such variation was noted as good practice.

21. Members were fully assured of the Individual Funding Request process in place.

Forward Work Programme 2020-21 22. The Committee agreed to receive an update on the backlog of Continuing Healthcare (CHC) assessments and reviews at the January 2021 Committee meeting.

Strategies/Policies approved N/A

Items of positive assurance or items for escalation to the NHS Leeds CCG Governing Body and/or Audit Committee. N/A

Items of discussion regarding Strategic Risks to the CCG This summary provides details of discussion in relation to the strategic risks aligned to the Quality & Performance Committee.

Any other Comments N/A

Agenda Item: GB 20/98 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25th November 2020

Title: Integrated Quality and Performance Report

Lead Governing Body Member: Tick as Category of Paper appropriate Helen Lewis, Director of Pathway Integration () Report Author: Decision Tamara McCabe – Planning and Performance Reviewed by EMT/Date: Discussion  N/A Reviewed by Committee/Date: Quality and Performance Committee Wednesday 11th Information November 2020 Checked by Finance: N Approved by Lead Governing Body member: Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city. 2. Quality of commissioned care is compromised and does not reflect best practice.  3. Failure to achieve financial stability and sustainability. 4. Failure to overcome local and national workforce shortages. 5. Business continuity of health and care services disrupted as a result of a significant event. 6. Ineffective patient and public engagement and lack of transparency in translation of engagement into decisions. 7. Partners and Professionals do not support the CCG strategy. 8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans. 9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY:

This report provides an overview of current performance levels against the measures set out in the NHS Mandate and Constitution.

Following the NHS declaration of a Level 4 National Incident on 30 January due to Covid-19, and subsequently those levels falling and rising since then, many of these performance measures have been adversely affected to the requirement to follow national instruction.

The dashboards included with this report are:  NHS Constitution and Operational Planning The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance. No assurance is being recommended to the Governing Body due to performance not being in line with nationally set targets/trajectories and there is no reasonable mitigation for this and/or there is no identifiable action that can be taken to rectify issues. NEXT STEPS: The key actions which will be undertaken in relation to performance are as follows:  To continue to closely monitor the commissioner and provider-led actions as part of phase 3 stabilisation and reset towards national performance expectations and system recovery towards at least national performance expectations as part of the phase 3 stabilisation and reset NHS Planning.  To continue to maximise all possible out of hospital capacity to free up beds for elective activity; however redeployment and sickness are still likely to impact very substantially.

RECOMMENDATION: The level of assurance being recommended to the Governing Body is:  No assurance – performance/quality is not in line with agreed targets/trajectories and there is no reasonable mitigation for this and/or there is no identifiable action that can be taken to rectify issues

The Governing Body is asked to:

a) CONSIDER the recommended level of assurance; b) RECEIVE and REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action, and the major risks to improvement faced by the level of Covid infection as of October 2020.

1. Background

1.1 This report provides an overview of current performance levels against the measures set out in the NHS Mandate and Constitution.

1.2 Following the NHS declaration of a Level 4 National Incident on 30 January due to Covid- 19, and subsequently those levels falling and rising since then, many of these performance measures have been adversely affected by the requirement to follow national instruction.

2. Summary

2.1 Primary and Proactive Care Access to primary and proactive care services continue to perform well with the proportion of the population with access to online consultations in Quarter 4 above the target of 75%. Many routine services were suspended for the latter part of 2019/20 and Quarter 1 of 2020/21 to focus clinical resources in managing patients with Covid or to support patient/staff safety.

There are five areas of impact for primary care and these include reducing the numbers of health checks undertaken for SMI and LD, reducing the numbers of cervical screening, reducing the number of incidents being reported through Datix maintaining childhood vaccinations and increasing the number of patients eligible to use a registered NHS app. NHS England have outlined some key areas of focus, either through the use of restart letters or through the amendments to the QOF arrangements.

The Primary Care team has refreshed the PQI so that it reflects a more population based approach in line with the strategic direction for the organisation with a focus on the key priority areas. In order to align these arrangements, NHS England has amended elements of the contract through the QOF arrangements for additional incentives to support the delivery of these priority areas.

The overall quality position is now that 100% of practices are rated good or outstanding with the CQC.

2.2 Planned Care and Long Term Conditions 18 week performance increased to 60.5% in August 2020, an increase of 8.2% from June 2020. Outpatient capacity during August was approximately 77% pre-Covid levels during August due to social distancing and staff annual leave absence over the summer months to ensure that staff are not too fatigued as winter approaches. There are continued challenges within the specialties of ophthalmology, spines, colorectal, ENT, plastic surgery and oral surgery even though all specialties were face to face where required.

As with 18 weeks and electives, all routine diagnostics were paused from 23rd March although urgent diagnostics (excluding endoscopy) continued. During April and May, a number of cancer diagnostics/treatments were placed on hold as services paused in line with national Covid-19 guidance. This therefore has continued long-terms impacts on 2 Week Waits, 31 day and 62 day performance during August.

The number of patients waiting over 18 weeks for a First Outpatient Appointment totalled 18,440 in September (down on previous months), but higher than pre-Covid levels (8,800 in March). Outpatient activity during September was 90% (with majority of contacts non-face to face). There is a risk that recovery will now be impacted due to growing Covid-19 cases within LTHT and staff absence due to illness/isolation and caring requirements i.e. children who are required to isolate. The number of patients waiting over 18 weeks is likely to increase during November regardless of activity levels, as the first week in November will mark 18 weeks since services were reinstated in June.

At the end of September, 35,700 patients are waiting longer than 3 months for an appointment, which is a significant risk particularly in the area of ophthalmology, where there is a risk of harm relating to sight loss. In the specialty of ophthalmology, 7964 patients are currently waiting longer than 3 months for a follow-up appointment with 915 ophthalmology patients also waiting over 18 weeks for a first outpatient appointment.

13,700 patients are currently awaiting a diagnostic at LTHT; diagnostic capacity at LTHT is currently at 82% of pre-Covid levels due to social distancing; which is a great achievement, up from 55% in August.

There were 1606 patients waiting longer than 52 weeks at the end of September, in the specialties of urology, colorectal, adult spines, paediatric urology and dentistry. This is a very steep rise from 346 at the end of June. This growth reflects the reality that very little routine surgery has been carried out, while the focus is on the most urgent clinical priorities, which are often also larger cases. Outpatient waits continue to increase too, then tipping onto surgical pathways later in a patient’s journey.

Urgent referral rates have returned to pre-Covid levels; with cancer 2 Week Waits referral rate exceeding pre-Covid levels at 104%. The rate of other 'urgent' referrals is at 77% and this therefore merits investigation and potentially attention as to why this has not returned to normal in the same way. .

Whilst services continue to do all they can to continue to deliver electives and outpatients, our planning assumptions will be at risk, depending on Covid-19 infection rates and the conversion to inpatient stays. The opening of additional Covid-19 wards, and the staffing required to support these, has substantially impacted on inpatient capacity and is likely to begin to impact outpatient and diagnostic services as staff and resources are redeployed to staff the many additional rotas required in the service configurations to create ‘hot wards’.

LTHT continues to work closely with Spire and Nuffield to maximize the use of independent sector theatres and beds, but these are limited compared to the volumes of patients usually treated across the City.

2.3 Unplanned Care The Emergency Care Standard (ECS) in September was below target at 82.8%. There has been a continued reduction in the ECS since May, when 95% was achieved for the first time in five years. Since the peak of the first wave of Covid, month on month increases in attendances have been recorded. By August attendances had returned to 85% of the figure in August 2019, with the reduction in attendances predominately within the lower acuity

patient cohorts. A&E department footprints and processes have been reconfigured in line with, and to meet national Covid-19 response guidance, as have admission processes, leading to some inefficiencies in patient flow. This has therefore impacted delivery against the ECS. Lower bed occupancy levels earlier in the year also contributed to improved performance in previous months.

Recent increases in demand across ED that includes a high prevalence of symptomatic Covid-19 and related presentations are likely to continue to impact on performance. Local Covid-19 infection rates suggest that growing demand and the requirement to meet national IPC guidance and reduce the transmission of infection will result in some delays to allocating beds for admissions.

In August, the Yorkshire Ambulance Service (YAS) showed a decrease in performance compared to previous months, with YAS achieving 4 out of 6 response targets. August performance indicates that 90% of patients requiring an urgent response within 7 minutes waited no longer than 12 minutes and 44 seconds.

Activity in August was 4.3% over plan in Leeds. This was the highest variance in activity plans year to date. High activity levels of contract plans were mainly within the Hear, Treat and Convey division of the shadow Payment by Results (PBR) tariff (40% over plan). This indicates that YAS are experiencing higher call volumes; however calls are being managed within the Emergency Operations Centre (EOC) as opposed to requiring an ambulance dispatch and conveyance. Conveyance remained below normal rates in August.

2.4 Mental Health and Learning Disabilities IAPT rates have been affected by reduced referrals/assessments due to Covid. Therefore the access rate is still below target at 12.4% against a target of 22%. Teams are working on a number of communication campaigns for November 2020 to market and promote the service which should result in increased access to the service during Q3 and Q4. Commissioners are also in the process of developing an access recovery plan with the service. With regard to IAPT waiting times for 6 and 18 weeks, there are some discrepancies currently in the reporting of these metrics and so those quoted within the IQPR dashboard are not a true reflection of the figures being reported by the Leeds Mental Health and Wellbeing Service. These discrepancies are being invested.

The dementia diagnosis rate has declined since March 2020 because the usual, expected mortality of people with a dementia diagnosis, plus the excess deaths during the Covid period, have not been offset by people newly-diagnosed with dementia. The memory assessment services were paused, but have now restarted. The initial estimate is that the backlog of referrals from January to March will be seen during October to December. The service is operating with a mix of remote and face to face assessment and will be testing out how to triage people between these methods. The LYPFT older people’s service leads have been in touch with LTHT radiology colleagues to factor in the capacity for brain imaging. Therefore, it is anticipated that there may be a decline in diagnosis rates as these level off during October and we stay just above national target or, we might fall below target and then stabilise around 65%, before recovering above it.

2.5 Children’s and Maternity During 2019/20 a huge amount of work has been undertaken to enable all providers to be able to submit to the Mental Health Services dataset. From November 2019 all providers have been able to submit and therefore going forward the figures published will demonstrate a true reflection of activity. In addition, an exercise was undertaken during April and May 2020 to allow providers to submit data for the whole year had they not been able to do so. We are therefore awaiting this updated position for 2019/20. The latest data run has shown what seem to be some inaccuracies in the MHSDS figures in comparison to what providers have submitted, and this is currently being investigated between commissioners and providers with the support of BI.

During the Covid period, services have altered their provision. The majority of CAMHS services were classified as critical services and therefore continued to support young people. Other third sector services were impacted initially and provision has been altered to ensure safe delivery however this will have an impact of future access rate figures. It should be noted though that services have contacted and risk assessed all service users to ensure they continue to receive the appropriate level of support.

Demand continues to rise in all children’s mental health services as an impact of Covid-19. Additional waiting list initiative funding has been provided to the MindMate Wellbeing Service – this was mobilised for a 1st September start date using a new contracting mechanism which will enable data not previously flowed to the MHSDS to be captured.

Waiting times for routine referrals to CYP Eating Disorder Service are currently at 93.3%. This is impacted by patient choice where first appointment time was rejected, and second appointment offer was cancelled. It is anticipated that demand will continue to rise within the Eating Disorder Service as an impact of Covid.

2.6 Continuing Health Care The Leeds position on the 28 day and 15% targets continues to be reported to NHSE on a quarterly basis. This reporting has remained in place throughout the Covid-19 pandemic. From 1st September 2020 until 31st March 2021 there is additional reporting on deferred assessment activity occurring on a fortnightly basis.

There has been a notable improvement in both Quality Premiums in Quarter 2 where NHS CHC eligibility decision made within 28 days was above target at 86.3%. This has improved due to reduced number of CHC referrals and staffing shielding at home having the capacity to undertake the assessments.

Although increased to 1.3% in Quarter 2 of 2020/21, the full NHS CHC assessments taking place in an acute hospital setting still remains above the target of less than 15%. This is due to an increase in Discharge to Assess beds enabling staff to undertake assessments outside of acute settings. Staff continue to complete most assessments as virtual assessments and this has been readily accepted by most patients and their families.

Throughout the pandemic there has been a notable increase in the proportion Fast Track referrals to other referral types compared to last year and this continues to be monitored.

The service anticipates a significant increase in complaints and challenges to the outcome of assessment as patients and their families have acclimatised to having fully funded care for many months. To try and reduce this, the team has RAG rated all patients.

3. NEXT STEPS

3.1 The key actions which will be undertaken in relation to performance are as follows:

 To continue to closely monitor the commissioner and provider-led actions as part of phase 3 stabilisation and reset towards national performance expectations and system recovery towards at least national performance expectations as part of the phase 3 stabilisation and reset NHSE Planning.  To continue to maximise all possible out of hospital capacity to free up beds for elective activity; however redeployment and sickness are still likely to impact very substantially.

4. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

4.1 Not applicable.

5. FINANCIAL IMPLICATIONS AND RISK

5.1 Not applicable.

6. COMMUNICATIONS AND INVOLVEMENT

6.1 Not applicable.

7. WORKFORCE

7.1 Not applicable.

8. EQUALITY IMPACT ASSESSMENT

8.1 Not applicable.

9. ENVIRONMENTAL

9.1 Not applicable.

10. RECOMMENDATION The level of assurance being recommended to the Governing Body is:  Overall: No assurance – performance/quality is not in line with agreed targets/trajectories and there is no reasonable mitigation for this and/or there is no identifiable action that can be taken to rectify issues

The Governing Body is asked to: a) CONSIDER the recommended level of assurance; b) RECEIVE and REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action, and the major risks to improvement faced by the level of Covid infection as of October 2020.

8 The Integrated Quality and Performance Report

Report Period: August 2020

Contents

Indicator Tables NHS Constitution and Operational Planning Measures Page 2-3

Report Key

RAG Rating Note: The RAG rating applied within this report is based upon calculating a limit of 5% higher/lower relative to the expected standard/target. For example, if the expected Standard is a minimum of 92%...

92.5% 'Green' performance would be ≥ 92% 88.0% 'Amber' performance would be 87.4% ≤ x < 92% 85.0% 'Red' performance would be < 87.4%

Performance measures shown to be 'Amber' should still be interpreted as underperforming - a RAG rating has only been applied to serve as a visual guide to understand how close performance is to the expected standard. They should not be interpreted as being currently within a tolerance level.

Interpreting Trends Trend analysis is currently based upon comparing the latest performance with the performance in the previous period. A green arrow represents an improvement in performance An amber arrow represents no change in performance A red arrow represents a deterioration in performance

Sparklines Sparklines have been produced to demonstrate the distance away from the expected target level, with green representing a positive position and red representing underperformance.

The most recent period of data is shown furthest to the right in each sparkline. NHS Constitution and Operational Planning Measures Performance Measures (1 of 2)

Measure Target Data Period Current Trend

NHS Constitution - RTT

RTT - Incomplete Pathway (18 week wait compliance) 92% Aug-20 60.5%

RTT - Incomplete Pathway (number of patients waiting) 47,411 Aug-20 41,014

RTT - 52 Week Waits 0 Aug-20 825

A&E 95% National A&E Waiting Times: % 4 hours or less (LTHT - All Types of A&E) Sep-20 82.8% (93.3% Local) NHS Constitution 99% National Diagnostic Waiting Times Aug-20 73.3% (99.5% Local)

Cancer - 2 Week Wait 93% Aug-20 65.7%

Cancer - 2 Week Wait (Breast) 93% Aug-20 29.1%

Cancer - 31 Day First Treatment 96% Aug-20 96.8%

94% National Cancer - 31 Day Surgery Aug-20 92.3% (94.3% Local) 98% National Cancer - 31 Day Drugs Aug-20 99.5% (98.2% Local)

Cancer - 31 Day Radiotherapy 94% Aug-20 100.0%

85% National Cancer - 62 Day GP Referral Aug-20 76.8% (85.3% Local) 90% National Cancer - 62 Day Screening Aug-20 0.0% (94.4% Local) 90% National Cancer - 62 Day Upgrade Aug-20 81.1% (68.6% Local) Mental Health

Dementia - Estimated Diagnosis Rate 67% Aug-20 67.5%

22% National IAPT Access (12 month equivalent based on rolling 3 months) Jul-20 12.4% (19.0% Local)

IAPT Recovery Rate 50% Jul-20 54.4%

IAPT Waiting Times - 6 Weeks 75% Jul-20 15.5%

IAPT Waiting Times - 18 Weeks 95% Jul-20 89.9%

60% National EIP - Psychosis treated within two weeks of referral Jul-20 60.0% (57.1% Local) People with a severe mental illness receiving a full annual physical health check 60% 2020/21 Q1 55.1% and follow-up interventions (Rolling 12 Months)

Improve access rate to CYPMH (YTD) 32% 2019/20 23.1%

Improve access to CYPMH (Rolling 12 Months) 34% Jul-20 25.2%

Waiting Times for Routine Referrals to CYP Eating Disorder Services - Within 4 95% 2020/21 Q1 74.3% Weeks (Rolling 12 Months) Waiting Times for Urgent Referrals to CYP Eating Disorder Services - Within 1 Week 95% 2020/21 Q1 100.0% (Rolling 12 Months)

IAPT Trainees 8 2019/20 Q4 5

Therapists co-located in primary Care 14 2019/20 Q4 47 NHS Constitution and Operational Planning Measures Performance Measures (2 of 2)

Measure Target Period Current Trend

Primary Care Target Period Current

Proportion of the population with access to online consultations 75% 2019/20 Q4 90.6%

Extended Access Appointment Utilisation 75% Aug-20 86.6%

Learning Disability Target Period Current

Reliance on Inpatient Care for People with LD or Autism - CCGs (All Length of Stays) 13 2020/21 Q2 14

Reliance on Inpatient Care for People with LD or Autism - NHSE (All Length of 11 2020/21 Q2 6 Stays) Other Commitments Number of personal health budgets that have been in place, at any point during 300 2020/21 Q1 503 the financial year

Children Waiting no more than 18 Weeks for a Wheelchair 92% 2020/21 Q2 97.6%

Annual Health Checks (AHCs) delivered by GPs for patients on the Learning 186 2020/21 Q1 177 Disability Register (YTD)

Agenda Item: GB 20/99a FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020

Title: Managing Conflicts of Interest and Standards of Business Conduct Policies

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Author: Sam Ramsey, Interim Head of Decision Corporate Governance and Risk  Reviewed by EMT/Date: N/A Discussion  Reviewed by Committee/Date: N/A Information Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to

1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city.  2. Quality of commissioned care is compromised and does not reflect best practice. 3. Failure to achieve financial stability and sustainability.  4. Failure to overcome local and national workforce shortages. 5. Business continuity of health and care services disrupted as a result of a significant event. 6. Ineffective patient and public engagement and lack of transparency in translation of engagement into decisions. 7. Partners and Professionals do not support the CCG strategy. 8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans. 9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY:

In line with Statutory Guidance on Managing Conflicts of Interest, the Conflicts of Interest and Standards of Business Conduct policies must be reviewed on an annual basis.

The policies have been reviewed and there are no amendments proposed. The policies are included within the supporting information documents. The policies were presented to the Audit Committee on 18 November 2020 and were recommended for approval.

NEXT STEPS:

The policies will be published on the website with the review date amended.

RECOMMENDATION:

The Governing Body is asked to:

a) REVIEW the Managing Conflicts of Interest and Standards of Business Conduct Policies, NOTE that there are no proposed amendments, and APPROVE for publication.

Agenda Item: GB 20/99b FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 25 November 2020 Title: Pharmaceutical and Related Industries Joint Working Policy

Lead Governing Body Member: Simon Stockill, Tick as Category of Paper appropriate Medical Director () Report Author: Sally Bower, Head of Medicines  Decision Optimisation Reviewed by EMT/Date: NA Discussion

Reviewed by Committee/Date: N/A Information Checked by Finance (Y/N/N/A - Date): NA Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

Assurance Framework – which risks on the GBAF does this report relate to: 1. Failure to deliver the CCG commitment to reduce health inequalities across our city.  2. Quality of commissioned care is compromised and does not reflect best practice.  3. Failure to achieve financial stability and sustainability. 4. Failure to overcome local and national workforce shortages.  5. Business continuity of health and care services disrupted as a result of a significant event. 6. Ineffective patient and public engagement and lack of transparency in translation of engagement into decisions. 7. Partners and Professionals do not support the CCG strategy. 8. Constraints on CCG organisational effectiveness impact the delivery of the CCG’s plans.  9. Inadequate system infrastructure to support the CCG’s plans.

EXECUTIVE SUMMARY:

Department of Health Guidance encourages NHS organisations and their staff to consider opportunities for joint working with the pharmaceutical industry, where there are clear advantages to patient care and improvements to patients’ health and well-being.

The NHS does not always have the expertise or necessary tools to aid implementation of innovation or best practice at the pace or scale that it desires. Pharmaceutical and other health care companies may wish to partner with the CCG to support this adoption of innovation.

It is essential that all projects or dealings with the Industry are open and transparent and are subject to the widest scrutiny to enable likely pitfalls to be highlighted at an early stage.

This policy aims to:

 Provide all staff working for or on behalf of NHS Leeds CCG with a framework and guidance for appropriate joint working  Ensure at all times that the interests of patients, public and NHS Leeds CCG are upheld and maintained  Assist NHS Leeds CCG to achieve its objectives and delivery of national and local priorities by building effective and appropriate working relationships with the pharmaceutical and related industries  Inform and advise staff of their responsibilities when entering into joint working arrangements with the pharmaceutical and related industries.

NEXT STEPS:

Receive and explore opportunities for joint working.

RECOMMENDATION:

The Governing Body is asked to:

(a) APPROVE the policy.

GB 20/100 GOVERNING BODY FORWARD WORK PLAN 2020/21

ITEM MAY JUN JULY SEPT NOV JAN MAR Lead Officer STANDING ITEMS Welcome & apologies X X X X X X X Chair Declarations of interest X X X X X X X Chair Minutes of previous meeting X X X X X X Chair Matters arising X X X X X X Chair Action log X X X X X X Chair Questions from members of the public X X X X X X X Chair Patient Voice X JH PERFORMANCE Chief Officer’s Report X X X X X X TR Integrated Quality & Performance X X HL/SA X X X Report FINANCE Finance Report X X X X X VPS AQP Update Paper X VPS Approval of Annual Report & Accounts X VPS Approval of Annual Budget X VPS STRATEGY CCG Operating Plan (incl. high level X SA/VPS budgets) People & OD Strategy/Refresh X SA Shaping Our Future – New Operating X TR Model Left Shift Blue Print X VPS Climate Change X SA RISK Governing Body Assurance X X X X X X SA Framework Corporate Risk Register X X X X X X SA GOVERNANCE Approval of Procurement Plan 2020/21 X VPS Approval of Business Cases/Investments over £1.5m (as Various required) Chair’s Summary of Committee X X X X X X Committee Meetings Chairs Committee Terms of Reference X Committee

Chairs

ITEM MAY JUN JULY SEPT NOV JAN MAR Lead Officer Update to Committee Terms of Reference & Scheme of Reservation & Chair Delegation Committee Annual Reports X Committee

Chairs Governing Body Effectiveness X GS Maternity and Neonatal Services X TR Consultation Approval of Governing Body Appointments / Reappointments (as Chair required) Approval of amendments to Chair Constitution (as required) Forward Work Plan X X X X X X Chair Policy Approval (as required) Various Review of Operational Scheme of X VPS Delegation Patient Experience & Complaints X JH Annual Report System Resilience Plan (included in PA/HL Q&P Summary) EPRR Compliance (included in Q&P PA/HL Summary)