Virtual Governing Body
To be held on Thursday 1 April 2021
From 1pm until 3.30pm
VIRTUAL GOVERNING BODY To be held on Thursday, 1 April 2021 at 1pm A G E N D A
Ref Item Enclosure Led By Action Required 1. Apologies for Absence Verbal Dr Crichton For noting
2. Declarations of Interest Verbal All For noting The CCG’s register is available via the Governance team or on the CCG website which can be accessed here.
3. Minutes of the meeting held on 4 March Enc A Dr Crichton For approval 2021 4. Matters Arising not on the Agenda Verbal Dr Crichton For discussion
5. Notification of Any Other Business Verbal Dr Crichton For discussion
6. Questions from Members of the Public Verbal Dr Crichton For discussion (See our website for how to submit questions – required in advance)
7. Patient Story Verbal Dr Crichton For discussion
Strategy
8. Delivery Plans Enc B A Fitzgerald For approval
9. Staff Survey Enc C L Devanney For noting
Assurance
10. Quality & Performance Report Enc D A Fitzgerald & For noting A Russell • Spotlight Report on Ageing Well
11. Finance Report Enc E H Tingle For noting
12. Chair and Chief Officers Report Enc F Dr Crichton & J For noting Pederson
13. Quarter 3 2020/2021 Corporate Assurance Enc G L Devanney For noting Report
14. Governing Body Assurance Framework Enc H L Devanney For approval 2020-2021 Quarter 3 Update
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Ref Item Enclosure Led By Action Required Items to Note
15. Terms of Reference – Executive Enc I Dr Crichton For approval Committee
16. Integrated Care System CEO Report Enc J Dr Crichton For noting
Receipt of Minutes
17. Receipt of Minutes Enc K Dr Crichton For noting
• Audit Committee – Minutes of the meeting held on 10 December 2020 • Executive Committee – Minutes of the meetings held on 17 February 2021 • Engagement & Experience Committee – Minutes of the meeting held on 4 February 2021 • Public Primary Care Commissioning Committee – Minutes of the meeting held on 11 February 2021. • Joint Commissioning Management Board – Minutes of the meeting held on 17 December 2020
18. Any Other Business Verbal Dr Crichton For discussion
19. Date and Time of Next Meeting For noting Thursday 6 May 2021 at 1pm
Governing Body Quorum is 6 Members: Chair or Vice Chair, at least 3 Clinical Members and Chief Officer or Chief Finance Officer
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Minutes of the Virtual Governing Body Thursday 4 March 2021 at 1pm
Members Dr D Crichton NHS Doncaster Clinical Commissioning Present: Group (CCG) Chairman (Chair) J Pederson Chief Officer H Tingle Chief Finance Officer A Russell Chief Nurse Dr E Jones Secondary Care Doctor P Wilkin Lay Member S Whittle Lay Member Dr M Khan Locality Lead, Central Locality Dr M Pieri Locality Lead, North Locality Dr R Kolusu Locality Lead, East Locality Dr M Pande Locality Lead, South Locality
Formal A Fitzgerald Director of Strategy and Delivery Attendees L Devanney, Associate Director of Corporate Service & Present: HR
In J Satterthwaite PA to Chair and Chief Officer (Minute attendance: Taker) J Telford Healthwatch Doncaster (Item 7 Patient Story) P Tarantiuk Strategy & Delivery Manager (Item 8 Learning Disabilities Strategy and 10 Performance Report) J King Doncaster Council (Item 8 Learning Disabilities Strategy and 10 Performance Report) C Ogle Associate Director Primary Care (Item 10 Performance Report) V Cheong Deputy Head of Medicines Management (Item 10 Performance Report)
Action 1. Apologies for Absence
Apologies were noted from:
• L Tully, Lay Member • A Goodall, Healthwatch Doncaster Representative • Dr R Suckling, Director of Public Health • P Holmes, Doncaster Council Representative
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2. Declarations of Interest
The Chair reminded Governing Body members of their obligation to declare any interest they may have on any issues arising at Governing Body meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub committees / working groups:
None declared.
Declarations of interest from today’s meeting:
Dr Crichton and the Governing Body GP Members all declared a pecuniary Conflict of Interest in Item 10, Primary Care Spotlight Report. The purpose of the report was to provide an update to the Governing Body with no formal decisions to be made therefore it was agreed that Dr Crichton and the Governing Body GP Members would remain in the meeting and be part of any discussions.
3. Minutes from the Previous Meeting held on 4 February 2021
The minutes of the meetings held on 4 February 2021 were approved as a correct record.
4. Matters Arising not on the Agenda
There were no Matters Arising.
5. Notification of Any other Business
There was no notification of further business to discuss.
6. Questions from Members of the Public
There were no questions received from the Public.
7. Patient Story
Dr Crichton informed the Governing Body that the Patient Story will be discussed in Item 10 as part of the Living Well Spotlight Report.
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8. All Age Strategy for People with Learning Disabilities (LD) and/or Autism 2021 - 2024
P Tarantiuk explained that the strategy was developed and refreshed in partnership with Doncaster Council, NHS Doncaster CCG, representatives of the Voluntary, Community and Faith sector including Autism Plus and Choice for All Doncaster (ChAD), people with lived experience, their families and carers and staff who work in the respective areas relating to the Strategic priorities. It addresses the key priorities as identified by the people with lived experience of Learning Disability and/or Autism, national guidance, policy, and emerging evidence.
The impact of COVID-19 has been significant for society. For many people with a Learning Disability and/or Autism and their families and carers, COVID-19 presents an even greater challenge, from social restrictions, greater caring responsibilities with less support, and the emerging evidence of increased risks from COVID-19 faced by those with either Learning Disability or Autism.
Through the engagement processes, people with lived experience, their families and carers identified areas of work that will make a positive improvement to their lived experience and expressed outcomes and identified areas of greatest importance. Stakeholders from all partner organisations were engaged and agreed the priorities set, with plans informed by underpinning evidence, national policy, and guidance.
The 5 key priority areas identified by stakeholders for development are:
• Diagnosis of Autism • Education and Inclusion • Employment. • Carers and Short Breaks • Housing and support
Three cross cutting themes are also being addressed across plans:
• Health Inequalities • Young People in Transitions • Transforming Care
Both the Learning Disability Partnership Board and the Autism Partnership Board have provided oversight of the emerging plans and their implementation, providing challenge and support where needed.
The strategy refresh addresses the emergence of COVID-19 during 2020 and recognises the inequitable impact the pandemic is having on people with Learning Disability & Autism, and from Black and Minority Ethnic (BAME) groups. Building on existing approaches, the Strategy outlines plans with key stakeholders and partners to reduce the disproportionate impact for these groups of people.
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The strategy refresh provides Doncaster Council and NHS Doncaster CCG with assurance that positive progress has been made on the delivery of the Strategic Plans. The “all age” approach ensures improvement in the experience of people in a life transition and embeds aspiration for equal citizenship from an early age.
The plans align with the Doncaster Place Plan, are supported by the Joint Commissioning Strategy, and revised in light of emerging evidence (for example the Strategic Housing Needs Assessment) and regular challenge and update from people with lived experience through the Learning Disability and Partnership Boards.
Launching the strategy will provide the opportunity for partners to note the progress made so far, celebrate success, and continue to deliver the plans to meet the needs of local people.
P Tarantiuk requested that the Governing Body approve the All Age Strategy for People with Learning Disabilities and/or Autism 2021 – 2024.
S Whittle informed the Governing Body that the Strategy has also been presented to the Engagement & Experience Committee and acknowledged that it has been co-produced with users and carers was impressed with both the Strategy and the Easy to Read Big Plan. Dr Crichton informed the Governing Body that he had agreed to include a small paragraph in the foreword of the strategy both he and J Pederson concurred that the easy read section was a good example of how we should be producing all out strategies as there is a significant number of people who may experience difficulties with dialogue and was supportive of its ambitions and support of digital encouragement and education.
Dr Jones reported that the Quality & Patient Safety Committee receives reports regarding LD mortality and quality of care they receive and ensures their care needs are appropriately met.
Dr Crichton commented that the strategy goes to 2024 which will be after the CCG exists and gives a commitment beyond the re-organisation of the NHS.
The Governing Body approved the All Age Strategy for People with Learning Disabilities and/or Autism 2021 – 2024.
9. Equality & Diversity Annual Report
L Devanney presented the Equality & Diversity Annual Report to the Governing Body which had been discussed at the Engagement & Experience Committee in February 2021.
It was requested that an action plan and staffing profile be included report. There has been a robust focus on engagement with our BAME colleagues and community and we have recently recruited a Gypsy Traveller worker who will liaise with these hard to reach groups. NHS Doncaster CCG has been awarded
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a Green Star rating which is testimony to the hard work that has been undertaken.
The Governing Body was asked to: • Approve the Equality & Diversity Annual Report. • Note the Equality Delivery System 2020/2021 updates.
S Whittle advised that the report is a good example of how we undertake Equality & Diversity for different groups. Dr Crichton added that a lot of work has been done to ensure everyone has access to the COVID-19 vaccine. A Fitzgerald reported that he is particularly pleased with the work and engagement with communities to take up the offer of the vaccine. There has been 100 patients vaccinated with complex lives to date and vaccination sites are being considered in places of worship.
The Governing Body:
• Approved the Equality & Diversity Annual Report. • Noted the Equality Delivery System 2020/2021 updates.
10. Quality and Performance Report
A Fitzgerald presented the Quality & Performance Report for noting by the Governing Body.
Dr Crichton explained that the Performance Report reflects a further decrease in performance due to Wave 2 of the COVID-19 pandemic after having seen an improvement post Wave 1. It is likely that the Governing Body Performance Report may reflect a similar picture for the next couple of months.
A Fitzgerald advised that the Governing Body would receive our refreshed Delivery Plans for approval in April 2021. The plans will focus on COVID-19 response, recovery, system transformation and our priorities regarding health inequalities will be central.
In Doncaster over 100,000 people have received their first dose of the COVID- 19 vaccine and this number includes the vast amount of those within cohorts 1 – 4. We are now moving into the second dose phase of the programme and it is expected that those people aged 50+ will be offered their vaccination by mid April and all adults will have been offered their first dose of the vaccine by 31 July 2021. We are working with providers to adapt the offer accordingly for hard to reach groups.
A Fitzgerald acknowledged the hard work of the Hospital Hubs, Primary Care Networks, Primary Care Doncaster, volunteers and administrators.
P Wilkin asked if the move into the second phase of the vaccination programme and the introduction of the second dose of the vaccine would impact on administering the first dose and if there will be sufficient resources. He was advised that planning showed that there would be enough to do both.
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Patient Story
J Telford presented the Patient Story as follows:
• The female patient works full time and had an acute health concern and wanted to see a female doctor. The patient was unsure of the availability of face-to-face appointments during COVID-19 and had anxieties regarding COVID-19 and the safety of the practice. • The patient contacted the GP practice on a Friday in February 2021. The Receptionist arranged for a ‘call back’ to the patient and was contacted by a male doctor within 30 minutes. He arranged for a further call back on the Monday from a female doctor. A link was provided to send a photograph and was utilised by the patient. The patient received a call back on the Monday and given advice. The doctor gave the patient her working arrangements so the patient could book days off work and make an appointment. A face-to-face appointment was made. • The patient attended the practice. There was doorbell access into the building, and she was greeted by the Receptionist. There were a few people in the practice. PPE was worn by the patient and staff and was informed of this arrangement prior to the appointment. The patient was anxious however less so on seeing the environment. The visit was quick, effective and a clinical examination completed and achieved the outcomes of the patient. • The GP agreed to check on progress of a previous referral to the hospital. • What went well: • Timely responses • Ability to use a link to send a photograph • Ability to see a female GP • GP providing her working days to facilitate further consultation or face to face appointment • Feeling safe in the practice • The GP has checked the referral to the hospital and the patient has subsequently received a letter. • What did not go well or could be done differently: • The patient did not want a digital appointment as this would not achieve the outcomes, ‘had something that needed to be seen’. • The patient had anxieties about whether they would get an appointment or feel safe in the practice, but both had positive outcomes. • Considering the points above the patient was happy with the experience and could not identify anything that did not go well or could have been done differently.
J Pederson reported that the CCG was concerned that some patients may not be aware of how to access Primary Care and other services during the COVID- 19 pandemic and undertook a big campaign to make patients aware. Healthwatch Doncaster has been instrumental in ensuring the message is out in the public domain that it is ‘business as usual’. They are also integral to promoting messages regarding the roll out of the vaccination programme.
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The patient story is a good example of the roll out of the digital appointments within Primary Care and we are keen to embed this in the future. We are aware however that this may not be suitable for every patient.
Dr Crichton thanked J Telford for attending the Governing Body meeting.
Spotlight Report – Living Well
Doncaster Learning Disability & Autism Living Well Update
P Tarantiuk gave an update to the Governing Body and highlighted the following points:
Learning Disabilities (LD) Annual Health Checks
• A Task and Finish Group has been established to improve uptake and quality to health checks. • LD patients die earlier from treatable conditions. In 2019/2020 57 health checks were completed however the clinics were suspended in March due to the COVID-19 pandemic. In 2020/201 Quarter 2 15% of health checks were completed compared to 13% the previous year. • A standardised health check template has been embedded to all GP practices and pre appointment questionnaires. All literature has been devised in co-production from people with lived experience. • Primary Care Passports were launched in 2019 and details the patient’s medication and how they would prefer to be spoken to. • Learning Disability Training is provided to Primary Care from the Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) Health Action Team. • Devised Health Check Improvement Model has been devised. • Children’s 14 years + engagement and promotion. • Enhanced Health in Care Homes. • Clinical Quality Review Group sub group established.
Transforming Care Programme position
• We are currently at 10 patients with 2 admissions and 2 discharges over the past 12 months, 2 high confidence discharges within next 3 months, 3 medium confidence discharges by July 2021 and 3 further medium confidence discharges by October 2021.
Community and Intensive Services
• Proactive Monitoring and Support Register • Crisis and Intensive Support team (CAIS) • Care (Education) and Treatment Review C(E)TR linked • Forensic Outreach Liaison Service (FOLS) • Enhanced Community Living Services
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Autism Diagnosis
• NHS Doncaster CCG and (RDaSH) have developed a Business case which aims to provide a viable long-term service which meets both the NICE Clinical guideline [CG142] workforce requirements and meets the 18 weeks Referral to Treatment (RTT) guidance. • It is not just about the diagnosis of Autism and a medical model, we also must consider what people really need.
Dr Jones informed the Governing Body that the Quality & Patient Safety Committee receives regular reports from the Transforming Care Programme and has been very impressed with the quality of care particularly during the COVID-19 pandemic and it is recognised outside of Doncaster as high quality.
P Wilkin asked if we are linking into services at RDaSH and voluntary groups post diagnosis. P Taratiuk confirmed that this is taking place with links Integrated Care System (ICS) workstreams, employment and education.
Primary Care Update
C Ogle gave the following Primary Care Update:
Key progress during 2020/2021
• GP Practice Inequalities and Risk Management o Primary Care Quality & Performance Framework o PCQ Tool developed o Primary Care Information Sub Group developments
• PCN Development o Additional workforce roles o New service requirements o Response to COVID19 o Engagement
• Improving Access o Online and video consultations – over 5000 patients have signed up to DoctorLink. o Service reconfiguration o Introduction of the Health Bus
• Supporting Infrastructure o Estates – there are discussion regarding capital funding for the Bentley, Rossington and Mexborough Hubs. We continue to look to use void space within LIFT buildings. o Digitisation o Primary Care daily Reporting Tool
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Key challenges during 2020/2021
• Inequalities and Risk Management o Business Intelligence Capacity o Information Sub Group and Primary Care Delivery Group suspension
• PCN Development o Additional Roles Budget
• Improving Access o Utilisation of extended access appointments o Public perception – fear and practices are closed
• Supporting Infrastructure o The Primary Care Digital Strategy paused o Development of enhances services paused o Workforce Strategy development
Next steps 2021/2022
• COVID-19 recovery o Business as usual o Ongoing vaccination plan o New ways of working maintained
• Primary Care Networks o Access offer o Integration agenda o Further development o Services requirements
• Infrastructure o Digital and Estates o Communication & Engagement o Workforce
Dr Crichton commented that there has been so many digital changes because of the pandemic that the some of the original Digital Strategy would have been overtaken.
Medicines Management Team (MMT) Update
Highlights
• Training (SMR) delivered to Doncaster practice and PCN pharmacists. • COVID-19 related support including guidelines, care home medication reviews, and vaccination. • MMT has provided resources across CCG departments supporting procurement of out of hours services, contract review of Minor Eye Care Services (MECS), Leger clinic, corporate governance, and primary care
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Local Enhanced Service (LES) and community pharmacy services commissioning. • SY&B ICS working on several workstreams: stoma and continence service, proxy ordering.
Challenges
• Pandemic and its workload on the prescribers and practices. • Impact on the prescribing budget due to out of stock issues at the beginning of the pandemic. • Poor uptake of Indicative Budget Scheme.
Next Steps
• To continue with areas of the 2020/2021 plan until March 2021 and into the next financial year. • To engage with the public and providers on areas of the new plan including how to stop 3rd party ordering. • To develop and build on strong links between pharmacy teams at place. • To build on good working relationship with ICS Medicines Management Teams and start to plan future working relationships. • To continue and improve working relationship with other CCG colleagues to support pathway and quality assurance processes of commissioning.
Dr Kolusu highlighted that it has been business as usual in regard to the core functions of the Medicines Management Team and gave his thanks for how the team had diversified to support Primary Care during the pandemic. A Russell concurred and added his thanks to the team
Dr Crichton thanked P Tarantiuk, C Ogle and V Cheong for attending the Governing Body meeting.
The Governing Body noted the Quality and Performance Report.
11. Finance Report
H Tingle presented the Finance Report for noting by the Governing Body. It set out the financial position as at the end of January 2021 and the forecast for the year end.
NHS Doncaster CCG was prudent in its assessment of prescribing costs at Month 6 due to the fluctuating and volatile spend incurred up to the end of July 2020. Now the actual data has been received up to the end of November 2020 the actual costs are lower than expected and it is felt that this will continue to the end of the year. NHS England have now advised that the prescribing variance will be clawed back, and this is expected to be confirmed for Month 11. This will therefore reduce the £3m positive variance. Other CCG’s in South Yorkshire & Bassetlaw are showing similar variances and as a system the financial position has improved overall for both commissioners and providers.
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Included in the plan for Month 7- 12 is an expectation of delivering Quality Innovation Productivity and Prevention (QIPP) of £3.2m across numerous budget lines including Continuing Healthcare, prescribing and running costs. Detailed schemes have not necessarily been developed in all areas but monitoring of actual spend against plan is demonstrating that the expenditure is being contained within the budget set, and therefore the QIPP is being delivered. Work is underway to assess baselines as we move into 2021/2022 and start to think about planning.
NHS England have confirmed that the current financial regime will continue into next financial year until at least the end of Quarter 1. CCG allocations are yet to be confirmed for this period or the rest of 2021/2022 and further guidance is awaited. The CCG has started work on baseline planning of future costs to enable this work to progress once guidance is released.
H Tingle informed the Governing Body that she attends several South Yorkshire & Bassetlaw regional financial planning groups.
P Wilkin queried how the Financial Plan will be signed off for 2021/2022 by the Governing Body. H Tingle explained that the intention is for the Governing Body to sign off the budgets backed up with the Financial Plan in April 2021.
The Governing Body noted the Finance Report.
12. Chair & Chief Officer Report
Dr Crichton presented the Chair & Chief Officer Report and highlighted the following point:
• Lung Health Check Programme Go Live confirmed – The Lung Health Check Programme has been confirmed to go live in the South of Doncaster at the end of March 2021 with communication and engagement work well underway to promote the service to those patients who are eligible. Invitations will be sent to patients from a small number of GP practices initially before the programme is rolled out across the borough in a staged way over the next 12 months.
Dr Crichton added that lung cancer and the commencement of the Lung Health Check Programme have been severely impacted on by the COVID-19 pandemic so was a necessary area of focus.
The Governing Body noted the Chair & Chief Officer Report.
13. Integrated Care System CEO Report
The Governing Body noted the Integrated Care System CEO Report.
14. Receipt of Minutes
The following minutes were received and noted by the Governing Body:
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• Executive Committee – Minutes of the meetings held on 20 January 2021. • Engagement & Experience Committee – Minutes of the meeting held on 3 December 2020. • Public Primary Care Commissioning Committee – Minutes of the meeting held on 10 December 2020.
15. Any other Business
There was no further business discussed.
16. Date and Time of Next Meeting
Thursday 1 April 2021 from 1pm.
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Meeting name Governing Body Meeting date 1 April 2021
Title of paper Doncaster Strategic Delivery Plans 2021-22
Executive / Anthony Fitzgerald, Director, Strategy & Delivery Clinical Lead(s)
Author(s) Ailsa Leighton, Deputy Director, Strategy & Delivery
Status of the Report
x To approve To consider / discuss
To note
Purpose of Paper - Executive Summary
1 BACKGROUND
In May 2020 the Governing Body approved the life stage delivery plans for Starting Well, Living Well and Ageing Well for 2020-21. During the year these plans have been refreshed, to take account of the impact of theCovid-19 pandemic, and the refreshed plans have been shared with the Governing Body.
Those plans have now been revised, both in light of the continuing impact of the Covid-19 pandemic, but also to set out our ambition for the forthcoming year.
Alongside this work providers and commissioners are also working towards the development of one Doncaster plan. This will be based on the Place Plan vision, setting out our joint aims for the year and describe how commissioners and the provider alliance will work together. The life stage delivery plans will be aligned with the one Doncaster plan.
2 CURRENT STATUS OF THE PLANS
The life stage delivery plans have been updated to take into account all local knowledge regarding priorities for 2021/22, including those services where actions were accelerated, delayed or superseded during this last year. However at the current time we are still awaiting key national guidance with regards to:
• The priorities for 2021/22 • The financial mechanisms and allocations for 2021/22 • The way in which performance baselines will be set and measured, given the
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unusual patterns of activity seen during the Covid-19 pandemic
As a result, whilst the actions within the delivery plans have been discussed locally across commissioners and providers, further refinement will be required in year, with particular reference to the outcome measures and the QIPP targets that we aim to work towards.
3 KEY RISKS
Whilst it is noted that every year there are risks associated with plans, 2021/22 is more unusual as there are additional risks associated with:
• System capacity to simultaneously refocus on a range of areas of activity impacted by COVID response and ongoing vaccination programme • External influences on use of services, in light of the Covid-19 pandemic and as lockdown restrictions change, that are beyond local control • Capacity within the CCG, particularly in light of the White Paper and changes that will happen during the course of the year
These risks will be monitored during the year and reflected in updates to the Governing Body.
Recommendation(s) The Governing Body is asked to:
• Approve the revised life stage delivery plans for Starting Well, Living Well and Ageing Well
Report Exempt from Public Disclosure
Yes No x If yes, detail grounds for exemption:
Impact analysis Quality impact analysis to be undertaken for individual work-streams, as Quality impact set out within the life stage plans
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
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Sustainability As set out within the life stage plans impact Financial As set within the life stage plans implications Legal None identified implications At this stage non have been identified as the plans do not commit to any Management specific procurements; any conflicts of interest arising from the of Conflicts of implementation of the plans will addressed through the implementation Interest period Consultation / Engagement Consultation has taken place with staff in NHS Doncaster CCG and (internal DMBC and with local providers as the plans have been developed. departments, clinical, stakeholder and public/patient) Report Discussions have taken place at the NHS Doncaster CCG Strategy & OD previously Forum as the plans have been developed presented at Risk As noted in the report above, point 3 analysis Corporative Objective / 2.2 Assurance Framework
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Health and Social Care Delivery Plan 2021/22 Starting Well DRAFT Delivery Plan: 2021/22 Children & Maternity (Starting Well)
VISION: To be the most child and family friendly Borough in the country
The outcomes will be refreshed for 2021/22 during Q1, aligning feedback received, key priorities for the Life Stage, Locality based work, Population Health Management and Health Inequalities work, and national Operating Framework Guidance. These will be reported on from Q2.
Key Programmes of Work Feeding into the Vision
Activity Joint/ CCG/ Owned By Outcome Ref Key Milestones Outcomes Due By Ref Council Name and Organisation
Provide resilience within Education to deal with return to curriculums from Sep 20 Introduction of a Recovery Curriculum and the development of an Emotional, health and wellbeing and trauma informed Universal public health services to Joint/ CCG/ Angela Harrington 1 FS1 & 3 Mar-22 support system. To include the SEMH and Education resume full service offer including Council Emma Price COVID strategy. focus on additional support for CYP for Recovery emotional wellbeing
Reduce the Waiting times for Neuro developmental Children will access assessment and 2 pathways, developing an all age approach to provision FS2 Mar-22 CCG Emma Price treatment within NICE guidelines looking at post diagnostic support for Families All children to live at home or as close to home as possible in family settings. Children will move back into Doncaster homes akin to a family setting, with systems and support in place for wider support ie education Joint/ CCG/ 4 Implement Future Placement Strategy and mental health services. FS4 Mar-22 Angela Harrington Council The goal is for less young people to be placed outside of Doncaster. Increase the number of in-house Foster Carers with the ultimate target of 75% of providers in house by 2023
Investment will be mirrored as per the Support the delivery of the NHS Long Term Plan including NHS MH investment standards 5 MH investment in both Eating Disorders and Perintal FS5 Oct-21 CCG Emma Price/ Kim Bottomley working collaboratively with our Pan Doncaster services in 21/22. providers to support pathways of care
Every child with an ECHP is Commission appropriate, quality education provision for all appropriately educated and supported SEND children based on identified need and local Joint/ CCG/ 6 to achieve their full potential at every FS6 Ongoing sufficiency. Council stage of education and future employment
Develop new service specification with a focus on out of Children will receive an appropriate 7 hospital care for Children's Community Nursing and Children's nursing service, timely and N/A Dec-21 CCG Emma Price/ Sally Brown/ Gill Wood Children's Therapies appropriately
5-19 integrated service model to be developed in conjunction with young 8 Recommissioning of 5-19 healthy child programme Mar-22 PH Carrie Wardle people and wider partners in preparation for open tender
Place Plan Embed and evaluate the impact of the first year of the pilot to develop an * 1001 days integrated offer for parents and * Vulnerable Adolescents families for the first 1001 days 01/09/2021 8 Vulnerable Adolescents - TBC Council Carrie Wardle/Callum Helman establishment of the delivery model and outcomes to evaluate the effectiveness of the pilot
Work together across partners to Mapping of locality data to identify area priorities to include identify areas of priority to provide Council/ Localities 9 feedback from residents. commissioning/service redesign TBC Mar-21 David Woodcock/Alan Wiltshire/John Gleek DCCG opportunities to increase patient and resident outcomes Increase the number of young carers identified and who have the opportunity of an appropriate assessment including a transition assessment at key points in their life. Joint All Age 10 Implementation of the Young Carers action plan To support this further a Young Carers FS7 Ongoing Council Denise Beevers Approach champion as a ‘go to’ person in all Doncaster schools.
Ensuring that children and young people on the autism, attention deficit and other neurodevelopmental Joint/ CCG/ 11 All Age Learning Disability Strategy Ongoing Kate Featherstone-Bennett pathways have their needs identified Council and met in a consistently timely manner ASD.
Initial scoping of the market to develop, shape, and improve a variety services across all age cohorts Joint/ CCG/ 12 All Age Market Position Statement Mar-22 Kerry North working closely with a range of key Council stakeholders
Ref Quality Outcomes Activity Measures FS1 COVID RECOVERY Ensure that all Schools are utilising the reformed toolkit for SEMH and engaging with MHST and locality teams Implement agreeed redcovery trajectory to ensure that 90% of Children have a wait of 18 weeks and less for a Neuro development FS2 COVID RECOVERY assessment FS3 COVID RECOVERY Ensure that all Schools are utilising the reformed toolkit for SEMH and engaging with MHST and locality teams FS4 PAN DONCASTER 65% In house foster provision by mixed economy of overnight short breaks provision by March 2022 FS5 PAN DONCASTER Reduce the number of Out Of Authority Education Placements by 20% by the end of the year FS6 All Age Joint Approach Increase the number of young carers identified and who have the opportunity of an appropriate assessment Stakeholders Links to other plans Doncaster Council Living Well Delivery Plan
Early Years Settings Children & Young People's Plan
Educational Settings Local Transformation Plan
Behaviour Improvement Programme Inclusion Strategy
Doncaster Children's Services Trust Future Placements Strategy
Doncaster Clinical Commissioning Group
Rotherham, Doncaster and South Humber NHS Foundation Trust
Doncaster & Bassetlaw Teaching Hospitals
Primary Care Doncaster
Key Risks Description of Risk
COVID 19 and reduction for Business as Usual Adaptive workstreams and commencement of provider alliance/ ICS conflicting responsibilites
Commissioning Delivery Plan Health and Social Care Commissioning Delivery Plan: 2021/22 Living Well VISION:
People feel supported within their community; where people do need health and care services they are coordinated and timely
Key Areas of Work to Deliver the Vision Outcome References the Joint/ CCG Only/ Category Name Ref. Key Milestones Due By: Owned by: Name and Organisation Milestone will Council Only Deliver
Support primary care to return to the new normal ensuring patients receive the care that they need in a timely manner, that the digital first options are continually improved and offer patients choice of access to services Primary Care Cell A 7MD 30 September 2021 Joint and that progress is made on system integration to maximise effiiciency and continuity of care between Katie Dowson (DCCG) primary care and secondary care providers
Recovery of services due to Covid-19 Mark Steward SLHD B Successful resettlement of homeless individuals accommodated as part of COVID19 emergency response 30 June 2021 Joint MarkWakefield/Sarah Sansoa DMBC DCCG rep (tbc)
Work closely with system partners at Place level supported by SYB Cancer Alliance on cancer prevention and awareness raising including particular focus on improvement in screening uptake rates. Continue to link with DCCG, Doncaster Council, Macmillan 1.1 PCNs supported by partners including developing behavoural science nudge messages to encourage self- 2LP, 7MD 01 March 2022 Joint, Living Well, PHE Screening, CRUK referral to GP with cancer symptoms and respond to cancer screening invite. Continue linking with hard to reach groups, particularly impacted through Covid-19.
Deliver suicide bereavement services across the borough as an integral part of the Doncaster suicide Helen Conroy DMBC, 1.2 7LP 31 March 2022 Joint prevention plan Stephen Emmerson DCCG
Dave Richmond SLHD 1.3 Continue implementation of the Homelessness and Rough Sleeping Strategy Prevention Delivery Plan 01 March 2022 Joint Mark Wakefield/Sarah Sansoa DMBC DCCG rep (tbc)
Develop the neighbourhood delivery model, including "local solutions", ensuring that primary care networks are embdedded into the approach, recognising that this action cuts across Starting, Living and Ageing Well. K Johnson (DMBC) 1.4 31 March 2021 Joint Once developed, deliver the actions agreed, with a focussed approach on the agreed neighbourhood Carolyn Ogle (DCCG) outcome for Living Well.
Low level Increase opportunities offered by technology, exploring technologies such as Brain in Hand via the Carla Weighill, Anika Leyland (DMBC) 1.4 Tbc Joint interventions, based Technology Enabled Independence Board, established during 2020/21. Paul Tarantiuk (DCCG) in our neighbourhoods Undertake a review of the services and support mechanisms available to the Caring Population, taking into account the commissioned services, the Direct Payment offer and the services that are in local communities. Angela Waite (DMBC) 1.5 Joint Following completion of the review, the report will make a number of recommendations to guide future Charlene Welsby (DMBC) procurement and market shaping activity, which will be developed into delivery plan
Review progress of the existing mapping exercises of community based assets through the lens of mental Julia King (DMBC) 1.6 30th June 2021 Joint health support and the transformation of mental health to inform the development of a delivery plan Stephen Emmerson (DCCG)
Collaborative working to identify the LA Priority workstreams as part of the MH transformation programme to inform the development of plans. Julia King (DMBC) 1.7 30th June 2021 Joint Stephen Emmerson (DCCG)
Reduce loneliness and social isolation with third sector collaboration, including social isolation alliance and voluntary action Doncaster 1.8 Mar-22 DMBC only Vanessa Powell Hoyland (DMBC)
Continue to roll out the strengths based Be Well model to support individuals and families respond to the 1.9 31 March 2022 DMBC only Vanessa Powell Hoyland (DMBC) commercial behavioural determinants of health
Reduce unnecessary follow-up appointments by embedding the agreed patient initiated follow-up clinical 2.1 4LP, 5LP, 6LP TBC CCG only CCG lead / DBTH lead (tbc) protocol
Maximise the use of alternatives to A&E through supporting people to access the right urgent care service by: - Embedding the new Urgent Care Model and Provider Alliance approach to urgent care provision - Reducing ambulance conveyance rates to A&E through increasing see & treat and exploring use of alternative conveyance pathways such as Doncaster UTC - Working across the system to enable NHSE 111 to direct patients to the service that best meets their needs and book a time slot wherever possible including EDs, UTCs and primary & community care 2.3 3MD, 7MD 31 March 2022 CCG Only - Further developing the Doncaster CAS (Community Assessment Service) to respond to NHS 111 calls and A Leighton (DCCG) Co-ordinated access provide local clinical advice to either resolve the call or direct patients to the most appropriate local to services when alternatives needed - Further developing Same Day Emergency Care - Ensuring 2 hour home response appointments are made available to ambulance services and other locally identified services for appropriate patients in the community
Victor Joseph (DMBC) Sarah Gill (PHE) Learn from the experience of the Covid vaccination programme to ensure that the take up of population 2.4 31 March 2022 Joint Carolyn Ogle (DCCG) in relation to screening and immunisation programmes during 2021/22 is optimised supporting primary care aspect Ailsa Leighton (DCCG)
2.5 Ensure the smooth transition of extended access services from current commissioned model to PCNs 31 March 2022 CCG only C. Ogle
Fully implement the Macmillan LWABC Programme including: e-holistic needs assessment (eHNA), e- DCCG lead (tbc), Graeme Fagan, 3.1 treatment summarie, Cancer Care Review by Primary Care for 100%. Apply for Macmillan 'community' link 30 April 21 Bid CCG /RDaSH RDaSH funding and implement 3 x posts at Place level supporting cancer patients. 31 March 2022 Implementation
Primary and Community Mental Health Locality Transformation Progress multi-year transformation of the Mental Health and Wellbeing offer as a locality model to support 2aMD,2bMD,1LP, Stephen Emmerson (DCCG) 3.2 patient holistic need. Join primary and community MH under a locality MH Hub offer that has an ethos of “no 31 March 2022 Joint 8LP wrong door”. Place the Locality MH Hub within seamless pathways across upstream MH specialisms and Julia King (DMBC) downstream neighbourhood assets.
Mental Health Inpatient Capacity, Flow & Therapeutic Offer: Where inpatient admission is necessary, improve the inpatient therapeutic offer to ensure admission remains 3.3 purposeful at all times with connection to onward community pathways as rapidly as possible. Sustain and 4MD 31 March 2022 CCG only Stephen Emmerson (DCCG) enhance patient flow learning from Covid-19 adaptation to further develop health / social / VCSE partnership solutions for barriers to patient discharge and onward recovery.
Continue implementation of the Homelessness and Rough Sleeping Strategy: Care and Support Delivery /Sarah Sansoa/ Plan: Mark Wakefield Annika Leyland (DMBC) 3.4 Review of floating support offer including mapping of existing provision 1LP 31 March 2022 Joint Mark Steward/Steve Review of health offer for homelessness and rough sleepers DCCG rep (tbc) Review of Complex Lives including BCF exit strategy
Carolyn Ogle, Ian Boldy, Michele Increase personalised care and support planning, personal health budgets and consider the future 3.5 11MD, 12MD 31 March 2022 Joint Clarke (DCCG)Charlene Welsby, Anika development of Social Prescribing, linking in with local Primary Care Networks Leyland (DMBC)
Holistic delivery of care and support Continue to work with Home First Provider Alliance to implement the specified Home First service Ailsa Leighton (DCCG) requirements in line with the "Hospital Discharge Service: Policy and Operating Model". This will ensure timely Jo Forrestall (DCCG) 3.6 3MD 31 March 2022 Joint transfer of care along the discharge process and delivery of the two new national standards (2-hour crisis Carolyn Nice (DMBC) response and 2-day reablement response), as described in the NHS Long Term plan Home First Provider Alliance
Strategic Commissioning to support Strategic Housing and Adults, Health & Wellbeing to develop the Physical Charlene Welsby / Adam Goldsmith/ / 3.7 31 March 2022 DMBC only Disability accommodation offer and wrap round care and support services Home First HoS
The Doncaster Place Based Workforce lead has been appointed and commenced in post in January 2021. She is progressing the development of the workforce strategy in partnership with Whole Systems Lisa Devanney (DCCG) 3.8 31 March 2022 Joint Partnerships. The current phase is finalising the workforce data across the system to fully understand any Sarah Jones (DMBC) future gaps in both capacity and skill set
Support PIC (together with Health Informatics as appropriate) in the refresh and update of the workplans for each of the priority areas (including the data and Key Performance Indicators requirements) within the refreshed Doncaster All Age Learning Disability and Autism Strategy (2021-2024): - Diagnosis of Autism - Education and Inclusion Julia King (DMBC) 3.9 - Employment 30 September 2021 Joint Rebecca Mason (DMBC) - Carers and Short Breaks Paul Tarantiuk (DCCG) - Housing & Support - Health Inequalities - link to the Engagement plan for people from Black and Minority Ethnicities (BAME) communities - Autism
Commissioning Delivery Plan Support the development of a Specialist Housing Framework to meet the housing needs of specialist groups 3.1 1LP 30 September 2021 DMBC only / Adam Goldsmith (DMBC) e.g. Learning Disability, Autism, Mental Health. Ruth Oliver
Scope the Housing & Support needed for mental health, and articulate the housing and support issues for Julia King, Stephen Emmerson, 3.11 1LP 30 September 2021 Joint people with mental illness into an action plan. Annika Leyland
Embed PCNs in to merging ICS structures both at place and across the wider system to ensure they continue Interim model Sept 2021 DICDG Partnership 3.12 to have a voice and influence the agenda at neighbourhood, Doncaster wide and SYB level and secure the Joint Full implementation 31 March 2022 (DCCG) embedding of the SYB Primary Care Strategy within Doncaster Carolyn Ogle
Mental Health Urgent & Emergency System Pathways (DCCG), Building on previous investment within MH Crisis / Unplanned care, consolidate new assets within a clear multi- Stephen Emmerson Helen 4.1 8MD, 9MD 31st March 2022 Joint agency map of care. Embed outcomes within a multi-agency protocol that underpins onward partnership Conroy (Public Health), Julia King working. (DMBC)
Responsive and accessible care in a crisis Continue implementation of the Homelessness and Rough Sleeping Strategy: Accommodation Delivery Plan Sarah Sansoa/MarkWakefield/ Annika - Determine the strategic direction re: hostel reform Leyland/ Debbie McKinney/Cathy 4.2 31 March 2022 DMBC/ St Leger Homes - Expand Housing First offer and establish a consistent evaluation model for Housing First Woofs, DMBC - Develop an understanding and oversight of non-commissioned supported housing sector Mark Steward, St Leger Homes
Work in partnership with PH substance misuse theme lead to integrate substance misuse accommodation Helen Conroy/Sarah 4.3 30 June 2021 DMBC only and support contract within ASPIRE substance misuse treatment contract Sansoa/MarkWakefield
Develop and implement a communications and engagement plan for the Learning Disability and Autism Julia King (DMBC), Paul Tarantiuk 5.1 10MD 01 March 2022 Joint Strategy work streams (DCCG), Rebecca Mason (DMBC)
Person centred support for people with complex needs Mental Health Complex Recovery and Rehabilitation Strategy Reform community and high dependency provision to enhance and extend the rehabilitation offer, and Julia King (DMBC) 5.2 31 March 2022 Joint prevent out of area care. Develop health / social / housing options in partnership with statutory and Stephen Emmerson (DCCG) independent organisations that are needs based and maintain wellbeing.
DCCG lead (Dave Woodcock) Work together across partners to identify areas of priority to provide commissioning/service redesign 5.3 31 March 2022 Joint (DMBC) opportunities to increase patient and resident outcomes John Gleek Allan Wiltshire To Deliver the following Outcomes/Monitored By:
Population Health Management and Health Inequalities work, and national Operating Framework Guidance. These will be reported on from Q2.
Ref: Must Be Dones Ref: Doncaster Local Priorities Ref: Neighbourhood Priorities
Increase the proportion of adults in contact with secondary mental health Increase the number of people receiving Personal Health budgets 1MD 1LP services living independently, with or without support (baseline to be North To confirm and report from Q2. (baseline to be determined once planning guidance received) determined once planning guidance received)
Reduce the life expectancy gap between people with severe mental illness and learning disability and the general population by Increase the proportion of physically active people in Doncaster (baseline 2aMD increasing the proportion of people on GP severe mental illness 2LP East To confirm and report from Q2. to be determined once planning guidance received) registers receiving physical health checks to the national standard of 60% from the 2019/20 baseline (trajectory for 2021/22 to be agreed) Reduce the life expectancy gap between people with severe mental illness and learning disability and the general population by 2bMD increasing the proportion of people with Learning Disabilities on GP 3LP Removed South To confirm and report from Q2. registers who receive their annual health check to 75% in 2021/22 from the 2019/20 baseline
Continue to improve the appropriateness of referrals to secondary care in Reduce delayed discharges of care (baseline to be determined 2021/22, measured by the proportion of patients discharged at first 3MD 4LP Central To confirm and report from Q2. once planning guidance received) appointment (baseline to be determined once planning guidance received)
Further increase the amount of people in Doncaster with anxiety Continue to improve the appropriateness of follow ups in secondary care, 4MD and/or depression accessing IAPT services (baseline to be 5LP by implementing the "Follow up Strategy" (baseline to be determined determined once planning guidance received) once planning guidance received)
Maintain uptake against all three National Screening Programmes Ensure that at least 85% of people wait no longer than 62-days from (Cervical, Bowel and Breast Screening) above the England average and 5MD 6LP urgent GP referral to first definitive treatment for cancer in 2021/22 work towards reducing the inequalities within Doncaster (Practices to be targeted TBC)
Improve the % of patients with cancer diagnosed at Stage 1 or 2 by Reduce suicides by March 2022 (baseline to be determined once 6MD the end March 2022 (baseline to be determined once planning 7LP planning guidance received) guidance received)
Improve access to Primary Care in 2021/22 , measured by the increase in extended access appointments utilised, and the National 7MD 8LP GP Patient Survey (baseline to be determined once planning guidance received)
Ensure that patients referred from the Emergency Department for 8MD urgent and emergency Mental Health patients receive a response within 1 hour in 2021/22 Reduce inappropriate Mental Health Out of Area Placements to 0 by 9MD end of 2021/22 Social prescribing increase to 8 referrals per 1,000 population 11MD
Increase personalised care and support planning (baseline to be 12MD determined once planning guidance received) Financial Savings Metrics Reduction in outpatient and follow up appointments through a number of actions (including increased use of Consultant Connect, further implementation of Evidence Based Interventions, implementation of the Follow Up Strategy and others). Savings to be FS1 quantified in year depending on financial regime.
FS2 Impact of Evidence Based Interventions, Commissioning For Outcomes audits and IFR queries (savings to be quantified in year depending on financial regime)
FS3 Removed
FS4 Removed
FS5 Removed
FS6 Contribute to minimising the growth in A&E attendances as a result of increased use of extended access appointments (savings to be quantified in year depending on financial regime)
FS7 Contribute to minimising the growth in A&E attendances , as a result of a reduction in ambulance conveyance rates (savings to be quantified in year depending on financial regime)
Contribute to minimising the growth in A&E attendances and subsequent admissions (including impact on tarriff complexity) as a result of the new statutory and third sector assets for crisis resolution/ alternative places, implementation of psychiatric liaison model FS8 and DOS review,(savings to be quantified in year depending on financial regime) Contribute to minimising the growth in A&E attendances as a result of increased annual health checks for people with learning disability, delivery of SAMI-RESTORE 2 and Enhanced Health in Care Home MDTs for care homes and supported living settings. FS9 (savings to be quantified in year depending on financial regime)
FS10 Minimise the growth in Non-elective admissions, as a result of a range of new models of care in the community.
FS11 Potential impact of bed occupancy reduction requirements, increase in Same Day Emergency Care and reducing Length of Stay on excess bed days (savings to be quantified in year depending on financial regime)
FS12 Review Young Onset Dementia service, with potential to re-commission the service; costs of re-commissioned service will be determined once review has taken place.
FS13 Reduction in Out of Area Placements for Learning Disability, (savings to be quantified in year depending on financial regime)
FS14 Reduction in NEL admissions through implementation of QUIT project (savings to be quantified in year depending on financial regime)
FS15 Reduction in NEL admissions through the Psychiatric Liaison Service model (savings to be quantified in year depending on financial regime)
Review impact of PCN DES against the local proactive care LES, with a particular consideration with regards to duplication FS16
FS17 Removed
FS18 Removed
Stakeholders Links to other plans Dependencies Doncaster CCG Starting Well Delivery Plan DMBC Ageing Well Delivery Plan Health & Wellbeing Board RDaSH LD & Autism Strategy DBTHFT Homeless Strategy FCMS Better Mental Health (Adult) Improvement Plan
Key Risks Description of Risk
Commissioning Delivery Plan Health and Social Care Commissioning Delivery Plan: 2021/22 Ageing Well VISION:
Doncaster ageing population will receive person centered flexible and integrated care and support in their own 'home' that aims to maximise their health, wellness and independence
Key Areas of Work to Deliver the Vision Outcome References the Joint/ CCG Only/ Category Name Ref. Key Milestones Due By: Owned by: Name and Organisation Milestone will Council Only Deliver Joe Bloggs (DCCG), Jane Doe e.g. Bed Base 1.1 Review the older age bed base across Doncaster and design new model to be agreed by all parties QO3, AM2, FS5 31st October 2019 Joint (DMBC)
1.1 Continue to promote dementia awareness and prevention initiatives in line with the dementia deep dive NP Q2/Q3 Council Louise Robson (DMBC) recommendations Continue to promote an Age Friendly vision for Doncaster by influencing key stakeholders, increasing 1.2 engagement with Doncaster population and capturing age friendly activity, including linking with the East NP Q4 Joint Lousie Robson (DMBC) locality frailty project In line with the Long Term Plan requirements undertake full stocktake of current position of Personal Health 1.3 2LP Q4 CCG Ian Boldy (DCCG) Budgets and develop a plan to increase uptake
Low level Develop the Integrated neighbourhood delivery model, including “local solutions”, ensuring that primary Outcomes to be interventions, care networks are embedded into the approach, recognising that this action cuts across Starting, Living and agreed Awaiting update from Karen 1.4 Joint Karen Johnson (DMBC) based in our Ageing Well. Once developed, deliver the actions agreed, with a focussed approach on the agreed collaboratively as Johnson neighbourhoods neighbourhood outcomes. models develop
Undertake a review of the services and support mechanisms available to the Caring Population, taking into Q2 account the commissioned services, the Direct Payment offer and the services that are in local Angela Waite/Charlene Welsby 1.5 2LP Joint communities. Following completion of the review, the report will make a number of recommendations to (DMBC) Q3 guide future procurement and market shaping activity, which will be developed into delivery plan
The Joint Partnership Manager to undertake a service review of the Community Equipment Service to Carla Weighill /Kate Anderson 1.6 Q4 Joint inform future commissiong intentions. Bratt/Amamda Greenhalgh (DMBC)
Co-ordinated Continue to work with Rapid Response to ensure delivery of two-hour hour crisis response target and access to services 2.1 5MD Q4 CCG Jo Forrestall/Ailsa Leighton (DCCG) explore opportunities across the partnership inc YAS and NHS 111 to further to promote usage. when needed Aligned to the Long Term Plan, the Place Plan and embedding the learning from the pandemic continue to review opportunities to transfer care into community settings. - Transfer the responsibility of the prescribing and patient management to the specialist community team Q3 - Explore opportunities for stoma patient management within the community Q3 3.1 1LP CCG Jo Forrestall - Continue to work with stakeholders to develop a Community DVT Management pathway Q4 - development of an pathway between IAPT and NROT to provide support for patients with a Functional Q2 Neurological Disorder
Continue to embed the 7 care elements within the Enhanced Health in Care Home (EHCH) Framework across all community stakeholders. Following the EHCH evaluation develop an action plan to focus 2MD,3MD,1LP,3LP,6 Q4 (with key deliverables within 3.2 continued delivery of transformational change across partners and stakeholders to embed integration, Joint Karen Tooley/Jo Forrestall LP the action plan) expanding work force development & skill sets, improve access to and provision of quality of care that wraps around vulnerable frail adults and embed the use of assistive technology and the IDCR.
Undertake a review of the existing community services supporting Care Homes inc. but not limited to Q3 3.3 Fraility team, OPMH Care Home Liason, Falls Service, Community Nursing, and explore a more co- 2MD,1LP CCG Jo Forrestall ordinated service offer including outcome measures
Implementation of the joint Care Homes contract and ongoing joint contractual management Q3 (depending on national Kate Anderson-Bratt / Jo Watkinson/Jo 3.4 2MD,1LP Joint - To include implementation of quality toolkit and consideration of roll out across Dom Care guidance) Forrestall
Continue to monitor long term effects and implications of Covid -19 amongst our population Q1 - Further embed Long Covid Assessment Service delivery, monitoring performancein line with National 3.5 CCG Kim Bottomley/Jo Forrestall Guidance, ensuring focus remains on self managemnent and a strength based approach Q2 - Develop an action plan to engage and raise awareness of LCAS amongst our hard to reach communities
Dementia Diagnosis and treatment - implement recovery plan - Eliminate varince in diagnosis rates across PCN's Stephen Emmerson/Michele Holistic delivery of 3.6 - Develop best practice protocol across PCN's 1MD,3MD,1LP,6LP Q3 CCG Clarke/Carolyn Ogle/MH - Undertake structural review of community integrated organic and functional teams and embed care and support Transformation Lead transformation.
Post Diagnostic Support- Review Deep Dive recommendations and implement actions by - Developing a new model for Cognitive Stimulation Therapy Stephen Emmerson/Michele 3.7 2MD,3MD,1LP,6LP Q4 Joint - Service review of Young Onset Dementia Service Clarke/Charlene Welsby - Developing pre/post diagnostic offer reconfigured across PCN's
Enhance the existing data set and functionality of the iDCR to improve and increase usage across Doncaster Place health and care settings. To focus on the following areas: • to support Care home Multi-Disciplinary Teams (MDTs) to ensure information including the patient’s 3.8 RESPECT form is shared Q4 Joint Katie Dowson • Reviewing the data shared from DBTH into IDCR to support improved detail on attendance and discharge information • Ensure interface between iDCR and Yorkshire & Humber Care Record (YHCR)
Co-produce a Market Position Statement to develop, shape and manage the Health and Social Care market 3.9 Q3 Joint Mark Wakefield/Charlene Welsby to stimulate a diverse and sustainable market capable of delivering commissioning priorities
Further embed the use and quality of ReSPECT process and documentation across the healthcare system 3.1 by continuing to educate and raise awareness across the system with specfic emphasis on discharge from 5MD,1LP,6LP Q3 CCG Kim Bottomley secondary care and exploration of digital approach
Commence Phase 1 of a strategic review ( data analysis and insight) of the existing Domiciliary Care offer Mark Wakefield/Jo Forrestall/Charlene 3.11 across Doncaster linked to the market position statement module development, this will inform future Q2 Joint Welsby phases, timescales and commissioning intentions.
Review of current community geriatrician service to ensure alignment with Home First model and Enhanced 3.12 Q3 CCG Jo Forrestall Health in Care Homes framework
Continue to work with Home First Provider Alliance to implement the specified Home First service (Timelines to be added when requirements in line with the "Hospital Discharge Service: Policy and Operating Model". This will ensure 2MD,4MD,5MD,1LP, Jo Forrestall/Home First Provider 4.1 Implementation plan received from Joint Responsive and timely transfer of care along the discharge process and delivery of the two new national standards (2-hour 6LP Alliance providers) accessible care in crisis response and 2-day reablement response), as described in the NHS Long Term plan a crisis 2MD,4MD,5MD,1LP, 4.2 Delivery of Clinical Frailty assessment within 30 minuts of arrival within A&E CCG Jo Forrestall 6LP Person centred support for people End Of Life Care- work with provider collabortive to scope an approach to delivering optimum EOL care for 5.1 Q2 CCG Jo Forrestall with complex Doncaster residents needs DCCG lead (Dave Woodcock) Work together across partners to identify areas of priority to provide commissioning/service redesign 31 March 2022 Joint (DMBC) opportunities to increase patient and resident outcomes John Gleek Allan Wiltshire To Deliver the following Outcomes/Monitored By: Life Stage, Locality based work, Population Health Management and Health Inequalities work, and national Operating Framework Guidance. These will be reported on from Q2.
Ref: Must Be Dones Ref: Doncaster Local Priorities Ref: Neighbourhood Priorities To reduce inequalities across Doncaster there will be a reduction in the percentage of There will be fewer than 9560 people aged 65 and over being admitted to At least 67% of people with Dementia will be diagnosed in line with people who died and had 3 or more emergency admissions in the 90 days prior to death to 1MD 1LP hospital as an emergency from the baseline of 9560 (2019) (Health and North the national standard in 20/21 (Oversight Framework 126a) 9% in 2020/21 from the baseline of 9.28% (England average 7.4%)for the North (NHS Wellbeing Board Outcome) Oversight Framework 105c)
There will be a reduction in emergency hospital admissions due to There will be an Increase in the proportion of people who use services To reduce inequalities across Doncaster there will be a reduction in the percentage of falls in people aged 65 and over per 100,000 to 2470 in 2020/21 who are aged 65 and over and reported that they had as much social people who died and had 3 or more emergency admissions in the 90 days prior to death to 2MD 2LP East from the 2017 baseline of 2520 (Public Health Outcom es contact as they would like to 60% in 2020/21 from the baseline of 49.50% 9% in 2020/21 from the baseline of 9.28% (England average 7.4%)for the East (NHS Framework C29) (2018) (Adult Social Care Outcomes Framework 11(1) Oversight Framework 105c) To reduce inequalities across Doncaster there will be a reduction in the percentage of There will be at least 77.3% of people diagnosed with dementia There will be a reduction in hip fractures in people aged 65 and over per people who died and had 3 or more emergency admissions in the 90 days prior to death to 3MD whose care plan has been reviewed face to face in the preceding 3LP 100,000 to 620 in 2020/21 from the baseline of 641 (2017-18) (Public South 9% in 2020/21 from the baseline of 9.28% (England average 7.4%)for the South (NHS 12 months (Oversight Framework 126b) Health Outcomes Framework E13) Oversight Framework 105c)
Commissioning Delivery Plan There will be an increase in the percentage of people aged 65 and To reduce inequalities across Doncaster there will be a reduction in the percentage of over still at home 91 days after discharge from hospital into There will be an increase in the uptake of flu vaccinations by people people who died and had 3 or more emergency admissions in the 90 days prior to death to 4MD reablement/rehabilitation services to 85% in 2020/21 from the 4LP aged 65 and over to 75% in 2020/21 from the baseline of 72.50% (2018- Central 9% in 2020/21 from the baseline of 9.28% (England average 7.4%)for Central (NHS baseline of 82.7% (2018)(Adult Social Care Outcomes Framework 19) (Public Health Outcomes Framework D06a) Oversight Framework 105c) 2B(1))
There will be at least 64% of people aged 65 and over who require There will be an increase in the uptake of shingles vaccinations by 5MD a crisis response (physical health) receiving it within 2 hours in 5LP people aged 70 and over to 40% in 2020/21 from the baseline of 38.30% 2020/21 (Long Term Plan) (2017-18) (Public Health Outcomes Framework D06c)
There will be an increase in the percentage of people who have jointly 6LP agreed with professionals their advanced care plan at end of life to 95% in 2020/21 from the 2019 baseline of 92.5%
Financial Savings Metrics- not yet quantified. Analysis will be undertaken once the work programmes are further developed Prescribing savings for Stoma products and continence products Savings to prescribing following implementation of Woundcare Allaince approach and adherence to formulary Efficiencies in service delivery following OT review Reallocation of existing "Falls Service" resource across other existing services. Increased service provision in Falls management by implementing strength and balance approach Possible reduction in admission and LOS following implementation of E-bag
Stakeholders Links to other plans Dependencies NHS Doncaster CCG Living Well Delivery Plan Ageing well strategy DMBC Health & Wellbeing Board RDaSH Doncaster Integrated Care Partnership Board DBTHFT Joint Commissioning Management Board FCMS
Key Risks Description of Risk COVID 19 impact on Business as Usual
Key actions common to other life stage plans
Key actions common to other life stage plans
Commissioning Delivery Plan
Meeting name Governing Body Meeting date 1 April 2021
Staff Survey 2020 Summary Report Title of paper
Executive / Lisa Devanney Clinical Lead(s) Associate Director of HR & Corporate Services Lisa Devanney Author(s) Associate Director of HR & Corporate Services
Status of the Report
To approve To consider / discuss
To note
Purpose of Paper - Executive Summary
The purpose of this report is to inform Governing Body members of the key findings from the results of the 2020 staff survey. The report details the scores and highlights some of the key areas against the themes within the staff survey. The scores are summarised as follows:
Equality, Diversity and Inclusion: 9.7 Health and Wellbeing: 7.5 Immediate Managers: 8 Morale: 6.8 Quality of Care: 7.3 Safe Environment – Bullying and Harassment: 9.3 Safe Environment – Violence: 9.9 Safety Culture: 7.5 Staff Engagement: 7.8 Teamwork: 7.5
Doncaster CCG rated above the national average across 10 of the themes and just below with 1 theme (Safe Environment – Violence).
A detailed staff survey report will be placed on the CCG website following its current embargo.
Recommendation(s)
To note the report.
Report Exempt from Public Disclosure
Yes No If yes, detail grounds for exemption:
Impact analysis Quality impact [Identify any quality impact]
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of N/A Interest Consultation / Engagement (internal All staff employed by the CCG at the point the survey was undertaken departments, were invited to participate clinical, stakeholder and public/patient) Report previously Strategy & OD Forum 18 March 2021 presented at Risk N/A analysis Corporative Objective / 1.0 Assurance Framework
NHS ANNUAL STAFF SURVEY RESULTS 2020
1. INTRODUCTION
The CCG participated in the 2020 NHS annual staff survey and chose to invite all staff to participate. The response rate received was 89%, an increase of 1% from the previous year and the highest response rate from the establishment of the CCG. The survey is broken down into the following themes:
Equality, Diversity and Inclusion Health and Wellbeing Immediate Managers Morale Quality of Care Safe Environment – Bullying and Harassment Safe Environment – Violence Safety Culture Staff Engagement Teamwork
This report highlights the views of the respondents for each of the themes and explores the pertinent indicators within each theme. The themes are scored 0 – 10 with 10 being the best and 0 being the worst. Across 10 themes Doncaster CCG rated above the national average score and just below for ‘Safe Environment – Violence’.
The survey captured data relating to the Covid-19 pandemic and details are contained in paragraph 3.
This year the survey also enabled reporting on certain elements which relate to the Workforce Race Equality Standard (WRES) and the Workforce Disability Standard (WDES) and the findings are detailed in paragraph 4.
2. THEMES
2.1. Equality, Diversity and Inclusion
A score of 9.7 was achieved which is consistent with the previous year. The CCG has maintained a consistent high score in this theme. The 2020 results show a decrease in the number of staff who perceived they have experienced discrimination in the workplace from managers/team leaders/colleagues. There was an increase of 0.7% of staff who had experienced discrimination at work from patients/service users, their relatives, or other members of the public. There was an increase of just over 9% in the provision of reasonable adjustments to enable staff to carry out their duties which is likely to be attributable to home working.
2.2. Health and Wellbeing
A score of 7.5 was achieved which is a very small decrease from 7.6 the previous year. There was decline in the opportunities for flexible working which appears to be in contradiction to other focus groups that have been held regarding agile working. This may be attributable to the enforced ‘work from home’ arrangements. More staff felt that the CCG takes positive action on health and wellbeing but unfortunately more staff had experienced work-related stress and musculoskeletal problems because of work activities, again this could be attributable to the pandemic and ways of working and working environments.
2.3. Immediate Managers
A score of 8 was achieved. There was a perceived increase in the support being given to staff by immediate managers and on being given clear feedback. More staff felt that their immediate manager valued their work and took an interest in their health and wellbeing. 87.3% of staff felt their managers could be counted on to help with a difficult task at work and 92% felt that their managers were supportive in a personal crisis.
2.4. Morale
A score of 6.8 was achieved which is consistent with the previous year. Less staff felt they had unrealistic time pressures and more felt that their immediate line manager encouraged them. There was an increase in relationships being strained and more staff were thinking about leaving the organisation in the next 12 months. There was a slight variance with those who were working from home or shielding for a household member having lower morale than those present in the office environment.
2.5. Quality of Care
A score of 7.3 was achieved which is a comparable with previous years. This is perhaps a difficult theme to improve upon as a many of the indicators are linked to the direct provision of care which CCG staff may feel removed from resulting in answers marked as not applicable or missing altogether.
2.6. Safe Environment – Bullying and Harassment
A score of 9.3 was achieved. There was decrease in the number of staff who experienced harassment, bullying or abuse at work from managers and/or colleagues. The decrease was relevant to staff working from home.
2.7. Safe Environment – Violence
A score of 9.9 was achieved. The results showed that 1.3% of staff had experienced physical violence from patients/service users and their relatives or other members of the public, 0.7% of staff experienced this from a manager and 0.7% of staff experienced this from a colleague.
2.8. Safety Culture
A score of 7.5 was achieved and this represents improvements in the view that staff who are involved in an error, near miss or incident are treated fairly, that the CCG takes action to ensure errors, near misses or incidents so not happen again and that feedback is given about changes made in response to reported incidents. More staff stated they would feel secure in raising concerns about unsafe clinical practice and that their concerns would be acted upon.
2.9. Staff Engagement
A score of 7.6 was achieved which is a decrease on last year’s results. Less staff looked forward to going to work and less felt enthusiastic about their job. Significantly more staff felt time passed quickly when they were working and more felt able to make suggestions to improve the work of their team. An area of great improvement was on communication between senior management and staff, an increase of 18.7% to 76.2% feeling this was effective. 84.1% of staff would recommend the CCG as a place to work.
2.10. Teamwork
A score of 7.5 was achieved which is a small increase from last year. which is above average. More teams had shared objectives and met more regularly to discuss effectiveness. Remote working has resulted in a greater emphasis being placed on keeping in touch as teams which has clearly been of benefit.
3. THE COVID19 PANDEMIC
15.6% of staff stated they had been redeployed due to the pandemic and 93.2% had been required to work from home/remotely. 8.1% of respondents were shielding for themselves and 13.4% for a member of their household.
4. WRES & WDES
The tables below show how the results for certain elements of the survey which form part of the WRES/WDES reporting requirements differ based on ethnicity and disability. Doncaster CCG results are shown with the average from other CCGs that took part in the survey.
WRES Survey White BME White BME Question Benchmark Benchmark % of staff 1.5% 7.1% 3.9% 17.4% experienced discrimination at work from manager/team leader or colleagues in the last 12 months % of staff 6.1% 26.7% 7.9% 7.7% experiencing harassment, bullying or abuse from patients, relatives or public in the last 12 months % of staff 10.7% 0% 16.7% 24.2% experiencing harassment, bullying or abuse from staff in last 12 months % of staff 95.9% No data 88.6% 54.7% believing that supplied the organisation provides equal opportunities for career progression or promotion
WDES Survey Staff with a Staff without Staff with a Staff without Question LTC or illness a LTC or LTC or illness a LTC or illness benchmark illness benchmark % of staff 16.1% 4.4% 18.0% 9.1% experienced discrimination at work from colleagues in the last 12 months % of staff 6.1% 8.7% 11.4% 8.7% experiencing harassment, bullying or abuse from patients, relatives or public in the last 12 months % of staff 12.1% 5.2% 16.9% 8.7% experiencing harassment, bullying or abuse from manager in last 12 months % of staff No data 60% 45.5% 43.2% saying that the available last time they experienced harassment, bullying or abuse at work they reported it % of staff 91.3% 94.2% 81.8% 87% believing that the organisation provides equal opportunities for career progression or promotion % of staff who 22.2% 12.5% 19.8% 12.7% have felt pressure from their manager to come to work, despite not feeling well enough to perform their duties % of staff 65.6% 73.9% 49.4% 59.8% satisfied with the extent to which their organisation values their work % of staff with 90.9% n/a 85.8% n/a a long-lasting health condition or illness saying that their employer has made adequate adjustments to enable them to carry out their work
5. CONCLUSIONS AND NEXT STEPS
Overall, the staff survey results are positive, but it is likely that the impact of homeworking, having to work differently and often responding to urgent areas of work that super-cede the ‘day job’ may have affected how staff have felt over the period in question where experiences have not been as positive.
The CCG will work with staff side and several staff survey champions who will be nominated from teams across the organisation to ensure appropriate representation to consider the results, being mindful to ensure issues are not wrongly attributed to the pandemic and to aim to fully understand areas of concern. Appropriate actions or interventions can then be planned accordingly.
The action plan in response to the survey results will be combined with actions that will be required to support staff as we being to move to recovery rather than response to the pandemic. We are yet to understand how the logistics of safe return to work will be managed and there will be a period of readjustment for staff. In addition, staff will be affected by organisational change because of the Governments White Paper and further support for staff is being planned in response to these issues.
Meeting name Governing Body Meeting date 1st April 2021 Title of paper Quality & Performance Report
Executive / Mr Andrew Russell, Chief Nurse Clinical Lead(s) Mr Anthony Fitzgerald, Director of Strategy & Delivery Performance and Intelligence Team Author(s) Quality Team
Status of the Report
To approve To consider / discuss
To note x
Purpose of Paper - Executive Summary This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (DCCG) Governing Body which due to reporting restrictions or information potentially identifiable to a patient level have not been included within the main report. This report reflects 2020/21 performance and includes a focus on 2020/21’s Ageing Well Delivery Plan.
Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Further details on the reporting ceased which have been agreed with DCCG’s main providers can be found here: https://www.england.nhs.uk/coronavirus/publication/reducing-burden-and-releasing- capacity-at-nhs-providers-and-commissioners-to-manage-the-covid-19-pandemic/.
Please note all data is validated and quality checked internally within DCCG and with Providers as necessary. Where there is a data quality concern on any of the data or metrics presented in the following report, this will be stated in the narrative accompanying the data. Measures which also form part of the NHS Oversight Framework have been identified as (OF) within this report.
The overall response will impact a number of measures, and the ability of providers to report information, in the coming which will be detailed in future reports.
The key areas of change, both positive and negative, to note since the last report are:
1
NHS Doncaster Clinical Commissioning Group (DCCG) • Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance deteriorated to 64.1% during February and remains below the 92% target (Page 6). The total waiting list size now exceeds the target. • 52 week waits – There were 1501 DCCG patients waiting over 52 weeks for treatment at the end of February. (Page 12). • Patients waiting less than 6 weeks for a diagnostic test – Performance in February failed to meet the 99% target at 66.3% though improved from January position of 57.2% (Page 14) • Cancer 2 week waits – Performance during January failed to meet the 93% target at 70.6% (Page 19). • 2 week wait for first outpatient appointment for patients referred urgently with breast symptoms – Performance during January failed to meet the 93% target at 28.6% (Page 21). • New measure: Cancer 28 days faster diagnosis standard – Performance during January was 47.7% (Page 22) • Cancer 31 day waits – Performance during January failed to meet the 96% target at 96.5% (Page 22). • Cancer 62 day waits – Performance during January failed to meet the 85% target at 66.7% (Page 24).
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) • Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance deteriorated to 61.8% in February (Page 6). • 52 week waits – There were 2272 patients at the Trust waiting over 52 weeks for treatment at the end of February 2020 (Page 12). • Patients waiting less than 6 weeks for a diagnostic test – Performance during February 2020 improved to 66.3% below the 99% target (Page 14). • Accident and Emergency – Performance deteriorated in February 2021 to 80.4% remaining below the 95% target (Page 17). • Cancer 31 day waits – Performance during January met the 96% target at 97.4% (Page 22). • Cancer 62 day waits – Performance during January failed to meet the 85% target at 76.3% (Page 24). • Stroke 4-hour access - Performance in December failed to meet the 75% target at 49.2% (Page 28)
Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH) • Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service was below the January 2021 target (15.3%) at 14.4% (Page 29)
Other Commissioned Services Yorkshire Ambulance Service – Only Category 1 90th centile performance met target during February 2021 at 12 minutes and 12 seconds against a target of less than 15 minutes (Page 27).
2
Performance is currently being adversely impacted by Covid-19 infections and hospital admissions in Doncaster which is limiting the capacity of local Providers to undertake non-urgent services which have been restored as much as possible after being stood down during the first wave of Covid-19.
Delivery Plan Reporting Full summary Ageing Well February 2020 position (Page 33)
Recommendation(s) The Governing Body is asked to:
Note the Quality and Performance Report Report Exempt from Public Disclosure If yes, detail grounds for exemption: Yes No x
Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report.
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result Impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability Nil impact Financial Nil implications Legal Nil Implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.
Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) Report N/A previously presented at 3
Risk Risks are captured in the Executive Summary. Analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework
4
Covid-19 Vaccinations
Various delivery models have been used to vaccinate the different staff and patients groups. The majority of patients have been vaccinated across the five local vaccination sites in Doncaster. Vaccination Roving teams have also been established in each Primary Care Network and have visited Care Homes to vaccinate both staff and residents however there has also been the opportunity for staff to also visit local vaccination sites. Roving Teams have also been able to vaccinate those that are housebound and fall into one of the below cohorts.
Hospital vaccination hubs have been established at Doncaster Royal Infirmary and Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and have taken on the responsibility of vaccinating health and care staff across the borough including other community provider health care staff
1 Residents in a care home for older adults Staff working in care homes for older adults 2 All those 80 years of age and over Frontline health and social care workers 3 All those 75 years of age and over 4 All those 70 years of age and over Clinically extremely vulnerable individuals (not including those under 16 years of age)
Fantastic progress has been made on the vaccination programme with everyone in cohorts 1-9 now been invited for their 1st COVID vaccination.
Up to and including 23rd March 136273 1st doses were administered (42627 to people aged 70 and over, 33323 to people aged 60-69 and 31602 to people aged 50-59) and a total of 10472 2nd doses.
2nd doses are now being administered to patients across the five local vaccination sites, care homes and the housebound. Work continues to reach the hard to reach groups and a good example of this is the recent delivery of vaccines from the Mosque and Gurdwara to reach the BAME communities.
All five PCNs have submitted expressions of interest to continue vaccinations to cohorts 10-12 and awaiting further national guidance on commencement date for these cohorts.
5 1.1: NHS Constitution Measures
1.1.1 Referral To Treatment (RTT) Performance (Oversight Framework Measure - OF)
Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks June- July- Commissioner Feb-20 Mar-20 Apr-20 May-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 20 20 Doncaster CCG 90.5% 89.7% 82.6% 73.5% 61.4% 52.9% 57.6% 64.1% 67.9% 68.9% 67.0% 65.0% 64.1%
Rightcare Peer Group 86.4% 83.5% 75.5% 65.3% 52.9% 46.5% 55.4% 64.9% 70.9% 73.1% 72.5% 72.7% Doncaster and Bassetlaw Teaching 90.4% 90.1% 82.2% 72.3% 58.8% 49.2% 54.0% 60.7% 64.9% 66.1% 64.6% 62.5% 61.8% Hospitals Foundation Trust (DBTHFT) England 83.1% 79.6% 71.5% 62.7% 53.0% 48.2% 54.8% 61.6% 66.3% 68.7% 68.3% 64.4%
Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%
Performance for Doncaster Clinical Commissioning Group (DCCG) patients at all Trusts was 64.1% in February 2021, below the 92% target. Performance was below control limits suggesting performance is under expected levels for the service. Patients on incomplete pathways who have been waiting no more than 18 weeks
90% 80% 70% 60%
50%
Jul-17 Jul-18 Jul-19 Jul-20
Oct-20 Apr-17 Oct-17 Apr-18 Oct-18 Apr-19 Oct-19 Apr-20
Jun-18 Jun-17 Jan-18 Jan-19 Jun-19 Jan-20 Jun-20 Jan-21
Feb-18 Mar-18 Feb-19 Mar-19 Feb-20 Mar-20 Feb-21
Nov-17 Dec-17 Nov-18 Dec-18 Nov-19 Dec-19 Nov-20 Dec-20
Sep-20 Aug-17 Sep-17 Aug-18 Sep-18 Aug-19 Sep-19 Aug-20
May-17 May-18 May-19 May-20
% waiting under 18 weeks Avg LCL Target
6 The chart above shows that RTT performance has deteriorated over the last 2 years with 3 clear stages of continual deterioration. Latest performance is below the normal range of the service, affected adversely during the Covid-19 pandemic. Seventeen specialties failed to meet the 92% standard for DCCG:
• Cardiology (83.9%) • Cardiothoracic surgery (88.6%) • Dermatology (93.5%) • Ear, Nose & Throat (52.3%) • Gastroenterology (84.5%) • General Medicine (79.3%) • General Surgery (62.5%) • Geriatric Medicine (86.4%) • Gynaecology (80.5%) • Neurology (91.0%) • Neurosurgery (82.8%) • Ophthalmology (52.9%) • Other (81.0%) • Plastic Surgery (73.4%) • Rheumatology (90.5%) • Thoracic Medicine (86.0%) • Trauma and Orthopaedics (T&O) (49.4%) • Urology (47.9%)
Benchmarking data from January 2021 (latest benchmark) shows DCCG performance was below the England average in 7 specialties, Cardiology, General Medicine, Neurology, Ophthalmology, ENT, Urology and Trauma & Orthopaedics. The waiting list shape for Doncaster CCG patients at any provider is shown below. The CCG monitors the waiting list weekly and is in regular contact with DBTHFT and North Lincolnshire and Goole Foundation Trust for the most up to date position on patients waiting over 40 weeks, in order to try to reduce long waiters, including those who may breach 52 weeks.
7 Doncaster CCG patients on incomplete RTT pathways on 28th February 2021 2000 1800 1600 1400 1200 1000 800 600 400 200 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52+ Weeks waiting
DBTHFT’s February 2021 position deteriorated to 61.8%. Nineteen specialties failed to meet the 92% standard:
• Breast Surgery (95.6%) • Cardiology (87.7%) • Clinical Haematology (95.0%) • Dermatology (92.8%) • Diabetic Medicine (90.4%) • Ear, Nose & Throat (51.3%) • General Medicine (79.5%)
8 • General Surgery (62.3%) • Geriatric Medicine (87.1%) • Gynaecology (82.0%) • Medical Ophthalmology (72.7%) • Nephrology (91.8%) • Ophthalmology (50.5%) • Oral Surgery (64.0%) • Orthodontics (70.1%) • Paediatric Cardiology (92.0%) • Paediatrics (95.2%) • Pain Management (79.7%) • Podiatry (59.5%) • Respiratory Medicine (87.2%) • Rheumatology (92.4%) • Trauma and Orthopaedics (T&O) (47.8%) • Upper GI Surgery (36.8%) • Urology (48.4%) • Vascular Surgery (74.2%)
There are many issues that have affected Referral to treatment target for DBTHFT. These include:
Outpatient departments with reduced capacity for face-to face activity due to COVID Safe Working, and Respiratory and Pain management activity reduced to accommodate staff supporting wards with Covid-19 demand. There has been additional shielding guidance for staff affecting service delivery across some areas. As part of the Mutual aid arrangements DBTHFT agreed to treat Out of area category 2 patients.
As part of the DBTHFT recovery plan, there are many approaches being taken.
DBTHFT implemented an improvement plan on 8th March 2021, with over 3000 letters being sent out to long waiting patients. To date only 38 patients have responded with 5 of these patients request to be removed from the list. This will be rolled out to other specialties. Insource and outsourcing plan is being developed to assist the backlog for recovery of patients waiting over 52 weeks.
9 A single patient list is being developed to ensure that all patients are visible and effectively managed with completion at the end of March 2021. There is a plan for theatre step up between March and May Elective operations will be stepped up to support the management of routine operations in line with all performance standards. A cancelled Operations Group are working towards a standardised approach to managing cancelled operations for both theatre and non- theatre activity.
There is a capacity assessment underway due to be completed 31st March. North England Commissioning Support (NECS) are currently involved with cleansing the active waiting list, with a net reduction of 2394 off the PTL (Patient Tracking List).
The capacity planning work with Foureyes is progressing, with completion due March 2021. This will provide a more detailed and robust capacity plan for all elective areas enabling more accurate recovery planning for 2021/22 to be monitored through the Performance Assurance Framework.
10
The graph is showing Doncaster CCG activity against the trajectory in the phase 3 plan that was submitted to NHS England. Less activity going through hospitals means the waiting list size will increase as fewer patients are being seen. The follow up ratios are being affected by COVID and the mix of activity going through DBTHFT, with little activity in Patient Led Follow-up. DBTHFT are hoping more specialities will be rolled-out (and hence less patients are followed up in the longer term).
11 1.1.2 Waiting List Size (OF)
Doncaster registered patients on incomplete RTT pathways 26000
24000
22000
20000
18000
Jul-19 Jul-18 Jul-20
Jan-19 Jan-20 Jan-21
Jun-19 Jun-18 Jun-20
Oct-18 Oct-19 Oct-20
Apr-18 Apr-19 Apr-20
Sep-18 Feb-19 Sep-19 Feb-20 Sep-20 Feb-21
Dec-18 Dec-19 Dec-20
Aug-18 Aug-19 Aug-20
Nov-18 Nov-19 Nov-20
Mar-19 Mar-20
May-18 May-19 May-20
Doncaster CCG Target
The expectation nationally has been revised to ensure that the number of patients on incomplete pathways is maintained below or at the waiting list size at the end of January 2020 by March 2021. The number of DCCG patients on incomplete RTT pathways decreased in February 2021 by 512 patients to 23222. This exceeds the waiting list target (22206) by 1016 patients. The Trust are currently working with North of England Commissioning Support Unit (NECS) to work on cleaning up the Patient Tracking List (PTL) and validating all the Patients on the PTL. The latest position shows a net reduction of 2394 patients.
1.1.3 52 Week Breaches (OF)
52 Week Waits –Incomplete Pathways
Provider Feb-20 Mar-20 Apr-20 May-20 Jun-20 July-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21
Doncaster CCG 0 0 6 20 50 104 184 235 281 426 664 1083 1501
DBTHFT 1 1 10 27 52 157 278 345 393 631 986 1635 2272
Target 0 0 0 0 0 0 0 0 0 0 0 0 0
12 The number of breaches has increased since April 2020 primarily due to Covid-19. The number of DCCG patients waiting over 52 weeks increased to 1501 in February 2021. Due the large increase during the month a review of referral numbers has been completed. There was a slightly larger number during February 2020 which may have contributed to this increase in comparison to previous months however no further explanation has been identified other than reduced capacity due to social distancing, elective operations being cancelled and staff being deployed to support COVID. This has meant the Trust has been unable to complete the activity it would have done previously. At the end of April 2021 DBTHFT are hoping to share their trajectory of how they see the number of 52 week breaches reducing and the anticipated time line for these.
Of the people waiting over 52 weeks, 1359 were at DBTHFT, 38 at Sheffield Childrens’s Hospital, 32 at Sheffield Teaching Hospital, 15 at Rotherham Hospital, 8 at Hull University Teaching Hospital, 8 at Leeds Teaching Hospital, 7 at Claremont Hospital, 7 at One Health Group, 5 at North Lincolnshire and Goole Hospital, 4 at Barlborough, 4 each at Barnsley Hospital and Mid Yorks Hospital, 2 at University Hospital of Leicester NHS Trust and University Hospital, Derby and Burton NHS Foundation Trust. Manchester University Hospital, Mid Yorks Hospital NHS Trust and The One Health Group. These other providers just have 1 person who is waiting over 52 weeks; Queen Victoria Hospital, Imperial College Healthcare NHS Trust, Cambridge University Hospital NHS Foundation Trust, University College London Hosital NHS Foundation Trust, Harrogate and District NHS Foundation Trust, Nottingham University, York Teachng Hospital, Aspen - Parkside Hospital, Mid and South Essex Foundation Trust, and Barts Health NHS Trust.
The graph below shows the number and length of waits as at February 2021.
Number of patients on RTT pathway who have waited over 52 weeks 160 140 120 100 80 60 40 20 0 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 86 87 88 89 93 105
The table below gives the breakdown of the total breaches for DCCG in February by specialty:
13
Ear, Nose & General General Plastic Thoracic Trauma & Provider Cardiology Throat (ENT) Medicine Surgery Gynaecology Neurosurgery Ophthalmology Other Surgery Rheumatology Medicine Orthopaedics Urology Total
DBTHFT 5 124 2 165 13 111 50 2 656 231 1359
Other provider 4 5 6 8 2 8 54 5 1 40 9 142 Total 9 129 2 171 21 119 104 5 2 696 240 1501
DBTHFT are currently reporting 2272 people waiting 52 weeks or longer for treatment at the end of February 2021.
1.1.4 Diagnostics (OF)
Patients waiting less than 6 weeks for a Diagnostic test
Commissioner Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21
Doncaster CCG 99.2% 90.0% 38.2% 29.2% 36.0% 49.6% 54.7% 58.4% 58.5% 61.8% 60.6% 57.2% 66.3%
Rightcare Peer Group 97.3% 91.8% 38.9% 37.7% 50.5% 61.9% 65.6% 71.7% 76.2% 77.2% 75.3% 74.0%
DBTHFT 99.1% 89.9% 36.9% 28.4% 35.5% 50.0% 54.4% 58.4% 58.8% 61.8% 60.4% 56.1% 66.3%
England 97.2% 89.8% 44.6% 41.5% 52.2% 60.4% 61.9% 66.9% 70.8% 72.5% 70.8% 66.7%
Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%
14 Patients waiting less than 6 weeks for a diagnostic test 100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
0%
Jul-20 Jul-17 Jul-18 Jul-19
Oct-19 Apr-17 Oct-17 Apr-18 Oct-18 Apr-19 Apr-20 Oct-20
Jun-17 Jan-18 Jun-18 Jan-19 Jun-19 Jan-20 Jun-20 Jan-21
Mar-18 Mar-19 Mar-20
Feb-18 Feb-19 Feb-20 Feb-21
Nov-18 Aug-17 Sep-17 Nov-17 Dec-17 Aug-18 Sep-18 Dec-18 Aug-19 Sep-19 Nov-19 Dec-19 Aug-20 Sep-20 Nov-20 Dec-20
May-17 May-18 May-19 May-20 % waiting under 18 weeks Avg LCL Target
Performance for DCCG in February 2021 improved to 66.3% of patients waiting less than 6 weeks for a test (3071 breaches) below the 99% target. Performance is below the statistical process control limits on the chart above which indicates performance is outside the normal variation expected for the service. Since March performance has been severely impacted by the COVID-19 pandemic.
DBTHFT’s February 2021 position improved to 66.3% against a standard of 99%. The table below shows the diagnostic modalities that were impacted by Covid-19. Due to the National and Local response to the pandemic from 18th March 2020 the majority of the Trust’s routine activity ceased limiting their ability to see patients already in the system and those referred in within the 6- week timeframe. There has been an increase in 2ww referrals, urgent and routine referrals for both Magnetic Resonance Imaging (MRI) and Non-Obstetric Ultrasound (NOUS) at DBTHFT since December 2020. This has added to the substantial backlog of patients waiting for NOUS and MRI caused by staffing shortfalls over a prolonged period.
The recovery plan is for the mobile MRI unit to do additional days in March with further additional sessions to be run in-house. Additional sessions have been agreed throughout March 2021 in other challenged modalities. Staff vacancies have had approval to be recruited to.
15 Due to COVID SAFE guidelines most modalities are not able to deliver pre-Covid activity levels. There has been a slight improvement in performance during February compared to the previous month. Services have been adversely affected by COVID related absences, administration, impacting booking and pre-calls.
Full details of individual testing pathways are shown in the table below.
Exam Type <6W >=6W Total Performance MRI 1504 92 1596 94.24% CT 1550 413 1963 78.96% Non-Obstetric Ultrasound 3976 2808 6784 58.61% DEXA 227 31 258 87.98% Audiology 163 307 470 34.68% Echo 181 4 185 97.84% Nerve Conduction 157 58 215 73.02% Sleep Study 12 0 12 100.00% Urodynamic 58 40 98 59.18% Colonoscopy 357 248 605 59.01% Flexible Sigmoidoscopy 90 103 193 46.63% Cystoscopy 238 78 316 75.32% Gastroscopy 425 360 785 54.14% Total 8938 4542 13480 66.31%
16 1.1.5 A&E attendance to admission, transfer or discharge (OF)
A&E attendances under 4 hours from arrival to admission, transfer or discharge
Provider Feb-20 Mar-20 Apr-20 May-20 June-20 Nov-20 Dec-20 Jan-21 Feb-21 Jul-20 Aug-20 Sep-20 Oct-20 DBTHFT (all attendances, based on 85.4% 88.0% 90.9% 94.7% 93.2% 91.9% 88.8% 82.6% 76.0% 76.9% 79.0% 80.7% 80.4% daily reported figures)
DBTHFT (Type 1 attendances) 80.4% 84.4% 92.5% 93.9% 91.7% 90.0% 85.7% 78.1% 70.8% 71.8% 74.9% 76.7% 75.3%
England (all attendances) 82.8% 84.2% 90.4% 93.5% 92.8% 92.1% 89.3% 87.3% 84.4% 83.8% 80.3% 78.5% 77.4%
Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
17 Performance remains under target during February with a slight decrease to 80.4% during the month. Performance remains below statistically anticipated levels within the service. Performance for February was 3% above the England average.
Covid-19 has continued to impact on both EDs with Departments split into 2 areas to manage 2 simultaneous pathways responding to Covid-19 symptoms and non-Covid-19 symptoms.
There were 11025 attendances in February which is fewer than in January but surges with high number of attendances within short timeframes placing additional demand on the service during the month. Some issues were also encountered through Covid-19 specific pathways where some discharges were delayed while awaiting test results to ensure safe discharges. Waits for doctors and beds made up the majority of delays in month with the latter also leading to a higher number of delays for handovers from paramedics.
Weekly escalation discussions are in place between the Trust and the Yorkshire Ambulance Service to address ‘batching’ concerns in a wider ‘System Forum’. Both sites are seeing an increase in both inappropriate and escalated acuity attendances with patient feedback indicating inability to access face to face primary care consultations. Ongoing discussions with the CCG continue to highlight concerns.
Ongoing work continues with the Teams to build and embed relationships and foster more effective patient pathways both within the Division and in the wider Trust. This is a long term project.
1.1.6 Cancer Measures
DBTHFT are participating in the testing phase of the Clinically-led Review of Standards (CRS) for cancer as 1 of 13 sites nationally. As part of the testing there will be a change in reporting with 2 week wait for Breast Symptomatic reporting no longer available for the Trust to be benchmarked. An additional Faster Diagnosis Standard will be trialed during this period and is defined as a ‘Maximum four weeks (28 days) from receipt of urgent General Medical Practitioner, General Dental Practitioner or Optometrist referral for suspected cancer, breast symptomatic referral or urgent screening referral, to the point at which the patient is told they have cancer, or cancer is definitely excluded’.
Work has been completed across Intelligence Teams within the Integrated Care System to ensure that the impact of Covid-19 can robustly be monitored in relation to cancer treatment. From April 2020 onwards Trusts have been requested to assign Covid-19 related 2 week wait breaches to ‘Other Reason’ which will include, anyone diagnosed with Covid-19, isolating due to symptoms or family reasons and capacity attributed directly to Covid-19. For all other measures ‘Other reasons’ relate to all miscellaneous reasons.
18 2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP
Apr- May- Jun- Q1 Aug- Sep- Q2 Oct- Nov- Dec- Q3 Jan- Commissioner Jul-20 20 20 20 20/21 20 20 20/21 20 20 20 20/21 21
Doncaster CCG 92.5% 97.9% 95.5% 95.5% 90.0% 86.8% 88.8% 88.5% 91.5% 79.6% 80.7% 83.8% 70.6%
Rightcare Peer Group 83.8% 96.5% 96.2% 93.1% 96.1% 92.8% 93.37 94.1% 94.6% 93.8% 95.6% 94.7% 93.5%
Cancer Alliance 89.1% 98.0% 95.7% 94.7% 95.0% 92.0% 96.4% 93.7% 95.5% 90.4% 90.4% 92.0% 83.9%
England 88.0% 94.2% 92.5% 92.0% 90.4% 87.8% 86.2% 88.0% 87.9% 87.0% 87.54 87.5% 83.4%
Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%
19 Performance in January 2021 was below the target of 93% at 70.6%. There were 283 breaches within January 2021 with the majority of those being outpatient capacity inadequate (148). The remaining breaches were split into ‘Other (80) of which were associated to Covid- 19, 'patient choice (25), admin delay (24) and clinic cancellation (6). The breaches were split across the following 9 tumour groups; Breast (216), Urology (26), Upper GI (15), Skin (12), Head and Neck (6), Gynaecology (3), Lower GI (2), Lung (2) and children’s cancer (1). There were 7 tumour groups that performed below the 93% threshold respectively, Breast (5.7%), Children (50%), Urology (67.5%), Upper GI (83.1%), Head and Neck (90.5%), Skin (92.2%) and Lung (92.3%).
The longest an individual had to wait to be seen was 58 days and this was due to an “patient choice”
In January 2021, there were a total of 962 people seen within January, which is in line with pre-Covid level of patients seen
Due to an increase in referrals at Barnsley and Rotherham hospital there is currently no capacity for Mutual Aid, to help DBTHFT out. The Trust are currently looking into running ‘Super Saturday sessions’ in April where additional clinics are planned, with up-to 40 patients being invited to attend. The main priority for the trust is reducing the number of patients that are waiting over 28 days for their first- appointment. The Trust is hoping to have caught up with the backlog by April 2021.
The Performance Intelligence Team are working closely with the Cancer Team at DBTHFT monitoring cancer referrals, showing that referrals and booked appointments are starting to recover to normal volumes from the first week of June. The numbers of referrals increased in August, and this pattern has continued into December showing an increase of 20% above pre-Covid average referral levels. All waits above target are monitored and discussed at the Cancer Programme Board.
20 2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)
Apr- May- Jun- Q1 Aug- Sep- Q2 Oct- Nov- Dec- Q3 Jan- Commissioner Jul-20 20 20 20 20/21 20 20 20/21 20 20 20 20/21 21
Doncaster CCG 100% 87.5% 88.9% 93.1% 100% 100% 80.6% 85.1% 59.6% 18.2% 3.6% 26.7% 28.6%
Rightcare Peer Group 89.1% 88.2% 85.8% 87.4% 93.3% 95.4% 82.6% 90.0% 94.0% 83.5% 88.8% 88.4% 82.7%
Cancer Alliance 90.9% 97.4% 98.1% 95.7% 93.3% 90.6% 88.6% 90.7% 86.4% 76.3% 80.1% 81.0% 74.4%
England 80.9% 93.7% 90.6% 89.5% 86.4% 82.3% 77.2% 81.9% 77% 67.8% 67.0% 70.4% 62.7%
Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%
The Breast Symptomatic 2 week wait data is excluded from the 2week wait measure for suspected cancer measure.
Performance in January 2021 was below the target of 93% at 28.6% due to the 10 breaches within the month, due to outpatient capacity inadequate. There has been an increase in referrals into the breast service this month, with the numbers referred remaining under previous baselines for 2019/20. The main impact of the breaches has been due to social distancing and a reduction in the number of radiographers that are currently working. The Breast service worked with other providers for 1 day in January and February, where patients attended other providers for their first outpatient appointment to enable DBTHFT to reduce the number of patients waiting to be seen. It is anticipated that March position for breast screening will improve, due to the revised social distancing work that has been carried out by the breast team, with an additional 30 slots being available per week.
21 Maximum four weeks (28 days) from receipt of urgent General Practice (General Medical Practitioner, General Dental Practitioner or Optometrist) referral for suspected cancer, breast symptomatic referral or urgent screening referral, to point at which patient is told they have cancer, or cancer is excluded. Commissioner Apr- May- Q1 Aug- Q2- Dec Q3 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Jan-21 20 20 20/21 20 20/21 20 20/21 Doncaster CCG 72.1% 85.5% 82.7% 80.5% 79.7% 73.5% 76.8% 76.8% 74.0% 73.0% 70.9% 86.9% 47.7%
The standard operating contract for the 2020/21 financial year indicated that the 28 Day Faster Diagnosis Standard (FDS) performance target will be held at 75%. However, after discussions with local services, it has been agreed to maintain the local target of 80%. During the Covid-19 pandemic the national pilot period for 28 Day FDS has been paused but Trusts are still required to report against performance.
Doncaster CCG achieved 47.7% against the 75% national target and 80% local target. There were a total of 1024 patients notified of the outcome for diagnosis with 536 being more than 28 days. When breaking down the patients into cohorts, those that received confirmation of diagnosis (31 patients) 57% were notified within 28 days. For those that had a ruling out of cancer (457 patients) 47.2% of patients were notified within 28 days.
The two main specialties that are contributing to this dip in performance are Lower GI (163 breaches) and Breast (187 breaches). For Lower GI, it is the time taken for Histology to be reported which has now improved to 4 weeks, and for Breast it is the time that patients are waiting for their first appointment.
31-day wait from diagnosis to first definitive treatment for all cancers May- Q1 Aug- Q2 Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan 21 20 20/21 20 20/21 20/21 Doncaster CCG 92.9% 92.9% 99.0% 94.8% 99.2% 97.2% 95.5% 97.3% 97.6% 95.6% 97.9% 97.0% 96.5%
Rightcare Peer Group 97.9% 95.4% 94.6% 96.1% 96.3% 95.4% 94.9% 95.5% 97.2% 95.9% 96.9% 96.7% 95.7%
Cancer Alliance 95.7% 94.2% 96.5% 95.5% 96.1% 95.7% 95.2% 95.6% 96.8% 96.0% 97.1% 96.6% 96.4%
DBTHFT 98.5% 97.9% 100% 98.8% 99.2% 100% 96.0% 98.0% 100% 96.7% 99.3% 98.7% 97.4%
England 96.3% 93.9% 93.8% 94.7% 95.1% 94.5% 94.5% 94.7% 95.7% 95.2% 96.0% 95.6% 94%
22 Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%
31-day wait from diagnosis to first definitive treatment for all cancers 100% 98% 96% 94% 92%
90%
Jul-17 Jul-18 Jul-19 Jul-20
Oct-19 Apr-17 Oct-17 Apr-18 Oct-18 Apr-19 Apr-20 Oct-20
Jun-17 Jan-18 Jun-18 Jan-19 Jun-19 Jan-20 Jun-20 Jan-21
Mar-18 Mar-19 Mar-20
Feb-18 Feb-19 Feb-20
Dec-18 Aug-17 Sep-17 Nov-17 Dec-17 Aug-18 Sep-18 Nov-18 Aug-19 Sep-19 Nov-19 Dec-19 Aug-20 Sep-20 Nov-20 Dec-20
May-17 May-18 May-19 May-20
% of people referred with cancer treated within 31 days Avg LCL Target
Performance in January 2021 was 96.5% against the 96% target. There were 4 breaches spread across the following 4 tumour groups; Gynae, Upper GI, Lower GI and Urology. The 3 breaches in surgery were attributable to DBTHFT due to ‘Other reason’ as the patients all had to self- isolate before surgery and 1 Radiology breach with STH as treating provider due to patient choice. The longest an individual had to wait for first treatment was 37 days due to patient choice in the Upper GI tumour group. In January 2021, there were a total of 113 patients treated which is in line with pre-Covid level of patients treated.
It is expected that the impact of the Covid-19 pandemic on treatments will be seen in the coming months as the total number of patients requiring a first treatment increases.
23 31 day wait for subsequent treatment May- Q1 Aug- Q2- Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 20 20/21 20 20/21 20/21 Surgery - Doncaster 100% 90.3% 100% 94.9% 96.3% 92.9% 90% 92.8% 95.0% 94.4% 94.4% 94.6% 95.5% CCG Radiotherapy - 95.4% 93.3% 78.3% 88.8% 85.5% 89.3% 91.9% 88.2% 91.7% 97.1% 100% 96.4% 100% Doncaster CCG Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% Drug Regimen - 100% 87.0% 97.8% 95.5% 100% 100% 100% 100% 100% 100% 100% 100% 100% Doncaster CCG Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%
In January 2021, Surgery, Drug Regimens and Radiotherapy all performed above the expected 94% and 98%, respectively. The 1 breach reported in Surgery was due to elective capacity inadequate in the tumour group Urology.
62-day wait from urgent GP referral to first definitive treatment for cancer (OF) May- Q1 Aug- Q2- Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 20 20/21 20 20/21 20/21 Doncaster CCG 72.6% 72.5% 94.0% 80.1% 91.5% 72.5% 71.0% 77.8% 63.4% 71.9% 79.2% 71.7% 66.7%
Rightcare Peer Group 78.7% 73.5% 75.1% 76.0% 77.7% 77.2% 75.2% 76.6% 76.8% 75.6% 72.2% 74.8% 69.5%
Cancer Alliance 77.6% 71.7% 78.6% 76.2% 74.1% 72.4% 67.4% 71.1% 66.8% 68.6% 68.8% 68.0% 61.9%
DBTHFT 79.3% 81.6% 93.7% 84.4% 79.6% 79.5% 74.9% 79.9% 66.7% 79.2% 81.4% 78.1% 76.3% Sheffield Teaching Hospitals Foundation 67.2% 70.1% 70.9% 67.4% 74.0% 65.2% 60.0% 64.4% 55.8% 61% 59.6% 59.3% 52.66% Trust (STHFT) England 74.3% 69.9% 75.2% 73.3% 78.4% 77.9% 74.7% 76.9% 74.5% 75.6% 75.2% 75.1% 71.2%
Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%
24 62-day wait from urgent GP referral to first definitive treatment for cancer
100% 90% 80% 70%
60%
Jul-17 Jul-18 Jul-19 Jul-20
Apr-17 Oct-17 Apr-18 Oct-18 Apr-19 Oct-19 Apr-20 Oct-20
Jun-19 Jun-17 Jan-18 Jun-18 Jan-19 Jan-20 Jun-20 Jan-21
Feb-18 Mar-18 Feb-19 Mar-19 Feb-20 Mar-20
Dec-20 Aug-17 Sep-17 Nov-17 Dec-17 Aug-18 Sep-18 Nov-18 Dec-18 Aug-19 Sep-19 Nov-19 Dec-19 Aug-20 Sep-20 Nov-20
May-18 May-17 May-19 May-20
% of people referred with cancer receiving subsequent treatment within 62 days Avg LCL Target
Doncaster CCG performed at 66.7% against the 85% target in January 2021 with 17 breaches noted. The breaches were within 8 specialties Breast (1), Gynae (1), Head and Neck (3), lower GI (6), Upper GI (1) Lung (2), Other (1) and Urology (2) tumour groups. The following breach reasons; Other reason (8), Complex diagnostic issues (3), Health care provider initiated a delay to diagnostic or treatment (3), Patient initiated delay to diagnostic test or treatment plan (1) Admin delay (1) and Patient choice relating to first outpatient appointment (1).
There were 2, 104+ day breaches in Lower GI (1) and Head and Neck (1). The Head and Neck breach of 122 days, was due to complex diagnosic pathway with STH as treating provider for surgery. The lower GI breach which is the longest breach of 292 days was due to patient initiated choice to delay diagnostics and treatent plan at DBTHFT. In January 2021, there were a total of 51 people treated which is in line with pre-covid levels.
The 104 plus day breaches are being monitored by Cancer Programme Board and assurances will be provided by the Cancer Leads and will continue to be presented at Clinical Quality Review Group on a quarterly basis. The Performance and Intelligence Team has been in discussion with the Cancer Team at DBTHFT regarding the 62 Day Patient Tracking List (PTL) and current referral levels. The details below provide assurance that DBTHFT are capturing the required patients. The PTL shows the number of patients that have had a first appointment but are still on the pathway without a decision to treat date and therefore can be awaiting diagnostics etc. for either a confirmation or ruling out of cancer.
25 62-day wait from referral from an NHS screening service or Consultant Upgrade to first definitive treatment for all cancers May- Q1 Aug- Q3 Commissioner Apr-20 Jun-20 Jul-20 Sep-20 Q2-20 Oct-20 Nov-20 Dec-20 Jan-21 20 20/21 20 20/21 Doncaster CCG – 100% 0% 50.0% 71.4% 0% 100% 88.9% 75.0% 88.9% 100% 100% 92.9% 58.3% screening service Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Doncaster CCG – 66.7% 71.8% 60.0% 60% 71.4% 60.0% 90% 84.6% 92.3% 68.2% 87.9% 82.3% 86.7% consultant upgrade
January 2021 saw an increase of 50% (6) in the number of screening referrals received by DBTHFT. Doncaster CCG performed at 58.3% against the 90% target, reporting 5 breaches, all in Lower GI. There have been capacity issue with histology as they are outsourced to another provider, currently taking 6 weeks to report back. I believe this position has now improved to 4 weeks.
Doncaster CCG performed at 86.7% against the 85% consultant upgrade target, with a total of 2 breaches in January. The breaches were with Lung and Lower GI. The breach reason being Other. Awaiting narrative from Jackie
26 1.2 NHS National Contract Key Performance Indicators
1.2.1 Yorkshire Ambulance Service (YAS)
June 20 July 20 Aug 20 Sept 20 Oct 20 Nov 20 Dec 20 Jan 21 Feb 21 Category 1 (Life threatening injuries and illness) target of 00:06:59 00:06:59 00:07:23 00:07:45 00:08:42 00:08:13 00:08:03 00:08:00 00:07:08 average time less than 7min Category 1 target 90% of times less than 15 min 00:12:15 00:12:01 00:12:44 00:13:22 00:15:00 00:14:07 00:13:54 00:13:43 00:12:11 Category 2 (Emergency) target of average time less than 18 00:13:37 00:15:34 00:18:30 00:22:43 00:29:13 00:24:35 00:24:03 00:24:30 00:21:24 min Category 2 target 90% of times less than 40 min 00:25:32 00:30:54 00:38:07 00:47:33 01:01:57 00:52:07 00:50:47 00:52:00 00:44:50 Category 3 (Urgent) target 90% of times below 2 hours 00:56:44 01:12:10 01:35:46 02:23:12 03:26:08 02:35:10 02:34:30 02:34:57 02:19:58 Category 4 (Less urgent) target 90% of times below 3 hours 01:45:33 02:12:28 02:48:10 03:04:05 04:09:00 03:23:35 03:45:36 04:08:47 04:02:12 Category 5 (Lowest acuity) target 90th centile Target TBC 00:40:19 00:30:12 00:45:18 01:53:58 01:57:45 01:13:06 01:19:53 01:50:42 01:23:54
With the exception of the Category 1 90th centile measure all measures failed to meet target during January 2021, though there were improvements across all other categories. The target for Category 1 (life threatening) was missed by 8 seconds (average time).
Representatives from YAS continue to attend meetings around joint pathways in Doncaster to ensure that any issues can be addressed and continue to work closely with DBTHFT. Challenges with extensive queueing across all hospitals including Doncaster Royal Infirmary were reported. YAS staff members were based within A&E at the start of December to help reduce handover times and has worked well. In addition, lateral testing for Covid-19 was rolled out for asymptomatic staff during the month.
YAS representatives attending the Daily Partners escalation calls which include all partners in Doncaster.
27 Section 2: Provider Exception Report
The following section of the report details performance by exception (those measures either rated Red or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH and other commissioned services. Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance for DBTHFT and Doncaster sites for RDASH, which does not simply relate to services provided to DCCG. Due to the COVID-19 pandemic NHS England and NHS Improvement have directed NHS organisations to reduce routine reporting requirements to free up capacity and manage responses. Some areas agreed with Providers are included below.
2.1 Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT)
This section only includes measures in the DBTHFT contract currently not meeting target which are not included in the constitution measures in Section 1.
Latest Measure Month Target Update performance
Proportion of December 49.2% 75% 80% Trust level performance for direct admission to patients directly 2020 60% the Stroke Unit within 4 hours, improved slightly admitted to 40% in December 2020 to 49.2% against the 75% hyper acute 20% target (30 breaches out of 59). stroke unit within 0% 4 hours of clock There is ongoing work at DBTHFT around start – No reviewing and updating the Stroke operational Proportion of patients directly admitted to a stroke unit < 4 hours further update Target policies that will be undertaken by the Stroke received Clinical Governance Lead. A stroke improvement group has been established to take this forward. The Inter Cranial Haemorrhage pathway is now in place in the Emergency Department, along with the RAPID software. There is currently a business case being written to expand access to acute MRI to facilitate thrombolysis of “Wake up Strokes” Clinical staffing issues remain, which have impacted on service delivery with 6 WTE nurse vacancies on the stroke unit.
28 2.2 Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)
This section only includes measures in the RDASH contract currently not meeting target which are not included in the constitution measures in Section 1. Latest Measure Month Target Update performance Improving Jan 14.4% 15.3% Performance for access into the service remained Access to 2021 below trajectory in January 2021 at 14.4% Psychological cumulatively. A revised trajectory taking into Therapies account the impact of Covid-19 has been (IAPT) – submitted to NHS England with access targets at Cumulative 4.6%, 4.9% and 5.1% for Quarters 2 to 4. Against percentage of this revised trajectory performance for Q3 was people entering only 0.8% below this aim (290 people). treatment as a proportion of The Service is offering additional telephone and people with digital interventions and a meeting has been anxiety or scheduled with the CCG to discuss recovery into depression (OF) 2021/22 in March 2021. Face to face treatment (RDASH specific has been ceased at the current time. DCCG data) IAPT – The Jan 52.6% 50% The service will continue to be monitored with the percentage of 2021 Trust through Finance, Performance and people who Information Groups held with DCCG. have completed treatment are The recovery rate and waiting time targets for the moving to service were both on track in January. recovery
IAPT – The Jan 93.0% 75% percentage of 2021 people who received treatment within 6 weeks of referral (incomplete treatment)
29 2.3 Joint Pathway
Latest Measure Month Target Update performance Dementia – the Dec 20 64.1% 67% The percentage of people estimated to have percentage of dementia in Doncaster who have received a patients diagnosis increased in January 2021. This estimated to pathway includes both DBTHFT and RDASH have Dementia with diagnostic testing and consultant services within Doncaster required. Covid-19 has impacted the ability to who have provide computerised tomography (CT) scans received a and face to face assessments which means diagnosis diagnoses have slowed since April 2020.
Resumption of scanning has resumed with the pathway altered to RDASH staff visiting patients in home settings to reduce risk.
A meeting between DBTHFT and RDASH staff has been arranged to discuss this pathway and how to effectively prioritise patients to provide positive outcomes, though capacity has been impacted by ongoing pressures related to Covid- 19. RDASH have been requested to share their patient lists with the Doncaster GP Practices to ensure that registers are accurate.
30 Section 3 Phase 3 NHS England Submissions
Following the submission of trajectories and activity across a range of measures, for DCCG, to NHS England (NHS E) in September 2020 a number of areas were identified as risks for achievement. These measures have been included below for monitoring and performance management going forwards with the exception of IAPT, Cancer and RTT which have been included in the Provider sections of this report.
3.1 Serious Mental Health (SMI) Physical Health checks (annual rolling figure)
As at the end of Quarter 3 2020/21 there have been a total of 29.4% (slight improvement from 29.0%) (665 people) of people on a GP register with SMI who have had a completed physical health and remains above the England average of 21.6%. A trajectory of 1350 by March 2021 has been submitted (60.4%) to NHS E. A new pathway across Primary Care and RDASH is due to begin in Quarter 3 which will allow increased capacity and sharing of data which will ensure a robust and accurate performance figure is available. There has been an issue of recording onto some GP systems from RDASH staff and this will be raised through contracting meetings to ensure that this is resolved during Q4.
3.2 Mental Health - The number of inappropriate Out of Area Placement bed days for adults
The trajectory submitted to NHS E aims to reduce inappropriate beds days to 270 days by the end of March 2021, with most recent figures at December at 645 days (over a rolling 3-month period), a increase of 15 days from the previous timeframe (now 5 patients). Due to Covid-19 there has been a nationwide slowing of transfers of patients as it has provided difficult to discharge patients home because of reduced community services. RDASH’s Chief Operating Officer now has weekly meetings with ward managers key personnel.
3.3 Number of women accessing specialist community perinatal mental health services
A trajectory has been submitted for the remainder of 2020/21 which aims to have 4.5% of women accessing the service on a rolling 12- month basis. This is below the aspiration of 7% indicated nationally. Currently information for 2020/21 is being developed and validated.
3.4 The number of adults (18 and over) who have a Learning Disability and/or autistic spectrum syndrome that are in inpatient care for mental and/or behavioural healthcare needs.
A trajectory has been submitted to reduce the number of adults in an inpatient setting to 5 or fewer by the end of March 2021. As of December there were 9 people identified within these settings. Work continues to identify appropriate placements within community
31 settings and risk review meetings are in place with a multi-disciplinary team to ensure that appropriate actions are in place to stop the escalation in acuity of people already within the community.
3.5 The number of Annual Health checks carried out for person aged 14 plus on GP Learning Disability Resisters
As at Quarter 2 (latest information) 178 people with Learning Disabilities had received their annual health check. During the quarter GPs and other health care professionals had taken opportunities to complete checks through other appointments available as there was an impact by Covid-19. A revised trajectory has been submitted to raise the number of checks to 360 by March 2021. This is below the stated aim at the start of 2020/21 however it is unlikely that services will have the capacity to fulfil more checks at the current time.
Section 4 Other Quality Elements
Safeguarding
Safeguarding Adult Reviews / Rapid Reviews
There has been 1 new Safeguarding Adult Review commissioned during this reporting period. It should be noted that due to the complexities of the review considerations continue to take place with the chair in relation to further review processes.
There have been no new Rapid Reviews commissioned during this reporting period.
Doncaster CCG continues to support the Safeguarding Adult Reviews and Rapid Reviews that remain on going within the partnership.
Lessons Learnt Reviews
There have been no new Lessons Learnt Reviews commissioned by the Doncaster Safeguarding Adults Board during this reporting period.
Domestic Homicide Reviews
Since the last Governing Body, there have been no further Domestic Homicide Reviews considered or commenced. Doncaster CCG continues to support the three reviews that are underway.
32 Meeting name Governing Body Meeting date 1st April 2021 Title of paper Ageing Well Life Stage Report
Joanne Forrestall, Head of Strategy & Delivery Executive / Clinical Lead(s) Performance and Intelligence Team Author(s)
Status of the Report
To approve To consider / discuss
To note x
Purpose of Paper - Executive Summary This report sets out the key quality and performance updates to be noted by the Governing Body from the quarterly updates provided by DCCG and Doncaster Council staff in relation to the Ageing Well Life Stage Strategic Delivery Plan. This report reflects 2020/21 performance and delivery areas.
Please note all data is validated and quality checked internally within DCCG and with Providers as necessary. Where there is a data quality concern on any of the data or metrics presented in the following report, this will be stated in the narrative accompanying the data.
All Ageing Well actions were reviewed in respect of COVID-19 and The Phase 3 NHS Response. As a result, several actions were either delayed or superseded by new actions.
Of the 30 actions, 4 are overdue and have been listed at the beginning of each section:
• Care Home Action Plan • Integrated Neighbourhood Delivery Model • Stocktake of Personal Health Budgets • Increase use of respite care & uptake of training for informal carers
15 actions have been delayed due to COVID-19.
Of the performance indicators within this life stage the following are off track against target:
• People aged 65 and over being admitted to hospital as an emergency • People aged 65 and over being admitted to hospital with a hip fracture • Percentage of people with Dementia who have been diagnosed
Recommendation(s) The Governing Boday is asked to:
Note the key quality performance areas for attention.
33
Report Exempt from Public Disclosure
If yes, detail grounds for exemption: Yes No x
Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report.
Tick relevant box
An Equality Impact Analysis/Assessment is not required x for this report.
An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Equality Governance / Corporate Governance Manager. As a impact result of performing the analysis/assessment there are no actions arising from the analysis/assessment.
An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability Nil impact Financial Nil implications Legal Nil implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details.
Consultation / Engagement (internal N/A departments,
clinical,
stakeholder and public/patient) Report N/A
34 previously presented at Risk Risks are captured in the Executive Summary. analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework
35
Section 1: Ageing Well Delivery Plan 2020/21
1:1 Actions
Completion Action Due Date Update (%) Recovery of Services due to COVID-19 Following on from the 31/12/2020 70% Review of Enhanced Health in Care Homes has commenced, this will provide focussed work during recommendations of future development areas which will be included within COVID-19 develop a robust 21/22 Ageing Well delivery plan Care Home action plan to include Quality including Integrated Personal Commissioning (IPC), Contracts, Enhanced Health in Care Homes (EHCH), Workforce Development & Training, Digital, Data. Building on progress to date 28/02/2021 70% By quarter 4 the following actions have been completed: on the Integrated • Presentations have been delivered to the Engagement Experience neighbourhood delivery Committee, the Horizon Policy Group (November) and the CCG model, develop an action Governing Body in December – all received positively and have plan to promote an Age resulted in some new links going forward particularly around Friendly vision for engagement Doncaster and deliver the agreed the outcomes for • A high-level implementation plan is in development and will our older population facilitate actions for 2021/22 • Links have been made with neighbouring areas to share good practice • Links are being explored with the Town Centre/Quality Streets Team regarding town centre improvement schemes • A list of potential stakeholders is being developed as a result of the recent conversations
36
Undertake a local review of 31/12/2020 100% Local assessment service has been commissioned and has started to receive the potential longer-term referrals. Further work is required to embed delivery and increase awareness care needs of COVID-19 across stakeholders. Monitoring performance in line with National Guidance will patients discharged also ensure that we can monitor equity of service offer. following an acute episode and assess against local services provision in line with “After-care needs of inpatients recovering from COVID-19" guidance
In light of the national 31/03/2021 20% The Provider Alliance is undertaking a Strategic Review to identify the longer- directed changes to the term approach for Intermediate Care for the next 3-5 years. However, some work discharge process align the is progressing with a review of Rapid Response, Community Therapies, ongoing review against Short Term Enablement Programme (Steps) and Reablement and Bed usage. Intermediate Care requirements and work with providers to implement the specified Intermediate Care service model.
In line with National To be 100% Assessments were recommenced in line with national directive. As a result of guidance from 1st Sept confirmed COVID-19, the assessment process is delivered using a combination of face-to- reinstate Continuing Health face review and Digital multi-disciplinary teams (MDTs). This enables full Care (CHC) assessments in participation of professionals and representatives. partnership with Doncaster Council and undertake a review of all patients discharged between 19 March 2020 and 31 August 2020, to align ongoing requirements of support package
37
Ongoing review of 31/03/2021 15% This work has been significantly delayed due to ongoing COVID-19 demand Rotherham, Doncaster & South Humber NHS Foundation Trust (RDaSH) community services as part of Reset/Recovery
Low level interventions, based in our neighbourhoods In line with the Long-Term 31/12/2020 50% On-going review of PHBs in place, opportunities to deliver PHBs explored Plan requirements through ongoing case management function. undertake full stocktake of current position of Personal Health Budgets and develop a plan to increase uptake Improve recognition of and 30/11/2020 100% Doncaster’s Carers Action Group- in place- carers seeking system improvements support for carers before carers rights day
• Increase use of respite 31/08/2020 40% Carers-Time-For-You operating model under development to have a short break care or access activities and interests at a lower threshold to reduce barriers to support
• Increase uptake of training 28/02/2021 40% Carers Training has faced challenges through the pandemic. Online training is for informal carers available to those who are able to access
Carer’s who are over 50- online 12-week wellbeing workshops available in East Area of Doncaster
38
Increase referrals to 31/12/2020 100% Service reach continues to increase. Service review expected Q1 2021/22 to Improving Access to modernise / reflect on COVID-19 delivery and next steps necessary to achieve Psychological Services trajectory growth rate (IAPT) services (specifically in relation to Frailty) • Scope opportunities for Long Term Conditions (LTC) offer Development of a Be Well 31/03/2021 70% In Quarter 4 the following milestones have been achieved: Doncaster (previously • All Be Well coaches have now been recruited and commenced in Healthier Doncaster) model post from January 2021. The new staff are embedded in the Well /business case to explore a Doncaster team alongside the full-time co-ordinator who was new opportunity for an appointed in quarter 3 integrated approach to wellness services in • Co-design workshops for designing the website portal are now Doncaster and by doing so underway and this is informing the development of the website supporting and developing portal. A Communications and Marketing provider has been the ageing well prevention procured to develop resources. agenda and promoting • Training is now underway for all new staff and links established positive messages around with Primary Care Networks ageing. • In the absence of the live portal a referral system is being agreed across all three Primary Care Networks (PCNs) and due to go live for referral in March. • Better Care Fund (BCF) returns and budget reviews are underway in view of planning for year 2 and beyond.
Formally establish a Social 31/03/2021 Update not received Isolation and Loneliness Alliance
39
Increase uptake in Direct 31/03/2021 30% Assumptions are that we will continue to see a reduction or very little increase in Payments in relation to new recipients of a Direct Payment (DP). We are also seeing people transferring Ageing Well to a commissioned service. This is associated with current behaviour where people have very little desire or confidence in recruiting a Personal Assistant (PA) with the lack of contingency planning related to COVID-19 related issues. The number of direct payments has reduced from 921 agreements for week ending 13/12/2020 down to 903 for week ending 28/02/2021. The number of agreements in place are much lower than they were for the same period last year.
Continue to promote 31/03/2021 This action has been delayed due to COVID-19 dementia awareness and prevention initiatives in line with the dementia deep dive recommendations Review existing Forest 31/10/2020 75% Notice issued in line with JCOG / JCMB decision Q4 2019/20 Gate service offer and consolidate with existing This action has been delayed due to COVID-19 respite and day opportunities
To appoint a Joint To be This action has been delayed due to COVID-19 Partnership Manager post confirmed to carry out a service review of the Community Equipment Service to inform future commissioning intentions
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Co-ordinated access to services when needed Ensure existing Rapid 31/10/2020 100% Completed. Response adheres to operating framework Yorkshire Ambulance Service (YAS) engagement will be further strengthened as guidance for 2 hour part of the Community Assessment Service (CAS) development response. Engage with Yorkshire Ambulance Service (YAS) to further promote usage
Market position statement To be Update not received for non-statutory providers confirmed re digital requirements aligned with Doncaster Place Digital Strategy
Further development and increase utilisation of Integrated Digital Care Record (iDCR)
Further align community 31/03/2021 This action has been delayed due to COVID-19 Single Point of Access (SPA) with Integrated Support and Assessment Team (ISAT) and Community Assessment Service
41
Holistic delivery of care and support Post Diagnostic Dementia 20% This action has been delayed due to COVID-19 Support- following the deep dive, implement outcomes which will improve access and service capacity, and better integration with the broader care system by:
A new model for Cognitive 31/03/2021 Notice served, model to be developed for market engagement during 2021. Stimulation Therapy Service and equity review 30/09/2020 Reviewing progress with DMBC lead. of Young Onset Dementia
MDT planning 30/09/2020 Options appraisal undertaken, timeline and approach to be proposed for consideration alongside CMHT / PCN functional reform Reshaping of the pre- and 30/06/2020 post-offer reconfigured across Primary Care Networks (PCNs) and aligned to physical health services
Implementation of the joint 01/04/2020 This action has been delayed due to COVID-19 Care Homes contract and ongoing joint contractual Also awaiting publication of the 2021-22 NHS Contract in order to move this management forward. • To include implementation of quality toolkit and consideration of roll out across Domiciliary Care
42
Implement E-bag with 30/06/2020 This action has been delayed due to COVID-19 DBTH
Acute psychiatric liaison - 30/06/2020 This action has been delayed due to COVID-19 realise benefit of increased investment to create an all- adult age integrated functional / organic / Drug & Alcohol psychiatric liaison team operating on the DRI site - develop system action plan which will include physical health community solutions
Explore the opportunities 31/05/2020 This action has been delayed due to COVID-19 for a jointly commissioned, pooled budget for community Occupational Therapy to provide practical support to empower people to facilitate recovery and increase people's independence.
Develop option appraisal for 31/10/2020 future delivery
43
Aligned to the Long-Term These actions have been delayed due to COVID-19 30/06/2020 Plan continue to review opportunities to transfer care into community settings and alignment to place plan and Primary
Care Network Directed
Enhanced Service (DES)
Continence prescribing and 30/04/2020 patient management
Explore opportunities for 31/05/2020 stoma patient management
Wheelchair service review 31/05/2020 (Adults and Children)
Develop Business Case 30/09/2020 This action has been delayed due to COVID-19 and implement delivery for complex care in Care Homes
44
31/03/2021 30% This action has been delayed due to COVID-19
Primary: Unwarranted variation being explored with Primary Care Network (PCN) Clinical Directors Dementia Deep Dive - Primary and Secondary Reconciliation of Rotherham, Doncaster & South Humber NHS Foundation Trust care development (RDaSH) diagnosed v GP practice Quality & Outcomes Framework (QOF) - Primary - co produce best register underway. practice opportunistic identification protocol to aid diagnosis, embed across Review to then inform best practice development and implementation networks, eliminate diagnosis rate variance within Primary Care Networks (PCNs) - Secondary - co-produce Secondary: decision support tool and clarify referral guidance to Options appraisal undertaken, timeline and approach to be proposed for primary care, undertake consideration alongside Community Mental Health Team (CMHT) /PCN structural review of functional reform community integrated organic and functional Mental Health team, explore opportunity for diagnosis within PCN and direct routes to Computerised Tomography (CT) imaging.
45
Responsive and accessible care in a crisis Ensure the urgent and 31/03/2020 This action has been delayed due to COVID-19 emergency pathway for people with Dementia that have a physical presentation is delivered within Intermediate care program see 3.4 above • Review data • Develop Business Case describing commissioners model of delivery
Person centred support for people with complex needs Review usage of Hospice 31/03/2021 100% Review of Hospice occupancy completed. and Windermere Ward and consider future 25% Windermere / Coniston review paper awaited from Rotherham, Doncaster & commissioning intentions South Humber NHS Foundation Trust (RDaSH)
Undertake option appraisal To be This action has been delayed due to COVID-19 for Discharge to Assess confirmed (D2A) provision, and ensure robust links with Intermediate Care offer
The Doncaster CCG and To be This action has been delayed due to COVID-19 Local Authority confirmed Performance Teams will work to provide a more advanced experience based approach for reporting against delivery plans key identifiable priorities
46
1.2 Performance measures and outcomes
A number of information and outcome lines are currently unavailable due to continuing prioritisation due to the Covid-19 pandemic. These lines will be developed and reported as workflows return to normal. A number of measures are taken from data published annually.
Local hospital admissions data.
Data from the Adult Social Care Outcomes Framework (ASCOF) published annually.
47
Local Provider data.
Local hospital admissions data
There was a significant increase in admissions during June to September. This coincided with the end of the first lockdown. Numbers started to fall again from October but remain higher than the previous year. Performance colleagues have noted this and will do some further analysis around reasons for admission.
48
Data from the Adult Social Care Outcomes Framework (ASCOF) published annually.
Local hospital admissions data.
Data from Public Health Outcomes Framework.
49
Data from Public Health Outcomes Framework - published annually. 2017-18 is the most recent.
Data published by NHS Digital.
A piece of work is being undertaken between Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and GP Practices within Doncaster to ensure that data quality of recording is improved. RDASH will share information direct to practices so that accurate lists are held. This will be completed in time to improve this measure for March 2021 data.
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51
Ageing Well
Jo Forrestall Joint Ageing Well Lead Commissioner Performance and Actions Deep dive areas
• After-care needs of inpatients recovering from COVID-19- Long COVID
• Wound Care
• Enhanced Health in Care Homes Long Covid Assessment service
• NICE Guidance and specification published in Dec 2020
• Service commenced Jan 21
• Delivered by IAPT & LTC physiotherapist
• Local Website and Group being developed
• National Recording and Reporting Wound care
• Provider Alliance approach commenced 1st Dec 2020
• Tiered approach to wounds
• Training Plan funded by CCG
• Pathways and referral criteria • • Single data set across all providers Wound Care
• Formulary development Enhanced Health In Care Homes (EHCH) • EHCH Framework, supported by Primary Care DES Enhanced Health In Care Homes (EHCH) • Implementation • Phased approach Enhanced Health In Care Homes (EHCH) • Progress 43 out of 48 care homes commenced Over 1600 reviews (to Jan 21)
• Evaluation/Stock take Quantitative • reduced the time taken for the referrer in completing the referral • Reduce in referrals to community nursing • For some GP’s more efficient ways of working Qualitative https://youtu.be/fVaOk6oVXto Enhanced Health In Care Homes (EHCH) • Next Steps- Finalise evaluation and share ?? • Action plan Inc workforce development, Digital, Contract/governance • Embedding Care plans across system (YAS, Urgent Care System etc.) • Ensure alignment to other aspects of Ageing Well agenda (EOL, Dementia, neighbourhood frailty project)
Meeting name Governing Body Meeting date 1st April 2021
Title of paper Finance Report February 2021 (Month 11)
Executive / Hayley Tingle, Chief Finance Officer Clinical Lead(s) Author(s) Tracy Wyatt, Deputy Chief Finance Officer
Status of the Report
To approve To consider / discuss
To note X
Purpose of Paper - Executive Summary
This report sets out the financial position as at the end of February 2021 and the forecast for the year end. It also provides a brief update on 2021/22.
The CCG has been working with an interim financial regime for April – September (Month 1-6) due to the Covid-19 pandemic and is under a new regime for the remainder of the year.
The report also outlines:
• The risks that the CCG is currently facing • The CCG’s Financial Summary (Appendix 1) • The CCG’s current spend related to Covid-19 (Appendix 2) • The CCG’s summary of allocations (Appendix 3)
Recommendation(s)
The Governing Body is asked to:
• Receive the report and note any risks and issues as highlighted in the report.
Report Exempt from Public Disclosure
Yes No X If yes, detail grounds for exemption:
Page 1 of 4
Impact analysis Quality impact N/A
Tick relevant box
An Equality Impact Analysis/Assessment is not required for this report. x Equality An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability NIL impact The CCG is showing a favourable variance of £1m against target, the Financial excess prescribing funding from Month 6 has now been clawed back and implications there are not expected to be any further clawbacks. Legal NIL implications Management of Conflicts of N/A Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder and public/patient) Report previously None presented at Risks have significantly reduced since the planning for Month 7-12 was Risk completed and are now considered minimal to achieving the year end analysis position. Corporative Objective / CO4 - maintain spend within allocations overall. Assurance Framework
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NHS DONCASTER CCG
2020/21 FINANCE REPORT MONTH 11 – FEBRUARY 2021
1. Introduction
This report provides the financial position for NHS Doncaster CCG for 2020/21 as at the end of February 2021 (Month 11) and includes a forecast for the year end.
The CCG now has a fixed allocation with the exception of specific pass through funding for hospital discharge and acute independent sector activity above the M1-4 baseline. The CCG is expected to manage within its own allocation for the remainder of the year including any further expenditure incurred in relation to Covid.
2. Current Position
At Month 11, the CCG is showing a positive variance of £1m against the year to date deficit target of £1.0m and a forecast of £1.6m variance against the annual deficit target of £1.3m. This is after the assumption that the funding for the Hospital Discharge Scheme for M11 is awarded plus funding for Independent Sector activity, these equates to £1,513k.
The two main areas where the CCG has a positive variance are prescribing £1.7m Service Development Funding (SDF) £0.9m and Primary Care Additional Roles £0.6m.
The previous issue in relation to the positive prescribing variance from Month 6 has now been resolved as NHSE have clawed back £1.7m of funding in Month 11 which has reduced the variance in this area.
In relation to SDF funding the CCG has reviewed the requirements of providers to received funding above their block contracts and determined that no further funding needs to be transferred to them as it is already included in their baselines, therefore the CCG has £0.9m of funding that is not required. At the time of writing NHSE have not confirmed whether this will be clawed back.
A robust forecast has now been completed in relation to required funding for additional roles in PCN’s based on plans received from Primary care. This has identified an underspend of £600k against the available funding for this year.
A full summary of the position is outlined in Appendix 1.
Other CCG’s in SYB are showing similar variances and as a system the financial position has improved overall for both commissioners and providers.
3. QIPP
Included in the plan for Month 7- 12 is an expectation of delivering QIPP of £3.2m across numerous budget lines including CHC, prescribing and running costs.
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Detailed schemes have not necessarily been developed in all areas but monitoring of actual spend against plan is demonstrating that the expenditure is being contained within the budget set, and therefore the QIPP is being delivered. Work is underway to assess baselines as we move into 2021/22 and start to think about planning.
4. Risks
When completing the plans for Month 7-12 several risks were identified regarding the ability to deliver a balanced position. As year-end is approaching it is felt that the risks have been managed and reduced significantly and are now not posing any risk to delivering the position. There are some areas of overspend but these are being managed within the overall allocation and the underspends outlined above.
5. 2021/22 Financial Regime/Planning
NHSE have confirmed that the current financial regime will continue into next financial year until at least the end of Quarter 1. CCG allocations are yet to be confirmed for this period although they will broadly be based on the second half of 2020/21 adjusted for inflation. Further guidance on planning priorities is expected before the end of March including timescales for planning. The CCG has started work on baseline planning of future costs to enable this work to progress once guidance is released.
6. Conclusion
The Governing Body are asked to note the current financial position to the end of February, the forecast and the current position for 2021/22.
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NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 1
SUMMARY FINANCIAL POSITION MONTH 11 2020/21
Month 11 Total incl Covid Forecast Budget Actual Variance Budget Actual Variance £'000 £'000 £'000 £'000 £'000 £'000 Revenue Resource Limit (in year) 531,413 531,413 0 585,444 585,444 0
Acute services - NHS (Block) 251,077 250,962 -116 275,600 275,513 -87 Acute services - Independent/commercial sector (outside of Nationally procured) 9,020 8,876 -144 9,868 9,717 -151 Acute services - Other non-NHS 0 -11 -11 0 0 0 Acute Services - Other Net Expenditure -919 -163 756 292 1,457 1,164 Acute Services 259,178 259,664 486 285,760 286,687 927
MH Services - NHS (Block) 38,219 39,017 798 41,577 41,574 -3 MH Services - Independent / Commercial Sector (outside of Nationally procured) 25,370 23,746 -1,624 27,662 26,769 -893 MH Services - Other non-NHS 478 271 -207 537 472 -65 MH Services - Other net expenditure -931 -852 78 -324 -989 -665 Mental Health Services 63,137 62,182 -955 69,451 67,826 -1,625
Community Health Services (ISFE) 48,060 49,568 1,507 53,069 54,515 1,446
Continuing Care Services (ISFE) 36,359 36,731 372 39,535 39,710 174
Prescribing 57,857 56,321 -1,536 63,253 61,508 -1,744 Community Base Services 5,041 5,603 561 5,862 6,512 650 Out of Hours 0 0 0 0 0 0 £1.50 per head PCN Development Investment 476 447 -29 522 488 -34 GP IT Costs 1,736 1,724 -12 1,937 1,859 -77 PC - Other 1,094 1,043 -50 1,189 1,122 -67 Primary Care Services (ISFE) 66,204 65,139 -1,065 72,761 71,489 -1,272
General Practice - GMS 26,658 26,553 -105 29,669 28,926 -742 General Practice - PMS 5,182 5,256 74 5,649 5,734 85 Other List-Based Services (APMS incl.) 1,899 2,004 105 2,093 2,207 114 Premises cost reimbursements 5,959 5,802 -157 6,518 6,378 -140 Primary Care NHS property Services Costs - GP 0 0 0 0 0 0 Other Premises costs 54 59 5 59 63 4 Enhanced services 1,156 1,215 60 1,264 1,294 30 QOF 3,848 3,806 -42 4,221 4,174 -47 Other - GP services 237 212 -25 287 222 -66 Primary Care Co-Commissioning (ISFE) 44,993 44,907 -86 49,760 48,998 -762
Other Programme Services (ISFE) 9,171 9,433 262 10,565 11,566 1,001
Total Commissioning Services 527,102 527,623 520 580,902 580,791 -111
Running Costs (ISFE) 5,357 5,091 -266 5,796 5,756 -40
Total CCG Net Expenditure 532,459 532,714 254 586,698 586,547 -151
In Year Underspend/(Deficit) -1,046 -1,301 -254 -1,254 -1,103 151
M11 Hospital Discharge Funding expected 925 925 1135 1,135 Independent Sector variance 445 445 548 548 less funding already allocated -99 -99 -170 -170
Revised in year variance -1,046 -30 1,017 -1,254 410 1,664 NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 2 SUMMARY OF COVID COSTS MONTH 11 2020/21 Total April May June July August Sept Nov Category Oct £000 Dec £000 Jan £000 Feb £000 YTD £000 £000 £000 £000 £000 £000 £000 £000 OOH capacity/CHUB * 0 122 38 15 13 8 14 18 24 18 -36 234 PPE (scrubs) 25 9 0 0 0 0 0 0 0 0 0 34 Hospital Discharge Programme 124 332 432 527 585 503 494 414 167 -63 924 4,439 Daycare Support 0 0 83 33 0 0 0 0 0 0 0 116 Care Home Digital Support 0 0 79 0 0 0 0 0 0 0 0 79 Sickness Cover 0 10 1 0 0 0 0 0 0 0 0 11 Renal Transport Costs (bulk heads and additional resources for all SYB) 87 80 57 86 119 178 -43 27 3 40 3 637 Cygnet Support Costs - nationally approved 0 0 0 0 0 20 0 0 0 3 19 42 GP Bank Holiday Cover 52 0 0 62 70 0 0 0 0 0 184 Primary Care Additional Costs 0 0 86 0 9 95 0 8 -1 -2 22 217 Community Equipment Costs 0 38 18 -18 0 20 -20 3 0 0 2 43 SMS costs 0 89 0 0 0 0 0 0 0 -74 0 15 Minor costs incl. comms 0 1 0 0 0 0 0 0 0 0 0 1 Total costs 288 681 794 705 796 824 445 470 193 -78 934 6,052 Notes:The Local Authority HDP costs have increased significantly in February due to the indentification of patients from prior months who had not been recharged The actual value of costs for additional SMS charges has been reviewed and costs are significatnly lower than originall anticipated. NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 3
SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 11 FEBRUARY 2021
Recurrent Non Recurrent Total £000's £000's £000's Published Baseline Allocation -493,117 0 -493,117 Running Cost Allowance -6,103 0 -6,103 Co-Commissioning -46,295 0 -46,295 Year end adjustments -670 0 -670 Total Resources Available at Plan Stage -546,185 0 -546,185
Adjustments to the Resource Limit:
Month 01 April No adjustments 0 0 0 0 0 0
Month 02 May Transfer 8 months Programme Allocation to central reserve 0 329,191 329,191 Prospective 4 months Programme Non-recurrent Adjustment 0 2,483 2,483 Transfer 8 months delegated allocation to central reserve 0 30,863 30,863 Prospective 4 months delegated Non-recurrent Adjustment 0 996 996 Transfer 8 months Running Costs allocation to central reserve 0 4,069 4,069 Prospective 4 months running costs Non-recurrent Adjustment 0 539 539 0 368,141 368,141
Month 03 June Retrospective adjustment Covid Costs -969 -969 0 -969 -969
Month 04 July Retrospective adjustment Covid Costs -793 -793 Retrospective adjustment Non Covid Costs -245 -245 0 -1,038 -1,038
Month 05 August Transfer 2 months Programme allocation from central reserve -82,298 -82,298 Prospective 2 months Programme Non-recurrent Adjustment 1,242 1,242 Transfer 2 months delegated allocation from central reserve -7,716 -7,716 Prospective 2 months delegated Non-recurrent Adjustment 498 498 Transfer 2 months Running Costs allocation from central reserve -1,017 -1,017 Prospective 2 months running costs Non-recurrent Adjustment 270 270 Month 4 Retro Top-up Allocation signed off COVID -706 -706 Month 4 Retro Top-up Allocation signed off Non COVID -1,516 -1,516 0 -91,243 -91,243 Month 06 September Month 5 Retro Top-up Allocation signed off COVID -795 -795 Month 5 Retro Top-up Allocation signed off Non COVID -451 -451 0 -1,246 -1,246 Month 07 October CYPMH Green Paper -945 -945 Error related to IPS in Mental Health (Corrected from NHS111 First) -327 -327 Targeted Lung Health Checks -703 -703 CCG NR Adjustments to Model Breakeven 6,084 6,084 Transfer 6 months delegated allocation from central reserve -23,148 -23,148 Transfer 6 months Programme allocation from central reserve -246,884 -246,884 Transfer 6 months Running Costs allocation from central reserve -3,052 -3,052 STP Plan Transfer - System top up distribution to other CCGs -14,977 -14,977 STP Plan Transfer - System Covid distribution to other CCGs -16,309 -16,309 STP Plan Transfer - Growth funding distribution to other CCGs -2,221 -2,221 Learning Disabilities Mortality Review Programme (LeDeR) -68 -68 Community/CETR -354 -354 CYP Keyworker -233 -233 0 -303,137 -303,137 Month 08 November Digital Primary Care (DPCT1-20/21-3-SYB-02) -330 -330 LD Complex Case Funding 20/21 (Bid 3 South Yorkshire TCP) -14 -14 LD Complex Case Funding 20/21 (Bid 4 South Yorkshire TCP) -14 -14 LD Long Term Planning Funding 20/21 (Bid 8 South Yorkshire TCP) -35 -35 Dynamic Support Registers -9 -9 Winter Pressures -125 -125 CYPMH Green Paper 395 395 Flash Glucose Offer to Patients with Learning Disability -5 -5 Impact and Investment Fund -134 -134 Care Homes Premium -109 -109 Increase in practice funding -55 -55 Children's & Young People's Palliative and End of Life Care Match Funding 20/21 -17 -17 RETRO Non-COVID for month 06 -5603 -5,603 RETRO COVID for month 06 -824 -824 0 -6,879 -6,879 Month 09 December GPFV GP RETENTION -61 -61 GPFV ONLINE CONSULTATION -79 -79 GPFV PRACTICE RESILIENCE -42 -42 GPFV RECEPTION & CLERICAL -53 -53 GPFV PRIMARY CARE NETWORKS -169 -169 FAIR SHARE CSF H2 -861 -861 Ageing Well - EHCH training and development funding -8 -8 MHST Correction from Month 8 -395 -395 Winter Initiatives 1 Funding-HSCN uplift -5 -5 Clinical Leads Oximetry @Home -10 -10 CYP Respite -26 -26 0 -1,709 -1,709 Month 10 January Transfer Diabetes allocation to NHS Doncaster CCG -5 -5 Diabetes Treatment and Care -80 -80 Suicide prevention funding -56 -56 SMI Outreach -25 -25 Inpatient discharge flow proposal - RDASH (Doncaster) -224 -224 Wellbeing Support & Staff Training for Critical Care - DBHFT pass through -87 -87 HSLI funding for DBHFT - Electronic Patient Record - e Observations -251 -251 HSLI funding for DBHFT - Electronic Patient Record - clinical noting -209 -209 Doncaster and Bassetlaw Teaching Hospital 2020 Winter Volunteers -15 -15 LD Complex Case Funding 20/21 (Bid 32 South Yorkshire TCP) -100 -100 Out of Envelope Reimbursement Mth7 & Mth8 - Hospital Discharge Programme -906 -906 Pension (6.3% uplift ) based on Mth09 BSA data and forecast for full year -341 -341 CYP Respite -24 -24 Flash Glucose Monitoring – Final Annual Allocation. -169 -169 0 -2,492 -2,492 Month 11 February Ageing Well -70 -70 IAPT -20 -20 Long covid clinic allocation -54 -54 CYP Suicide Bereavement Support -5 -5 Perinatal MOCT -21 -21 Adult MH Crisis & CHRTT -42 -42 Inpatient discharge flow proposal -45 -45 Progression Annex Covid 19 -20 -20 Digital First Primary Care Funding -19 -19 Privileged Access Management (PAM) - DONCASTER AND BASSETLAW TEACHING -10 -10 Out of Envelope Reimbursement Mth9 - Hospital Discharge Programme -167 -167 Historic Surplus/Deficit -14,396 -14,396 M10 Reimbursement Hospital Discharge Programme 62 62 FOT Interim allocation for reimbursement Hospital Discharge Programme -170 -170 RETRO Prescribing Clawbacks (above 2% of BSA spend) 1,663 1,663 M11 Adjustment to Transforming Care Partnerships 231 231 0 -13,083 -13,083
Revised Resources available as at Month 11 February 2021 -546,185 -53,655 -599,840 Meeting name Governing Body Meeting date 1 April 2021
Title of paper Chair and Chief Officer Report
Executive / Dr David Crichton, Clinical Chair Clinical Lead(s) Jackie Pederson, Chief Officer Author(s) Cheryl Rollinson, Head of Corporate Governance
Status of the Report
To approve To consider / discuss
To note X
Purpose of Paper - Executive Summary
1. Introduction The purpose of this report is to update the Governing Body on issues relating to the activity of the Doncaster Clinical Commissioning Group (DCCG) of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper.
2. This month the paper includes updates on the following areas:
CCG Update: • Integration and Innovation: working together to improve health and social care for all • Covid19 Vaccinations Update • Covid-19 Vaccination for Healthcare Workers • Lung Health Checks Launch • Agile Working Policy • Primary Care BAME Network Update
National Update: • Roadmap Out of Lockdown
Recommendation(s)
The Governing Body is asked to note the report.
Report Exempt from Public Disclosure
Yes No X If yes, detail grounds for exemption:
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Impact analysis Quality impact Neutral Neutral
Tick relevant box
Equality An Equality Impact Analysis/Assessment is not required for this report. X impact An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of Paper is for information. No relevant interests. Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Nil analysis Assurance CO1 - 1.1 Framework
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Chair and Chief Officer Report 1 April 2021
1. CCG Update
1.1. Integration and Innovation: working together to improve health and social care for all The White Paper was published 11 February 2021 and proposes how NHS services might be commissioned and delivered in the future. The ambition is for ICS’s to be established from 1st April 2022 and to take on the statutory responsibilities of CCGs. The CCG are represented on the South Yorkshire & Bassetlaw ICS workstreams to consider the implications of the changes and manage the smooth transition to the new model.
1.2. Covid-19 Vaccinations Update Almost a third of Doncaster’s residents have now received their first Covid-19 vaccination as the programme continues at pace across the borough. People continue to answer the call to attend local vaccination sites set up by GPs. Care home residents, people aged over 60 and frontline health and social care workers are among those who have received their first dose. In response to concerns in the media around the AstraZeneca vaccine, Dr Rupert Suckling (Director of Public Health at Doncaster Council) has provided an update and reassurance to Doncaster residents which is available on the CCG website here. For more information about the vaccine and read frequently asked questions please visit https://www.doncasterccg.nhs.uk/covid-19-vaccine/.
1.3. Covid-19 Vaccination for Healthcare Workers Organisations are being urged to support frontline workers who have declined the offer of a Covid-19 vaccination. The Chief People Officer, NHS England / Improvement, Prerana Issar, has encouraged managers to meet with member of their staff who have yet to take up the offer of the vaccine to understand any concerns and to use Occupational Health advice to support staff in making an informed choice. It is recognised that this must be approached sensitively and at the present time vaccinations for staff are not mandated.
1.4. Lung Health Checks Launch The Lung Health Check Programme has now gone live with patients from four practices in the south of Doncaster being invited to book in for their telephone lung health check assessment. The mobile scanning unit will be sited initially at the Rossington Miners Welfare Scheme on West End Lane in Rossington from 29th March for those patients eligible to have a low dose CT scan. After a period of approximately 2months, the mobile scanning unit will move to the next location and the programme will be rolled out across the borough over the next 12 months.
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Communication and engagement work is well underway to promote the service to those patients who are eligible. More information about the Doncaster programme can be found at www.lunghealthchecks.co.uk.
1.5. Agile Working Policy The Executive Committee have approved a newly drafted policy regarding agile working. The main focus of the policy is around the ability of staff to work flexibly from any location and / or at different times. The policy is the result of extensive staff engagement on ways of working and supports the aims of the NHS People Plan in terms of being a flexible employer. It covers all aspects of agile working including how to maintain effective communication, health and wellbeing and information governance.
1.6. Primary Care BAME Network Update The Chief Officer attended the Primary Care BAME meeting held on 17.03.21 along with other senior colleagues from the CCG. Powerful lived experiences were shared by the network members and some key issues such as career progression and Board Level representation were discussed. The Chief Officer reinforced the support from the CCG for the network and advised that the CCG was open to working with the network to progress the Equality, Diversity and Inclusion agenda.
2. National Update
2.1 Roadmap Out of Lockdown In February, the Government announced a 4-step roadmap out of lockdown with restrictions in England starting to lift from 8 March 2021. Only when the government is sure that it is safe to move from one step to the next will the final decision be made and the decision will be based on four tests:
• The vaccine deployment programme continues successfully • Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated • Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS • Our assessment of the risks is not fundamentally changed by new Variants of Concern
More information can we located on the Governments website.
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Governing Body Meeting name
01 April 2021 Meeting date
Title of paper Quarter 3 2020/21 Corporate Assurance Report
Executive / Lisa Devanney, Associate Director of HR & Corporate Services Clinical Lead(s) Cheryl Rollinson Head of Corporate Governance Author(s) Alison Edwards Corporate Governance Manager
Status of the Report
To approve To consider / discuss
To note X
Purpose of Paper - Executive Summary
1. The purpose of the report is to provide assurance to Governing Body on all corporate matters.
2. The following key points are drawn to the attention of Governing Body:
• Board Assurance Framework (BAF): The Quarter 2 update was presented to Audit Committee 10 December 2020 and Governing Body 4 February 2021.
• Risk Register: At the end of Quarter 3, there were fifteen risks on the risk register, four risks being rated as very high.
• Internal Incident Reporting: There were no incidents reported during Quarter 3.
• External Assessments: During Quarter 3, work has remained ongoing around the 2020/21 Head of Internal Audit Opinion and the Stage 1 memo was received by the Audit Committee in December 2020. The CCG is celebrating its fourth consecutive ‘outstanding’ rating from NHS England and NHS Improvement for 2019-20 following confirmation in December 2020. The CCG have also been assessed as ‘Green Star’ following the 2019/20 national assessment and moderation process by NHS England for the Patient and Community Engagement Indicator which is part of the NHS Outcomes Framework.
• Corporate Governance: There have been no amendments to the Constitution, Establishment of the Governing Body, the Governance Structure or changes to statutory roles during Quarter 3. There have been no declarations of gifts or hospitality during Quarter 3. Ten policies have been reviewed and approved via the appropriate committee during Quarter 3 and five policies have been deferred.
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• Health & Safety, Fire and Security: The competent person for Health & Safety at the CCG has confirmed that the is CCG compliant with legislation. During Quarter 3, the corporate team reception staff undertook virtual fire warden training and two compliance inspections of Sovereign House and White Rose House have been undertaken.
• Information Governance and Data Quality: The 2020/21 toolkit was released mid-November 2020, an action plan has been agreed to meet the requirements. Nationally, the submission date for 2020/21 toolkits has been extended to 30 June 2021. During Quarter 3 there were 26 FOI and 3 SAR requests.
• Equality and Diversity: The Equality Delivery System is a national tool which is used to assess and grade our equality performance each year. The outcomes are included in the Equality and Diversity Annual report which can be found on the CCG website. The 2020-21 annual report and progress on the action plan will be reported to the Engagement and Experience Committee in February 2021.
3. Future Inclusions
• Following discussions at Audit Committee 11-Mar-2021, it was agreed that from the next report an update around BAME networks and developments will be included under Section 7: Equality & Diversity
The full report can be reviewed in Appendix 1.
Recommendation(s)
The Governing Body is asked to note the Corporate Assurance Report Quarter 3, 2020- 21.
Report Exempt from Public Disclosure
Yes No X If yes, detail grounds for exemption:
Impact analysis Nil Quality impact
Tick relevant box
Equality An Equality Impact Analysis/Assessment is not required for this report. X An Equality Impact Analysis/Assessment has been completed and approved by the impact lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
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Sustainability Nil impact Financial Nil implications Legal implications Nil Management of Conflicts of None Identified Interest Consultation / Engagement (internal departments, None clinical, stakeholder & public/patient) Report previously The report was presented to Executive Committee 17 February 2021 presented at and Audit Committee 11 March 2021. Risk N/A analysis Assurance CO1 – 1.1 Framework
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CORPORATE ASSURANCE REPORT
Quarter 3 2020/21 (1 October – 31 December 2020)
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Contents ______
Section Sub-Section Page
Executive Summary 3
Section 1 Risk Management 4 1.1. Assurance Framework 4 1.2. Risk Register 4 1.3. Internal Incident Reporting 5 1.4. Claims & Legal Issues 6
Section 2 External Assessments 7
Section 3 Committee Activity 9
Section 4 Corporate Governance 15 4.1. Constitution & Establishment 15 4.2. Standards of Business Conduct / Conflicts of 15 Interest 16 4.3. Governance Structure 16 4.4. Statutory roles 16 4.5. Procedural Document Management 17 4.6. Health & Safety, Fire Safety & Security 17 4.7. Emergency Resilience & Business Continuity 18 4.8. Sustainability 19 4.9. Complaints Management 19 4.10. Counter Fraud 20 4.11. Whistleblowing 20
Section 5 Information Governance and Data Quality 21 5.1. The protection and use of personal confidential data 21 5.2. Information Governance Toolkit 21 5.3. Information Governance Work plan 22 5.4. Freedom of Information Act Requests 22 5.5. Subject Access Requests 23
Section 6 Organisational Development & Staffing Governance 24 6.1. Organisational Development 24 6.2. Workforce Structure 24 6.3. Workforce Breakdown 25 6.4. Mandatory & Statutory Training 26 6.5. Workforce Capacity 26
Section 7 Equality and Diversity 28 7.1 Strategy 28 7.2 Equality and Delivery System 2 and Annual Report 28
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Executive Summary ______
The key points from this report to which the organisation’s attention is particularly drawn are:
• Board Assurance Framework (BAF): The Quarter 2 update was presented to Audit Committee 10 December 2020 and Governing Body 4 February 2021. The Quarter 3 update of the BAF will next be presented to the Audit Committee in March 2021.
• Risk Register: At the end of Quarter 3, there were fifteen risks on the risk register, three risks being rated as very high and one risk rated as extreme.
• Internal Incident Reporting: There were no incidents reported during Quarter 3.
• External Assessments: During Quarter 3, work has remained ongoing around the 2020/21 Head of Internal Audit Opinion and the Stage 1 memo was received by the Audit Committee in December 2020. The CCG is celebrating its fourth consecutive ‘outstanding’ rating from NHS England and NHS Improvement for 2019-20 following confirmation in December 2020. The CCG have also been assessed as ‘Green Star’ following the 2019/20 national assessment and moderation process by NHS England for the Patient and Community Engagement Indicator which is part of the NHS Outcomes Framework.
• Corporate Governance: There have been no amendments to the Constitution, Establishment of the Governing Body, the Governance Structure or changes to statutory roles during Quarter 3. There have been no declarations of gifts or hospitality during Quarter 3. Ten policies have been reviewed and approved via the appropriate committee during Quarter 3 and five policies have been deferred
• Health & Safety, Fire and Security: The competent person for Health & Safety at the CCG has confirmed that the CCG compliant with legislation. During Quarter 3, the corporate team reception staff undertook virtual fire warden training and two compliance inspections of Sovereign House and White Rose House have been undertaken.
• Information Governance and Data Quality: The 2020/21 toolkit was released mid-November 2020, an action plan has been agreed to meet the requirements. Nationally, the submission date for 2020/21 toolkits has been extended to 30 June 2021. During Quarter 3 there were 26 FOI and 3 SAR requests.
• Equality and Diversity: The Equality Delivery System is a national tool which is used to assess and grade our equality performance each year. The outcomes are included in the Equality and Diversity Annual report which can be found on the CCG website. The 2020-21 annual report and progress on the action plan will be reported to the Engagement and Experience Committee in February 2021.
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Section 1 – Risk Management ______
1.1. Board Assurance Framework (BAF): Assurance a) The BAF captures risks to the achievement of our strategic Framework corporate objectives. The Audit Committee received the Quarter 2 update at its meeting held 10 December 2020, this will be presented to the Governing Body in February 2021. The Quarter 3 update of the BAF will next be presented to the Audit Committee in March 2021.
b) Meetings with the Senior Risk Owners have taken place at the end of Quarter 3.
c) As at 18 January 2021, the BAF showed:
Start of End of End of End of End of Score Risk rating year Q1 Q2 Q3 Q4 1 to 3 Low 0 0 0 0 4 to 6 Medium 3 2 1 0 8 to 12 High 8 9 6 10 15 to 20 Very High 0 0 4 1 25 Extreme 0 0 0 0 TOTAL 11 11 11 11
1.2. Corporate Risk Register: Risk Register At the end of Quarter 3 2020/21, there were fifteen risks on the Corporate Risk Register. Two risks are rated as medium risks, nine risks are deemed as high and all have action plans to treat the risks. There are three very high risks are:
• Non-achievement of Cancer 62 day target, posing a potential risk to the timely treatment of Doncaster patients. • More patients are waiting longer for planned treatment (Referral to Treatment 92% / waiting list size increasing).
• Fewer people are accessing IAPT services (anxiety and depression) than set out in national target.
Since Quarter 2, the risk rating for Covid19 has been increased from 16 (very high) to 25 (extreme). This is due to the impact on staff capacity and staff absences related to Covid19 and risk to service capacity and demand due to Wave 2.
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Quarter 3 results are as follows:
Start of End of End of End of End of year Q1 Q2 Q3 Q4 20/21 Risk Tolerate 13 *18 12 11 treatment Treat 3 *4 4 4
Start End End End End of of Q1 of Q2 of Q3 of Q4 Score Risk rating year 20/21 20/21 20/21 20/21 20/21 1 to 3 Low 0 0 0 0 0 4 to 6 Medium 3 *3 2 2 8 to 12 High 10 *15 10 9 15 to 20 Very High 3 *4 4 3 25 Extreme 0 0 0 1 TOTAL 16 *22 16 15
*In Quarter 1 the Corporate Risk Register incorporated the risks from the Health Cell.
The Health Cell Risk Register has since been reviewed as a separate document therefore there has been a decrease in the number of risks on the Corporate Risk Register.
There have been no incidents in Quarter 3. 1.3. Internal Incident Start 2020/21 Reporting of End of End of End of End of year Q1 Q2 Q3 Q4 20/21 Accident / Injury 1 0 1 0 Communication 1 0 0 0 Information 12 4 2 0 Governance Disruptive or Violent 0 0 0 0 behaviour / Assault Category Estates / Facilities / Security / Health & 6 0 2 0 Safety Financial loss 0 0 0 0 Patient Safety 0 0 0 0 Other 0 0 0 0 TOTAL 20 4 5 0
Start End End End End Score Risk rating of of Q1 of Q2 of Q3 of Q4 year 1 to 3 Low 17 4 4 0 0 4 to 6 Medium 3 0 1 0 0 8 to 12 High 0 0 0 0 0 15 to 20 Very High 0 0 0 0 0 25 Extreme 0 0 0 0 0 TOTAL 20 4 5 0 0
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1.4 Insurance to the CCG is commissioned from NHS Resolution Claims (Formerly NHS Litigation Authority - April 2017). There have been & no legal issues or claims during Quarter 3. Legal Issues
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Section 2 – External Assessments ______
The following external assessment / inspection reports have been received in the last Quarter.
Completed Audit Reports: There have been no completed audits to report for Quarter 3. 2.1
Internal Audit Work has remained ongoing around the 2020/21 Head of Internal
Audit Opinion and the Stage 1 memo was received by the Audit (Service Committee in December 2020. commissioned
from 360 Counter Fraud: Assurance) No updates were received during Quarter 3 however the CCG
continue to liaise with the Counter Fraud Specialist regarding the review of policies.
2.2 No further updates to report for Quarter 3, the Audit Committee External Audit received the latest KPMG technical update in December 2020.
(Service The Audit Committee received and approved the 2020/21 Audit commissioned Plan and fee proposal for 2021/22 at its meeting held 10 from KPMG) December 2020.
Shared Business Services (Financial Accounting Services): 2.3 Nothing to report for Quarter 3. Service Auditor Business Services Authority (Prescribing): Reports Nothing to report for Quarter 3.
Electronic Staff Record: Nothing to report for Quarter 3.
NHS Doncaster CCG Annual Assessment 2019/20 In December 2020, the CCG received confirmation that we had achieved the ‘outstanding’ rating from NHS England and NHS 2.4 Improvement for the CCG’s 2019-20 Annual Assessment. This is Other External the fourth consecutive year that the CCG has received this rating. Assessments The formal assessment takes place every year and is based on four broad areas: • Better Health – improving health outcomes for patients in areas such as diabetes and tackling obesity
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• Better Care – improving the way care is provided and received in areas such as cancer, mental health, learning disability and maternity service • Sustainability – ensuring we provide services within budget, and • Leadership – improving working relationships with local partners, stakeholders, and members of the public.
Patient and Community Engagement Indicator 2019/20 Following the 2019/20 national assessment and moderation process by NHS England, the CCG have been assessed as ‘Green Star’ for how well the CCG has discharged its public involvement duty and commitment to supporting continuous improvement in public participation.
Under the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012), CCGs have a statutory duty to involve the public in commissioning (section 14Z2). In addition to meeting statutory responsibilities, effective patient and public participation helps CCGs to commission services that meet the needs of local communities and tackle health inequalities.
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Section 3 – Committee Activity ______
At the virtual meeting held 10 December 2020, with the following noted:
• Received and approved the KPMG Audit Plan for 2020/21 and fee proposal for 2021/22 • Received the 2020/21 Head of Internal Audit Opinion Stage 1 Memo • Received the 360 Assurance Management Board Letter 20.11.20 3.1 • The latest Assurance Framework for Quarter 2 Audit • Deep Dive around Corporate Objectives 1.1, 2.1 & 2.4 Committee • An update on the Financial Plan • Received the latest Finance Exception Report • Noted that the Standing Orders, SFIs & Scheme of Delegation had been reviewed and no amendments were required • The updated HFMA Covid Governance Checklist • Agreed the proposal for the 2020/21 Audit Committee Self-Assessment of Effectiveness • Reviewed and approved the Audit Committee Terms of Reference
3.2 Nothing to report for Quarter 3. Remuneration Committee
There has been one virtual meeting during Quarter 3, the Committee discussed the following:
• Primary Care update 3.3 • Flu Vaccines – there has been a great uptake so far and Quality & practices are ensuring these are accessible to patients in Patient Safety terms of providing drive through/walk in clinics, all of which Committee have been carefully designed to keep patients and staff safe. • Proactive Care • National Reporting and Learning System (NRLS) – reporting has continued throughout the current Covid-19 pandemic and no patterns or trends have been identified. • Case Conference reporting
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• Workforce – the General Practice Nurse virtual forum continues to take place and be a positive platform for peer support and sharing of best practice. • Wound Care - the commencement of the integrated wound care service for Doncaster patients through the Provider Alliance was delayed due to the Covid-19 pandemic • Care Quality Commission (CQC) – no reports have been published by the CQC since the last report in September 2020. • Staff morale within Primary Care was raised and that we need to work collaboratively to provide peer support. • Medicines management continue to monitor drug safety updates and send out important information. • RDaSH Quality Report • Doncaster Bassetlaw Foundation Teaching Hospital Quality report • Premier Care Direct are not reporting any staffing issues at present and continue to communicate effectively. • Specialised Placements Update Report • Transforming Care Programme Report • Care Home reporting, locality arrangements were put in place as a result of Wave 1 of Covid-19 pandemic and these continue to be in place. • Continuing Healthcare Report; the main focus at present is case management, hospital avoidance and supporting discharges from DBTHFT • Learning Disabilities Mortality Review Report (LeDeR) • Infection Prevention and Control update • Safeguarding update • Fylde Coast Medical Services (FCMS) • Yorkshire Ambulance Service (YAS) • Corporate Risk Register and Escalation of Risks • Caldicott Log & Caldicott Work Plan (Exceptions)
Three virtual meetings were held in Quarter 3, with the following noted:
• Complaints update 3.4 • Healthwatch Monthly Report Engagement & • Primary Care Communications and Engagement Experience Strategy 2020/21circulated to EEC members. Committee • The Gypsy and Traveller Business Case went to Joint
Commissioners Operational Group (JCOG) recently and it was agreed the post for a link worker would be funded for 2 years from April 2021. • Deep Dive October meeting – Living Well • Deep Dive November meeting – Aging Well Page 10 of 28
• Deep Dive December meeting – Starting Well • Transgender Prescribing and Commissioning Update. EEC members were informed that the Porterbrook Clinic is currently expected not to discharge Doncaster patients until GPs are more familiar with the appropriate drugs that they require. A support service across Doncaster is on hold due to the current pandemic. • Black Asian Minority Ethnic (BAME) and Equality Report Update. A network has been developed across the ICS footprint with other CCGS for BAME CCG, provider and primary care colleagues. The primary care BAME network had its first meeting on 16 November and was well attended, 66 attendees in total. • Engagement & Experience Committee Self-Assessment Report 2020/21
Three virtual meetings were held during Quarter 3, with the following noted:
• Update and discussions around Medicines Management Quality Innovation Productivity and Prevention (QIPP) update and supporting business plan proposals • An update on the CHC/Specialist Placements QIPP Plan and proposals around a work plan and in-depth reviews • An update on the Post-Stroke Spasticity Management clinic and approved the reinstatement of the clinic for a period of 6 months • Reviewed and approved a short-term proposal for the Leger Clinic 3.5 • The de-commissioning of the Complex Care - Day Executive Opportunities service in Doncaster with immediate effect Committee • An update on the Cognitive Stimulation Therapy (CST) Service and approval of proposals • The Executive Committee Self-Assessment Results for 2020/21 • Approved SY&B CCGs On Call Procedure • Detailed review of the Corporate Risk Register • Discussed and approved Option 3 around proposals for Additional Primary Care openings • Business cases for Bentley and Rossington Hubs • Proposals around income guarantee of the LES payments to General Practices • Proposals around uplifts on Local Enhanced Services in 2020/2021 • Detailed discussions around the approach to Commissioning Prioritisation • Quarter 2 TARGET Report
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• Received the New Surgery and Mexborough Health Centre GPs independently commenced work on an Outline Business Case (OBC) for the development of a new combined health centre • Proposals of an inflationary uplift on the Pharmacy Local Enhanced Services payments in 2020/2021 which was agreed • Reviewed and approved the proposals for the recommissioning of the Sleep Service • Received and approved proposals and a business case around Palliative and End of Life Care following a review • Reviewed the Inclusion & Fairness Forum Business Case for Better Care Funding and supported it being presented to the Joint Committee Operational Group with the proviso that a robust evaluation and exit plan is included • Received the Quarter 2 Corporate Assurance Report • Received proposals around Care Providers for Fast Track (EOL) Patients and options for consideration • Reviewed recommendations on an Integrated Care System (ICS) approach to the funding opportunity towards Children’s Palliative and End of Life Care services • An update on the Lower GI Straight to Test and agreed a principle approach to the recording of activity in monthly monitoring • Received and approved proposals around a recurrent commitment to diabetes funding for the Diabetes Transformation Service • Approved the CCG signing the Armed Forces Covenant pledge • Approved the updated SY&B CCG Shared Health & Safety MOU
Three virtual meetings were held during Quarter 3, with the following noted:
• An update on the Estates Implementation Plan and the 3.6 proposal to seek funding from One Public Estate to Primary Care support the Bentley and Rossington Projects Commissioning • Estates end of year report Committee • A draft Communication & Engagement Strategy, which
was approved • Review and approval of minor amendments to the Committee’s Terms of Reference • An update on the new Primary Care Network guidance released in September 2020:
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o Amendment to the Network Contract DES 2020/21 o Arrangements for the Quality & Outcomes Framework 2020/21 o Investment and Impact Fund Guidance 2020/21 o Structured Medication Reviews and Medicines Optimisation Guidance • The draft findings of the recent Healthwatch survey on accessing GP services during the Covid-19 pandemic • An update on the decisions made at Primary Care Cell in response to Covid-19 • The quarterly Finance and Contracting report which outlined the 2020/21 financial position as at 30th September 2020 and an update on the position for October 2020 to March 2021 • An overview of quality and patient safety activity in relation to Primary Care in Doncaster • The approval of the Primary Care Quality and Performance Framework • An update on the GP Forward View which covered extended access, online consultation, care navigation and funding for the GP Forward View programmes • A Primary Care Network update which focused on Indicative Workforce plans & Additional Roles Funding and PCN Development Funding • Updates on the decisions made at Primary Care Cell in response to Covid-19 • The outcomes and actions from the Committees 2020 self-assessment survey • The Programme Business Case for the primary care capital programme which had been approved by the ICS and would be submitted to NHS England • An update on the 2020/21 Primary Care delivery plan, including progress made and challenges faced • An update on the Strategy & OD Forum discussion around the Committees 2020 self-assessment survey results
Only one meeting has been held during Quarter 3, which was in 3.7 December 2020. The draft minutes have not yet been made Joint available. Commissioning
Management The ratified minutes from the meeting held 17 September 2020 Board have now been ratified with the following noted:
• The Doncaster Operating Model and Commissioning
Approach
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• Update on the Localities work, integrated working and commissioning • Revised delivery plans for 2020/21
The following meetings which were scheduled for Quarter 3 were cancelled as follows:
• Wednesday 28 October - The October meeting in public was cancelled as there were no items for the Committee to discuss or decisions to be made. 3.8 Joint • Wednesday 25 November - The November meeting in Committee of public was cancelled as there were no items for the Clinical Committee to discuss or decisions to be made. Commissioning Groups • Wednesday 16 December - The December meeting in public is cancelled for a number of reasons.
The Joint Committee of Clinical Commissioning Groups has not held a meeting in public since August. The Chair, Dr Richard Cullen has published a short video explaining why no meetings have taken place, this can be accessed here.
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Section 4 – Corporate Governance ______
4.1. The CCG Constitution was last formally approved by NHS Constitution England on 7 January 2020 and was published on the CCG’s and website. Establishment Amendments of the Constitution There have been no amendments to the Constitution during Quarter 3.
Establishment of the Governing Body There have been no changes to the establishment during Quarter 3.
4.2. Disclosure of Gifts and Hospitality: Standards of There were no disclosures of Gifts and Hospitality made within Business the Quarter 3. The ‘nil’ register can be found on the Doncaster Conduct & CCG website. Conflicts of Interest Conflicts of Interest: In line with NHS England Managing Conflicts of Interest: Guidance the CCG must publish the disclosures of decision making staff. This enables our commissioners to demonstrate that they are acting fairly and transparently and in the best interests of their patients and local populations.
In line with NHS England Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017, the CCG must publish the disclosures of decision making staff which should remain on the public register for a minimum of 6 months. The current register of all decision makers is published on the website.
4.3. No changes have been made to the governance structure in Governance Quarter 3. Structure
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4.4. The Officers fulfilling the key statutory roles required of a CCG are: Statutory Roles Strategic: • Accountable Officer – Chief Officer • Accounting Officer – Chief Finance Officer
Governance: • Accountable Emergency Officer – Chief Officer • Conflict of Interest Guardian – Lay Member for Audit & Governance • Conflict of Interest Lead – Associate Director of HR and Corporate Services • Whistleblowing Lead – Associate Director of HR and Corporate Services • Senior Information Risk Owner – Associate Director of HR and Corporate Services • Health & Safety Competent Person – Head of Health, Safety & Security • Fire Safety Responsible Person – Associate Director of HR and Corporate Services • Fire Safety Competent Person – Head of Health, Safety & Security • Security Management Director – Associate Director of HR and Corporate Services • Local Security Management Specialist – Head of Health, Safety & Security • Claims Officer – Associate Director of HR and Corporate Services Local Counter Fraud Specialist – 360 Assurance • Registration Authority – HR Team
Quality / Safeguarding: • Caldicott Guardian – Chief Nurse • Safeguarding – Chief Nurse • Research Governance – Chief Nurse • Equality & Diversity Executive Lead – Associate Director of HR and Corporate Services • Accountable Officer Controlled Drugs – Director of Nursing in the local NHS England Area Team (delegated operationally to the CCG Head of Medicines Management).
There have been no changes to any of the Statutory Roles in Quarter 3.
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4.5. Policy and procedural documents are regularly monitored for review. Procedural Document During Quarter 3, ten policies have been reviewed and approved via Management the appropriate committee. The policies approved are:
• Alcohol & Substance Misuse and Smoke free Policy • SYB Management of Organisation Change • Maternity, Adoption, Maternity Support (Paternity) Parental Leave and Shared Parental Leave Policy • Equal Opportunities Policy • Harassment & Bullying at Work Policy • Risk Management Strategy, Policy & Procedure • Disciplinary Policy • Expenses Policy • Grievance & Dispute Policy • Primary Care Quality & Performance Framework
During Quarter 3, five policies have been deferred due to the current unprecedented times during the Covid-19 pandemic. The policies are: • Flexible Working & Leave for Domestic, Carer, Personal and Family Reasons Policy • Induction, Mandatory & Statutory Training • Retirement Policy • Study Leave & Funding Policy for All Learning and Development • Workplace Wellbeing Policy
4.6. The South Yorkshire and Bassetlaw CCGs are all party to a shared Health and Health & Safety Service which is currently hosted by NHS Rotherham Safety, Fire CCG. The service commenced on the 1st December 2015 when the Safety and team transferred to NHS Doncaster CCG from Yorkshire and Humber Security Commissioning Support. During 2016/17 the host has changed from
NHS Doncaster CCG to NHS Rotherham CCG. The service is covered by a Memorandum of Understanding signed by all parties.
Government advice during the Covid-19 pandemic has been to work from home. The Health and Safety team have followed this advice and provided a “virtual” service to the CCG with regards Health & Safety, Fire Safety and Security advice.
The health and safety team have provided virtual assistance to members of staff with regards their workstations at home, offering practical advice and guidance to a variety of issues which have affected staff while they work from home during the Covid pandemic.
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Health, Safety and Fire Safety During the Covid-19 pandemic; the Health and Safety Manager has visited Doncaster CCG to ensure the CCG complies with all required H&S/Fire safety legislation. During Quarter 3 the health and safety manager conducted two compliance inspections of Sovereign House and White Rose House. Remedial action from the inspections are currently on-going
Fire Warden Training During Quarter 3, the corporate team reception staff undertook virtual fire warden training to ensure Doncaster CCG remained compliant with fire legislation.
Security There have been no reported security concerns in the last quarter.
Tenants Meeting On the 16th November 2020 a virtual meeting was held between Doncaster CCG and NHS PS to discuss any building issues. In attendance was the Facilities Support Assistant (NHS PS), Head of Corporate Governance (DCCG), Corporate Governance Manager (DCCG), Health and Safety Manager (RCCG – Shared service) and Staff Side Affiliation. Remedial actions from the meeting are currently on-going.
4.7. Emergency Preparedness, Resilience & Response (EPRR): Emergency The Assistant Chief Officer at Rotherham CCG is the responsible Resilience and lead for EPPR for South Yorkshire and Bassetlaw CCGs. Since Business March 2020, the CCG has been responding to the Covid19 Continuity pandemic, in line with national guidance.
In August 2020, the CCG received notification of the 2020/21 Emergency Preparedness, Resilience and Response (EPRR) annual assurance process. In previous years, this involved demonstrating evidence against the EPRR Core Standards however the requirements for 2020/21 were streamlined in anticipation of a potential further wave of Covid19.
The deadline for submission was 30 October 2020, the CCG submitted their assurance on the 15 October 2020 as follows:
• Confirmation was provided that the CCG were compliant for 2019/20 and therefore did not need to demonstrate progress against partial or non-compliance for the previous year.
• The CCG provided detailed narrative around the process of capturing and embedding the learning from the first wave of the COVID-19 pandemic and included progress and learning from winter planning preparations. Specifically, the CCG confirmed that throughout the pandemic the Doncaster system has undertaken formal reviews of the actions put in place, in Page 18 of 28
response to national requirements and had shared learning across the system as a result of those actions. This has taken place through our local Integrated Care Operational Group. In addition, detailed narrative was provided around a number of significant pieces of work that have also been undertaken to build on those actions and ensure that the lessons are included within plans for winter and further Covid resurgence.
Business Continuity: A Cyber Security virtual business continuity exercise was carried out by Survey Monkey on 11 December 2020. The aim of the exercise was to determine how the staff would respond to different examples of cyber incidents. 40 staff completed the exercise and their actions have been collated. The results are being analysed to inform any recommendations or actions required.
4.8. Sustainability The CCG continues to have recycling facilities in place for paper, cans, batteries and plastics at both Sovereign House and White Rose House. Due to the Covid19, majority of staff usually based in White Rose House and Sovereign House have been working from home remotely with very limited numbers of staff occupying these buildings. During Quarter 3, the CCG commenced transitioning from a Sustainability Plan to a Green Plan, which is line with the guidance from the Sustainability Development Unit for the NHS and Health Care Sector. A draft plan and associated action plan are under review and will be made available once approved.
4.9. Quarter Three Complaints Report: Complaints Management Total Partially Not Carried 2019/20 Upheld Complaints upheld upheld Forward Quarter 6 0 0 1 5 1 Quarter 6 4 1 1 1 2 Quarter TBA TBA TBA TBA TBA 3 Quarter
4
Quarter 3 complaints acknowledged and brought forward figures are currently unavailable due to current Covid-19 demands.
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4.10. The CCG’s Counter Fraud Specialist (CFS) is commissioned via 360 Counter Assurance. The Audit Committee receives assurance via Counter Fraud Fraud reports and agrees the annual work plan.
CFS send regular bulletins and updates which are shared with relevant people in the Finance team, where there is a specific issue highlighted relating to, for example: accounts payable. The CCG always undertake the necessary checks and respond to CFS with any findings or action required.
Accounts payable and payroll systems are tested on a cyclical basis and the CCG is linked into the National Fraud Initiative.
Assurance around risk is taken from the outcome of audits, where the CCG has never had any recommendations related to financial fraud and no issues have been found.
The CCG have two active Fraud risks on the Corporate Risk Register, one is in relation to procurement / asset areas and the other is in relation to staff fraud. The CCG is confident that its processes are sufficient to protect against and identify any fraud should it occur.
4.11. Whistleblowing may relate to financial, employment or clinical care Whistleblowing concerns. There were no whistleblowing disclosures in the last quarter.
2020/21 Category Q1 Q2 Q3 Q4 Whistleblowing disclosures 0 0 0
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Section 5 – Information Governance ______
5.1. GDPR is embedded in the CCGs daily business and there are The robust systems and processes in place. Information governance protection and data protection training is forms part of the annual Data and use of Security awareness training, compliance is monitored by the Personal Corporate Governance Team. Confidential Data The Head of Corporate Governance has responsibility for managing and leading on the Information Asset Register, Information Sharing Agreements, Data Sharing Agreements and Data Protection Impact Assessments. The ISAs, DSAs and DPIAs are all reviewed at the Information Governance Group. Deep dives are undertaken at the Information Governance Group to ensure the IAR is fit for purpose and details all the CCGs known data flows and assets.
The CCG are currently reviewing any new data flows that have been implemented since the start of the Covid19 Pandemic. These will be captured on the CCG’s data flow register as they will require review when the national COPI notice expires.
During Quarter 3, a review of existing information assets and dataflows (not Covid related) has commenced. The outcomes will be reported to February Information Governance Group. In addition, the CCG’s privacy notice has been reviewed and updated during Quarter 3, amendments were approved by the SIRO and is available on the CCG website.
5.2. The Data Security and Protection Toolkit is a national toolkit Data administered by NHS Digital which enables us to measure our Security and information governance compliance. As our IT provider, Rotherham Protection Doncaster and South Humber NHS Trust provide responses to Toolkit many of the IT Standards required in the toolkit. (DSPT) The 2020/21 toolkit was released in mid-November 2020. The CCG has developed an action plan to meet the requirements which was presented to the Information Governance Group in November 2020. Meetings with Rotherham Doncaster and South Humber NHS Foundation Trust have commenced in order to start working on the action plan.
Nationally, the submission date for 2020/21 toolkits has been extended to 30 June 2021.
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5.3 The Information Governance Report is presented to the Information Information Governance Group. The report includes updates for the following: Governance Workplan • Data Security Protection Toolkit (DSPT) – updates on the current position • Information Governance Staff Training Compliance – there continues to be a push on the COI training and Data Security Awareness training • Information Governance Incidents – the report provides a breakdown of incidents • Subject Access Requests • Risk - updates regarding information governance risks from the Corporate risk register. There are currently no information Governance risks.
5.4. Freedom of Information (FOIs) Quarter Three Report - 2020/21: Freedom of Information Act Requests FOI's Received
90 80 81 80 70 77 70 69 69 69 60 64 64 Q1 50 58 56 54 Q2 40 45 Q3 30 Q4 20 26 22 10 0 2017/18 2018/19 2019/20 2020/21
There were: • 13 FOIs received in October • 7 FOIs received in November • 6 FOIs received in December • A total of 26 for quarter three.
Number of Received Review We have received a noticeable reduction in the number of requests this quarter in comparison to previous years and quarter 2; likely due to the ongoing pandemic and national lockdown.
Response Times • All requests were responded to in the 20 working day timeframe.
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5.5. The CCG is required to meet statutory timeframes for responding to Subject Subject Access Requests under the Data Protection Act. Access Requests There were three Subject Access Requests received in Quarter 3.
Two requesters were advised that no information was held by the CCG, one request has been responded to and further information is currently being gathered. Due to the Covid19 pandemic we have experienced understandable delays with gathering the information therefore it has been necessary to issue an extension.
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Section 6 – Organisational Development & Staffing Governance ______
6.1. The final NHS People Plan was published in July 2020 and Organisational incorporates the NHS People Promise. Development The CCG’s People and OD strategy has been reviewed and updated to include strategic aims that are in tune with the overall ambitions of the NHS People Plan.
The strategy has been presented at Strategy and OD Forum, shared with Staff Side Colleagues. The final version was approved by Governing Body in October 2020.
The final approved strategy is available on the CCG website.
6.2. Governing Body: Our Governing Body membership Workforce comprises 12 roles – the Chair, four elected Locality Leads, Structure three Lay Members, a Registered Nurse (also the Chief Nurse), a Secondary Care Specialist Doctor, the Accountable Officer (the Chief Officer) and the Chief Finance Officer.
Chair: Dr David Crichton. Chief Officer: Mrs Jackie Pederson. Locality Leads: Post holders and portfolios are detailed below:
Locality Lead Lead clinical areas Lead corporate areas • Remuneration Committee Dr Rao Koluso • Quality • Quality & Patient Safety East Locality • Prescribing Committee • Planned Care Dr Marco Pieri • Cancer and Tobacco North Locality Control Alliance Dr Marney Khan • Remuneration Committee • Planning and Strategy Central Locality • Audit Committee • Engagement & Experience Committee Dr Manju Pande • Primary Care South Locality Commissioning Committee
Lay Members: Post holders and portfolios are detailed below:
Lay Member Lead areas Lay Member - • Chair of Audit Committee Audit & • Lay lead for Audit and Governance Governance Mr Paul Wilkin • Conflict of Interest Guardian Lay Member - • Chair of Engagement & Experience Committee Patient & Public • Public and Patient Involvement Champion Involvement Mrs Sarah Whittle • Chair of Remuneration Committee
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Lay Member - Primary Care • Chair of Primary Care Commissioning Committee Commissioning • Lay lead for Primary Care Commissioning Mrs Linda Tully Secondary Care • Chair of Quality & Safety Committee Doctor Member • Chair of Clinical Reference Group Dr Emyr Wyn • Lead for Secondary Care, bringing an understanding of Jones patient care in the secondary care setting
Senior Management Team: Post holders and portfolios are detailed below:
Team Member Lead areas Chief Finance Officer’s Team: • Financial Strategy, management, control, reporting & governance Chief Finance • Contracting Officer • Procurement Mrs Hayley Tingle • External Audit • Internal Audit • Counter Fraud Chief Nurse’s Team: • Quality & Safety • Safeguarding • Medicines Management Chief Nurse • Serious Incident management Mr Andrew • Contractual quality Russell • Clinical governance and assurance • Continuing Healthcare (including Previously Unassessed Periods of Care) • Personal Health Budgets Director of Strategy & Delivery’s Team: • Strategic Plan Director of • Delivery Plans Strategy & • System transformation Delivery • Commissioning in partnership Mr Anthony • Performance management, Business Intelligence & Fitzgerald Information Technology • Primary Care Commissioning • Communications, Engagement and Experience Associate Director of HR & Corporate Services’ Team: Associate • Corporate Governance – including Risk Management, Director of HR & Information Governance, Health, Safety & Security, Corporate Emergency Planning, and Headquarters management Services • Human Resources & Organisational Development Mrs Lisa • Equality & Diversity Devanney • Secretariat and corporate support function
There have been no changes to the workforce structure during Qtr 3.
6.3. Headcount 167 Whole Time Equivalent 148.36 Workforce Cumulative Sickness 2.07% Breakdown Absence Rate Turnover Rate 1.00% Gender Male 21% Female 79%
Age 16-20 1% 21 - 30 7% 31 – 40 30% 41 – 50 26%
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51 – 60 28% 61 – 70 8% 70+ 0% Ethnicity White 88% Mixed – Multiple Ethnic 2% Groups Asian/Asian British 4% Black/African/Caribbean/Black 3% British Other 1% Not disclosed 2% Disability Declared disability 6% No declared disability 86% Not disclosed 1% Religion/Belief Christianity 64% Sikhism 1% Islam 1% Atheism 15% Hinduism 1% Other 7% Not disclosed 11% Sexual Orientation Gay/Lesbian 2% Heterosexual 93% Not disclosed 5%
6.4. Mandatory and Statutory Training: Mandatory Compliance is monitored on a quarterly basis to ensure that and Statutory employees who are non-compliant, or who will become non- Training compliant in the next three months, are encouraged to complete their training.
Those areas that are requiring attention are being addressed through Executive leads and line managers to address the compliance rate.
Compliance rate Name of Training Q1 Q2 Q3 Q4 2020/21 2020/21 2020/21 2020/21 Equality & Diversity 97% 96% 94% Fire Safety 89% 87% 87% Fraud 92% 95% 95% Health & Safety incorporating Risk 97% 94% 93% Management Information Governance – Data Security 93% 90% 89% Moving & Handling 95% 95% 91% Safeguarding Adults 96% 93% 93% Safeguarding Children & Young People 94% 94% 94% Infection Prevention 93% 95% 94% Conflicts of Interest 84% 96% 94%
6.5 The Strategic Workforce and Education Committee (SWEC) is Workforce chaired by the CCG’s Associate Director of HR & Corporate Capacity Services.
SWEC lead on the planning and development of the workforce across the system. SWEC is responsible for assessing the current workforce against future need and planning workforce development, education and training. Meetings are held on a quarterly basis.
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Whole Systems Partnerships have been commissioned to undertake a Workforce Planning exercise at Place which will inform the wider workforce strategy.
A Place-Based Workforce Lead has now been appointed and have commenced in post. They will be supporting the workforce strategy work across system partners.
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Section 7 – Equality and Diversity ______
7.1 Strategy: Equality and Equality and diversity is at the heart of the NHS Strategy. Diversity Reducing health inequalities is a priority for NHS Doncaster Strategy CCG, as highlighted in our partnership working on the Doncaster
Health & Wellbeing Board.
The aim of equality and diversity is to ensure that everyone has access to the same opportunities and the same fair treatment. Doncaster CCG actively promotes equality and diversity in the workplace.
We will continue with our programme of ensuring all staff are trained in recognising and responding positively to equality and diversity issues through our Equality and Diversity mandatory training.
Equality Impact Assessments (EIAs): EIAs are a way of assessing the CCGs policies and services to establish how they might impact on different communities and equalities groups. An EIA should be considered for all business cases and reports submitted to committees using the Engagement in CCG Delivery Plans Template which requests details of engagement with the nine protected characteristics.
7.2 Equality Delivery System (EDS): Equality and The Equality Delivery System is a national tool designed to help Delivery the NHS in assessing and grading their equality performance System each year. The CCG must demonstrate that it has due regard to And Equality the need to: eliminate unlawful; discrimination, harassment and and Diversity victimisation. We grade our performance against the 9 protected Annual characteristics; age, disability, gender reassignment, marriage Report and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.
NHS England have informed the CCG that there has been a delay in releasing the 2020 EDS. The 2019 report remains on Doncaster CCG website using the following link: www.doncasterccg.nhs.uk/wp-content/uploads/2020/05/Equality- Delivery-System-Report-2019.pdf
Equality and Diversity Annual Report: An action plan has been developed for 2020-21 and work remains ongoing. The 2020-21 annual report and progress on the action plan will be reported to the Engagement and Experience Committee in February 2021.
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Meeting name Governing Body Meeting date 01 April 2021
Governing Body Assurance Framework 2020-21 Title of paper Quarter 3 Update
Executive / Clinical Lisa Devanney, Associate Director of HR and Corporate Lead(s) Services Author(s) Cheryl Rollinson, Head of Corporate Governance
Status of the Report
To approve X To consider / discuss
To note
Purpose of Paper - Executive Summary
1. Introduction
• The report presents the current position of the Governing Body Board Assurance Framework (BAF) as at the end of Quarter 3 2020/21.
2. Board Assurance Framework
• The BAF can be viewed in Appendix 1.
• Additions are highlighted blue and removals are highlighted red.
• The following key changes were presented to the Audit Committee held 11 March 2021
o CO1 (1.1) – the likelihood score has increased from 2 to 4 and the consequence score has increased from 2 to 3 to reflect the new variant of the covid virus, roll out of the vaccination programme that requires CCG resource and wave 3 of the pandemic which is preventing recovery work taking place. A deep dive of this risk was undertaken at Audit Committee held 10 December 2020. This risk has now increased from medium to high.
o CO2 (2.4) – both the likelihood and consequence scores has increased from 3 to 4 to reflect wave 3 of the pandemic which has seen an increase in infection rates which may result in greater demand coupled with likelihood of increased staff absence. The Covid19 Governance Structure for wave 3 and the escalation framework continues. A deep dive of this risk was undertaken at Audit Committee held 10 December 2020. This risk has now increased from high to very high.
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o CO3 (3.1) – both the likelihood and consequence scores have decreased from 4 to 3 to reflect the improved financial position for 2020/21 which is due to prescribing and Service Development Funding (SDF). The improvement around prescribing is primarily due to the settling of the volatility of expenditure each month and that we are not anticipating a significant impact from the EU Exit as initially predicted. This risk has now decreased from very high to high.
o CO3 (3.2) - both the likelihood and consequence scores have decreased from 4 to 3 to reflect the current arrangements established for 2020/21 however once a revised financial plan is available for 2021/22 the risk will be reconsidered. This risk has now decreased from very high to high.
o CO3 (3.3) - both the likelihood and consequence scores have decreased from 4 to 3 to reflect further information that has become available around funding settlements, this is both at CCG and system level and with the information we know, this reduces the financial risk for 2020/21. This risk has now decreased from very high to high.
o CO3 (3.4) - both the likelihood and consequence scores have decreased from 4 to 3 to reflect that the CCG are meeting their control total for 2020/21 and the financial position has improved. The risk will be reconsidered for 2021/22 when national guidance is available. This risk has now decreased from very high to high.
3. Deep Dives
• A deep dive of Corporate Objectives 2.2, 2.3, 4.1 & 4.2 was undertaken at the Audit Committee held 11 March 2021.
4. Quarter 4 Updates
• Senior Risk Owners are scheduled to review and updated risks at the end of March, early April to reflect the Quarter 4 position.
• The Quarter 4 position will be presented to the Audit Committee scheduled 13 May 2021.
Recommendation(s)
The Governing Body is asked to:
- Review the updated Assurance Framework - As recommended by Audit Committee, confirm that the Assurance Framework is an accurate position of the CCG’s principle risks as at the end of Quarter 3 and that Governing Body are assured that appropriate actions are taking place to mitigate potential impacts and consequences
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Report Exempt from Public Disclosure
Yes No X If yes, detail grounds for exemption:
Impact analysis Quality impact N/A
Tick relevant box
Equality An Equality Impact Analysis/Assessment is not required for this report. X An Equality Impact Analysis/Assessment has been completed and approved by the impact lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.
Sustainability impact Nil Financial Nil implications Legal Nil implications Management of None identified Conflicts of Interest Consultation / Engagement (internal Engagement with Senior Risk Owners or nominated deputies. departments, clinical, stakeholder & public/patient) Report previously Audit Committee 11-Mar-2021 presented at Risk Captured throughout the Assurance Framework analysis Assurance All Assurance Framework risks Framework
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NHS Doncaster CCG Governing Body Assurance Framework
Corporate Objectives (COs)
CO 1 Ensure an effective, well led, and well governed organisation and its statutory obligations are met.
CO 2 Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population.
CO 3 Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change.
CO 4 Work collaboratively with partners to improve health, care and reduce inequalities in well governed and accountable partnerships.
Consequences / Impact
Insignificant Minor Moderate Major Catastrophic Likelihood of 1 2 3 4 5 occurrence Rare 1 2 3 4 5 1 Unlikely 2 4 6 8 10 2 Possible 3 6 9 12 15 3 Likely 4 8 12 16 20 4 Almost Certain 5 10 15 20 25 5
1-3 Low The risk appetite under which risks can be tolerated is a score of 12 4-6 Medium or below. 8-12 High 15-20 Very High Risks scored at or in excess of a score of 13 must be escalated to 25 Extreme the Governing Body.
Page 1 of 13 Governing Body Board Assurance Framework 2020-21 - Quarter 3
Risk Consequent / Impact Assessment Risk Rating Corporate Oversight Assurance High Level Risk Description Owner Objective Catastrophic Major Moderate Minor Insignificant Year-End 2020-21 (Committee) (Committee) 25 20 16 15 12 10 9 8 6 5 4 3 2 1 2019-20 Q1 Q2 Q3 Q4 Organisational Change - The CCG may not have the right workforce capacity and capability to meet its organisational C I T Associate Director CO1 (1.1) objectives and to meet its statutory obligations. 4 4 4 12 of HR and Executive Governing Body Corporate Services
Quality Impact - There is a risk to maintaining quality, services I C and outcomes through local transformation. Quality and CO2 (2.1) 10 10 10 10 Chief Nurse Governing Body T Patient Safety Quality Impact - The quality of care delivered to patients and the achievement of associated quality and performance targets I Director of Strategy CO2 (2.2) could be adversely affected if we fail to commission effective, 9 9 12 12 Executive Governing Body and Delivery resilient and sustainable services. C T
Primary Care: The quality of care delivered to patients and the I achievement of associated quality and performance targets Director of Strategy Primary Care CO2 (2.3) 9 12 12 12 Governing Body could be adversely affected by the failure to engage and and Delivery Commissioning involve primary care. C T The Provider Workforce lacking the capacity of sufficiently skilled staff, which could be detrimental to patient care. I C T Associate Director CO2 (2.4) 9 9 9 16 of HR and Executive Governing Body Corporate Services
Transformation - Expenditure is in excess of income and QIPP / transformation plans fail to bridge the gap resulting in the I C T CO3 (3.1) CCG not meetings its statutory financial and quality duties. 6 9 16 9 Chief Officer Executive Governing Body
Efficiencies - The quality and efficiency savings within the Delivery Plans are not achieved, therefore alternative I C T CO3 (3.2) commissioning arrangements including the decommissioning of 6 6 16 9 Chief Officer Executive Governing Body services may be required. Control Total and System Affordability - Inability to commission efficiently, effectively and to achieve value for money if the I C CO3 (3.3) control total is impacted is not achieved. 9 9 16 9 Chief Officer Audit Governing Body T Control Total - As further delegation of statutory duties and financial decision-making develops (with the Doncaster I C Chief Finance CO3 (3.4) Council in ‘Place’ and with other CCGs in the SYB ICS) the 8 8 16 9 Audit Governing Body CCG may agree to decisions which are considered to be in the Officer greater good. T Joint Working: The dual areas of focus may stretch the local system leadership as resource is aligned both locally and I C T Director of Strategy CO4 (4.1) across a wider collaborative footprint, this complexity could 9 9 9 9 Executive Governing Body potentially impact upon our capacity to commission services. and Delivery
Engagement & Prevention: Doncaster Place does not achieve the move towards tackling inequalities and move towards Director of Strategy CO4 (4.2) I C T 8 8 8 8 Executive Governing Body greater self-care prevention and patient empowerment. and Delivery
1-3 Low I Initial The risk appetite under which risks can be tolerated is a score 4-6 Medium C Current of 12 or below. 8-12 High T Target 15-20 Very High Risks scored at or in excess of a score of 13 must be 25 Extreme escalated to the Governing Body. Gaps in Gaps in control Internal and External assurance and Reference Risks Current Controls Positive Assurance and timescale for Actions to be taken Progress Against Actions Assurances timescales for remedial action remedial action Responsible Director and Operational Lead Initial Risk Rating Current Risk Rating Lead Committee/ Action Where can we gain Board for evidence that the Areas where we End Date What evidence Areas where we do delegation of What controls/systems do we controls / systems are not What could Happen and shows we are not have adequate Actions Date Identified have in place that are we are placing receiving
Should the Risk Target Risk Rating reasonably controls /systems Detail the Actions CO1 - 1.1 Lead operating at this level and reliance on are evidence that Update on Actions, is the plan on track
Materialise, What is the Total Total managing our risks in place or existing Taken Likely Likely assist in the delivery of aims effective internally / controls / Impact and our objectives controls /systems and manage / mitigate risks. externally? systems are are being delivered are not effective Date and Name of effective
Impact / Consequence Impact / Consequence Committee or Board
Strategic Objective 1 -Ensure an effective, well led, and well governed organisation and its statutory obligations are met. Outcomes i) Established • Organisational Development (OD) External Assurances: • Executive Committee Awaiting finalisation of • To work with the Place- 06.01.2021 - Senior Risk Owner Meeting Governance Strategy. The People and OD • Annual and quarterly minutes (also reported to the Workforce Based Workforce Lead as Score increased from 2x2 to 3x4 due to the new variant of and Strategy was presented and agreed reviews with NHS Governing Body) planning for Doncaster a team Doncaster partner, the covid virus, roll out of the vaccination programme that management of at the October Strategy and OD England • Quality of Leadership Place-Based who will commence in post requires CCG resource and wave 3 which is preventing the local Risk Description: The CCG Forum, following staff and staff side • Annual and quarterly Assessment results • Outcome of the ICS from Jan 2021 recovery work taking place. The CCG will need to consider commissioning may not have the right engagement. reviews with Integrated • Internal Audit on Integrating Care - Next • The CCG will need to the outcome, once available, of Integrating Care - Next strategy and workforce capacity and • Business Continuity Plans at team Care System Workforce Planning Steps Guidance consider the outcome, once Steps Guidance that sets out the options for ICS's and how wider capability to meet its level • Staff Survey (nationally (January 2019) - available, of Integrating the next steps will impact on Commissioning functions. A collaborative organisational objectives and • Executive Committee - administered) 2019 significant assurance Care - Next Steps deep dive of this risk was undertaken at Audit Committee commissioning to meet its statutory obligations. responsibility for deploying action plan pending. • Head of internal audit Guidance that sets out the held 10 December 2020. commitments. organisational resource • SYB Governance opinion - significant options for ICS's and how • Constitution, Standing Orders, Leads Meeting assurance 2018-19. the next steps will impact 27.10.2020 - Senior Risk Owner Meeting. ii) Improvement Governance Meeting Structure, Risk • Annual and quarterly on Commissioning The Place-Based Workforce Lead has now been appointed Assessment Management, Information Internal Assurances: reviews with NHS functions. and will commence in post January 2021. The Whole Framework Governance, Health & Safety, • Colleague Engagement England. Systems Partnership work has recommenced, a follow up (NHSE) Emergency Preparedness and Group (CEG) & Staff • Annual and quarterly meeting was held Thursday 22 October, the Whole Systems submission. Mandatory & Statutory training Briefs - involving staff in reviews with Integrated Partnership are collating data around Local Authority health Risk Cause: A lack of • Organisational Development / readiness for the future Care System. staff which will be combined with NHS Workforce data with iii) Delivery of workforce and OD strategy to Learning & Development budget • Executive Committee • Place-Based Workforce stakeholder engagement commencing in January 2021 People and support the current and future • Personal Development Reviews minutes (Workforce Lead has been appointed when the Place-Based Workforce Lead is in post, Organisational direction of the CCG. (PDRs)/Talent Management Policy related reporting) and have commenced in recognising existing capacity in the system is being directed Development Corporate Governance • Organisational Development • Management training post and are picking up to managing the pandemic. No changes to risk score. Strategy structure failing to meet network established, membership being delivered in-house workforce strategy work statutory obligations. includes senior HR/OD • Appropriate for whole system 22.07.2020 Senior Risk Owner Meeting. iv) Assured by professionals within Team participation in regional partnership Action remains ongoing with a revised end date. The Internal Audit on Doncaster, accountable to DGT talent boards recruitment of Workforce Lead was postponed by RDaSH, a Governance Portfolio Group • Audit Committee deep revised banding structure has been agreed and this is now and Risk • Workforce is a standing agenda dives of the BAF back out to advert. The expectation is to complete Associate Management. item on the Executive Committee • Risk assessment for recruitment in August 2020. The Whole Systems Director of 3 4 • Doncaster Place Based workforce buildings have been Partnership was on hold due to Covid-19, following a HR and Apr-19 4 2 8 12 4 None Identified Mar-21 Executive and Education committee completed to facilitate meeting held 21.07.20 this will now recommence with work Corporate established safe return due to Covid- across the ICS footprint. Serivces • Delivery Plans to meet strategic life 19 stages: Starting, Living and Ageing • Majority of staff have 20-02-2020 Audit Committee Deep Dive. Workforce Well, detailing actions and had an individual challenging to measure, most recently commissioned Whole outcomes reported to Governing assessment to facilitate Systems Partnership is looking at workforce planning for the Risk Consequence: Not Body. safe return to work due to next five years and help produce a workforce strategy for achieving both our local • Quarterly reviews with Integrated Covid-19 Place. Successful recurrent funded workforce lead, commissioning strategy and our Care System. • Staff survey results for accountable to Team Doncaster, interviews 2 March 2020. wider collaborative • Commissioned whole systems 2020 received and Review of NHS People Plan. Solutions with regards to commissioning commitments. partnerships to undertake a piece of overall are positive Admin have been raised at the Strategic Workforce and Reputational and structural risk workforce planning at Place-based •CCG received education committee. Current risk score reduced from 6 to if we are not seen to be forward leading to the development of a outstanding for fourth 4. Target risk score of 4 achieved. thinking and transformational Doncaster Place Workforce year for 2019/20 within the Integrated Care Strategy. 04-02-2020 Senior Risk Owner Meeting. System. • Currently recruiting Place-based Actions achieved: Approval given across the Accountable Poor annual review from NHS Workforce Lead Partnership to engage a workforce planning Consultancy. E / I in relation to the • Refreshed Management Appointment of a Band 8B fixed term post to support Improvement Assessment Organisational Change Policy which Workforce Development. Framework. is now consistent across all SYB People and OD Strategy to be approved by Governing Body. CCG's and agreed with staff side, Amendments to the risk description, cause and approved by GB consequence. Current risk rating is the likelihood of the risk • Majority of CCG staff now have has reduced due to securing the whole systems partnership Safemove to access servers piece of work, resulting in a current risk score of 4, remotely achieving the overall target score for quarter four. Progress • Microsoft Teams has been against delivery of the outcomes will be reported in quarter implemented for virtual meetings one of 2020/21. Gaps in Gaps in assurance control and and Reference Risks Current Controls Internal and External Assurances Positive Assurance timescale for Actions to be taken Progress Against Actions
Lead timescales Rating Rating remedial
Initial Risk for remedial Operational Current Risk Current Risk Director and Director and action Responsible action Lead Areas where Action Committee / we do not Areas where End Board for have adequate What could Where can we gain evidence that the we are not Date delegation of controls Actions
Happen and Date Identified What controls/systems do we have in place that are controls / systems we are placing What evidence shows we are reasonably receiving /systems in Detail the Actions CO2 - 2.1 Lead Should the Risk Rating Target Risk operating at this level and assist in the delivery of aims and reliance on are effective internally / managing our risks and our objectives evidence Update on Actions, is the plan on track
Total Total place or Taken Materialise, What Likely Likely manage / mitigate risks. externally? are being delivered that controls existing is the Impact Date and Name of Committee or Board / systems controls are effective /systems are Impact / Consequence Impact / Consequence not effective
Strategic Objective 2: Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population. Outcomes • Quality Surveillance Group across South Yorkshire & Bassetlaw (SYB) External Assurances: • Reporting of information to Q&PSC minutes • Emerging • Emerging • Development and 08.01.2021 Senior Risk Owner Review. area • NHS England (NHSE) Quarterly Review • Care Quality Commission website Governance Governance understanding of required Deep dive of risk undertaken at Audit Committee held • Safeguarding Boards for Children and Adults meetings; benchmarking data • All Provider and Partnership minutes structure for new structure for clinical governance and 10.12.20, score reviewed and remains relevant. The Risk Description: • Quality Accounts from our main providers - reviewed by Quality Team • CQC website • Routine surveillance reporting to NHSE models of new models of quality assurance Covid19 Governance Structure for Wave 3 of the Quality Impact - There • Care Homes/Provider Risk Meetings • Safeguarding Board minutes • NHSE QSG working. working. framework for joint areas of Pandemic and the escalation framework continues. is a risk to maintaining • Joint Commissioning Management Board (JCMB) meetings plus sub • JCMB minutes • CRG minutes • Outcome of the • Clinical working. The CCG will need to consider the outcome, once quality, services and structure of Doncaster Integrated Care Partnership (DICP) and • Prescribing Sub Group & APC minutes ICS Integrating governance • Develop joint available, of Integrating Care - Next Steps Guidance outcomes through Doncaster Integrated Care Operational Group (DICOG) - system wide • Quality Accounts published in public domain Care - Next across commissioning relationship that sets out the options for ICS's and how the next local transformation. with agreed devolution for joint commissioning • CRG minutes Steps Guidance providers with Providers with new steps will impact on Commissioning functions. • Safer Stronger Partnership Board (SSPB) membership and sub groups. model of care • Provider and other Partnership Governance meetings. Internal Assurances: • Influence providers to 04.11.2020 Senior Risk Owner Review. • Quality & Patient Safety Committee (Q&PSC) with agreed Terms of • Quality & Safety Directorate structure develop clinical governance Risk score still relevant, Quality & Patient Safety Reference • CRG minutes structures Committee has continued . The Covid19 Governance • Quality & Performance Reports monthly to Governing Body • CQRG - (Quality schedules, KPIs and • The CCG will need to Structure has been reviewed and updated in • National oversight and benchmarking of key quality performance targets information schedule). consider the outcome, anticipation of managing Wave 2 and additional winter • Contractual provider quality monitoring reports including CCG oversight • Patient level assurance for individual once available, of pressures. An escalation framework has also been Risk Cause: of the quality impact of provider Cost Improvement Programmes placements. Integrating Care - Next agreed across the system. Any new system specific Deterioration in the • Incident Management Group (IMG) oversees Serious Incident • Provider and other partnership governance Steps Guidance that sets high risks in relation to Covid19 and quality are quality of patient care Reporting meeting minutes and report. out the options for ICS's discussed at the Health & Care Group and escalated. and safety. • Prescribing Sub Group; Area Prescribing Committee (APC) • CHC performance and quality. and how the next steps will • Quality & Safety Team - capacity and capability assurance • Quarterly and annual report on complaints impact on Commissioning 21.02.2020 Senior Risk Owner Review. Risk score • Primary Care Commissioning Committee (PCCC) through Q&PSC functions. still relevant due to reduction in assurance processes • Contract provider governance structure and contractual arrangement • Reporting of information to Q&PSC minutes whilst managing the Covid pandemic however the i) Achieve safe • Primary Care Data Information SubGroup • Governing Body minutes Quality & Patient Safety Committee has continued to effective care Chief • Chief Officer Safeguarding Oversight Board (SOB) • IMG minutes Quality and meet and the CCG has implemented temporary Apr-19 5 4 20 5 2 10 10 Mar-21 and a positive Nurse • LeDeR Process. • QSG minutes Patient Safety governance arrangements and controls during the experience. • Continuing Health Care (CHC) capacity and capability. • CQRG minutes Covid pandemic which Governing Body have been • Complaints and enquiries process. • Quality and performance report to Governing kept up to date on. Actions remain ongoing. • Quality risk profile tool and process Body • Clinical Quality Review Group (CQRG) minutes • Patient experience and engagement process 12-02-2020 Senior Risk Owner review. LeDeR • Patient experience and engagement process • Each QIPP plan has a quality and safety Learning Group added as a level of assurance. No • Chief Nurse is a member of the Quality Improvement Productivity impact assessment change to the risk scoring. Programme Board (QIPP) • LeDeR Learning Group • Chair of the Q&PSC is Chair of the Clinical Reference Group (CRG) • Minutes from the Covid 19 Governance • Medicines Management Group (MMG) Structure Meetings i.e Health & Care Group Risk Consequence: • Temporary Internal Governance Arrangements and Controls During Patient harm, Covid Pandemic wave 1 i.e Healthcell experience and • The Covid 19 Governance Structure has been reviewed and updated reduced outcomes. for Wave 2 Gaps in Gaps in control assurance and Reference Risks Current Controls Internal and External Assurances Positive Assurance and timescale for Actions to be taken Progress Against Actions timescales for Rating remedial action
remedial action
Current Risk Risk Current
Director and and Director
Responsible Responsible Operational Lead Operational Initial Risk Rating Risk Initial Lead Action Committee / End Board for Where can we gain evidence that Areas where we do Areas where we Date delegation What controls/systems do we What could Happen the controls / systems we are not have adequate are not receiving of Actions Date Identified Date have in place that are operating at What evidence shows we are
and Should the Risk Rating Risk Target placing reliance on are effective controls /systems evidence that
CO2 - 2.2 Lead this level and assist in the reasonably managing our risks and Detail the Actions Taken Update on Actions, is the plan on track Total Total
Materialise, What is Total internally / externally? in place or existing controls / Likely Likely delivery of aims and manage / our objectives are being delivered the Impact Date and Name of Committee or controls /systems systems are mitigate risks.
Board are not effective effective
ImpactConsequence / ImpactConsequence /
Strategic Objective 2: Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population.
Outcomes i) Achieve actions • Relevant delivery groups (eg. Planned External Assurances: • Delivery Plans (Strategic Delivery Plan for • Dedicated Mental None • Mental Health Board has been 18.01.2021 - Senior Risk Owner Meeting. NHS England response level and outcomes Care Board) . • NHS England approval of winter plan each Life Stage) received by Governing Health Board has agreed in principle, interim model in as been increased to Level 5 due to Covid pandemic. The CCG and within Joint • Contracts with providers for CCG annual planning submission. Body October 2019 (minutes). been agreed in place provider services have had to prioritise capacity to meet Covid response Commissioning Risk Description: management and monitoring of the • Quality and Performance monthly reports principle, but is not yet • Work to be agreed around and implementation of the vaccination programme, this has led to the Health and Social Quality Impact - The delivery of services. Internal Assurances: to Executive Committee and Governing in place. outpatient transformation system planning accordingly for Winter and prioritised services to manage Care Strategy quality of care delivered • Quality & Performance monitoring • Governing Body focus on Life Stage Body. • Place Plan - gaps in programme and the capacity to Wave 3 demand. System escalation framework still in place and risks / to patients and the reporting to Governing Body. (rolling cycle each month) October 2019 • Regular contract meetings with main capacity with strategic support threats continue to be managed through Health & Care Cell. A Deep achievement of • Patient Experience reported to (minutes). providers. change across Dive was undertaken at Governing Body on the 3rd December around ii) Achieve actions associated quality and Engagement and Experience • Minutes of relevant Delivery Groups to • Regular system-wide reporting from partnership - sign off Ageing Well delivery plans. and outcomes performance targets Committee. Executive Committee. whole system. of capacity to support within Place Plan could be adversely • Place Plan refresh. • Signed contracts and minutes of Contract • Positive friends and family test reports. Place Plan. 06.11.20 Senior Risk Owner Meeting. The CCG have submitted all affected if we fail to • Whole system winter plan developed Board Meetings. • CQRG minutes to Quality and Patient planning assumptions and trajectories to NHS England for the remainder commission effective, and implemented. • Quality & Performance Reports monthly Safety Committee. of 2020/21, as guided by the NHS England phase 3 letter. Reprioritised resilient and sustainable • Temporary Internal Governance at Governing Body and Executive • Mental Health reported through delivery plans were presented and agreed at Septembers Governing services. Arrangements and Controls During Committee (minutes). governance structures and frameworks. Body. A system escalation framework has been developed and agreed to Covid Pandemic i.e. Healthcell • Contract Board, Finance Performance • Governing Body have been kept informed support management of Winter pressures / Covid. Daily assurance • The Covid 19 Governance Structure and Information Group and Clinical Quality with Covid Pandemic Arrangements meetings with NHS England have been scheduled. A deep dive into has been reviewed and updated for Review Group Meeting (CQRG) minutes • System escalation framework has been cancer and urgent care was presented to November Governing Body. Wave 2 with main providers. signed off and is implemented. Due to moving into Wave 2 of the pandemic and winter pressures • System Escalation Framework • Life stage reports are taken to Joint combined with system capacity to manage demand and maintain quality, implemented from November 2020 Commissioning and Operational Group the impact score has been increased from 3 to 4. Risk Cause: • Daily assurance meetings commenced (JCOG) on a monthly basis and issues System capacity cannot with NHS England from Qtr 3 (2020) escalated to JCMB, as appropriate. 23.07.2020 Senior Risk Owner Meeting. Whilst there has been some respond to demand. • Place Plan reporting monthly at acceleration in certain areas, the majority of delivery plans have been Doncaster Integrated Care Operational paused due to the pandemic and national guidance during phases 1 and 2 Group (DICOG) and quarterly Doncaster of the pandemic The CCG have maintained Quality Assurance meetings with providers and processes have been implemented to ensure providers Director of Integrated Care Partnership board have undertaken clinical prioritisation i.e. waiting times. Performance Strategy • Minutes of QIPP Programme Board Executive Apr-19 4 3 12 4 3 12 6 Mar-21 targets are not being met due to guidance around the response to the and • 2019/20 Year end update on delivery Committee pandemic but work is taking place with providers around recovery plans. Delivery. plans presented to March Governing Body • Minutes from the Covid 19 Governance The current financial regime related to the pandemic limits the CCG's Structure Meetings i.e Health & Care ability to achieve QIPP in 2020/21. Activity and finance planning is being Group reviewed with NHS England and the CCG are reprioritising delivery plans • Governing Body Minutes from September which will be presented to September Governing Body for approval. In terms of actions, interim Mental Health Board arrangements are in place Risk Consequence: 2020 demonstrate discussion and approval and new models to support the Joint Commissioning Strategy and Place • Deterioration in the of reprioritised delivery plans Plan have been complete. Recruitment for the two strategic change posts quality of patient care • System Escalation Framework presented are now complete. No change to risk score. and safety. to November 2020 Governing Body • Patient harm and 20-02-2020 Deep Dive at Audit Committee - Utilised Mental Health potential death. investment monies for the joint post. • Reduction in The financial ability links to Corporate Objective 3. Mitigation is £10.7M constitutional QIPP, if the CCG achieves delivery plans. This will release savings and performance targets. has worked. Putting robustness in quality impact assessments for QIPP • Increase in patient flow 2020-21. The CCG is reviewing commission boundaries. Provider across the system. Alliance is stronger and there will be a number of contracts with the • inability to financially Provider Alliance. Financial pressure is with joint working with South balance health and Yorkshire and Bassetlaw CCG's. The Better Care Fund transformational social care system. monies have been utilised to appoint to posts to redesign services. A prioritisation tool has been developed through JCOG which will be aligned to the Place Plan Gaps in control Gaps in assurance Internal and External Positive Reference Risks Current Controls and timescale for and timescales for Actions to be taken Progress Against Actions
Lead Assurances Assurance Rating
Rating remedial action remedial action
Initial Risk
Operational
Current Risk
Director and Responsible Lead Committee/ Action Board for Where can we gain What evidence Areas where we End Date delegation of evidence that the controls shows we are do not have Areas where we What could Happen Actions
Date Identified What controls/systems do we have in place that are / systems we are placing reasonably adequate controls are not receiving and Should the Risk CO2 - 2.3 Lead Target Risk Rating operating at this level and assist in the delivery of reliance on are effective managing our /systems in place evidence that Detail the Actions Taken Update on Actions, is the plan on track
Materialise, What is
Total Total Likely Likely aims and manage / mitigate risks. internally / externally? risks and our or existing controls / systems the Impact Date and Name of objectives are controls /systems are effective
Committee or Board being delivered are not effective
Impact / Consequence Impact / Consequence
Strategic Objective 2: Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population.
Outcomes i) Achieve against • Primary Care Strategy and Delivery Plan. External Assurances: • Minutes of Primary • Some individual None. • Implementation of workforce 08.01.21 - Associate Director of Primary Care Review the Primary Care • Primary Care Commissioning Committee oversight. • CQC Visits to Practices. Care Commissioning practice issues with strategy, place based workforce The estates busines case has been approved by all 5x CCG's and is Strategy and Annual • Local implementation of GP investment through long term • Delegation Agreement from Committee. sustainability and lead commences in post Jan 2021 now with the ICS HEG Group for ratification. PCN clinical directors Workplan plan 2019/20. NHS England to CCG. • Delegation business models. and work around the WSP and CCG meetings are taking place monthly and estates will be • Delegation from NHS England for commissioning primary • Positive feedback from NHS Agreement from NHS • Timeliness of programme has commenced discussed as part of that forum. Daily sitrep reports are now being ii) Achieve GP IT Risk Description: medical care services - supports better integration of primary England primary care team and England to CCG. practice engagement Implementation of estates received from practices which identifies any pressures that requires Operating Primary Care: If we fail medical care commissioning with the wider CCG ICS. • Practice Intelligence with the CCG strategy is ongoing. CCG support. 360 Assurance are scheduled to undertake the next Framework to commission effective, commissioning strategy. • Healthwatch - Primary Care Reporting. • More development • Primary Care Commissioning mandatory audit on primary care contract management during Qtr4. resilient and sustainable • Quarterly reporting from Primary Care Commissioning Access Survey. • Positive feedback needed of receives updated Estate Action The next quarterly NHS England stage gate review is scheduled for primary medical care Committee to Governing Body. * NHSE outcomes from the from NHS England triangulation of Plan monthly. Qtr 4. The Primary Care delivery plan will be presented to March services, the quality of • National oversight and benchmarking of key quality quarterly stage gate reviews primary care team and primary care data and • Primary Care Commissioning Governing Body. Score reviewed and remains the same due to care delivered to performance targets. ICS. sustainability within Committee to receive an updated additional pressures with delivering vaccination programme, patients and the • Quality Performance Reporting on Primary Care to Quality & Internal Assurances: • Primary Care individual practices. plan in one years' time - managing workforce absence which potentially could be impacted achievement of Patient Safety Committee. • Delivery Plan received by Commissioning Issues • Development of the September 2020. November 2020 by Covid and maintaining business as usual services. associated quality and • Quarterly contract meetings with Primary Care Doncaster Governing Body April 2020 Log relationship of the • Primary Care Delivery plan for performance targets Federation . (minutes). • Annual 360 PCNs. 20/21 in development reflective of 03.11.20 - Associate Director of Primary Care Review. Projects are could be adversely • Primary Care Matrix and Associated quality visits to practice. • Minutes of Primary Care Assurance audits on integrated neighbourhood progressing around estates development and use of capital, monthly affected, and the full • Director of Strategy and Delivery visits to every practice Commissioning Committee. commissioning, working, development of PCNs report presented to PCCC and the programme business case will be vision contained within within 12 months. • Practice Intelligence governance and and improving access as well as presented in November for PCCC approval. Limited engagement the Place Plan could • Use of NHS England GP resilience monies. Reporting. procurement. supporting Primary care around Primary Care due to other priorities with managing the potentially be adversely • Use of local Doncaster CCG non-recurrent resilience money. • Primary Care Commissioning • Neighbourhood infrastructure. pandemic, Primary Care Manager is maintaining engagement affected. • Primary Care Workforce Strategy and workplan & quality Issues Log (PCQ) profiles and GP Matrix. • Development of a Primary Care directly with practices. Primary Care Cell continues to operate on a implementation. • Primary Care Matrix and • Detailed guidance on Quality and Performance weekly basis to consider and implement national guidance and make • Primary Care Estates Strategy and workplan Variation in Practice contract framework for Framework which will be local decisions, a Primary Care escalation framework has been implementation. • Roadshows primary medical care presented to the Primary Care agreed. Windows 10 and Office 365 upgrades are taking place. • Regular strategic meetings with Local Medical Committee • Newly formed Information Sub published 6 February Commissioning Committee in The PCN's are on with recruiting additional roles required. A and Primary Care Doncaster. Group to the Delivery Group. 2020. November 2020 meeting has been held with Healthwatch to review and implement • Locality Meetings with GP Locality Lead, Manager and • 2019/20 practice visits by • New contractual • Programme Business Case for the results from the Healthwatch Survey around online access representation from practices. Director framework for estates to be presented to during Covid pandemic. Score remains the same. • Agreement and formation of five primary care networks • 2019/20 Year end update on community pharmacy Primary Care Commissioning across Doncaster delivery plans presented to published October Committee for sign off in 28.07.20 - Associate Director of Primary Care Review - An interim • Monthly meetings with Primary Care Network Clinical March Governing Body 2019. November 2020 estates manager is now in post and workshops were held in Directors. • Action taken by CCG • Programme • The CCG will need to consider February 2020 around Communications & Engagement and the Risk Cause: • New GP Contract Framework and national letters regarding regarding any adverse practice Business Case for the outcome, once available, of Nurse Awards. Director practice visits were completed for 2019/20, contractual implications due to Covid, including recovery estates signed off in Integrating Care - Next Steps these visits highlighted issues around finance, IT, medicines • Primary Care services CQC ratings • Temporary Internal Governance Arrangements and Controls Nov 2020 Guidance that sets out the options management and access processes which have been followed up. are unsustainable. • Use of the Primary Care During Covid Pandemic i.e Primary Care Cell • PCCC reived and for ICS's and how the next steps The CCG are reprioritising delivery plans following the pandemic. • Primary Care Strategy Matrix Tool • The Covid 19 Governance Structure has been reviewed approved the estates will impact on Commissioning The GP IT operating framework was released and the CCG Practice Director of is not delivered. • Minutes from the Covid 19 Primary Care and updated for Wave 2 plan in Nov 2020 functions. Agreement was updated and had these were all signed and returned Strategy & • GP IT Operating Apr-19 4 3 12 3 4 12 6 Governance Structure Meetings Mar-21 Commissioning * Quarterly assurance report to NHSE around the • 2021/22 Delivery Plans to be by the 31st March. The score has been increased from 3x3 to 3x4 Delivery Framework is not i.e Health & Care Group Committee development of our PCNs developed. to reflect a possible second wave of the pandemic and the stepping delivered • Decision made by Primary • Primary Care Quality and Performance Framework which Care Healthcell during Covid19 back up of services as part of recovery both of which will impact on was approved by PCCC in November 2020 are presented to Primary Care Primary Care capacity to deliver. Commissioning Committee 20-02-2020 Audit Committee Deep Dive. Monthly meetings are held with the CCG, GP Federation and Primary Care Networks. The CCG is currently formalising the approach on the development of the relationship with the PCNs. Primary Care Access Survey undertaken by Healthwatch provides further external assurance. The CCG is working on an intelligence tool - Primary Care Matrix Tool, this generates a prioritisation and risk log that is reported to Primary Care Commissioning Committee. Primary Care demand and capacity intelligence is not a gap and remains a control.
11-02-2020 - Meeting with Senior Risk Owner. Full review undertaken. Current risk score remains as nine. Risk Consequence: • Adverse quality and 10.02.20 - Associate Director of Primary Care review. Capital experience for patients investment to ICS for primary care estate. Doncaster has two within primary care. approved bids being worked on with others in reserve. • There would be Locality meetings and Terms of Reference reviewed and refreshed significant demand upon to enable commissioning discussions to take place earlier. other services within Commissioning intentions also being discussed with Primary Care Doncaster eg. Acute Network leads in February and discussions have commenced with services. the Primary Care Federation about how the PCNs are best represented at Provider Alliance level. Organisational Development money allocated to PCNs to move along maturity matrix. Assurance on proactive care provided for Q1 & Q2. Practice visit template being worked on and a framework which will describe escalation from quality to performance. Gaps in control Gaps in assurance and Internal and External Reference Risks Current Controls Positive Assurance and timescale for timescales for remedial Actions to be taken Progress Against Actions Assurances
Rating remedial action action
Current RiskCurrent
Director and Director
Responsible Initial Risk Rating Initial OperationalLead Lead Action Committee / End Board for Where can we gain evidence What could Areas where we do Date delegation of that the controls / systems we What evidence shows Happen and What controls/systems do we have in place not have adequate Areas where we are Actions DateIdentified are placing reliance on are we are reasonably
Should the Risk TargetRisk Rating that are operating at this level and assist in controls /systems not receiving evidence CO2 - 2.4 Lead effective internally / managing our risks and Detail the Actions Taken Update on Actions, is the plan on track
Materialise, the delivery of aims and manage / mitigate in place or existing that controls / systems
Total Total Likely Likely externally? our objectives are being What is the risks. controls /systems are effective Date and Name of Committee delivered Impact are not effective
or Board
Impact / ConsequenceImpact / ConsequenceImpact /
Strategic Objective 2: Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population.
Outcomes i) Provider • Refreshed Doncaster Place Plan - a vision of an External Assurances: • All statutory organisations • Education & training • Development of a consistent 06.01.20 - Senior Risk Owner Assurance Accountable Care System with providers working in • All statutory organisations have have supported the vision in programmes which meet health and social care Score increased from 3x3 to 4x4 due to wave 3 which has seen an through partnership together. supported the vision in the Place the Place plan the needs of the future competency framework, training increase in infection rates which may result in greater demand Contract Board Risk Description: • Team Doncaster - working together to improve the plan. • Strategic Workforce and health and social care delivered by DBTHFT. coupled with likelihood of increased staff absence. The Covid19 The Provider economic climate in Doncaster, attract and retain • Minutes of Team Doncaster - Chief Education Committee workforce. • Education and training Governance Structure for Wave 3 of the Pandemic and the Workforce lacking new workforces, and train our own staff from within Officer & Chair representation. • Place based workforce lead programme in progress to support escalation framework continues. A deep dive of this risk was the capacity of Doncaster. • Minutes of Joint Commissioning funded recurrently. • Place Based Workforce the health and social care undertaken at Audit Committee held 10 December 2020. sufficiently skilled • Better Work and Jobs Network formulated Management Board. • Vaccination programme Strategy. workforce. staff, which could (inaugural meeting February 2020). • ICS Place Based Workforce Lead underway and front facing • Potential development of a 27.10.2020 - Senior Risk Owner Meeting. • Joint Commissioning Partnership with Doncaster healthcare workers are being University Campus in Doncaster Risk narrative reworded from "The Provider Workforce being ii) Positive be detrimental to in place. Council - including the Better Care Fund. vaccinated for health and care. insufficiently skilled, which could be detrimental to patient care" to Quality and patient care. • Strategic Workforce and • Doncaster Place Director of Digital appointed with • Development of skills reflect capacity challenges of skilled workers. The NHS People Plan Performance Education Committee (SWEC) responsibility for implementation of the Doncaster passport to enable has now been published and each local organisation has developed a reports linked to schools, colleges and Place Digital Strategy. universities to promote career movement of staff between local versions. An ICS Strategic Workforce Lead has been appointed • Integrated care record to support Digital Strategy. pathways. NHS organisations and an to work across workforce planning, a workforce strategy has been • Partnership engagement with Health Education • Doncaster Growing Together agreed MOU produced in relation to the phase 3 planning guidance. The Place- England and Doncaster College on provider Strategy detailing learning, working, • Place-Based Workforce Based Workforce Lead has now been appointed and will commence workforce needs. living and caring. Lead has been appointed in post January 2021. SWEC not been meeting due to capacity and • Integrated Care Partnership receives reports on • Daily ops meeting held by the and have commenced in competing priorities in regards to the pandemic. The Covid19 provider workforce. Trust to review capacity post and are picking up governance structure has been reviewed and updated. Daily ops • Provider organisations have shared workforce risk • Daily regional touch point workforce strategy work for meeting held by the Trust to review capacity and daily regional touch assessments with the CCG and have plans in place meetings with Directors of whole system partnership point meetings take place with Directors of Commissioning to to mitigate these risks. Commissioning to understand understand system wide pressures. The Health & Care Group • NHS Interim People Plan system wide pressures (formally the Healthcell ( meets at least weekly for escalation of • Commissioned whole systems partnerships to • Health & Care Group (formally the issues and to, where possible, enact any mutual aid/support between undertake a piece of workforce planning at Place- Healthcell( meets at least weekly for organisations. This group may escalate to Team Doncaster Gold based leading to the development of a Doncaster escalation of issues and to, where where appropriate. No change to risk score. Place Workforce Strategy. possible, enact any mutual • Currently recruiting Place-based Workforce Lead aid/support between organisations. 22.07.2020 - Senior Risk Owner Meeting • Temporary Internal Governance Arrangements This group may escalate to Team Actions achieved: Provider organisations to provide a response to and Controls During Covid Pandemic Doncaster Gold where appropriate NHS E / I on the Interim People Plan and development of nurse • The Covid 19 Governance Structure has been apprenticeships. An ICS Strategic workforce lead has been Risk Cause: reviewed and updated for Wave 2 Internal Assurances: appointed as support for the whole system which will result in an ICS Associate Workforce • Minutes of Doncaster Workforce Plan. The recruitment of Workforce Lead was postponed Director of Strategies of the Interoperability Group - assurance Executive by RDaSH, a revised banding structure has been agreed and this is HR and Apr-19 5 4 20 4 4 16 8 Mar-21 Providers fail to on IT. Committee now back out to advert. The expectation is to complete recruitment in Corporate recruit and retain • Chief Officer engagement within August 2020. Revised end date identified for remaining actions. Services appropriate skills Team Doncaster. sets and capacity • Executive Committee minutes 20-02-2020 - Audit Committee Deep Dive. Associate Director of HR to meet the (workforce related reporting). and Corporate Services chairs the SWEC, which links to Doncaster requirements. • Established the Healthcell during College. Discussion on building University Campus as well as a Covid-19 with representatives from hospital. Education Programme is being developed and with new providers, responsible for escalating entrants. SWEC is reviewing how to build courses locally and future risks including workforce ready. • Minutes from the Covid 19 Whole Systems Partnership is looking at workforce planning for the Governance Structure Meetings i.e next five years and help produce a workforce strategy for Place. Health & Care Group Successful recurrent funded workforce lead, accountable to Team Doncaster, interviews 2 March 2020. Review of NHS People Plan. Solutions with regards to Admin have been raised at the Strategic Workforce and education committee. Associate Director of HR and Corporate Services to link workforce planning and the five year strategy. The voluntary sector has available estate to support the strategy. No change to the current risk scoring.
04-02-2020 - Senior Risk Owner Meeting. Actions completed are: Approval given across the Accountable Partnership to engage a workforce planning Consultancy. Appointment of a Band 8B fixed term post to support Workforce Development. Amendments to the risk Risk description, cause and consequence. The risk scoring remains in Consequence: Not place until the impact of the Place-Based Workforce Strategy and achieving both the Lead is known. Outcomes of the delivery against this objective are to local be reviewed following approval of the Placed-Based Workforce commissioning Strategy and Lead in place. strategy and the wider collaborative commissioning commitments. Gaps in assurance Gaps in control and Reference Risks Current Controls Internal and External Assurances Positive Assurance and timescales for Actions to be taken Progress Against Actions
timescale for remedial action Rating
Rating remedial action
Initial Risk
CurrentRisk Directorand Responsible Lead Committee/ Operational Lead Action Board for End delegation of Date What could Where can we gain evidence that the Areas where we are Actions What evidence shows we are Areas where we do not have
Happen and DateIdentified What controls/systems do we have in place that are controls / systems we are placing not receiving reasonably managing our adequate controls /systems Detail the Actions CO3 - 3.1 Lead Should the Risk TargetRisk Rating operating at this level and assist in the delivery of reliance on are effective internally / evidence that Update on Actions, is the plan on track
risks and our objectives are in place or existing controls Taken
Total Total Likely Materialise, What Likely aims and manage / mitigate risks. externally? controls / systems being delivered /systems are not effective
is the Impact Date and Name of Committee or Board are effective
Impact/ Consequence Impact/ Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change
Outcomes i) Achievement • South Yorkshire & Bassetlaw (SYB) Sustainability & External Assurances: • Monthly reporting to Governing • Outcome of the ICS Integrating None • Ambition to have a 15.01.2021 - Meeting with CFO. The financial position has improved against the joint Transformation Plan (STP). • Collaborative Partnership Board minutes Body on CCG Delivery Plan Care - Next Steps Guidance system wide approach to since the last update which is due to prescribing and Service commissioning • Collaborative Partnership Board for the SYB STP - Chief • NHS E operating plan submission progress. financial stability. Newly Development Funding (SDF). The improvement around prescribing is health and social Officer representation. • NHS E IAF Reports • NHS England Improvement & long term plan to primarily due to the settling of the volatility of expenditure each month, care strategy • Doncaster Place Plan. • Right Care tracker document Assessment Framework Reports contribute to system wide we had a prudent forecast in the early months of the financial year due and operational • CCG Commissioning & Contracting Intentions. • Health & Wellbeing Board minutes - Chair & • NHS England review process financial stability to uncertainty, in addition we are not anticipating a significant impact delivery plans • Joint Commissioning Strategy with the Local Authority and Chief Officer representation • Governing Body reporting of established system wide from the EU Exit as initially predicted. SDF Funding has been received Risk Description review of Delivery Plans for the three stages (Starting, Living, • NHS E Annual review process. refreshed plan and deep dives on transformation. by the CCG however this is already included in provider baselines and is Transformation: Ageing Well). • Doncaster System Place review - quarterly. delivery plan at each Governing • Managing individual therefore double funding. These two elements have resulted in a Expenditure is in • Operational planning templates 2019-20 submitted to NHS • Team Doncaster minutes. Body meeting placements for Out of favourable variance against plan. We continue to work with managers excess of income England (NHS E) alongside a planning narrative setting out • Established ICS System Efficiency Board • Governing body approved Joint Area Placements. to develop and push forward efficiency savings however these will not and QIPP / plans to deliver agreed activity reductions, standards and minutes. Commissioning Strategy for • Transforming Care be delivered until 2021/22 and the financial pressure of QIPP delivery transformation plans targets and financial affordability. • Integrated Care Partnership group refreshed Health and Social Care March Partnership - entering a due to the improved forecast has decreased. A joint project is being fail to bridge the gap • NHS Long Term Plan (LTP) (5 years) and Technical November 2018, agrees the overall strategy of 2019 risk share with other undertaken with RDaSH on out of area placements and a further project resulting in the CCG Guidance review and sbumission of operating plan to NHSE, the LA, CCGs, NHS Provider and other local • QIPP Efficiency Savings report CCGs. is underway with external support to look at high cost individual ii) Delivery of not meetings its currently being developed. Implenentation framework issued providers, Chief Executive led. and minutes • Joint commissioning and placements. Risk score reduced from 4x4 to 3x3. Place Plan with statutory financial 27 June 2019. • ICS System wide Finance meetings • Financial reports demonstrate pooling of resources with partners and quality duties. • Commissioning for Value Decision Making Framework. the control total is being met. LA and CCG - 16.11.2020 . Following the notification of the Allocations and the • NHS E Improvement & Assessment Framework (IAF) - a Internal Assurances: • System wide costing exercise commissioning for service financial framework, a revised financial plan has been developed. There continuous risk-based process, with meetings as required, • QIPP)Programme Board minutes. undertaken. and pooled-budgets is is significant risk built into this plan which looks at efficiency savings informed by performance indicators and a wide range of other • Governing Body reporting of refreshed plan • Patient validation work being progressed with across both CHC and prescribing. A number of schemes have been sources of insight, leading to a formal assessment against the and deep dives on delivery plan at each undertaken by DBTHFT, Children's Continuing developed to support the delivery of these savings and were signed off 4 domains of assurance at the year end. Governing Body meeting. commissioned by the CCG. Healthcare. To be at the Executive Committee on 21.10.2020. Mobilisation plans are now • Internal assessment of national potential Right Care and Get • Commissioning legal agreement between • Achievement of 2019/20 reconsidered in 2021/22 underway and delivery will be monitored closely each month. In addition It Right First Time opportunities and tracking of progress Local Authority and CCG (1 April 2020). statutory financial requirements • CCG to review outcome we have agreed with the ICS that the CCG have an underlying £1.8m of against these. • Joint Commissioning Strategy for Health and of projects supporting high unmitigated risk in our plan, the ICS are developing risk share • Integrated Care System (ICS) has a System Efficiency Board Social Care with the Local Authority to be cost individual placements arrangements across the system in the event of any Organisation not to review right care opportunitices, Get It Right First Time, approved by Governing Body on 31 March once available. achieving its control total. In 2021 the CCG will have limited ability to Risk Cause iii) Achieve Chief working with external consultancy and CCG representation. 2019. • The CCG will need to invest in transformation schemes. Risk score increased to 4x4 due to Financial spend in Apr-19 4 4 16 3 3 9 8 Mar-21 Governing Body control total, Officer • Health & Wellbeing Board - local collaborative work to • Monthly reporting to Governing Body on CCG consider the outcome, uncertainty. delivery of services efficiencies and improve health outcomes and address health inequalities; Delivery Plan progress. once available, of will be higher than system Health & Wellbeing Board challenge of CCG plans. • Governing Body approval of CCG Integrating Care - Next 30.07.2020 - Meeting with CFO. The CCG met its statutory duties and our contract plans. affordability. • Quality, Innovation, Productivity and Prevention (QIPP) Commissioning & Contracting Intentions – Steps Guidance that sets required efficiencies as at 31 March 2020. From 1 April, the CCG's The service would Delivery Plan. March 2019 out the options for ICS's financial plan has been suspended due to the response to the Covid not be delivered in • Quality, Innovation, Productivity and Prevention (QIPP) • Governing Body support of Joint Health and and how the next steps pandemic. Allocations were provided for the first four months, an integrated care Programme Board. Social Care Commissioning and delivery plans - will impact on confirmation is awaited on allocations for the remainder of 2020/21. setting. • Joint Transformational Board with Doncaster system partners March 2019. Commissioning functions. Nationally, the financial framework is being reviewed which we anticipate including Bassetlaw CCG, looking at joint efficiency • Governing Body support of the Integrated will clarify future arrangements and system wide working, the principle of opportunities, part of the remit is to look at joint activity and Care System - April 2018 a system wide approach to financial stability remains. the CCG are waiting list planning and redesign of service transformation. • CCG and DBH Transformation Board currently refreshing delivery plans and developing reprioritisation plans. • Governance and Finance Sustainability Self-Assessment. minutes. The deep dive into CHC spend was suspended due to the pandemic • Commissioning legal agreement between Local Authority and will be reconsidered at a future date once in recovery. Actions and CCG (1 April 2018) and has been extended to March remain the same but the consequence score has been increased to 2020. reflect the unknown expectations of the revised planning arrangements Risk Consequence • Memorandum of Understanding - Accountability Care Plan expected imminently. The CCG would not (ACP) Agreement. meet its statutory • Partnership working with Team Doncaster. 31-12-2019 Meeting with Deputy CFO - Quarterly system assurance financial • Daily CCG Covid meetings which incudes finance Place meeting with NHSE/I and all partners. Individual OOA placements requirement. • Sub-Group under RDaSH Board to progress out of area financial management (disputed) being reviewed by NHSE. CHC spend The CCG would not placements project currently undergoing a deep dive. TCP - process being agreed for a meet the integration • CFO and Chief Nurse are joint SRO's for overseeing high funding allocation split with CCGs. Progress continues with the pooled- of care systems cost indivdiual placemenst project which will report to budgets for CHC and fully implemented in 2021. agenda. Executive Committee The CCG is on target to meet its statutory financial requirement. Current risk rating remains at 6.
14.11.19 - Deep dive at Audit Committee meeting - it highlighted ongoing issues that are being controlled and managed within the plan. Members discussed the increasing pressure from high costs drugs for Gaps in Gaps in control and assurance and Reference Risks Current Controls Internal and External Assurances Positive Assurance Actions to be taken Progress Against Actions
timescale for remedial action timescales for
Rating Rating
Initial Risk remedial action
Operational
Current Risk Current Director and Director and
Responsible Lead Action Committee/ End Board for Where can we gain evidence that Areas where we What could Date delegation of What controls/systems do we have in the controls / systems we are What evidence shows we are Areas where we do not have are not receiving Actions
Happen and IdentifiedDate place that are operating at this level and placing reliance on are effective reasonably managing our risks adequate controls /systems evidence that CO3 - 3.2 Lead Should the Risk Target Risk Rating Detail the Actions Taken Update on Actions, is the plan on track
assist in the delivery of aims and manage internally / externally? and our objectives are being in place or existing controls controls /
Total Total Likely Materialise, What Likely / mitigate risks. Date and Name of Committee or delivered /systems are not effective systems are is the Impact
Board effective
Impact / Consequence Impact / Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change Outcomes i) Achievement • Financial Strategy refreshed further after the External Assurances: • Joint Commissioning Strategy for • A single System Control total has Prescribing Internal • Commissioning for Value 15.01.2021 - Meeting with CFO. The CCG are still against the publication of the five year allocations 2019 - 24. • Collaborative Partnership Board Health and Social Care (Local been agreed in the 12 organisation Audit to take place Framework limiting to NICE holding QIPP Board meetings and managers are joint • Commissioning for Value Decision Making minutes. Authority and CCG). across the ICS footprint, there will 2020/21. (previous guidance. Developing working on QIPP schemes but the current financial commissioning Framework • NHS England financial plan • NHS England Improvement & be a requirement if one was 2014/15). guidelines for outpatient regime limits delivery. Score reduced from 4x4 to 3x3 at health and • Standards of Business Conduct & Conflicts of submission. Assessment Framework Reports. organisation within that footprint activity. this point in time due to the arrangements established for social care Interest Policy - including business case and • NHS England Improvement & • NHS England Review process. fails to deliver, that an action plan • QIPP monitoring and delivery 2020/21 however once a revised financial plan is strategy and procurement requirements Assessment Framework Reports. • Governing Body reporting of will be developed. There will be plan deep dive discussion is available for 2021/22 the risk will be reconsidered as the operational • ICS has a System Efficiency Board to review • NHS England Review process. refreshed plan and deep dives on an impact on other organisations taking place at each Governing impact and consequences will increase. Following the delivery plans right care opportunities, Get It Right First Time, • Integrated Care Partnership group delivery plan at each Governing Body should one organisation fail. Body. EU Exit, prescribing costs will be monitored but not Risk Description: working with external consultancy and CCG refreshed November 2018, agrees the meeting. • Primary Care prescribing costs • The CCG will need to anticipating any impact at this stage. Efficiencies: The representation. Four business cases being overall strategy of the LA, CCGs, NHS • Update of prescribing spend to still higher than peers. consider the outcome, once quality and efficiency assessed. Provider and other local providers, Chief Executive Committee. • Outcome of the ICS Integrating available, of Integrating Care - 16.11.2020 . Following the notification of the Allocations savings within the • Monitoring of Prescribing is presented on a Executive led. • QIPP programme board required a Care - Next Steps Guidance Next Steps Guidance that sets and the financial framework, a revised financial plan has Delivery Plans are quarterly basis to the Executive Committee. • ICS System wide Finance meetings monthly performance report. Each out the options for ICS's and been developed. There is significant risk built into this not achieved, • South Yorkshire & Bassetlaw Integrated Care lead for each scheme provides an how the next steps will impact plan which looks at efficiency savings across both CHC ii) Delivery of therefore alternative System update to the meeting. on Commissioning functions. and prescribing. A number of schemes have been Place Plan with commissioning • Collaborative Partnership Board for the South Internal Assurances: • Deloitte report - NHS commissioned • The CCG will need to developed to support the delivery of these savings and partners arrangements Yorkshire & Bassetlaw ICS - Chief Officer • Joint Commissioning Strategy for against delivering our QIPP schemes. consider and develop 2021/22 were signed off at the Executive Committee on including the representation Health and Social Care approved by • ICS System Efficiency Board looking financial plan once guidance is 21.10.2020. Mobilisation plans are now underway and decommissioning of • Doncaster Place Plan Governing Body in March 2019 and at joint opportunities. published but this is likely to be delivery will be monitored closely each month. In addition services may be • CCG Commissioning & Contracting Intentions delivery plans. • Doncaster System Wide delayed. we have agreed with the ICS that the CCG have an iii) Achieve required. • Joint Commissioning Strategy for Health and • Right Care tracker document is used to Transformation Board. underlying £1.8m of unmitigated risk in our plan, the ICS control total, Social Care with the Local Authority, including target areas in order to prepare efficiency • Achievement of 2019/20 statutory are developing risk share arrangements across the efficiencies and refresh and review of Delivery Plans for the three plans. financial requirements system in the event of any Organisation not achieving its system stages (Starting, Living Aging Well) approved • Prescribing Reports to Prescribing Sub • 92% QIPP delivery ambition for control total. In 2021 the CCG will have limited ability to affordability. March 2019 by the Governing Body. Group (minutes), monitoring to Executive 19/20 achieved invest in transformation schemes. Risk score increased • Operational planning templates 2019-20 Committee. to 4x4 due to uncertainty. submitted to NHS England alongside a planning • Governing Body support of the narrative setting out plans to deliver agreed Integrated Care System - April 2018 30.07.2020 - Meeting with CFO. The CCG achieved its activity reductions, standards and targets and • Quality, Innovation, Productivity and 92% QIPP ambition by 31 March 2020. A reprioritisation financial affordability. Prevention (QIPP) Programme Board plan is being prepared and delivery plans are being • NHS Long Term Plan (5 years) and Technical minutes. refreshed. Nationally, the financial framework is being Guidance review and submission of operating • Commissioning for Value. reviewed which we anticipate will clarify future plan to NHSE. Implementation framework • Governing Body support of Doncaster arrangements. Actions remain ongoing and no change issued 27 June 2019. Place Plan. to risk score. • NHS England Improvement & Assessment • Governing Body approval of CCG Chief Framework - a continuous risk-based process, Commissioning & Contracting Intentions 31-12-2019 - CCG is on target to achieve 90% of the Risk Cause: The 4 4 16 3 3 9 8 Mar-21 Governing Body Officer with meetings as required, informed by – March 2019. QIPP saving. Although not achieving the full QIPP the CCG won't achieve performance indicators and a wide range of other • Monthly reporting to Governing Body on CCG will achieve break-even due to other fortuitous delivery against the sources of insight, leading to a formal CCG Delivery Plan progress. underspend within the plan. identified schemes. assessment against the 4 domains of assurance If prescribing costs at the year end. Commissioning for value framework has been increase, financial • Procurement Strategy and the Contract implemented as part of the providers' contracts. balance may be Management Plan, reporting to Audit, Executive impacted. Committee and Governing Body. Deloitte's completed the review and developed four • Deep Dive with CCG Leads on Delivery Plans business cases. these have been assured through a to Governing Body. review proves. Partners are developing future plans to • Quality, Innovation, Productivity and Prevention deliver savings. (QIPP) Delivery Plan • Quality, Innovation, Productivity and Prevention The BAF is to be updated in quarter 1 2020 to reflect (QIPP) Programme Board future challenges. • Joint Transformational Board with DBH and Bassetlaw looking at joint efficiency opportunities, The CCG is on target to break-even and there are no part of the remit is to look at joint activity and requirement to increase QIPP to deliver this. waiting list planning and redesign. • Services Delivery Plan refresh for 2019-20 - 14.11.19 - Deep Dive Audit Committee: the QIPP target joint agreement with local acute foundation trust for 2019-20 is £10.1M, although there has been slippage to undertake joint activity and waiting list planning in October 2019. There is a 90% achievement of this Risk Consequence: • Governance and Finance Self-Assessment target, with inherent risks linked to CHC and prescribing. Breach of break- • Daily CCG Covid meetings which incudes It is anticipated that the control total will be delivered for even statutory finance 2019-20. We are currently working on achieving what responsibility. other CCGs have been able to deliver in relation to Increase QIPP to prescribing. The CCG has an opportunity to learn from deliver more Rotherham and Sheffield CCGs. The key focus is on savings. high risk areas and five year plan challenges. Decommission services. Gaps in control and Gaps in assurance
Reference Risks Current Controls Internal and External Assurances Positive Assurance timescale for and timescales for Actions to be taken Progress Against Actions
Lead Rating
Rating remedial action remedial action
Initial Risk
Operational
Current Current Risk Directorand
Responsible Lead Action Committee/ End Board for Areas where we do Where can we gain evidence that the Areas where we are Date delegation of What could Happen and What controls/systems do we have in place What evidence shows we not have adequate controls / systems we are placing not receiving Actions Should the Risk DateIdentified that are operating at this level and assist in are reasonably managing controls /systems in Detail the Actions Update on Actions, is the plan on
CO3 - 3.3 Lead Target RiskRating reliance on are effective internally / evidence that
Materialise, What is the the delivery of aims and manage / mitigate our risks and our objectives place or existing Taken track
Total Total Likely Likely externally? controls / systems Impact risks. are being delivered controls /systems Date and Name of Committee or Board are effective
are not effective
Impact / Consequence Impact / Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change Outcomes i) Achievement • South Yorkshire & Bassetlaw Integrated Care External Assurances: • NHS England yearly Review • Outcome of the ICS A single System Control • Contracts are now likley 15.01.2021 Meeting with CFO. Over the against the joint System. • Collaborative Partnership Board minutes. process. Integrating Care - Next total has been agreed in to be nationally last few weeks further information has commissioning • Collaborative Partnership Board for the South • NHS England operational plan submission. • ICS quarterly assurance Steps Guidance the 12 organisation determined based on become available around funding health and Yorkshire & Bassetlaw ICS - Chief Officer • Working Together Partnership Board minutes - meetings. across the ICS footprint, block contracts with an settlements, this is both at CCG and system social care representation. received by Governing Body. • Updated version of the South there will be a element of aligned level and with the information we know this strategy and Risk Description: Control • Doncaster Place Plan. • NHS England Review process. Yorkshire & Bassetlaw ICS MoU. requirement if one incentives attached. The reduces the financial risk however there are operational total and System Affordability: • CCG Commissioning & Contracting Intentions. • Updated South Yorkshire & Bassetlaw ICS • Commissioning legal agreement organisation within that CCG will work with still some uncertainties around forecast for delivery plans Inability to commission • Joint Commissioning Strategy for Health and MoU. between Local Authority and CCG footprint fails to deliver, providers once guidance example prescribing and potential efficiently, effectively and to Social Care has been developed with the Local • Internal Audit Plan and Counter Fraud Work - 31 March 2020. that an action plan will be is published to enact adjustments in relation to the Month 9 achieve value for money if the Authority, including refresh and review of Delivery plan 2019-20. • Governing Body approval of developed. There will be arrangements allocations. The risk will be kept under control total is not achieved. Plans for the three stages (Starting, Living Aging • Integrated Internal Audit and Counter Fraud Strategy - March 2019. an impact on other • Continue to develop regular review and updates continue to be As further delegation of Well). Work plan being prepared for 2019/20. • Joint Commissioning Strategy organisations should one aligned incentive provided to Governing Body. The risk will statutory duties and financial • Operational planning templates 2019-20 submitted • Head of Internal Audit Opinion; 2018/19 for Health and Social Care (Local organisation fail. contracts with providers be reconsidered for 2021/22 when national decision-making develops to NHS England alongside a planning narrative Budgetary Control & Key Financial Systems Authority and CCG). which will aim to reduce guidance is available. Risk score reduced (with the DMBC in ‘Place’ and setting out plans to deliver agreed activity Internal Audit Report - full assurance. • Integrated Internal Audit and volatility across the from 4x4 to 3x3 ii) Delivery of with other CCGs in the reductions, standards and targets and financial • Annual Audit Letter; ISA260 Report to those Counter Fraud Work plan system. Place Plan with SYandB ICS) the CCG will be affordability. charged with Governance 2018-19. 2019/20. • Consideration of revised 16.11.2020 . Following the notification of partners adopting decisions that are • NHS Long Term Plan (5 years) and Technical • Published as Outstanding Rating for the CCG • Head of Internal Audit Opinion; financial framework and the Allocations and the financial framework, for the greater good of Place Guidance review and submission of operating plan (external assessment) where finance is a 1819DCCG09R, Budgetary allocations once available a revised financial plan has been or the ICS, resulting in a risk to NHSE. Implementation framework published 27 significant element. Control & Key Financial Systems • Consideration of revised developed. In addition we have agreed of deviating from the Joint June 2019. • Established ICS System Efficiency Board. Internal Audit Report - significant contract once available with the ICS that the CCG have an Commissioning Strategy and / • Commissioning for Value Decision Making • Doncaster System Wide Transformation assurance. • The CCG will need to underlying £1.8m of unmitigated risk in our iii) Achieve or financial plan. Framework. Board. • Annual Audit Letter, ISA260 consider the outcome, plan, the ICS are developing risk share control total, • Working Together Partnership Board - • ICS System wide Finance meetings Report to those charged with once available, of arrangements across the system in the efficiencies and collaborative decision making on Hyper Acute Governance 2018-19. Integrating Care - Next event of any Organisation not achieving its system Stroke Unit services and Children's Surgery & • Achievement of 2019/20 Steps Guidance that sets control total. Risk score increased to 4x4 affordability. Chief Anaesthesia and Hospital Services Review. Internal Assurances: statutory financial requirements out the options for ICS's due to uncertainty. Officer / • Place Plan State of Readiness Report and • Governing Body approval of Strategy - March • National planning guidance has and how the next steps Audit Committee Chief Apr-19 4 4 16 3 3 9 9 recommended next steps. 2019. been received in Qtr 3 2020 will impact on Mar-21 and Governing 30.07.2020 - Meeting with CFO. The Finance • Quality, Innovation, Productivity and Prevention • Joint Commissioning Strategy for Health and Commissioning functions. Body control total for 2020/21 is unknown. From Officer (QIPP) Delivery Plan. Social Care (Local Authority and CCG). 1 April, allocations were provided for the • Quality, Innovation, Productivity and Prevention • Quality, Innovation, Productivity and first four months, confirmation is awaited on Risk Cause: Statutory duties (QIPP) Programme Board. Prevention (QIPP) Programme Board minutes. allocations for the remainder of 2020/21. not being undertaken. • South Yorkshire & Bassetlaw ICS Memorandum • Governing Body approval of CCG Nationally, the financial framework is being of Understanding (MoU). Commissioning & Contracting Intentions – reviewed which we anticipate will clarify • Commissioning legal agreement between Local March 2019. future arrangements. A revised financial Authority and CCG (1 April 2019) 31 March 2020. • Governing Body support of Doncaster Place plan will be required , in addition the • Governance and Finance Sustainability Self- Plan. national contract framework will be Assessment. • Governing Body support of the Integrated amended which may support the CCG's Financial Strategy being refreshed further after the Care System. intention to develop aligned incentive publication of the five year allocations 2019 - 24. • Integrated Care Partnership group refreshed contract with providers. Actions remain Risk Consequence: The • Finance Report to Governing Body on a monthly November 2018, agrees the overall strategy of ongoing and no change to risk score. CCG would be in breach of basis. the LA, CCGs, NHS Provider and other local the statutory duties to • Standing Financial Instructions, Standing Orders, providers, Chief Executive led. 31-12-2019 - financial settlement being commission efficient, & Scheme of Delegation. agreed for 2018-19 with the acute trust. effective and value for money • Finance, Performance & Information Group Aligned incentive contracts being discussed health care services. (FPIG) meetings with Providers. for 2021. Joint commissioning with Local • This would lead to • Internal Audits. Authority continues and the agreement is increasingly limited financial • External Audit. being reviewed. resource which may require • Non-ISFE returns to NHS England (put in full) and the CCG to undertake greater provides a summary of our risk and mitigation. The CCG has considered that it has prioritisation to meet the • Daily CCG Covid meetings which incudes finance currently met its statutory duties to deliver needs of the population. effective and efficient and value for money healthcare. Gaps in control Gaps in assurance and timescale Actions to be Reference Risks Current Controls Internal and External Assurances Positive Assurance and timescales for Progress Against Actions
for remedial taken Rating Rating remedial action
Initial Risk action
Current Risk Current
Director and Director and Responsible
Operational Lead Lead Committee/ Action Areas where we Board for End do not have delegation of Date Where can we gain evidence that the adequate Areas where we are Actions What controls/systems do we have in place What evidence shows we are
What could Happen and Should IdentifiedDate controls / systems we are placing controls not receiving Detail the that are operating at this level and assist in reasonably managing our risks CO3 - 3.4 Lead the Risk Materialise, What is Target Risk Rating reliance on are effective internally / /systems in evidence that Actions Update on Actions, is the plan on track
the delivery of aims and manage / mitigate and our objectives are being
Total Total Likely the Impact Likely externally? place or existing controls / systems Taken risks. delivered Date and Name of Committee or Board controls are effective
/systems are not Impact / Consequence Impact / Consequence effective Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change
Outcomes i) Achievement • Financial Strategy refreshed after the publication of External Assurances: • Governing Body approval of Joint Uncertainty of the A single System • Continue to 15.01.2021 Meeting with CFO. The CCG are against the the five year allocations 2019 - 24. • Internal Audit Plan and Counter Fraud Commissioning Strategy for Health impact on the CCG Control total has been develop aligned meeting their control total for 2020/21 and the joint • Commissioning for Value Decision Making Workplan 2019-20. and Social Care - March 2019. if the single system agreed in the 12 incentive financial position has improved. The risk will be commissioning Framework • Head of Internal Audit Opinion; 1819 • Joint Commissioning Strategy for control total that has organisation across the contracts with reconsidered for 2021/22 when national guidance is health and • Finance Report to Governing Body on a monthly Budgetary Control & Key Financial Systems Health and Social Care (Local been agreed in the ICS footprint, there will providers which available. Risk score reduced from 4x4 to 3x3 social care basis Internal Audit Report - significant assurance. Authority and CCG) 12 organisation be a requirement if one will aim to strategy and • Standing Financial Instructions, Standing Orders, & • Annual Audit Letter 2018-19; ISA260 Report • Head of Internal Audit Opinion; across the ICS organisation within that reduce volatility 16.11.2020 . Following the notification of the operational Scheme of Delegation to those charged with Governance. 1819-DCCG-09-R – Budgetary footprint is not footprint fails to deliver, across the Allocations and the financial framework, a revised delivery plans • Finance, Performance & Information Group (FPIG) • Published as Outstanding Rating for the CCG Control & Key Financial Systems achieved. that an action plan will system. financial plan has been developed. In addition we meetings with Providers (external assessment). Internal Audit Report - full assurance • Outcome of the be developed. There have agreed with the ICS that the CCG have an • Internal Audits • Collaborative Partnership Board minutes. • Annual Audit Letter 2018-19; ICS Integrating will be an impact on • The CCG will underlying £1.8m of unmitigated risk in our plan, the Risk Description: Control total: If • External Audit • NHS England financial plan submission. ISA260 Report to those charged with Care - Next Steps other organisations need to consider ICS are developing risk share arrangements across we do not meet our CCG statutory • South Yorkshire & Bassetlaw ICS Plan • NHS England Review process. Governance Guidance should one the outcome, the system in the event of any Organisation not control total due to the impact of • Doncaster Place Plan • Updated South Yorkshire & Bassetlaw ICS • NHS England yearly review organisation fail. once available, achieving its control total. Risk score increased to external controls on CCG allocations • Delivery Plans in place to deliver the Joint Plan MoU - 2018. process - Improvement Assessment of Integrating 4x4 due to uncertainty. and/or the impact of unpredicted in- Commissioning Strategy for Health and Social Care • ICS System Efficiency Board minutes. Framework Care - Next year cost pressures, then we will be • Joint Commissioning Strategy for Health and Social • Integrated Care Partnership group refreshed • Updated version of the South Steps Guidance 30.07.2020 - Meeting with CFO. The CCG met all unable to commission efficiently, Care with the Local Authority, including refresh and November 2018, agrees the overall strategy of Yorkshire & Bassetlaw ICS Plan that sets out the its statutory requirements for 2019/20. The control ii) Delivery of effectively and to achieve value for review of Delivery Plans for the three stages (Starting, the LA, CCGs, NHS Provider and other local MoU -2018 options for ICS's total for 2020/21 is unknown. From 1 April, Place Plan with money. Living Ageing Well). providers, Chief Executive led. • Integrated Care Partnership group and how the allocations were provided for the first four months, partners This will lead to increasingly limited • Operational planning templates 2019-20 submitted to • ICS System wide Finance meetings refreshed November 2018, agrees next steps will confirmation is awaited on allocations for the financial resource which may require NHS England alongside a planning narrative setting the overall strategy of the LA, CCGs, impact on remainder of 2020/21. Nationally, the financial the CCG to undertake greater out plans to deliver agreed activity, standards and NHS Provider and other local Commissioning framework is being reviewed which we anticipate will iii) Achieve prioritisation to meet the needs of the targets and financial affordability. Internal Assurances; providers, Chief Executive led. functions. clarify future arrangements. Actions remain ongoing control total, population. • NHS Long Term Plan (5 years) and Technical • Joint Commissioning Strategy for Health and • Commissioning legal agreement and no change to risk score. efficiencies and Guidance review and submission of operating plan to Social Care approved by Governing Body in between Local Authority and CCG - system NHSE. March 2019 and delivery plans. 31 March 2020. 31-12-2019 - the CCG considers it is currently affordability. • Partnership working across Team Doncaster. • Governing Body support of the Integrated • Internal Audit Plan and Counter meeting its statutory duty to achieve its control total. Chief • Working Together Partnership Board Care System. Fraud Workplan 2019-20. Current risk scoring has been achieved. Finance Apr-19 4 4 16 3 3 9 9 Mar-21 Audit Committee • Quality, Innovation, Productivity and Prevention • Quality, Innovation, Productivity and • Integrated Internal and Counter Officer levels (QIPP) Delivery Plan Prevention (QIPP) Programme Board minutes. Fraud Plan 2019/20 • Quality, Innovation, Productivity and Prevention • Governing Body approval of Commissioning • Procurement Strategy and the (QIPP) Programme Board for Value Framework. Contract Management Plan, • ICS System Efficiency Board • Governing Body approval of CCG reporting to Audit, Executive • Doncaster System Wide Transformation Board with Commissioning & Contracting Intentions – Committee and Governing Body. Doncaster system partners including Bassetlaw CCG March 2019. • QIPP monitoring report to looking at joint efficiency opportunities, part of the remit • Governing Body support of Doncaster Place Executive Committee. is to look at joint activity and waiting list planning and Plan. • Monthly financial report to transformation service redesign. • Non-ISFE returns to NHS England (put in full) Governing Body. • South Yorkshire & Bassetlaw ICS Plan Memorandum and provides a summary of our risk and • Achievement of 2019/20 statutory Risk Cause: of Understanding (MoU) mitigation. financial requirements Statutory duties not being undertaken. • Commissioning legal agreement between Local • CCG and DBH Transformation Board Authority and CCG - 31 March 2020. minutes. • Governance and Finance Sustainability Self- Assessment • Monthly one-to-one’s with Accountable Officer / Chief Finance Officers to discuss financial position. Risk Consequence: • The CCG • Joint meetings at Place level with Chief Finance would be in breach of the statutory Officers / Chief Executive Officers across RDaSH / duties to commission efficient, DBHTFT and CCG. effective and value for money health • South Yorkshire & Bassetlaw Directors of Finance - care services. Finance and Assurance Meeting. • This would lead to increasingly • Daily CCG Covid meetings which incudes finance limited financial resource which may require the CCG to undertake greater prioritisation to meet the needs of the population. Gaps in Gaps in control Internal and External assurance and Reference Risks Current Controls Positive Assurance and timescale for Actions to be taken Progress Against Actions Assurances timescales for Rating remedial action
remedial action
Current Risk Risk Current Director and and Director
Responsible Responsible Lead Operational Lead Operational Initial Risk Rating Risk Initial Committee/ Action Areas where we Board for Where can we gain evidence End Date do not have Areas where we delegation of that the controls / systems What could Happen and What controls/systems do we have in What evidence shows we adequate are not receiving Actions Date Identified Date we are placing reliance on
Should the Risk Rating Risk Target place that are operating at this level are reasonably managing controls /systems evidence that
CO4 - 4.1 Lead are effective internally / Detail the Actions Taken Update on Actions, is the plan on track Total Total
Materialise, What is the Total and assist in the delivery of aims and our risks and our objectives in place or controls / Likely Likely externally? Impact manage / mitigate risks. are being delivered existing controls systems are Date and Name of /systems are not effective Committee or Board
effective
ImpactConsequence / ImpactConsequence /
Strategic Objective 4: Work collaboratively with partners to improve health, care and reduce inequalities in well governed and accountable partnerships.
Outcomes i) Improvement in • Governing Body approval for the level of External Assurances: • BCF Reports to JCMB. • Outcome of the ICS None • Creation of Doncaster mini-commissioning 18.01.2021 - Meeting with Director of Strategy and Delivery. The quality as part of delegation to Joint Committees. • JCMB approved terms of • JCMB, JCOG, JCCC, Team Integrating Care - teams across life stages of commissioning is CCG have recommissioned Hill Dickenson for a further 6 months of the ICS delivery • South Yorkshire & Bassetlaw (SYB) Health reference. Doncaster minutes. Next Steps Guidance ongoing. work with place partnership, Place Board have agreed a letter of objectives. Executive Group - Collaborative Partnership • Signed Section 75 agreement. • Health and Wellbeing Board • Joint BI / SPU integration plan, ongoing. response to the NHS Guidance around future arrangements of ICS's, Board for the SYB Integrated Care System • Collaborative Partnership Board reporting. • Joint Partnership Board level which will be submitted Qtr 4. Following the ICS Governance (ICS) Chief Officer and Chair representation. minutes. • Governing Body reporting communications to be approved by CCG once Review, the CCG will have membership on all relevant steering • Doncaster Integrated Care Partnership Board • JCCCG / Working Together • Non recurrent funding agreed to finalised boards for further ICS development. Agreement has been obtained Risk Description: Joint (Doncaster Place Plan) - represented on Partnership Board minutes - support complex lives and • Bi-monthly Place newsletter for staff and to extend the commissioning agreement with the Local Authority for working focus: We have collaborative partnership by Chair & Chief received by Governing Body. vulnerable adults programmes public to be launched from November further 12 months. Further work is underway to associate funding dual areas of partnership Officer and Director of Strategy and Delivery. • Team Doncaster minutes and • Bi-monthly Place newsletter for • The CCG will need to consider the outcome, with integrated locality development and improvement in outcomes commissioning focus - our • Partnership working across Team Doncaster attendance. staff and public launched once available, of Integrating Care - Next during 2021/22. local focus on Doncaster as ii) Achieve Patient representation. November 2020 Steps Guidance that sets out the options for a place delivering the and Public • Section 75 agreement with Doncaster Council Internal Assurances: ICS's and how the next steps will impact on 06.11.2020 Meeting with Director of Strategy and Delivery. Hill ambition described in the Involvement NHSE (Better Care Fund). • Governing Body minutes. Commissioning functions. Dickenson work has now concluded, Joint Partnership Board level Doncaster Place Plan, and requirements • Commissioning agreement with Doncaster • Governing Body support of ICS communications are being agreed which will require sign off via our collaborative Council and Joint Commissioning Management Plan. individual organisational governance processes. A bi-monthly Place commissioning commitments Board (JCMB). • Governing Body support of newsletter for staff and public will be launched from November. The within South Yorkshire & • Regular updates to staff at Staff Briefing. Commissioning Agreement - Provider Alliance Emergency & Care programme went live from Bassetlaw ICS This • Memorandum of Understanding (MOU) for March 2018. Extended to April October with further actions around the Provider Woundcare complexity could potentially Continuing Health hosting arrangements by 2020. programme which will be launched 1 December 2020. Non-recurrent impact upon our capacity to NHS Doncaster CCG. • Staff Brief presentations. funding has been agreed to support the Complex Lives & Vulnerable commission services. • Standards of Business Conduct & Conflicts • Governing Body assurance Adults programmes. The ICS Governance review has commenced. of Interest Policy 2018 - including business focus upon Life Stages reports Risk score remains the same. iii) Achieve actions case and procurement requirements. (actions and outcomes).z and outcomes • Chief Officer representation on Joint • Minutes from the Covid 19 23.07.2020 Meeting with Director of Strategy and Delivery. contained in the Committee of Clinical Commissioning Groups Governance Structure Meetings Discussions are being undertaken at Place level to re-evaluate place Joint (JCCCG) and ICS Programme Board. i.e Health & Care Group governance arrangements in light of the Covid pandemic response, Commissioning Chief • Individual representation on ICS • Governing Body Minutes from Executive aiming to conclude these discussions by the end of Qtr2. Hill Apr-19 3 4 12 2 3 9 6 Mar-21 Health and Social Officer workstreams. September 2020 demonstrate Committee Dickenson have been commissioned to work with the Partnership Care Strategy • Chief Finance Officer, Director of Strategy discussion and approval of Board around models of joint working. In terms of actions and Delivery, and Chief Nurse representation reprioritised delivery plans completed, mini-commissioning teams are now in place for Starting Risk Cause: Breakdown of on System Efficiency Board. Well and Aging Well, a support post to the Provider Alliance has now Governance agreements • Chair representation on ICS Governance been recruiting and working on the place plan priorities, in addition and conflicting objectives Group. the Commissioning review of support to ICS work streams was across joint commissioning. • Lay Member input into future ICS workshop. completed. Risk score has not changed. • Lay Member for Patient and Public Involvement is a member of ICS Integrated 31-03-2020 Lead changed from Director of Strategy and Delivery to Assurance Committee. Chief Officer. • Chief officer and Director of Strategy and Delivery repesentation on JCCCG Sub Group 20-02-2020 - Audit Committee Deep Dive. Joint working is complex. • Director of Strategy and Delivery attendance Involved in response to NHS Long Term Plan and Operating at monthly SYB Directors of Commissioning Framework. The ICS is reviewing governance arrangements. A five Meeting year joint commissioning plan with the five CCGs has been • SYB Joint Commissioning Plan. developed. Risk of dual focus has increased. There are impacts Risk Consequence: • Temporary Internal Governance on demand in capacity. Regular feedback is presented to Strategy • Complexity within the Arrangements and Controls During Covid and Organisational Development Forum and Governing Body. commissioning cycle and Pandemic i.e Healthcell Current risk scoring has moved from six to nine. contracting with providers. • The Covid 19 Governance Structure has • Reduction in quality been reviewed and updated for Wave 2 experience and financial sustainability. Gaps in control and Gaps in assurance Reference Risks Current Controls Internal and External Assurances Positive Assurance timescale for and timescales for Actions to be taken Progress Against Actions
Rating remedial action remedial action
Director and Current Risk
Responsible Operational Lead Initial Risk Rating Lead Action Committee/ End Board for Where can we gain evidence that Areas where we do Date delegation Areas where we of Actions
What could Happen Date Identified What controls/systems do we have in place the controls / systems we are What evidence shows we are not have adequate are not receiving and Should the Target Risk Rating that are operating at this level and assist in placing reliance on are effective reasonably managing our controls /systems in CO4 - 4.2 Lead evidence that Detail the Actions Taken Update on Actions, is the plan on track
Risk Materialise, the delivery of aims and manage / mitigate internally / externally? risks and our objectives are place or existing
Total Total Likely Likely controls / systems What is the Impact risks. Date and Name of Committee or being delivered controls /systems are effective
Board are not effective
Impact / Consequence Impact / Consequence
Strategic Objective 4: Work collaboratively with partners to improve health, care and reduce inequalities in well governed and accountable partnerships.
Outcomes i) Improvement • Communication & Engagement Strategy. External Assurances: • Governing Body approval of None None • Implementation and 18.01.2021 - Meeting with Senior Risk Owner. The CCG 2019/20 IAF score has in quality as part • Equality & Diversity Strategy - incorporating our • Health & Wellbeing Board minutes - Chair Revised Communication & recommendations of NHS long been confirmed at 'Outstanding' and the CCG engagement assessment has been of the ICS approach to health inequalities and our equality & Chief Officer representation. Engagement Strategy. term plan through the use of confirmed as Green. The CCG has recruited to replace Head of Communications delivery objectives. • Healthwatch Contract monitoring. • Public Sector Equality Duty case studies to demonstrate and Engagement and recruitment is underway for Gypsy and Traveller link worker. objectives. • Engagement & Experience Committee (EEC). • Healthwatch monthly reporting to EEC. Internal Audit Report updated outcomes A System communications and engagement subgroup has been implemented for • Doncaster Inclusion & Fairness Forum - CCG • IAF Patient and Public Involvement rating - EEC February 2018 – significant • Summary of Healthwatch the Covid vaccination programme. The Doncaster Communications Cell membership. Green Star, by NHS England. assurance. survey on video and online continues with a focus on Covid response. The BAME survey has been • Strong relationship with Healthwatch Doncaster, •CCG 2019/20 IAF score rated as • Complaints Report to EEC. consultations to be presented completed and a Primary Care BAME network has been established, the second Risk description: ii) Achieve who also sit on our Governing Body. 'Outstanding' by NHS England • You Said, We Did. to EEC and PCCC once meeting is scheduled in January. BCF funding has been agreed for further Engagement & Patient and • Health & Wellbeing Board - local collaborative work • IAF Patient and Public Involvement rating • Recommendation of the Annual available development of the inclusion and fairness forum. prevention: Doncaster Public to improve health outcomes and address health Green by NHS England. Patient and Public Involvement • CCG to review requirements Place does not Involvement inequalities; Health & Wellbeing Board challenge of Statement by EEC in October for 2020/21 patient and public 02.11.2020 - Head of Communications and Engagement Review. achieve the move NHSE CCG plans. Internal Assurances: 2019. involvement statement Still awaiting CCG 2019/20 IAF score, NHS England considering moving to a place towards tackling requirements • Cross-Doncaster Communication & Engagement • Governing Body approval of E&D • CCG IAF Patient and Public • Survey planned for August in based assessment, details awaited. Place plan engagement on transformation inequalities and move Group, revolving chair across Doncaster Health and Strategy - July 2018 involvement assessment by NHS regards to preparing for winter work is currently paused due to pandemic response; however a 12 months on towards greater self- Social Care organisations, supporting public • Minutes of Engagement & Experience England, rated as Green Star. between CCG and main piece has been pulled together and ready to be published (likely to be after the care prevention and engagement in the Place Plan. Committee. • Recognition from SYB ICS that providers second national lockdown). CCG worked with Healthwatch in terms of patient patient empowerment. • Monthly Health and Social Care communications • Governing Body minutes, written Doncaster is an exemplar for experience around video and online consultations during pandemic; report due to group, Chaired by Head of Communications & agreement for co-working with Local patient, public and stakeholder be published imminently. The CCG has reviewed the CCG website and it is now Engagement, DCCG - to align agendas and reduce Authority. engagement for all things COVID- more accessible, particularly for people that need the content translating. No iii) Achieve duplication • Delivery of the Communication & 19. changes to risk score. Primary Care myth busting campaign continues, along with actions and • Commissioning of Healthwatch Doncaster to lead Engagement Strategy. • EEC approval of E&D Annual Health Bus posts alerting patients to additional GP appointments if they cannot get outcomes within public engagement on the ICS Plan. • Delivery plan reports on experience and Report in February 2020 an appointment at a convenient time with their local practice. Key priorities for Joint • Member of the South Yorkshire & Bassetlaw engagement to EEC and published on Doncaster place currently at plans for the second national lockdown – the Commissioning Shadow Integrated Care System - Comms and CCG Website. Doncaster comms cell will collectively determine comms and messaging. Health and Director Engagement Group. • Lay Members report back from ICS to of Executive Social Care Apr-19 3 4 12 2 4 8 6 • Qualititiave dashboard developed. EEC. Mar-21 28.07.2020 - Head of Communications and Engagement Review. Currently Strategy Strategy • Engagement workshops with NHSE. • CCG staff intranet news stories, forums Committee awaiting CCG 2019/20 IAF score, NHS England considering moving to a place & Delivery Risk Cause: • Combined structure for Communications and and blogs. based assessment, details awaited. Place plan engagement on transformation • Failure to engage Engagement workforce. • Committee coversheets include reduction work is currently paused due to pandemic response. Place supported a survey with Doncaster • Joint health and social care commissioning in health inequalities. being undertaken by RDaSH around patient experience linked to mental health population on place strategy. • Posts on social media accounts - services during pandemic. CCG are working with Healthwatch in terms of patient plan vision and • CCG IAF Patient and Public involvement Facebook and Twitter experience around video and online consultations during pandemic. The CCG actions. assessment. • Minutes posted on DCCG website, along have reviewed the CCG website and will be looking to make it more accessible. iv) Ensure the • Place Plan objectives • CCG staff intranet - Connect. with papers for every EEC meeting No changes to risk score. reporting of will not be achieved. • The new location finder for My NHS services is now • 2019/20 Annual Report and AGS which reducing health Eg. Demand in to live and accessible from the homepage of NHS contains specific information on CCG and 08-04-2020 - Head of Communications and Engagement provided an update inequalities is acute services is not Doncaster CCG. This links direct through to MyNHS Place communication and engagement current controls, assurances, positive assurance and gaps in control. transparent reduced. and enables patients to find local NHS and care activity across the three services - such as GP, dentist and other services. 20-02-2020 - Audit Committee Deep Dive. Significant improvement in Life Stages. • Constitution sets our statutory obligations for Public communications and engagement. Joined up approach to communications Involvement across Place. Budget approved for communications team to strengthen the future • Place Plan Communication & Engagement Strategy working. Engagement and Experience Committee monthly focus on two delivery • Temporary Internal Governance Arrangements and areas. Leads discuss engagement and experience within the three life stages Controls During Covid Pandemic i.e Communications which are aligned with the Governing Body. Significant amount of work in primary Cell which meets weekly care and public experience. • The Covid 19 Governance Structure has been Risk Consequence: reviewed and updated for Wave 2 Patient quality and experience and financial sustainability. Meeting name Governing Body Meeting date 1 April 2021
Title of paper Executive Committee Terms of Reference
Executive / Lisa Devanney, Associate Director of HR and Corporate Services Clinical Lead(s) Author(s) Cheryl Rollinson, Head of Corporate Governance
Status of the Report
X To approve To consider / discuss
To note
Purpose of Paper - Executive Summary
1. Introduction
- The Executive Committee terms of reference (Appendix 1) have been reviewed and updated to reflect that a Confidential session of the meeting will be held.
- Additions are highlighted in blue text, deletions in red text.
Recommendation(s)
The Governing Body is asked to: - discuss and approve the terms of reference
Impact analysis Ensuring the CCG meets its duties with regard to patient and public involvement, the public sector equality duty and patient Quality impact experience.
Ensure all member of the public are treated inclusively and Equality fairly (refer to Equality and Diversity Strategy) Impact
Sustainability impact Nil Financial implications Nil Legal Nil Implications Management of N/A Conflicts of Interest Consultation / N/A Engagement (internal
Page 1 of 2 departments, clinical, stakeholder & public/patient) Report previously Executive Committee 17.03.21 presented at Risk N/A Analysis Assurance Framework CO1 – 1.1
Page 2 of 2
Terms of Reference Executive Committee
1. Introduction
1.1. The Executive Committee (the Committee) is established in accordance with NHS Doncaster Clinical Commissioning Group’s Constitution.
1.2. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution.
1.3. The Committee’s remit is to direct operational aspects of the organisation and oversee the provider contractual reporting structure.
2. Role of the Committee
The Governing Body has delegated the following functions to the Executive Committee.
2.1. Coordinating and directing the operations of the CCG in accordance with the strategic direction set by the Governing Body, ensuring operational delivery on behalf of the Governing Body.
2.2. Deploying the resource of the organisation effectively and efficiently to deliver the strategies of the organisation.
2.3. Horizon scanning to enable review and discussion of the implications and implementation of key policy documentation issued by NHS England, the Department of Health and other statutory authorities for recommendation to the Governing Body regarding the potential impact on plans and on services commissioned by the CCG.
2.4. Overseeing the operational commissioning and contracting of healthcare services for the Doncaster population.
2.5. Overseeing integration of commissioning functions across the Doncaster health and social care community and a wider footprint.
2.6. Approving proposals, business cases, service change, funding requests and procurements where they are in line with the CCG’s strategic plan, financial scheme of delegation and approved budgets.
2.7. Ensuring that the organisation has systems in place to obtain appropriate advice from persons who, taken together, have a broad range of professional expertise in healthcare and public health.
2.8. Undertaking regular scrutiny of financial risks of the organisation.
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2.9. Taking decisions and action on any other appropriate matter within the delegated authority of its individual members.
2.10. Ensuring the development and performance management of delivery plans to reduce health inequalities.
2.11. Ensuring the principle of patients’ rights to choice under the NHS Constitution is maintained by commissioners and providers.
2.12. Provide oversight and delivery of risk management arrangements including a review of the CCGs risk register, ensuring any agreed actions are completed.
2.13. Provide oversight of data / information quality and compliance arrangements, ensuring standards of good practice in relation to information quality.
2.14. Developing and approving policies and procedures relating to CCG operations within the functions of the Committee as set out in its Terms of Reference.
2.15. Establishing Sub-Groups to assist in discharging delegated responsibilities of the Committee as set out in its Terms of Reference.
3. Sub Groups
3.1. The Executive Committee has established the following sub-groups:
• Strategic Contracting Meetings with the organisation’s main providers • Quality, Innovation, Productivity and Prevention (QIPP) Programme Board • Information Governance Group.
The meetings shall report directly to the Executive Committee and the minutes of these shall be formally recorded and submitted to the Committee.
3.2. The following meetings shall submit minutes to the Executive Committee for information:
• Doncaster Joint Commissioning Operational Group • A&E Delivery Board – Doncaster and Bassetlaw • Clinical Reference Group
4. Membership
4.1. Members
The members of the Committee shall comprise:
• Chief Officer (Chair) • Clinical Chair
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• Director of Strategy & Delivery • Chief Finance Officer (Vice Chair) • Chief Nurse • Associate Director of HR and Corporate Services
4.2. Members are required to attend nine out of 12 scheduled meetings. Attendance will be monitored throughout the year and any concerns raised by the Chair with the relevant Member.
4.3. Attendees
Other attendees requested to attend shall comprise:
• Head of Corporate Governance (Board Secretary and formal Deputy for the Associate Director of HR and Corporate Services) • Deputy Director of Strategy and Delivery (formal Deputy for the Director of Strategy and Delivery) • Deputy Chief Finance Officer (formal Deputy for the Chief Finance Officer) • Deputy Chief Nurse (formal Deputy for the Chief Nurse) • Other individuals may be invited to attend for all or part of any meeting as appropriate.
5. Appointment Of Chair
The Chair shall be appointed by the Governing Body. The Vice-Chair shall be determined by the Committee.
6. Meetings and Conduct of Business
6.1. The Committee will operate in accordance with the CCG’s Standing Orders.
6.2. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.
6.3. The Committee will hold a confidential session of the meeting for any items that may be sensitive in nature or at a stage where they are not suitable for wider disclosure.
6.4. Secretary
The Board Secretary shall provide appropriate advice to the Chair and Committee members and shall make arrangements for the Committee to have an administrator who will arrange meetings, collate and distribute papers, take minutes and keep a record of issues to be carried forward.
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6.5. Quorum
6.5.1. A quorum shall be four members. Delegated authority for decisions can only be exercised if a member (or their formally nominated deputy) with the necessary authority to act is present.
6.5.2. If a quorum has not been reached, then the meeting may proceed if those attending agree but any record of the meeting should be clearly indicated as notes rather than formal minutes, and no decisions may be taken by the non- quorate meeting of the Committee.
6.5.3. Members of the Committee may participate in meetings by telephone or by the use of video conferencing facilities where they are available. Participation by any of these means shall be deemed to constitute presence in person at the meeting.
6.6. Frequency
The Committee will aim to meet at least 10 times a year. Extraordinary meetings may be called at the discretion of the Chair.
6.7. Notice of meetings
Items of business for inclusion on the agenda of a meeting shall be notified to the Chair of the meeting at least 10 working days before the meeting takes place. Supporting papers for such items shall be submitted at least six working days before the meeting takes place. The agenda and supporting papers shall be circulated to all Committee members and attendees at least three working days before the date the meeting will take place.
6.7 An Annual Schedule of Meetings shall be agreed at, or before, the last meeting each year in order to circulate the schedule for the following year.
7. Decisions
7.1. The Committee will apply best practice in its decision making processes and effectively declare and manage all conflicts of interest.
7.2. The Committee will make decisions within the bounds of its remit.
7.3. In line with the CCG’s Standing Orders, it is expected that decisions will be reached by consensus. Should this not be possible, then a vote of members will be required, the process for which is set out below:
• Majority necessary to confirm a decision – simple majority • Casting vote – Chair • Dissenting views – dissenting views must be recorded in the minutes.
7.4. The Committee has full authority to commission any reports it deems necessary to help it fulfil its obligations.
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7.5. The Committee may establish Sub-Groups to assist it in discharging responsibilities of the Committee as set out in its Terms of Reference.
7.6. Urgent matters arising between meetings
The Chair and Deputy Chair of the Committee in consultation with the Chair of the Governing Body, Chief Nurse and Director of Strategy and Delivery may also act on urgent matters arising between meetings of the Committee. Any actions taken outside the meeting, will be minuted at the next available meeting of the Committee.
8. Reporting Arrangements
8.1. The minutes of the Committee meetings shall be formally recorded and submitted to the Governing Body.
8.2. Recommendations and decisions arising from the work of the Committee will be reported to the CCG Governing Body as required.
8.3. The Committee will annually review and assess its effectiveness and report its findings to the Governing Body. It will do this by:
• Reviewing its terms of reference; • Reviewing the attendance rate of Committee members; • Reviewing its work plan; • Reviewing its performance.
9 Confidentiality and Conflicts of Interest / Standards of Business Conduct
9.1 All Members are expected to adhere to the CCG Constitution and Standards of Business Conduct and Conflicts of Interest Policy.
9.2 In circumstances where a potential conflict is identified the Chair of the Committee will determine the appropriate steps to take in accordance with the CCG’s Conflicts of Interest decision-making matrix. This action may include, but is not restricted to, withdrawal from the meeting for the conflicted item or remaining in the meeting but not voting on the conflicted item.
9.3 All Members shall respect confidentiality requirements as set out in the CCG Constitution.
9.4 The Committee will conduct its business in accordance with any national guidance and relevant codes of conduct / good governance practice including the Nolan Principles1.
1 Available at http://www.public-standards.gov.uk/ Page 5 of 6
10 Disclosure / Freedom of Information Act (FOI)
The CCG senior officer with responsibility for corporate governance will be responsible for ensuring that FOI requirements in relation to the Committee are met. The chair of the committee will seek the advice of the senior officer with responsibility for corporate governance in relation to any matters where an exemption as defined within the Freedom of Information Act 2000 is believed to apply.
11 Links and Interdependencies
The Executive Committee will link, in particular, to the following forums: • Governing Body (board) • CCG Quality and Patient Safety Committee • Joint Commissioning Management Board • Working Together Joint Committee • Audit Committee
12 Review of the Terms of Reference
The Committee will review its terms of reference on a two-yearly basis and the attendance rate of Committee members. Any resulting changes to the terms of reference or membership shall be submitted to the Governing Body for approval.
Last reviewed: February 2021
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Enclosure B
Chief Executive Report
Health Executive Group
9 March 2021
Author(s) Andrew Cash Sponsor Is your report for Approval / Consideration / Noting
For noting and discussion
Links to the ICS Five Year Plan (please tick)
Developing a population health system Strengthening our foundations
Understanding health in SYB including Working with patients and the prevention, health inequalities and public population health management Empowering our workforce
Getting the best start in life
Better care for major health Digitally enabling our system conditions
Innovation and improvement Reshaping and rethinking how we flex resources
Building a sustainable health and care Broadening and strengthening our system partnerships to increase our opportunity
Partnership with the Sheffield Delivering a new service model City Region
Transforming care Anchor institutions and wider
contributions Making the best use of
resources Partnership with the voluntary sector
Committment to work together
Are there any resource implications (including Financial, Staffing etc)?
N/A
Summary of key issues This monthly paper from the System Lead of the South Yorkshire and Bassetlaw Integrated Care
1 System provides a summary update on the work of the South Yorkshire and Bassetlaw health and care partners for the month of February 2021.
Recommendations
The SYB ICS Health Executive Group (HEG) partners are asked to note the update and Chief Executives and Accountable Officers are asked to share the paper with their individual Boards, Governing Bodies and Committees.
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Chief Executive Report
SOUTH YORKSHIRE AND BASSETLAW INTEGRATED CARE SYSTEM
Health Executive Group
9th March 2021
1. Purpose
This paper from the South Yorkshire and Bassetlaw Integrated Care System System Lead provides an update on the work of the South Yorkshire and Bassetlaw health and care partners for the month of February 2021.
2. Summary update for activity during February
2.1 Coronavirus (COVID-19): The South Yorkshire and Bassetlaw position
South Yorkshire and Bassetlaw (SYB) continues to experience a downward trend in COVID-19 infections across the five places in common with the wider North East and Yorkshire region where the rolling seven-day rate of positive cases is 150 per 100,000 population.
Sheffield currently has a reduction in positive COVID-19 cases (now below 100 per 100,000 population) compared with the rest of SYB, with Barnsley and Doncaster experiencing a similar steady decrease also. Whilst there are slightly higher rates in Bassetlaw and Rotherham, the overall picture is one that is showing a gradual decline in community infections, and an overall feeling of optimism that SYB has passed the peak of the third wave.
The number of hospital admissions is falling faster than the number of new cases, with the fall in hospitalisations also faster among the age groups already vaccinated (compared with those in younger age groups yet to get a jab). This steady decline in admissions, particular among the COVID-19 vaccination priority groups (1-4), has the added positive effect on reducing hospital bed occupancy rates - much improved since early October 2020.
Data from the Office for National Statistics shows that Covid-related deaths across Yorkshire and the Humber are around 320 per week (as per the latest report) with the trend steadily decreasing.
Whilst there are small increases in the infection rate among individuals of a working age (16 – 64), and particularly within younger age groups, we are not seeing any stacking (incidental passing of the virus to older generations in their family or household who are more likely to develop serious illness).
Similarly, as a result of the good weather at the end of February, mobility data shows that more people were leaving the house for walking which saw a steady increase in park use and workplace visitations. Data and reports also suggest that people are still very much abiding by the rules.
In summary, the news is encouraging and means that we are starting to see the parallel impact of SYB’s vaccination programme and lockdown restrictions curtailing the spread of COVID-19.
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2.1.1 SYB Vaccination Programme
We are now more than 12 weeks into the vaccination programme with over 20 million people in the UK having now received their first dose of a COVID-19 vaccine. In SYB, over 415,000 have now received their vaccination as of 2nd March.
To support the national target, SYB Vaccination Programme Steering Group met last week to discuss modelling and supply lines and we remain on-track to meet our 18 April target to vaccinate JCVI priority groups 5-9.
2.1.2 Additional funding to tackle vaccine inequalities
An additional 100k funding been awarded to SYB to support the improved vaccine uptake among Black Asian and Minority Ethnic (BAME) groups. It is part of the national pot of £4.2 million pounds being made available to deliver the COVID-19 vaccine deployment programme. This NHS funding complements the £1.4m awarded to councils and voluntary organisations in the five SYB places in February to support those most at risk from COVID-19 and boost vaccine take up.
The funding will help to deliver a wide range of measures to protect those most at risk - building trust, communicating accurate health information and ultimately helping to save lives. This will include developing new networks of trusted local champions where they don’t already exist and will also support areas to tackle misinformation and encourage vaccination take-up.
These developments to help reduce vaccine inequality were further boosted by the addition of individuals on the GP learning disability register now being fast-tracked for a COVID-19 vaccination in England (as part of Group 6), equating to an additional 150,000 people, supporting some of our most vulnerable groups across SYB.
2.1.3 National Vaccination Programme
To further support the national roll-out, NHS England and NHS Improvement (NHS E/I) issued a letter setting out the key priorities and actions for immediate review.
The letter pays particular focus in the areas of ensuring maximum reach/uptake across Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts, including second dose planning and delivery preparations for vaccination when supplies increase. There are also new recommendations around how to boost vaccination uptake from within social care staff groups.
At this point, two million more invites will sent to people aged 60 to 63 years-old with Primary Care Networks continuing to invite their patients (of all ages) who are particularly at risk due to a health condition/or living with a learning disability.
This follows the news of sixteen frontline charities (including The British Heart Foundation, Macmillan Cancer Support and Mencap) joining up to form a new partnership to encourage those with long-term health conditions and their carers to get the COVID-19 vaccine.
2.2 Regional update
The North East and Humber Regional ICS Leaders continue to meet weekly with the NHS England and Improvement Regional Director to discuss the ongoing COVID-19 incident, planning that is taking place to manage the pandemic and where support should be focused. Discussions during February focused on recovery and military supported planning, ICS development, the COVID-19 response and vaccination programme.
2.3 National update
On February 11th 2021, the same day the Department for Health and Social Care published its White Paper Integration and Innovation: working together to improve health and social care for all, 4
NHS England and NHS Improvement (NHS E/I) set out its response to its earlier engagement on Integrating Care: Next Steps and its recommendations to government.
The document, Legislating for Integrated Care Systems: five recommendations to Government and Parliament, makes recommendations to Government on the question of how to legislate to place Integrated Care Systems (ICSs) on a statutory footing, having gathered the views of the NHS, local government and wider stakeholders. The recommendations built on the successful integration, collaboration and partnership efforts of ICSs to date. The recommendations are:
Legislative recommendation 1: The Government should set out at the earliest opportunity how it intends to progress the NHS’s own proposals for legislative change.
Legislative recommendation 2: ICSs should be put on a clear statutory footing, but with minimum national legislative provision and prescription, and maximum local operational flexibility. Legislation should not dictate place based arrangements.
Legislative recommendation 3: ICSs should be underpinned by an NHS ICS statutory body and a wider statutory health and care partnership. Explicit provision should also be made for requirements about transparency.
Legislative recommendation 4: There should be maximum local flexibility as to how an ICS health and care partnership is constituted, for example using existing arrangements such as existing ICS partnership boards or health and wellbeing boards where these work well.
The composition of the board of the NHS ICS body must be sufficiently streamlined to support effective decision-making. It must be able to take account of local circumstances as well as statutory national guidance.
Legislation should be broadly permissive, mandating only that the members of the NHS ICS Board must include a chair and CEO and as a minimum also draw representation from (i) NHS trusts and Foundation Trusts, (ii) general practice, and (iii) a local authority. As with CCGs now, NHSE/I should approve all ICS constitutions in line with national statutory guidance.
Legislative recommendation 5: Provisions should enable the transfer of primary medical, dental, ophthalmology and pharmaceutical services by NHS England to the NHS ICS body. Provision should also enable the transfer of delegation by NHS England of appropriate specialised and public health services we currently commission. And at the same time, NHS England should also retain the ability to specify national standards or requirements for NHS ICSs in relation to any of these existing direct commissioning functions.
2.4 Department for Health and Social Care white paper Integration and Innovation: working together to improve health and social care for all
On February 11th 2021, the Department for Health and Social Care published its White Paper Integration and Innovation: working together to improve health and social care for all.
As anticipated, the White Paper proposals follow the journey of integrating care in neighbourhoods, places and across the system that we have been on across SYB for many years and is designed to support us by removing many of the obstacles that stand in our way on a daily basis. It builds on the ambitions of the Long-Term Plan to tackle health inequalities through a whole population health approach, to plan for improvements in health and health care at system level and to work in partnerships at place and in provider collaboratives. This will allow us to join up care and to ensure that no matter where people live, they have the same opportunity to access services and the opportunity to level up health outcomes across the system.
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ICSs will be established, to include an NHS body and a Health and Care Partnership
The NHS body will be:
Responsible for strategic planning, taking on the commissioning functions of CCGs and be directly accountable for NHS spend and performance within the system, with its chief executive becoming the accounting officer for NHS money allocated to the NHS ICS body As a minimum, include a chair, the chief executive and representatives from NHS trusts, general practice and local authorities, with others determined locally. ICSs will also need to ensure they have appropriate clinical advice when making decisions Responsible for developing a plan to meet the health needs of the population within their defined geography; developing a capital plan for the NHS providers within their health geography; and securing the provision of health services to meet the needs of the system population.
The Health and Care Partnership will be responsible for developing a plan that addresses the wider health, public health and social care needs of the system, with the NHS ICS board and local authorities having to regard that plan when making decisions.
SYB health and care partners have agreed a framework for taking forward the proposals and this is set around the four key building blocks of an ICS:
Place Partnerships Provider collaboratives Future commissioning and how the nature of commissioning will change ICS operating model
In addition, there are two enabling work streams:
HR and people transition ICS Financial framework
An ICS Development Steering Group, made up of partners from across the ICS, has been formed to oversee all workstreams and it is working on a Compact for the Health and Care Partnership to support the direction of travel in the 2021/22 transition years and until the Bill is enacted. The Compact is based around the SYB quadruple aim of better health and wellbeing for the whole population, better quality care for all patients, sustainable services for the taxpayers, reduction in health inequalities. The HCP roles, responsibilities and terms of reference are also being developed as part of the work.
In the coming weeks, we expect to conclude the governance arrangements for the transition year and capture the outputs from the wider workstreams. This will include a review of the existing meeting arrangements to streamline them where possible.
At the same time, we are embarking on a collective approach to the transition with staff working in CCGs, the ICS PMO and NHS E/I. All four ICSs in the North are taking a consistent approach with agreed HR principles that build on the FAQs that came out with the white paper. These are minimum disruption, smooth transition, reducing anxiety, employment commitment and “one workforce”, while recognising the importance of place and place teams.
National HR principles to guide the transition and further guidance after the second reading of the Bill are expected in due course. In the meantime, the HR transition is being supported by Christine Joy, ICS Change and HR/OD Programme Lead from the national HR and OD team. Christine is working closely with the ICS to develop an inclusive engagement approach with staff to minimise uncertainty and enable us to work together to co-create the new SYB ICS NHS Body.
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2.5 Government roadmap for England
The release of the Government’s four-step roadmap on February 22nd outlined the plan for the coming months. The plan will be punctuated by five-week intervals to assess the impact at every phase, with ‘data not dates’ being used to guide and steer the decision-making process on future relaxations. It will be assessed against the data performance in four key areas:
1. Vaccine deployment - the programme continuing successfully. 2. Variants of Concern - the assessment of the risks is not fundamentally changed by new strains. 3. Hospitalisations and deaths in those vaccinated - evidence showing vaccines are sufficiently effective in reducing both numbers. 4. Surge in hospitalisations causing high concern - infection rates do not translate into unmanageable spikes in new cases that would put unsustainable pressure on the NHS.
Benchmarking against these measures will be vital and will take place over four-week intervals, allowing public health teams to safely evaluate effectiveness of each new phase. If the data at these check-points show a worsening position or public health concern, the dates and timelines may be altered accordingly. If each of the criteria is met, this will trigger a seven-day notice to proceed with the next step of relaxations.
2.6 What Matters to You
World Cancer Day took place on Thursday 4 February and as part of the commitment to providing high quality, personalised care for patients who experience cancer, the South Yorkshire and Bassetlaw Cancer Alliance has launched an important new initiative to help shift the focus of health and care professionals from, “What is the matter with you” to “What matters to you?”
Every person is different. As is their journey and experience of cancer. In partnership with Voluntary Action Rotherham (VAR) the What Matters To You initiative provides an online learning platform for any health and care professional in contact with people with a cancer diagnosis to become a Certified Care Professional.
Launching primarily within the voluntary and community sector, we hope that the What MattersTo You certification becomes synonymous with quality personalised care which can be recognised by both professionals and patients throughout South Yorkshire and Bassetlaw.
2.7 QUIT Programme
The funding agreement with Yorkshire Cancer Research has now been signed which will secure £1.8m to support the delivery of the QUIT Programme. This will fund the appointment of 45 whole time equivalent specialist Tobacco Treatment Advisors (TTAs) who will help deliver QUIT across SYB NHS Trusts in the Programme.
The first Trusts (Barnsley Hospital NHS Foundation Trust and the Rotherham, Doncaster and South Humber NHS Foundation Trust) are now recruiting and the first TTAs will be in post by May 1, 2021. They will be supported by the Trust Healthy Hospital Programme Managers and Health Improvement Managers.
The QUIT Programme recognises that smoking is an addiction, a preventable illness that can and should be treated - NOT a lifestyle choice. It will ensure that treatment for tobacco dependency is built into the routine care offered to every patient attending any hospital in South Yorkshire and Bassetlaw. Support and treatment will also be available for Trust staff who wish to quit and for parents of paediatric patients.
A wide range of training and treatment resources have been put together and will be accessible through a dedicated QUIT website that will go live at the beginning of April.
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Nearly 200,000 people smoke in South Yorkshire and Bassetlaw. More than half of those people will die prematurely from smoking-related illness, losing on average 10 years of life. Decreasing the prevalence of smoking is a key Long Term Plan ambition for South Yorkshire and Bassetlaw Integrated Care System and a major strand to our developing health inequalities plan.
The QUIT Programme is based on evidence from Ottawa, Canada, and if it proves as successful in South Yorkshire and Bassetlaw, we have the potential to save 2,000 lives and up to 4,000 hospital readmissions in a year.
2.8 Voluntary, Community and Social Enterprise SRO Update
In recent months, the ICS strengthened and embedded partnership working with the VCSE within the SYB system with the formation of the South Yorkshire and Bassetlaw Voluntary Community and Social Enterprise (VCSE) Leaders Group and the appointment of Catherine Burn as ICS VCSE Senior Responsible Officer (SRO).
Catherine, who is both Director at Bassetlaw Community and Voluntary Services (BCVS) and Chair of the Bassetlaw Place Partnership, is stepping down from her role at BCVS at the end of March 2021 to take up a new appointment in Cumbria. Catherine has been on the integrated care journey with SYB from the very beginning when we started life as a Sustainability and Transformation Partnership in 2016, through to becoming an Integrated Care System in October 2018. Throughout the last five years she has provided VCSE leadership and been instrumental in establishing strategic partnerships with the voluntary sector. We have been extremely fortunate to have such an experienced and talented VCSE leader in our system and we wish Catherine all the very best in her new role.
The VCSE Leaders Group will now discuss and agree which of its members will take on the VCSE SRO role and put forward their recommendation to the HEG in due course.
2.9 SYB Reporting Radiographer Academy
Twelve new trainee radiographers started their training at the SYB Reporting Radiographer Academy in January 2021. There have been many challenges to getting the Academy started this year and it is credit to the team that the trainees are now well underway with the programme. When fully trained, the radiographers will go on to provide crucial extra support for image reporting across South Yorkshire and Bassetlaw.
3. Finance update
The financial position at Month 10 forecasts a surplus of £42.7m which is £6.6m better than the Month 9 forecast and £46.6m better than the planned deficit of £3.9m. Forecast capital slippage against plan is £21m. This will allow the system to meet its two key financial targets for the year.
The planning round for 21/22 has been deferred and the financial framework that has been in place for months 7/12 20/21 will be rolled forward to Q1 and possibly to Q2. No decision has yet been taken on the financial framework for the remainder of the financial year. System capital envelopes are due out shortly with an indicative timetable of mid-April for submission of system capital plans.
Andrew Cash System Lead, South Yorkshire and Bassetlaw Integrated Care System
Date: 4 March 2021
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Minutes of the Audit Committee Meeting Thursday 10 December 2020 at 9.00 am via Microsoft Teams
Present: P Wilkin (Chair) Lay Member for Audit and Governance Dr E Jones (Vice Chair) Secondary Care Doctor Lead Dr M Khan Locality Lead, Central S Whittle Lay Member for Engagement and Experience
In attendance: H Tingle Chief Finance Officer, CCG L Devanney Associate Director of HR and Corporate Services, CCG (until 10:55 am) C Rollinson Head of Corporate Governance, CCG T Wyatt Deputy Chief Finance Officer, CCG A Russell Chief Nurse, CCG (until 10:15 am) C Page Client Manager, 360 Assurance
C Partridge External Auditor, KPMG J Motala Manager, KPMG J Whittaker Senior Corporate Services Support Officer (Minutes) Action
1. Welcome and Apologies
P Wilkin welcomed everyone to the meeting and J Motala was introduced to the committee members.
No apologies were noted.
2. Declarations of Interest
P Wilkin reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk
The meeting was noted as quorate.
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Declarations of interest from sub committees / working groups: None declared.
Declarations of interest from today’s meeting: None declared.
3. Minutes and Action Trackers from Previous Meetings
The minutes and action tracker of the meeting held on 10 September 2020 were approved as a correct record.
4. Matters Arising not on the Agenda
There were no items raised.
5. Notification of Any other Business • Latest financial position - verbal update to be included as part of Item 9, Financial Reporting
6. External Audit
External Audit Plan 2020/2021 – J Motala presented the report which details the external audit plan for the year ending 31 March 2021 and highlights the following: • Materiality level has not changed from last year, which is £10.9 million, based on 2% of total resource allocation. • No change from previous year in terms of significant risk. • Audit risks and audit approach – there will be an increased focus on journals/journal entries, as well testing samples of expenditure transactions and year end accruals. • Value for Money (VFM) - for 2020-2021 onwards, KPMG are required to provide a public commentary on the arrangements in place for ensuring value for money is achieved at the CCG. This is expected to be incorporated within the Annual Audit Letter that is published on the CCG’s website. This will include a commentary on our view of the appropriateness of the CCG’s arrangements against each of the three specified domains of value for money: financial sustainability; governance; and improving economy, efficiency and effectiveness. Work is on- going in regards to the VFM risk assessment. It was raised that it was felt the VFM audit is beneficial and updates will be provided following completion of the risk assessment and planning procedures.
External Audit Technical Update C Partridge presented the report which provides health sector updates and highlights any technical issues impacting the sector. The key highlights were as follows:
Areas to bring to the attention of the CCG are as follows: 1. Contracts and Payment Guidance October 2020 - March 2021. 2. Agreement of Balances Guidance 2020-2021.
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3. Social care sector: winter plan and Coronavirus (Covid-19) support taskforce report. 4. Brexit: How healthcare providers can prepare for 1 January 2021. 5. Approaching the end of the Brexit transition: practical implications for the NHS.
Agreement of Balances – next step is to review the guidance to identify key changes and required actions applicable for the 2020/2021 financial year and it was felt this should be a simple and straightforward exercise.
Brexit: how healthcare providers can prepare for 1 January 2021 – L Devanney advised regular, national updates with Professor K Willett continue to take place in regards to EU preparedness. An assurance exercise was undertaken, which covered medical supplies, devices, medicines etc and we were rated green across the board, with the exception of finances, which were amber, as we do not know what costs we may incur and are unsure of the impact in January 2021. In terms of preparedness, we are prepared as much as we can be, and mitigation is in place for supply and distribution of medicines and devices as well as a dedicated supply chain to support the NHS. Updates will continue to be provided to the Governing Body.
The Audit Committee noted the update.
7. Internal Audit Progress Report
C Page presented the internal progress report which identifies progress made in relation to completion of work from the CCG’s Internal Audit Plans and covers the work carried out during the period to 2 December
2020. The key points were as follows:
• Given the impact of Covid-19, the audit plan is still in the early stages of delivery. • The Conflicts of Interest (COI) review is currently in progress. It was highlighted this has been delayed due to auditor absence. An alternative resource will be allocated to complete the work if the absence becomes long term, with the final report to be presented to March 2021 Audit Committee. C Page • Data Security Protection Toolkit – the annual submission
deadline has been extended to 30 June 2021. In line with the
agreed internal audit plan, delivery of audit of compliance will continue with the Data Security Standards before the 31 March 2021. • Integrity of the General Ledger, Financial Reporting and Key Financial Systems - planning of this review has commenced. It was originally intended to review budgetary control arrangements in 2020/2021. However, due to the changes in the current financial regime, it is proposed that we now review the accounts payable and cash and bank systems for 2021. C Page raised currently in the plan, there are five days in the
contingency around Integrated Care System (ICS) assurance and asked the Audit Committee to consider the appropriateness 3
of reallocating those days to the financial system review. Following discussion, the Audit Committee were in agreement to the reallocation of the five days, which will give a total of 15 days overall. A discussion was held around the ICS governance review. S Whittle will raise this at the ICS forum in January 2021 and C Page to take up conversations with all clients in regards to
the joint approach to look at ICS governance in 2021/2022. Further discussions will take place at a future Audit Committee Meetings, as required. • Quality of Care in Care Homes 2019/2020 – this is currently at draft report stage and are awaiting a response from the CCG. A Russell advised there are some areas that still require clarification in the draft and will look to bring back the report to the next Audit Committee in March 2021. A Russell
2020/2021 Stage 1 Head of Internal Audit Opinion Report The report was shared prior to today’s meeting, and covers work undertaken to mid-November 2020. A review has taken place of the effectiveness of strategic risk management and governance arrangements in the year to date and this has included Covid-19 risk management and governance, incorporating basic incident command arrangements. Four low risk recommendations have been made.
It was raised this was a reassuring report, however, need to ensure we continue to act on recommendations made and reduce risks where we can despite the disruption due to Covid-19. L Devanney stated a meeting was held with P Wilkin and C Rollinson to go through the recommendations and they are in the process of being implemented.
The Audit Committed noted the Stage 1 Head of Internal Audit Opinion report.
360 Assurance Management Board Letter 20.11.20 – a letter was sent out by Leicestershire Partnership NHS Trust, which hosts 360 Assurance, and details the potential impact on their ability to deliver internal audit work across all client bases due to second wave of Covid- 19 and that they will endeavour to deliver plans as agreed at last quarter, as well as recognising pressures clients are under also.
The revised plan was submitted to the Audit Committee in September 2020 in terms of working to a reduced plan, which will cover core audits, and is resourced to deliver by 31 March 2021. C Page advised they cannot see any reason to reduce or change the plan further as long as both sides are able to continue to support this in terms or resources.
The Audit Committee noted the letter from 360 Assurance Management Board.
8. Governance Governing Body Assurance Framework The Assurance Framework was shared with the Audit Committee and C Rollinson advised she had met with Senior Risk Owners in October 4 and November 2020 to update the principle risks at the end of Quarter 2 2020/2021. The key changes were as follows: CO2 (2.2) – the consequence has been increased from 3 to 4 to reflect the challenges of moving into Wave 2 of the pandemic and winter pressures combined with system capacity to manage demand and maintain quality. This risk remains high.
CO3 (3.1) – both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and transformational expenditure. Following the notification of the allocations and the financial framework, a revised financial plan has been developed. This risk is now increased from high to very high. CO3 (3.2) - both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and efficiencies. There is significant risk built into the revised financial plan which looks at efficiency savings across both CHC and prescribing. This risk is now increased from high to very high. CO3 (3.3) - both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and the system control total/affordability. The ICS are developing risk share arrangements across the system in the event of any Organisation not achieving its control total. This risk is now increased from high to very high. CO3 (3.4) - both the likelihood and consequence scores have been increased to reflect the uncertainty around finances and the CCG control total. The CCG have agreed with the ICS that the CCG have an underlying £1.8m of unmitigated risk in our plan. This risk is now increased from high to very high.
The Audit Committee reviewed and noted the updated assurance framework.
Deep Dive Corporate Objectives
CO1.1 - Organisational Change - The CCG may not have the right workforce capacity and capability to meet its organisational objectives and to meet its statutory obligations. CO2.4 The Provider Workforce being insufficiently skilled lacking the capacity of sufficiently skilled staff, which could be detrimental to patient care. L Devanney delivered a presentation, which provided an update on how issues have been addressed throughout the Covid-19 pandemic and the key highlights were as follows: • Refreshed business continuity plans early in 2020. • Roll out of Safemove and MS Teams in March 2020. • Staged approach to remote working. • Additional health and wellbeing support. • Continuation of 1:1 supervision/PDR’s, team brief and staff briefings supported with weekly staff updates. • Shared additional governance structure put in place to support
Covid. • Reduction in sickness. • Reducing the Burden and Managing Capacity guidance implemented. 5
• Risk Assessments for whole workforce. • Re-deployed staff into other roles.
CO 2.1 Quality Impact - There is a risk to maintaining quality, services and outcomes through local transformation. A Russell delivered a presentation, which provided an update on how issues have been addressed throughout the Covid-19 pandemic and the key highlights were as follows: • Pressures already in system from November 2019 as a result of the floods. • Staff continue to be flexible. • Teams significantly changed how they have worked and provided leadership across the system.
• Reducing the burden for the CCG and for the system. • Flexible and responsive governance. • Pausing parts of the system without losing intelligence i.e. complaints/Continuing Health Care (CHC). • Recognition of quality and safety impacts and mitigation. • Accelerated changes – registered care settings and specialist placements, partnership working, digital transformation, trained
over a 1,000 people in terms of IP and C.
• Moving forward, continued focus on quality and safety during recovery, restart and refresh, and flexible and responsive teams and governance.
Recognition was given to the strengthened relationships with organisations and staff members’ ability to work flexibly to cope with unforeseen challenges whilst maintaining core work throughout the pandemic.
The question was raised as to how to maintain the good working practices/relationships which have been developed throughout the pandemic as well as looking at lessons learnt. A discussion was held and it was agreed it would be beneficial to capture this information in a more formal way and undertake some reflection across each of the teams in terms of what has worked well/not so well and to share accordingly with Committee members.
The Audit Committee thanked A Russell and L Devanney for the comprehensive update, which reflects the huge amount of work that has been undertaken and congratulated the teams on how they have responded to both the flood and Covid-19 crises.
A Russell left the meeting at 10.15 am
Corporate Assurance Report Quarter 2 C Rollinson presented the report and the key highlights were as follows: • As of Quarter 2, 10 risks deemed as high, all of which have action plans. • Risk Register – four very high risks on the corporate risk register.
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• Score has reduced around risk for fraud and bribery. • There is a separate Health and Care Cell Threat and Risk Assessment to capture risks separately that come through the additional governance structure put in place to support Covid-19.
• Incident Reporting - there was one information governance breach during Quarter 2. This was not required to be externally reported and has been closed. C Rollinson to share details of C Rollinson the breach with the Committee. • Corporate Governance - there have been no amendments to the Constitution, Establishment of the Governing Body, the Governance Structure or changes to statutory roles during Quarter 2. There have been no declarations of gifts or hospitality during Quarter 2.
• – work remains on-going in terms Equality and Diversity (E&D) of the E&D action plan. • External Assessments - during Quarter 2, work has commenced on the 2020/2021 Head of Internal Audit Opinion and the annual Conflicts of Interest audit. • Data Security Protection Toolkit 2020/2021 - the annual
submission date has been extended to June 2021 and the CCG
have produced a draft action plan, with a focus to work to the original deadline of 31 March 2021.
The question was raised as to whether information should be updated in terms of the Constitution and the new structures that have been put in place as a result of Covid-19. It was agreed for L Devanney and C L Devanney & Rollinson to discuss this further outside of the meeting. C Rollinson
The Audit Committee noted the Corporate Assurance Report Quarter 2, 2020-2021.
9. FINANCIAL REPORTING
Financial Plan Update
H Tingle provided an update and advised the financial plan was submitted and approved at Governing Body last week. It was acknowledged there are some risks in the plan in terms of delivery of a balanced position for Month 7-12 including risk of overspends in areas such as Individual Placements, CHC and Prescribing. It was highlighted
that our plan is consistent with that of the other four CCGs across the patch.
Latest financial position update H Tingle provided a brief update on the latest financial position and
advised due to the Covid-19 pandemic one of the changes to the financial regime was to split the financial year into two parts (Months 1- 6 and Months 7-12). For Months 1 to 6 we have a breakeven position, and funding has been secured in regards to system top-ups for Month 6.
A detailed piece of work in regards to forecasting is also currently being undertaken within the CCG.
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It was highlighted that it was felt financial risks have reduced since the last meeting so will look to reduce those risks on the corporate risk
register in January 2021.
The Audit Committed noted the update.
Finance Exception Reports
T Wyatt provided a brief overview of the report, which identifies any losses and special payments, debtors or creditor balances over six months old and over £5,000 waived as per standing orders or Standing Financial Instructions (SFI’s). The following points were highlighted: • There have been no losses or special payments.
• Application of Standing Financial Instructions waiving of tender • and quote procedures – awaiting further information from procurement team, which will be shared at the next Audit T Wyatt Committee Meeting. • The number of outstanding debtor balances over 6 months old and £5,000 is £1,339,993 of which £1,274,588 relates to 13 invoices raised to DMBC for CHC recharges. There are then three smaller invoices which are being actively chased. It was felt we are in an improved position for CHC. • The number of outstanding creditor invoices over six months old and £5,000 now stands at £377,245 (41 invoices of which 10 relate to YAS and 9 to Cygnet). Please note that this excludes any balances with DMBC as these are reported separately. Issues to the value of £282k have been resolved and paid since the last report and £170k of new issues have gone past the six month date. • As at 2 December 2020, DMBC owe the CCG £1,281,972 which is a reduction since March however this does not include a number of recharges that have not yet been raised as we are waiting confirmation from the Local Authority (LA) of any queries before they are raised. All of the old debt relates to CHC recharges to the LA.
The Audit Committee noted the update and it was agreed for CHC updates to continue to be provided within the finance exception report.
It was noted that guidance on International Financial Reporting Standard (IFRS) 16 on Leases for NHS providers and commissioners has been deferred for a further year until 1 April 2022 for NHS and DHSC group bodies.
Standing Orders, SFIs & Scheme of Delegation Following the review, there are no amendments required to any of the documents and the current versions appended to the CCG Constitution remain relevant.
The Audit Committee noted the update.
10. HFMA Covid Governance Checklist
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H Tingle advised this was presented earlier in the year when responding to the pandemic.
Narrative has been added to the checklist against each of the recommendations in terms of the approach, which provides further governance and assurance.
It was highlighted that we are starting to incur expenditures in terms of the implementation of the Covid-19 vaccine, which will be starting next week in Doncaster.
It was agreed to add the checklist as an appendices to the Governing Body report.
The Audit Committee noted the HFMA Covid Governance Checklist and the update provided.
11. Extracts from 360 Assurance Client Briefing November 2020
The following extracts were raised with the Audit Committee to confirm if the Executive Team were aware of this information as follows:
• NHS to introduce ‘one stop shops’ in the community for life saving checks https://www.england.nhs.uk/2020/10/nhs-to- introduce-one-stop-shops-in-the-community-for-life-saving- checks/
• What the £13bn debt write-off means for the NHS https://www.health.org.uk/publications/reports/what-the-13bn- debt-write-off-means-for-the-nhs - regular updates will continue to be provided by H Tingle to the Audit Committee.
• CCG mergers: How clinical commissioning groups and local government can work together https://www.nhscc.org/policy- briefing/updated-for-2020-21-how-clinical-commissioning- groups-and-local-government-can-work-together/ - conversations are taking place at Governing Body around the Integrating Care and ICS guidance due to take effect.
Following discussion, H Tingle advised she would raise the above items with the Executive Team and feedback to the Audit Committee. H Tingle
L Devanney left the meeting at 10.55 am
12. Integrated Risk Issues arising from other Committees
No items to raise.
13. 2020/2021 Audit Committee Self-Assessment of Effectiveness Proposal
A draft set of questions have been proposed and shared with the Audit Committee for 2020/2021. The intention is to run the review as a survey 9
with a report being presented for discussion at the next Audit Committee in March 2021.
The Audit Committee considered and approved the proposed self- effectiveness questions and were happy to move forward with this.
14. Committee Terms of Reference Review
The Terms of Reference (ToR) were shared with the Audit Committee for recommendation of approval to the Governing Body, in line with the annual review.
The Audit Committee were in agreement to recommend the ToR to the Governing Body and these will continue to be reviewed on an annual basis.
15. Review Audit Committee Forward Planner
No additional items raised.
16. Reflections from Committee on Decisions and Outcomes
No items raised.
17. Escalation of risks to Governing Body
It was agreed for the following items to be included in the Governing Body report: • External Audit Plan and addition of VFM report. • External Audit Technical Update – agreement of balances, EU update. • Internal Audit – update on COI review, reallocation of five days to financial system review and discussion regarding ICS governance. • To raise Stage 1 Head of Internal Audit Opinion Report. • Briefing around assurance framework and deep dive. • Report on CHC improvement within financial review. • Report on HFMA Covid-19 government checklist. • Commencement of self-assessment for Audit Committee. • Recommend the ToR for approval by the Governing Body.
18. Any Other Business
No items raised.
19. Date and Time of Next Meeting: Thursday 11 March 2021 from 9:00 am to 12:00 pm via MS Teams
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Minutes of the Virtual Executive Committee Held on Wednesday, 17 February 2021, 9am
Present J Pederson Chief Officer (Chair) H Tingle Chief Finance Officer A Russell Chief Nurse A Fitzgerald Director of Strategy & Delivery L Devanney Associate Director of HR & Corporate Services
In J Satterthwaite PA to Chair and Chief Officer attendance: P Tarantiuk Strategy & Delivery Manager (Items 6) E Price Head of Strategy & Delivery – Children (Item 6)
Action 1. Apologies
• Dr Crichton, Chair
2. Declarations of Interest
The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub committees / working groups:
None declared.
Declarations of interest from today’s meeting:
None declared.
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3. Minutes from Previous Meeting held on 20 January 2021.
The minutes of the meeting held on 20 January 2021 were approved as a correct record subject to the following amendment:
Page 16, Item 15, Performance Report, Bullet Point 2, Line 2 amend to read ‘The Doncaster Partnership is considering the response and issues are being escalated through agreed governance routes’.
4. Matters Arising not on the Agenda
J Pederson proposed that as a Confidential Executive Committee meeting has now been established, the Executive Committee Terms of L Devanney Reference should be reviewed and updated.
5. Notification of Any Other Business
There was no other business notified.
6. Adult Autism Spectrum Disorder (ASD) Service
Local commissioners commission Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) provides children’s and Adult ASD services in each of the three localities it serves.
In Doncaster, negotiations were underway prior to the COVID-19 pandemic to review the service specification for the Adult ASD service, with a proposed start date of 1 April 2020. Both NHS Doncaster CCG and RDaSH proposed an expansion of the service in line with NICE and the Transforming Care Programme guidance. The COVID-19 pandemic
resulted in a suspension of contract negotiations and existing service specifications have rolled over to 2020/2021.
The current service specification commenced in April 2017 and was due for renewal from April 2020.
The service receives referrals from:
• GP’s • Consultant Psychiatrist’s
• Community Mental Health Teams • Family members/carers • Self-referrals • Doncaster Council Autism/Asperger’s Workers
The two Band 6 Specialist Practitioners employed to provide the service, will consider an assessment for a possible ASD.
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In addition to assessment and diagnosis the service supports adults of working age (18+) who have a diagnosis of an ASD (inc. Asperger’s Syndrome) and clearly identified health needs for example mental health problems, mental disorders, risk and engagement issues. It provides 4-6 sessions over 3 months post-diagnostic maximum capacity of 14 patients. The Trust facilitates referrals to the appropriate social care service where social needs are the main area of difficulty.
Referrals into the adult ASD service in Doncaster are made via the Single Point of Access (SPA). The Learning Disability services consider all referrals at a weekly Learning Disability MDT prior to accepting for a screening referral. The Head of Mental Health and Learning Disability Services and the Service Manager – Learning Disabilities have worked with staff to review the current service provision and consider proposals to increase the service provision for the population of Doncaster.
The service is proposing four options for consideration:
• Option 1 – Service Remains as is. • Option 2 – Short Term Non-Recurrent Funding. • Option 3 – Additional Recurrent Funding.
• Option 4 – Short Term Non-recurrent funding and Additional Recurrent Funding.
The ASD Service recommends the approval of Option 4 – Additional Recurrent and Short-Term Non-Recurrent funding to expand the existing service and to clear the existing waiting lists.
The Executive Committee was asked to:
• Provide either a recurrent or non-recurrent financial allocation to
RDaSH based on the significantly deteriorating clinical pathway. Due to continual COVID pressures the service does not have capacity to continuously adapt and reprofile potential options of provision. • Approve Option 3 to provide a viable long-term service which meets both the NICE workforce requirements and the 18 weeks Referral to
Treatment guidance.
H Tingle reported that we are aware that investment is needed in Mental Health services and this business case is the first of several. A detailed conversation is required to determine which services to invest in. E Price advised that there has been some discussion to establish a deeper understanding of the costs involved to eliminate any potential double funding and there is further work to be undertaken on this. There are other business cases within the system that will be presented to the E Price Committee in the future and J Pederson requested that a list be forwarded to her for perusal.
It was proposed that an urgent discussion take place with RDASH H Tingle/ colleagues to collectively determine the priority of all expected business A Fitzgerald
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cases. There was also a proposal that the CCG works with RDASH colleagues to establish a provider commissioned model for out of area placements. The ambition being to move to an MHIS local investment model. H Tingle and A Fitzgerald agreed to propose this to RDASH colleagues and use the next contracting meeting to work through this J Pederson approach. J Pederson agreed to also discuss the preferred approach with K Singh.
Following the above actions taking place, the business case is to be presented to the Executive Committee on 17 March 2021 with a revised P Tarantiuk financial framework and costings.
7. Corporate Assurance Report Quarter 3
L Devanney presented the Corporate Assurance Report for Quarter 3 for noting by the Executive Committee. The following key points were highlighted:
• Board Assurance Framework (BAF) – The Quarter 2 update was
presented to the Audit Committee on 10 December 2020 and the Governing Body on 4 February 2021. The Quarter 3 update of the BAF will be presented to the Audit Committee in March 2021. • Risk Register – At the end of Quarter 3 there were 15 risks on the risk register, with 4 rated as very high.
• Internal Incident reporting – There were no incidents reported during Quarter 3. • External Assessments - During Quarter 3, work has remained ongoing around the 2020/2021 Head of Internal Audit Opinion and
the Stage 1 memo was received by the Audit Committee in December 2020. The CCG is celebrating its fourth consecutive ‘outstanding’ rating from NHS England and NHS Improvement for 2019/2020 following confirmation in December 2020. The CCG has also been assessed as ‘Green Star’ following the 2019/2020 national
assessment and moderation process by NHS England for the Patient and Community Engagement Indicator which is part of the NHS Outcomes Framework. • Corporate Governance - Ten policies have been reviewed and approved via the appropriate committee during Quarter 3 and five
policies have been deferred. • Health & Safety, Fire and Security - The competent person for Health & Safety at the CCG has confirmed that the CCG compliant with legislation. During Quarter 3, the corporate team reception staff
undertook virtual fire warden training and two compliance inspections of Sovereign House and White Rose House have been undertaken. • Information Governance and Data Quality - The 2020/2021 toolkit was released mid-November 2020. An action plan has been agreed to meet the requirements. Nationally, the submission date for
2020/2021 toolkits has been extended to 30 June 2021. During Quarter 3 there were 26 Freedom of Information requests. • Equality and Diversity - The Equality Delivery System is a national
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tool which is used to assess and grade our equality performance each year. The outcomes are included in the Equality and Diversity
Annual report which can be found on the CCG website. The 2020/2021 annual report and progress on the action plan was reported to the Engagement and Experience Committee in February 2021.
A Fitzgerald noted the increased demand upon the Complaints Team as there has been a significant increase in the constant queries about the vaccination programme. All MP enquiries should be directed to H Joerning, Complaints Manager for response. A Russell stated that any available administrative time from other teams to assist would be L Devanney welcome. L Devanney agreed to consider options.
J Pederson queried the asterix in the table on Page 5 of the report. L Devanney agreed to raise this with the Governance Team. L Devanney
The Executive Committee noted the Corporate Assurance Report Quarter 3.
8. Retirement Policy
L Devanney presented the reviewed and updated Retirement Policy to the Executive Committee for approval. The Policy has been amended to be explicit as regards the required break in employment for employees of NHS Doncaster CCG wishing to undertake Flexible Retirement.
• The key change was summarised as follows:
Amendment to local process for required break in employment for internal applicants for flexible retirement from 24 hours, to 14 days. This action mitigates against risk in respect of continuous
service/redundancy claims and brings the CCG into alignment with the others across the South Yorkshire footprint.
The Executive Committee approved the Retirement Policy.
14. Planning and Contracting
The following Planning and Contracting update was received by the Executive Committee:
Planning
• There has been no further guidance on performance. • The CCG will continue with the refreshment of our Delivery Plans and following a Strategy & Delivery Team Time Out to discuss, will work with the Quality and Finance and present the refreshed plans to the Strategy & Organisational Development Forum in March and the Governing Body for sign off in April 2021.
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J Pederson commented that the organisation must be realistic on level ambition within Delivery Plans for 21/22 due to structural changes taking place within the NHS.
Contracting
• The Finance Team has commenced preparation for financial planning. All contracts will have assumptions included within them. When we know the bottom line, we will look at any gaps. • The team are undertaking horizon scanning for prescribing. • The team have the indicative Mental Health Investment Standard figure and discussions are commencing (see item 6).
The Executive Committee noted the Planning and Contracting update.
15. Performance update
• Living Well Delivery Plan
A Fitzgerald gave the following update to the Executive Committee:
• The Living Well Delivery Plan portrays a positive picture. Work is currently being undertaken to ascertain those actions which will be required to carry forward into 2021/2022. • Performance measures are by exception namely Improving Access to Psychological Therapies (IAPT), Serious Mental Illness (SMI) and cancer. • The Governing Body Spotlight Reports will focus on Primary Care,
Medicines Management and Learning Disabilities. Performance
measures. • Out of Area Placements – Quarter 2 information shows an improvement.
The Executive Committee noted the update.
16. Items for inclusion in the next Governing Body Chair & Chief Officer’s Report
The following items were identified for the February Governing Body Chair & Chief Officer Report:
• The White Paper • CCG Improvement and Assessment Framework 20/21 • Final EU Exit Group meeting
17. EU Exit Update
There was nothing further to update.
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18. Escalation of Risk
There were no risks identified.
19. Bring forward Agenda
Executive Committee
March 2021
• Review of Contracts 21/22
Future Agenda Items
• Medicines Management Investment • Communications Healthwatch Review • Cognitive Stimulation Therapy (CST) Service
Strategy & Organisational Development Forum
March 2021 • Refreshed Delivery Plans • 2021/2022 Review of Contracts • Staff Survey
April
• Function Planning • ICS HR Framework • CCG Support Plan
Future Agenda Items
• Healthwatch Primary Care Access Report
Governing Body
March 2021
• Planning/Contracting • White Paper • Doncaster All Age Learning Disabilities and Autism Strategy
Future Items • Commissioning Principles for CHC and Individual Placements • Liberty Protection Safeguard Partnership
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20. Any Other Business
There was no further business discussed.
21. Date and Time of Next Meeting
Wednesday 17 March 2021, 9am
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Engagement & Experience Committee (EEC) Meeting Thursday 4 February 2021, 10.00 am – 11.30 am via Microsoft Teams
Present: S Whittle (Chair) Lay Member for Patient & Public Involvement, NHS Doncaster Clinical Commissioning Group (CCG) A Fitzgerald Director of Strategy & Delivery, CCG
Dr M Pande GP Lead, South Locality A Edwards Corporate Governance Manager, CCG H Joerning Patient Experience Manager, CCG A Coggan Head of Performance and Intelligence, CCG A Goodall Chief Operating Officer, Healthwatch Doncaster
In attendance: C Ogle Associate Director of Primary Care, CCG E Ross Primary Care Engagement Officer, CCG K Connolly Senior Corporate Services Support Officer (Minute Taker), CCG
Agenda Subject Action Ref Required By 1. Welcome and Introductions
S Whittle welcomed everyone to the meeting. She thanked R Mather, Senior Communications and Engagement Officer who recently left her role at Doncaster CCG for all her hard work and contribution to her work for Communications and Engagement.
2. Apologies for Absence
S Whittle noted apologies of absence from the following:
• A Smith, Senior Communications & Engagement Officer, CCG • L Robson, Public Health Theme Lead • D Atkin, Public Governor (Doncaster)
3. Declarations of Interest
S Whittle reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following
Page 1 of 9
link: www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub committees / working groups:
None declared
Declarations of interest from today’s meeting:
None declared
4. Minutes from Previous Meeting
The minutes from the previous EEC meeting, held on 3 December 2020, were approved as a correct record.
5. Action Log Update
Both the open & closed action logs were updated :
• 7 actions closed • 1 action remains open • 1 new action
The updated open action log is circulated with the minutes of this meeting.
6 Notification of Any Other Business
There were no notifications of further business for discussion.
7. Priority Area – Deep Dive on Living Well
S Whittle welcomed C Ogle and E Ross to the meeting to provide Committee members with an overview of the Living Well Strategy around Primary Care and the GP Patient Survey.
C Ogle provided the following update around Primary Care Engagement.
The last update to EEC was December 2019, a summary of engagement since that date is:
• Monthly meetings with PCN Clinical Directors • Bi monthly contract meetings with Primary Care Doncaster Ltd • Bi weekly to monthly meetings of Practice Managers • LMC and LPC monthly meetings up to March 2020 • GPN and Pride of Primary Care Awards and primary care event focus on comms and engagement • Primary care cell established as collective response to COVID • Practice engagement in estates projects and on specific issues
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• Care navigator super users • Implementation of new service requirements – enhanced health in care homes, medicines optimisation and early cancer diagnosis • Primary Care staff survey and BAME primary care network development The following have been stood down due to the pandemic: • Face to face practice visits • Provider Engagement Group • LPC/LMC monthly meetings • Primary Care Delivery Group Patients and Local Communities: • Ongoing support from the comms team re primary care messaging particularly myth busting about practices being open • Healthwatch survey about access using digital options • Residents group re Rossington development • Bentley and Nelson merger engagement exercise • Community participation group development East and 4Doncaster
The impact from this engagement has seen: • Positive relationship building – collaborative working • Sense of pride in jobs well done and team approach to primary care • Clarity of message to general public • Bringing teams together on projects that are at early stages of development • Changes to plans based on patient feedback • Inclusivity • Plan to close Scawthorpe primary care site delayed due to patient feedback and concerns • Greater awareness of primary care being available and open • In process of going through OSC and PCCC process regarding Scawthorpe plans
During 2021/22: • Engagement with local communities on premises developments in Bentley and Rossington • Further work with Bentley and Nelson practice as well as Petersgate on the planned closure of Scawthorpe site • Recommencement of primary care communications plan on six themes – PCNs and access, using right service, self care, health professionals, estates, digital • Transition of extended access from CCG commissioned contract to PCNs
Covid has restricted what can be done face to face and therefore concerns that the harder to reach become even harder to reach
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• Plan to engage with older people about the impact of Scawthorpe closure by ensuring letter sent to patients home and ensuring that they have an opportunity to comment • Options to be developed around gender reassignment services in primary care – consultation will be through health ambassadors to this group • Ongoing development of BAME network and focus on clinically vulnerable staff
This is ongoing work and requires action planning and review. Some work has slowed due to COVID need to ensure that extended access offer reaches those most impacted by health inequalities.
GP Patient Survey
E Ross provided the following update around the GP Patient Survey.
There are a number of areas identified where Doncaster falls below that of the national average e.g. ( ease of getting through to practices by telephone, awareness of online services, perception of care at last appointment). In response to the survey there have been a number of actions that have been taken to address some of the areas that have been raised via the survey some of which have had to be expedited as a result of the COVID pandemic. Other areas are being advanced but are potentially more difficult to do so in the shadow of COVID. We will also make sure that further work is undertaken to address the issues not addressed thus far by the work planned or that has already been carried out. We are ensuring that we work with our partners, patients and stakeholders wherever possible with the elements within our control. Ease of getting through to practices by telephone Due to feedback through out the COVID pandemic, many practices across Doncaster have increased the number of telephone lines within practices to meet this demand. Awareness of online services The primary care digital strategy, which encompasses online consultation, video consultation etc. has been expedited due to COVID, patients are more aware of the online symptom checker and have also accepted remote consultations due to this. Work has also taken place with NHS 111, allowing the service to book more patients direct into practice appointment slots. Potentially this could mean patients less inclined to use digital methods could find calling their practices easier. Early work is taking place with Health Watch in gathering patients opinions of digital and online services which will help to shape the feel and look of this moving forward. Perception of care at last appointment
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There are positives and negatives around this particular section, telephone triage is without a doubt more popular now, given the COVID situation which at times can take longer per appointment, meaning patients wait times could increase. A new care navigation system template was distributed to practices in February 2020 to support practice staff to have conversations with patients where other services could be more appropriate (pharmacy). Patients have been more accepting of discussing symptoms with practice staff due to COVID symptoms being discussed.
• The Estates strategy which has been implemented across Doncaster will also effect patient perception, as the CCG are working with practices to ensure practice buildings are fit for purpose, plans are in place for new builds, renovations and extensions across Doncaster. • It has been noted that the fantastic work the Communication and Engagement team have done to debunk myths around practices, promoting the varied roles within a practice and setting realistic expectations for patients around additional cleaning times etc practices are now completing. • All work has been completed jointly with practices under exceptional circumstances. It was noted that the update will be going to Governing Body in March. EEC Members thanked C Ogle and E Ross for the extremely informative update.
8. Complaints Update
H Joerning provided EEC members with a verbal update on enquiries, complaints and concerns from the last month.
The key points were as follows:
• Total 232 Contacts in Q3
The details that relate to the CCG are:
• 7 Complaints o 5 relate to different financial restitutions/reimbursements o 1 fast track process and funding o 1 E Systems within the NHS • 6 Compliments • 7 Concerns • 118 Enquiries • 4 MP Enquiries
Although contact remains high – complaints and concerns continue to remain low.
Dr M Pande asked if there is a standard response to patients concerning issues around vaccinations. H Joerning to formulate a
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response and send out to all practice managers in Doncaster along H Joerning with a FAQ sheet around Covid vaccinations.
EEC members noted the update and thanked H Joerning.
9. Healthwatch Doncaster Update
A Goodall provided EEC members with a verbal update on Healthwatch Doncaster.
The key points were as follows: • Cancer and cancer pathways prior to and during the pandemic o 14 patient stories – • Care homes – digital insight report with resident, carer and home manager available February/March • Big focus on Mental Health – working with partners • Rebrand and relaunch of website – now live • Moving ahead with Daily Dose and Facebook Live – themed weeks including Covid Vaccine, BAME Community, Digital Inclusion
S Whittle thanked A Goodall for the update.
10. Equality Duty – Annual Report
A Edwards shared the Equality Duty – Annual Report with EEC members.
The Engagement and Experience Committee were asked to:
• Approve the Equality and Diversity Annual Report 2020/2021 • Note the Equality Delivery System 2020/2021 Updates
EEC members requested A Edwards to add the Equality and Diversity Action Plan and Staffing Equality Data and Staffing Profile to the annual report.
The Engagement and Experience Committee:
• Approved the Equality and Diversity Annual Report 2020/2021 • Noted the Equality Delivery System 2020/2021 Updates
11. We Asked, You Said, We Did – Quarterly Report
The We Asked, You Said, We Did quarterly report was shared and noted by EEC members.
12. Gypsy and Traveller Project Action Plan Update
R Mather provided the following update, via email, to EEC members on BAME and Equality.
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The CCG has been working with colleagues, through the Engagement and Experience Committee and at the council to better understand the health and well-being needs of the 4-6,000 Gypsies and Travellers in the Doncaster area. Following a successful bid to the Better Care Fund, funding has been secured to appoint a dedicated Gypsy and Traveller Link Worker, for an initial period of 2 years. The post is currently being advertised and will form part of our Communications and Engagement Team.
EEC members noted the update.
13. Trailblazer – With Me In Mind Update
E Price provided the following update, via email, to EEC members on Mental Health Support teams in Schools (MHST) – January 2021
• MHST continue to support all schools in Doncaster, even during a third lockdown with a digital offer as well as a face to face model available where needed.
• WMIM website continues to be utilised by young people of Doncaster with RDASH expecting to do a one-year refresh and comms campaign to ensure the service is once again put into the spotlight. The CAMHS team are currently working with RDASH to ensure this is undertaken.
• Large scale piece of work on SEMH (Social Emotional Mental Health) was developed in November 2020 to look at the number of young people attending secondary care for further MH support.
• This has now led to a SEMH Education strategy to be developed to ensure Schools remain at the heart of the support systems for young people.
• I have managed to secure further support from the Anna Freud Foundation who will deliver educational MH packages to schools in the summer term and allow the WMIM and MHST service to reflect back on current provisions
• It is also anticipated that Wave 5 and 6 NHSE funding will come on stream at the end of January and a joint bid between Rotherham and Doncaster will be submitted to ensure equity over our populations.
A further update will be brough to EEC which will describe the full SEMH strategy once formal engagement has begun.
EEC members noted the update.
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14. BAME and Equality Update
R Mather provided the following update, via email, to EEC members on BAME and Equality.
We held the second meeting of the primary care BAME staff network in January, following the establishment of this group in November. 23 people joined the Zoomed call and heard from two guest speakers, Andrew Lee, Consultant in Health Protection at Public Health England and Jagtar Singh, NED and Equality and Diversity Consultant. These meetings have provided inspirational speakers and an hour of thought- provoking discussions. We are extremely grateful to the joint Chairs for their leadership of the Network, Dr Vijay Kumar and Dr Suman Thullimalli and look forward to the next meeting March. We have identified mental and well-being of our BAME staff and the absolute vital importance of collecting data for our BAME patients as key issues to tale us forward.
January also saw the launch of our BAME Network for staff working in the CCG and CCGs across South Yorkshire and Bassetlaw, as well as in the ICS. At the first meeting 15 members of staff joined the call and discussed how they would like to see the Network develop. We have asked for further details of our BAME workforce and will be working across the system to better understand the data, taken from our Workforce Race Equality Standard (WRES). We circulated a short survey in October last year to better understand the needs of BAME staff and at the first meeting of the network, it was agreed to re- circulate this to get a wider understanding and response from our BAME colleagues. The survey is available here: https://www.surveymonkey.co.uk/r/C5H3VZ9 The Network will meet again in March with a guest speaker and we have asked staff to volunteer to help organise the meetings going forward. We aim to pair staff together from different CCGs to facilitate networking across our system.
The CCG attends fortnightly meetings of the Minorities Partnership Board to support work across Doncaster with BAME communities and marginalised groups. This group has recently developed a newsletter to highlight its work, including support for people suffering domestic violence and abuse. We have also featured a local Doncaster resident, well know at the local Mosque, Mr Abdul Karim Din speaking about the importance of the vaccine after being vaccinated recently and urging all other Muslims to do the same.
EEC members noted the update.
15. Escalation of Risks to the Governing Body
There were no risks identified to escalate to Governing Body.
16. Any Other Business
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There was no further business discussed.
17. Date & Time of Next Meeting:
Thursday 4 March 2021, 10am – 11.30am, via Microsoft Teams
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Minutes of the Primary Care Commissioning Committee (Public) Held on Thursday 11 February 2021 at 12.30 pm Live Streamed via Zoom
Voting Members S Whittle Lay Member (Chair) Present: J Pederson Chief Officer, CCG H Tingle Chief Finance Officer, CCG A Fitzgerald Director of Strategy and Delivery, CCG
Non-Voting C Ogle Associate Director for Primary Care & Commissioning, Members Present: CCG A Ibbeson Head of Quality & Designated Nurse for Children’s Safeguarding & LAC, CCG Z Head Lead Nurse Primary Care Quality, CCG Dr N Alsindi Clinical Lead Primary Care, CCG Dr M Pande South Locality Lead GP S Barnes Interim Estates Lead, CCG J Telford Healthwatch Representative P Barringer NHS England Representative
In Attendance: A Small Senior Finance Manager, CCG K Smith Senior Officer, Digital Primary Care (Technical Support), CCG K Connolly Senior Corporate Services Support Officer, CCG (minutes)
Meeting Start 12.30 pm Action 1. Apologies for Absence
Apologies for absence were received from:
• L Tully, Lay Member • A Russell, Chief Nurse, CCG • K Roberts, Primary Care Manager, CCG • Dr D Eggitt, GP - Chief Executive Officer, LMC
2. Declarations of Interest
The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
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Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate.
Declarations of interest from sub committees / working groups: None noted.
Declarations of interest from today’s meeting:
Dr Alsindi declared an interest in agenda item 7.3 Bentley Surgery and the Nelson Practice Merger. Dr Alsindi is a salaried GP at Bentley surgery. Considering the content of the report and the action required The Chair and Committee agreed for Dr Alsindi to remain in the meeting with his audio, camera and chat facility off.
The Chair stated all GPs have an interest in agenda item 7.2 Primary Care Estates - Implementation Plan Update but could remain in the meeting as an update was being provided but no decisions were being made.
S Barnes noted that he is also undertaking a similar role for estates for Rotherham CCG. The chair decided that there was no risk of undue gain or influence for all parties concerned.
3. Notifications of Any Other Business
No items were raised.
4. Minutes From Previous Meeting
The minutes of the last meeting held on 10 December 2020 were approved as an accurate record.
5. Matters Arising not on the Agenda
• AP127 – C Rollinson has shared her findings with L Tully. To discuss when L Tully has returned. • AP128 – Communications to go out twice per week through the update and communications from Governing Body to Localities and vice versa now organised. The Communications route had been formalised to capture actions.
The Primary Care Commissioning Committee noted the update for actions AP127 and AP128.
6. Action Tracker
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The Primary Care Commissioning Committee discussed and updated each item on the Action Tracker. The latest updates can be viewed on the Action Tracker.
7. Finance and Contracting
7.1 Full Quarterly Report
H Tingle presented the full quarterly finance report. The report outlined the 2020/21 financial position as at 31st December 2020 of the Primary Care Delegated Co-Commissioning (GP Contracts) and other associated Primary Care expenditure. It also provided a forecast year end position.
H Tingle explained that due to the current financial regime, the CCG received an initial allocation that did not cover costs of the GP Contracts and therefore, at month 6, were showing an overspend against the budget. An exercise was undertaken at month 6 and CCGs submitted their total costs up to that point. The allocations were then retrospectively adjusted to cover the costs and the CCG position improved on the Primary Care budgets as additional funding was received as part of the exercise.
An exercise is currently in process for practices to claim for any PPE costs, that have been incurred outside the central purchasing system, from 1st August to 31st December 2020. It is anticipated these costs will be covered from additional funding from NHSE.
H Tingle advised the overall Primary Care budgets are over spent by £250,000 which is £22,000 under spend against Delegated Co- Commissioning and £272,000 over spend by Local Primary Care Services budgets.
The Primary Care Committee noted the Q3 2020/2021 reported financial and forecast financial position.
7.2 Primary Care Estates Strategy - Implementation Plan Update
S Barnes provided a monthly update to the Committee on the implementation of the CCG Estates Strategy.
Work is ongoing for the following projects:
1. Bentley Hub Project – work is concluding on the feasibility study with a draft report in circulation for comments 2. Rossington Health Centre – A project team has been formed with representation from the GP practices and respective landlords 3. Mexborough GP Led Project – District Valuer being appointed 4. Scott Practice Extension and Reconfiguration – Work is progressing and planning submission submitted.
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5. 4 Doncaster PCN Transformation – being withdrawn from the SYB Capital Programme 6. Petersgate Practice Extension and Reconfiguration – Paused until June 2021
S Barnes advised work is progressing well on all projects.
The Primary Care Commissioning Committee thanked S Barnes on the informative report and noted the contents.
7.3 Bentley Surgery and the Nelson Practice Merger
C Ogle updated the Primary Care Commissioning Committee on the merger between Bentley and Nelson Practice.
In July 2020 the Primary Care Commissioning Committee received and approved in principle the formal notification of intent to merge Bentley Surgery and the Nelson Practice. The effective date of the merger would be 1st April 2021. The system merger is scheduled to take place on 19th April 2021. The plans to close Scawthorpe surgery had been agreed in principle subject to the outcome of the patient and stakeholder engagement process and the equality impact assessment which had now been undertaken.
No questions were raised.
The Committee approved the merger between the Nelson Practice and Bentley Surgery with effect from 1 April 2021. In approving the merger, the Committee noted the concerns raised by the Scrutiny Panel in terms of: • Further engagement with patients via letter and • Support to the Petersgate practice which will be the only remaining GP practice in the Scawthorpe area once Scawthorpe surgery closes.
8. Quality
8.1 Full Quarterly Report
Z Head presented the full quarterly quality report to the Primary Care Commissioning Committee.
Z Head gave an overview of quality and patient safety activity in relation to Primary Care in Doncaster around the following areas:
• Covid-19 Pandemic Practices are continuing with remote consultations where possible. Face to face consultations with non-symptomatic patients are being carried out if clinically necessary.
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• Test and Trace in Primary Care Numbers of staff becoming symptomatic and subsequently testing positive have remained steady over the last month, however, there are also a number of staff having to self-isolate due to family members becoming symptomatic and/or testing positive.
• Covid-19 Vaccination The vaccination programme is progressing well
• Influenza Vaccine The vaccination programme is continuing.
• Primary Care Matrix The Primary Care Matrix is continually being updated.
• National Reporting and Learning System During the current COVID-19 pandemic, NRLS reporting has continued and collated and logged for identification of any local patterns and trends no patterns or trends have been identified.
• Case Conference Reporting / Attendance Case conference reporting has continued throughout the COVID response, where all providers have faced significant challenges. Response numbers continue to fluctuate month on month.
• Wound Care Service The integrated wound care service for Doncaster patients went live on 1st December 2020.
• Care Quality Commission There have been no further inspections since the last report.
No questions were raised.
The Primary Care Commissioning Committee thanked Z Head for the very comprehensive and informative report and noted the progress and challenges in respect to quality care within the reporting period.
9. Strategy and Planning
9.1 Primary Care Networks Update
C Ogle presented the Primary Care Networks update which focused on the following:
Network Agreement
Primary Care Doncaster is co-ordinating the agreement on behalf of all five PCNs and they have all agreed it, it is just signatures that are being chased. The CCG remains red on the NHS England assurance framework for this indicator.
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Medicines Optimisation Roles It is a requirement of the Network Contract DES that the Medicines
Optimisation in Care Homes posts recruited through the NHS England scheme are transitioned to PCNs by 31 March 2021. This is progressing through Primary Care Doncaster’s HR department.
Additional Roles Update on Recruitment and Underspend Plans
In order to better forecast the underspend position the PCNs have all updated their recruitment plans for the current year. The letter from NHS England and NHS Improvement dated 9th October 2020 confirmed that CCGs could access the remaining 40% of the allocation, held centrally; once it had claimed the total of the 60% already allocated and ongoing claims would cause the CCG to exceed this amount.
Based on the plans that have been shared it is anticipated that the PCNs would be just above the 60% allocation received by March. Given the anticipated level of underspend it was agreed that there could be some flexibility to maximise spend of the 60% and that underspend could be used for: • Recruitment costs • Induction • Training • Locum paramedics or mental health practitioners This list is not exhaustive but any underspend has to be used in direct support of the Additional Roles.
The Committee were asked to consider how/when the funding should be allocated. Options are:
• Assume full allocation is drawn down and payments made to
PCNs a) Divide pro rata by list size full level of underspend – this would mean that 3 PCNs would be allocated more than in their underspend plans. b) Allocate the amount requested to the 3 PCNs and divide the
remainder pro rata between the 2 PCNs that have requested more than their fair share c) Pay on an actual evidenced claim basis those items that meet the criteria of direct impact on ARRS
• Assume allocation is not drawn down in full and claim can only be made on actual spend, therefore actual spend claims from PCNs required to be put through to trigger maximum draw down in March 2021.
There is a level of risk to the CCG with each option as the draw down process is unclear, on balance it is recommended that the second option is pursued based on actual spend claims.
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Dr Alsindi asked if all South Yorkshire CCGs are experiencing the same issue. C Ogle confirmed all CCGS in South Yorkshire are facing the
same situation. P Barringer advised option 2 is best from a lower risk perspective. It was agreed that the approach would be discussed at the PCN directors meeting the following day.
P Barringer will find out when the funding will come through and PB
feedback.
• Development Plans Four PCNs have submitted plans to demonstrate use of funding in 20/21 and an indication of the plan against the maturity matrix.
• Contract Changes/Plans for 2021/22 Contract changes will be discussed with PCN Clinical Directors at the monthly meeting with the CCG.
The Committee:
• Noted the update on the Network Agreement, the transition of the Medicines Optimisation roles and PCN Development • Considered the additional roles underspend for 2020/2021 and agreed this would be discussed at the PCN directors meeting the following day. Option 2, claiming on actual spend was advised but not supported. • Noted the update in relation to contract changes for 2021/2022 as they apply to PCNs in particular the extended access approach.
9.2 Primary Care Cell Update
The Primary Care Commissioning Committee noted the Primary Care Cell briefing paper and the information provided in relation to the Primary Care Cell update.
9.3 Integrating Care – Next Steps
J Pederson advised Primary Care Commissioning Committee the Department for Health and Social Care has today published its White Paper on working together to improve health and social care for everyone.
As anticipated, the White Paper proposals follow the journey of integrating care in neighbourhoods, places and across the system that have been across Doncaster and SYB for many years and is designed to support us by removing many of the obstacles that stand in our way on a daily basis.
The White Paper sets a course for ICS’s to become NHS Statutory bodies from April 2022 through the transfer of accountabilities that currently sit with CCGs and also some NHS E/I accountabilities.
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The Primary Care Commissioning Committee thanked J Pederson for the informative update.
10. Forward Planner
The Primary Care Commissioning Committee noted the Forward Planner.
There are no further items added.
11. Items to Escalate to Governing Body
The Primary Care Commissioning Committee agreed there were no items to escalate to Governing Body.
12. Risk Register
The Primary Care Commissioning Committee reviewed the 2 Primary Care risks on the Corporate Risk Register and confirmed both risks are appropriately scored and described.
The Primary Care Commissioning Committee confirmed that they are assured that appropriate actions are taking place to mitigate potential impacts and consequences.
13. Any Other Business
No items were raised.
14. Date and Time of Next Meeting
Thursday 11 March 2021 at 12.30pm - live streamed via Zoom.
Meeting Closed 1.35pm
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Meeting: Joint Commissioning Management Board Date: Thursday 17th December 2020 Time: 9.30 – 11am Location: Via MS Teams
Attendees Jackie Pederson - Chief Officer Rupert Suckling – Director of Public Phil Holmes - Director of Adults Health Doncaster CCG - Chair Health & Wellbeing – Doncaster Council Anthony Fitzgerald - Director of Dr David Crichton – Clinical Chair Dr Marney Khan – Strategic Clinical Strategy & Delivery Doncaster CCG Doncaster CCG Lead Doncaster CCG Hayley Tingle - Chief Financial Officer Faye Tyas – Assistant Director of Andrew Russell – Chief Nurse Doncaster CCG Finance – Doncaster Council Doncaster CCG Stephen Emmerson Mark Wakefield Emma Price Head of Strategy & Delivery – Adult Head of Service – Strategic Head of Strategy and Delivery Mental Health Commissioning Children’s Mental Health and Maternity NHS Doncaster Clinical Strategic Commissioning Commissioning Group Public Health Doncaster Council Kerry North Interim Commissioning Manager (Commissioning and Market Development) Children’s Commissioning Doncaster Council
Gill Parker – note taker Apologies Linda Tully – Lay Person Leanne Hornsby – Assistant Director Damian Allen – Chief Exec Doncaster –Education, Skills, Culture and Council (alternate Chair) Heritage – Doncaster Council Riana Nelson – Director of Learning, Cllr Rachael Blake – Portfolio Holder Opportunities and Skills Doncaster Council
Item Discussion/Comments Action
Welcome, introductions and apologies 1 Jackie welcomed everyone. Apologies as above.
Minutes of the previous meeting and matters arising It was agreed by all to accept the draft minutes of our meeting on 17th September as accurate. 2 David made a suggestion that all business cases which had been approved by email to be noted in today’s minutes, so we have a record of them. Action – Gill to record.
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Action • Gill to record all business cases as virtually approved by JCMB members GP
Headline updates from Life Stage Leads - Starting , Living And Ageing Well Anthony introduced this item – following on from our September meeting, where we had a refresh of the refresh – further good work has been ongoing. Each of the Life Stage leads was asked to talk
about their biggest challenge, plus a particular success.
Starting Well
Emma shared the below presentation:
Starting Well Presentation Questions were asked as follows: David asked if we were capturing the right people, as sometimes it’s hard to engage with the right groups/individuals and they don’t come forward. Kerry advised priority places were offered two weeks prior to going on general offer – this lead to 30 requests being received from organisations who were given places. However, some negative feedback was received, as needs weren’t met regarding short break providers – improvements will be made on this in the future.
3 Marney asked about the waiting times for medium tier children. Are we reviewing them while they are awaiting an assessment? Kerry advised that contact with families is maintained , however, ASD
and ADHD have different waiting list structures – we are doing as much as we can, but could do better in the future. Action – Marney to liaise with Emma to provide some case examples. Rupert commented it was very useful to have the Mental Health worker involved as it provided a much broader approach. Rupert asked why the First 1001 Days was not used as a good example – is there any update on this? Kerry updated this got off to a great start in September, and there is a
robust model in place providing good support to families.
Jackie raised the following three points:
I. Is there an opportunity to invest more in the Young Advisers? II. Digital Inclusion – some families may struggle to access this III. Targeted work with DCST – want to see the impact on the Looked After Children
Kerry and Emma to address these issues Action –
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Living Well Mark and Stephen shared the below presentation:
Living Well Presentation
Covid was a huge challenge, but led to improvements in providers working together, giving a better service to our LD clients. A daily multiagency Learning Disability Cell was developed to keep Covid infection risks as low as possible and also to support providers, with MENCAP putting a robust business continuity plan in place. Day services were stopped for several months and many clients decided not to return, as had found alternative activities. Some of the Walshingham clients were supported remotely with creative solutions. Support plans are now being reviewed.
Challenges were faced in maintaining a coordinated response to managing the risks of Covid in and on services, while continuing to drive forward system wide transformational change of Mental Health Services. A multiagency Adult Mental Health Demand and Escalation Cell was developed, and met daily to focus on issues and find rapid solutions. Homeless and Complex Lives clients raised challenges due to their chaotic lifestyle, poor health, addiction etc. Also, as many hostels have shared living space. However, providers were supported to risk-assess and adapt services to minimise spread of the virus. £291k bid secured from MHCLG’s Next Steps Accommodation Programme to enable continuation of emergency accommodation and support for rough sleepers and people at risk of homelessness. Homelessness and Rough Sleeping Strategy - strategy delivery plans presented to and supported by the recently convened Homelessness Board. Questions were asked as follows: Rupert commented there has been a lot of innovation – is there any way to shorten the gap for future commissioning, instead of waiting for the next contract renewal? Mark answered that the new ways are staying for the future and there’s no evidence of us falling back into old ways. Stephen added that transformation work means we won’t shy away from cultural shifts – we need to keep out innovative solutions. Phil commented it feels like a challenge to move beyond contractors. Covid has provided some better provider collaborations, however, some services are being propped up, for example
Homeless. Mental Health and LD providers are taking the initiative. How do we incentivise providers going forward? Jackie commented that provider collaborations can make decisions if there isn’t a contracted arrangement – we need this in our future model.
Aging Well
Jo shared the below presentation:
Aging Well Presentation
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Jo informed some timelines have slipped and some have moved forward. The emphasis has been on patient needs, rather than what the service can deliver. The flow is a lot better – the Covid Discharge Pathway has identified different ways of working. IPads have been rolled out to care homes and 500+ email accounts set up to enable better updates. GP practices are working well with the four providers for Wound Care, and there is a big training programme going forward. We are ensuring Wound Care is part of the Complex Lives provision. There will be one contract across Doncaster for Wound Care. Transformation has been difficult due to Covid, and many actions haven’t been delivered due to care moving from acute settings to community settings, which has led to many operational challenges. Robust therapy is essential for Older People. It felt as if we didn’t even have the capacity to look at the capacity. The Aging Well Board was set up, and is looking at wider inclusion for providers.
Questions were asked as follows:
Anthony commented that he and Rupert are sponsors of Aging Well. Heather of Age UK, as the chair of the Board, has given them many challenges. We now need the providers on board. How do we get the provider alliance to drive strategic conversations? David commented we need to reflect on the week –vaccination has begun and this is going well. We need to build on the strengths of our Older People. Jo added that not all our over 80’s are frail and we need to keep them as positive members of our communities – three quarters of them are not house-bound.
Phil informed the Provider Alliance Executive met last week to think about and evaluate services – Emergency Care and Wound Care have been very successful – this is a useful example of how we need to work going forward. Due to the volume of people, Aging Well is part of the system most in need of reform – we need to stop “processing people”. There was very little focus on Starting Well in the Provider Alliance. The way we respond needs more focus. There is not enough system focus on Young People – we need to think for the future. Jackie thanked everyone for continuing this important work and the Board agreed with this. Action – Jackie asked for another update in around three months’ time, to look at what the future looks like and how we can influence it. Actions • Marney to liaise with Emma to provide some case examples regarding the medium tier MK & waiting list children. EP • Kerry and Emma to address three points raised by Jackie EP & KN • Gill to make sure this is on the agenda GP
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NHS Consultation Document
a. Strategic Commissioning approach b. Approach with Provider Alliance Future approach with Commissioning agreement Jackie has tried to look where we are as a place and shared the below presentation:
Place Plan Presentation
Good access to joined up and integrated care when required is essential.
The offer to everyone in our place already links to the Neighbourhood Approach:
• Starting Well • Joined up care • Digital Services • Keeping people as well as possible
Testing this way of working - it feels like we are not a million miles away in Doncaster.
People require access to high quality specialist services when they need them.
The vertical provider collaborative covers the three tiers of the Place Plan. The horizontal provider
4 collaborative covers the fourth tier. We need to work out what and where we need to focus integrated work on. Phil agreed that the building blocks are in place, but is worried about the Place Plan – it still has some weaknesses – the ICS magnifies these. There is much work to do in 2021-22 to drive forward what we are trying to achieve. Jackie commented that there’s less to do at system and more to do at Place regarding ICS. The Pace needs to make decisions on the changes. Rupert commented that Jackie’s presentation was very helpful and asked if it was likely to be a
‘trickle down’ approach regarding the ICS or the ICS built from the ‘bottom up’. The provider alliance for LD and Children are very much big Health providers – how do we work with them? We already have a Health and Wellbeing Board, so we don’t want to duplicate. We need to be mindful of the strengths and weaknesses. Jackie felt that as a partnership, we agree what the ICS should do. When we talk about commissioning, it should be done in place.
Anthony shares Phil’s concerns, however, on the positive side, we are future-proofing ourselves
well. Operationally – we need to make this happen. As chair of DICOG, Anthony informed the group had not been used as it should have been, and needs help on this. This is in place until the end of March 2021 – conversation with Legal required before then.
David commented the devil is in the detail – the engagement ends on 8th January and then it will be presented to Parliament as a Bill. Conversations are ongoing with ICS. Our destiny is in our hands. Phil feels we need to talk about the Acute Trust before provider alliance. We need to address the population health needs and see the provider alliance as a way to get things done.
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Jackie added we’re in a good starting position, but still a lot to be done. Jackie commented on the Commissioning Agreement – it doesn’t make sense to unpick this now. Rupert agreed we don’t have the head space to amend it at the moment – the Board agreed to let this roll forward. Key Decision • Allow the Commissioning Agreement to roll forward RS/AP
BCF Non Recurrent Funding Investment approach 2021/22 Rupert and Anthony shared the below presentation:
Use of BCF Presentation
JCMB set the challenge to use the BCF for transformation. Non-recurrent funding has been used in a conventional way, however, this appears to be working. More rigour has been put in to the
approval process to ensure applications meet the BCF requirements, however, funding still seems
to be granted on a first-come-first-served basis. It is also being used to prop up mainstream funding, with fundamental posts and services such as Complex Lives, CLS, First 1001 Days etc.. Although there is a big approval process in place, there is no robust process further down the line.
For 2021-22 there is currently £2.4M unallocated – this figure will grow due to underspends.
For integrated locality commissioning – overarching outcome targets have been built into the Life Stages.
5 The East locality, through non-recurrent funding – has piloted some Frailty work in the Thorne area, which has been very successful.
Much work has been undertaken to collate high levels of data. The locality ‘silver’ workshops which were planned unfortunately had to be stood down but will
happen next year.
We are aiming for consistency and flexibility and what matters most to people.
There are currently too many projects in Doncaster. The desired changes will take longer than two years – we need vehicles to drive them through. Is there a support to look at the non-recurrent pot for localities to achieve strategic outcomes?
Phil asked, with regard to developing provider alliances for the areas, how do we frame Health outcomes? Phil agreed with the presentation. We need to be very clear on rigour (on the what), data insight, impact made and drive improvements. Focus on how rather than what. Put pressure
on strategic commissioners. For example Complex Lives/ Homelessness – how do we drive this?
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Rupert commented we have the ability to mainstream approaches that are successful, for example, Wound Care has been mainstreamed. Complex Lives is a good service, but has not yet been mainstreamed. For the futures, do we need to top slice for infrastructure preparation? Digital and
IT is a challenge. We need to base around population leading outcomes. Resources coming in allow
us a greater input.
David commented (to Anthony) that representatives from the Estates meeting want to be included in the locality work
Jackie commented on the need to be outcome focused and not prescriptive. There will be layers of scale for the provider alliance.
We need to test the model for our way of thinking – Jackie is supportive of this. The window of opportunity up to March 2022- we must make the most of the resources for Doncaster next year.
Hayley commented that urgent detailed conversations with Council Finance colleagues is needed to
add more flexibility and how we utilize this next year. This has been a hard and challenging year
financially due to Covid, with a lack of clarity and guidance evolving through the pandemic. The NHS England return was submitted last month. We now have a window of opportunity to utilize
funds flexibly across the Council and CCG. Faye added there is big uncertainty on future funding –
no Social Care funding and no long-term sustainable model. Action – Jackie, Hayley, Damian, Faye and Debbie Hogg to meet to discuss asap. Action – Anthony to do further work then bring a formal paper on use of the Non-Recurrent BCF to
our next meeting for sign off by JCMB.
Phil commented that the four strategic commissioners – Anthony, Rupert, Debbie and Hayley – need to get together, with Anthony and Rupert being very closely involved, as we can’t afford any splits.
Actions HT &FT • CCG and Council Finance colleagues to get together to discuss better flexibility
• Anthony to do further work and produce a paper for approval at our next JCMB meeting on AF the Non-Recurrent BCF money
Virtual Approval of Business Cases – Key Decisions Due to the cancellation of our last meeting, the following business cases were approved virtually:
• Complex Lives 6 • Gypsy Traveller • Social Prescribing • Vulnerable Adolescents • Inclusion and Fairness Forum
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Any Other Business Phil updated on Home First – much work has gone on amongst providers, however there have been issues of scope. Contention is on what we define – i.e. – Intermediate Care. 7 Focus on everything through the Front Door of the hospital. Conversations required around this. Jackie felt that IC is good, but more discussion is required. Anthony advised this was to be the focus of the first hour of Partnership Board tomorrow.
Date and time of next meeting:
Thursday 21st January 2021 9.30 – 11am
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