Agenda Governing Body Board (Part 1) - Waltham Forest CCG€¦ · Committee (April 2016) For info...

Agenda Governing Body Board (Part 1) [25 May 2016]

Agenda

Governing Body Board (Part 1)

Date: 25 May 2016

Time: 12.00-14.00

Venue: Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP

Chair: Dr Anwar Khan

Topic Action Required

Clinical Lead/

Lead

Lead Officer(s)

Page No.

General Business

Apologies and announcements To discuss Dr Anwar Khan

Declarations of interest (register on public view)

To discuss ALL

Draft minutes from March’s Board To discuss

Matters Arising To note 1

Chair’s update including Chair’s action To note

Clinical Director update To note Dr Dinesh Kapoor

Questions from Members and Public To note

2 Governance

2.1 Board Assurance Framework To note Alan Wells

Anne Walker

3

2.2 Conflicts of Interest To approve - Terry Huff 30


Clinical Lead/

Lead

Lead Officer(s)

Page No.

2.3 Planning and Innovation Committee Terms of Reference (ToR)

To approve - Richard Griffin

38

3 Performance and Quality

3.1 Performance and Quality Report For discussion Dr Dinesh Kapoor

Les Borrett & Anne Walker

43

3.2 1.40pm slot – Findings and Actions: Stroke Quality Assurance visit Whipps Cross Hospital – November 2015

For info Roser Icart

Anne Walker

-

3.3 Phlebotomy Services Report To approve - Jane Mehta 61

4 Finance and QIPP

No items

5 Strategy and Planning

5.1 a.

Transforming Care Partnership To approve - Jane Mehta 74

b. Process for signing off NEL STP (Sustainability and Transformation Plan)

To approve - Jane Mehta 83

c. Operating Plan To approve - Jane Mehta 94

d. Better Care Fund To approve - Terry Huff & Jane Mehta

97

6 For information

6.1 Minutes of Audit Committee (March 2016)

For info Alan Wells Les Borrett 107

6.2 Minutes of Performance and Quality Committee (March 2016)

For info Dr Dinesh Kapoor

Anne Walker

112

6.3 Minutes of Planning and Innovation Committee (March and April 2016)

For info Richard Griffin

Jane Mehta 125 & 132


Clinical Lead/

Lead

Lead Officer(s)

Page No.

6.4 Minutes of IT Committee (March and April 2016)

For info Dr Mayank Shah

Les Borrett 138 & 147

6.5 Minutes of Medicines Management/Optimisation Committee (March and April 2016)

For info Dr Ravi Gupta

Anne Walker

159 & 168

6.6 Care Close to Home Project Initiation Document (PID)

For info - Jane Mehta 178

6.7 Minutes of Primary Care Commissioning Committee (April 2016)

For info Alan Wells Jane Mehta 181

6.8 Minutes of Finance and QIPP Committee (March and April 2016)

For info Alan Wells Les Borrett 185 & 189

6.9 Actions from Leyton/Leytonstone, Chingford and Walthamstow Locality Meetings (March and April 2016)

For info

Dr Dinesh Kapoor, Dr Anwar Khan, & Dr Tonia Myers

Jane Mehta 192 & 195

7 AOB

8 Forward plan For discussion ALL 199

Next meeting

Date: 22 June 2016

Time: Formal Board 12.00-14.00 & 16.00-18.00

Venue: Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP

Action Log Waltham Forest CCG Governing Body Part 1 on 23 March 2016 including earlier Brought Forward Items [May 2016]

Action log Waltham Forest CCG Governing Body Part 1 on 23 March 2016 including earlier Brought Forward Items Date: 23 March 2016 earlier

Time: 2-3.30pm

Minute No.

Action Lead/ Owner

Due Date

Status Status

Approval

Date Completed

230/15 Invite clinicians from the Whipps Cross Stroke Unit to present an update report to the Governing Body on the recommendations arising from the assurance visit

HD May 2016

WX clinician attending May’s GB Board

Closed May 2016

258/15 (ii)

Provide Duty of Candour presentation to all Governing Body members

HD May 2016

Duty of Candour briefing paper sent to GB members

Closed

April 2016

1

Action Log Waltham Forest CCG Governing Body Part 1 on 23 March 2016 including earlier Brought Forward Items [May 2016]

Minute No.

Action Lead/ Owner

Due Date

Status Status

Approval

Date Completed

276/15 Provide proposal to improve the provision of phlebotomy services to Governing Body meeting, May 2016

JM May 2016 Closed - On May 2016’s GB Board agenda

May 2016

279/15 Review design of main dashboard to enable improvements against trajectories to be more visually reflective of actual performance

LB May 2016 Closed – Trends have been included in the Performance and Quality report

May 2016

2

Item 2.1

Title of report Board Assurance Framework

From Helen Davenport, Director of Nursing, Quality and Governance - WFCCG

Author David Pearce, Head of Governance - WFCCG

Purpose of report

The purpose of this report is to present NHS Waltham Forest Clinical Commissioning Group’s (WFCCG) Governing Body with its key strategic risks as at April 2016.

Changes/additions/amendments to paper as a result of discussions held at Audit Committee

None

Recommendations

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

There are 7 risks reported on the BAF of which 6 are red (extreme risk) rated and 1 is orange (medium risk) rated.

Risk description relating to the Primary Medical Services (PMS) review risk has been enhanced to reflect delays in the process following the London wide Local Medical Committees (LMC) intervention, March 2016.

Impact on patients & carers

Early identification and management of risks will enable the CCG to intervene and ensure provider organisations improve the provision of health care for patients and carers.

Risk implications

If not managed to acceptable levels, the risks reported on the BAF may lead to:

Some patients not receiving the quality care WFCCG commissions and therefore have a poor experience and risk of harm.

Inhibit WFCCG from achieving its corporate objectives. Reputational risk.

Financial implications

Financial implications are identified in the individual reported risks.

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Board Assurance Framework

Equality analysis

The CCG is committed to fulfilling its obligations under the Equality Act 2010, and to ensure services

commissioned by the CCG are non-discriminatory on the grounds of any protected characteristics. The

CCG will work with providers, service users and communities of interest to ensure that any issues

relating to equality of service within this report are identified and addressed.

Business Intelligence Source

Executive Directors of WFCCG; Committees of WFCCG and associated minutes; Economy wide meetings and committees and associated minutes.

Other committees/groups, including the CCG Reference Group and Rapid Feedback Group

Executive Directors of WFCCG; WFCCG Audit Committee. Agreed in full with no suggested changes.

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WFCCG BAF, May 2016

1.0 Introduction

1.1 This report identifies the key strategic risks to NHS Waltham Forest Clinical Commissioning Group (WFCCG). The risks are recorded on WFCCG’s Board Assurance Framework (BAF). This is subject to scrutiny and challenge by the Audit Committee on behalf of its Governing Body.

2.0 Summary of the BAF Risks

2.1 Table 1 presents a summary status of the 7 risks that are reported on the BAF as at April 2016. It aligns the BAF risks with the WFCCG Corporate Objectives. As such it demonstrates the likely impact that the risk will have on achievement of the Corporate Objectives in respect to, for example, quality and patient safety, performance and delivery, and financial balance. The risks are therefore managed through the WFCCG Executive team.

2.2 Table 2 presents the details associated with each risk. It identifies:

The description of the risk The risks current risk rating When the risk was first recorded on the BAF The progress to date in managing the risk Who has management oversight of the risk

Table 2a provides an illustrative example of key areas of the BAF template

2.3 Table 3 presents those risks that have been removed from the BAF since the last report to the

Governing Body. It identifies the reason for the risk being removed from the BAF and how, if appropriate, the risk is being managed currently.

2.4 Table 4 presents those areas of risk that have been identified as having a zero tolerance status. It

identifies the specific zero tolerance risks, their current risk rating, how the risk is being managed, and the directorate responsible for managing the risk.

3.0 Challenge and scrutiny of the BAF

3.1 The BAF is constructed following review at individual director level prior to sign off through the WFCCG executive team.

3.2 The BAF is subject to review and challenge by the Audit Committee on behalf of the Governing Body.

3.3 The BAF alone does not provide the Audit Committee with all the assurances required to demonstrate the predicted year end risk position will be achieved.

3.4 To provide additional assurance the summarised BAF identifies those with responsibility of providing management oversight of the risk area and who are responsible for reviewing in detail the performance and risk mitigation plans. As will be seen, the detailed management of risk in the main is not managed by the Governing Body or the Audit Committee but by the relevant committee that reports to the Governing Body. This is where the BAF risk issues are addressed in detail.

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WFCCG BAF, May 2016

Table 1: BAF Summary Status April 2016

To improve the health outcomes of our local population through system leadership and the effective communication of high quality services by:

Corporate Objective:

Risk Description Summary

1. Meeting our statutory requirements

1a. (Risk Ref: Risk 1) The CCG does not achieve its targets for Referral to Treatment (RTT) waiting times due to poor performance by its providers, particularly Barts Health.

1b. (Risk Ref: Risk 2) The CCG does not achieve its target for 95% of A&E attendees to be treated within 4 hours, as per the NHS Constitution, due to poor performance by Barts Health and other key providers.

1c. (Risk Ref: Risk 3) The CCG does not achieve its national cancer wait targets due to poor performance at Barts Health. This means that some patients are not receiving the quality care WFCCG commissions and some patients have a poor experience and are at risk of potential harm. 1d. (Risk Ref: Risk 7) In November 2014 the CQC found Whipps Cross to be non-compliant with eight standards of care and was placed into special measures.

2. Being clinically led 2a. (Risk Ref: Risk 6) There is a risk that NHS Waltham Forest Clinical Commissioning Group’s (WFCCG) review of Primary Medical Services (PMS), as requested by NHS England, (NHSE) will not meet the required deadlines. This means that there could be delays in the delivery of elements of the primary care transformation agenda.

3. Strengthening collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS

3a. (Risk Ref: Risk 1) The CCG does not achieve its targets for Referral to Treatment (RTT) waiting times due to poor performance by its providers, particularly Barts Health.

3b. (Risk Ref: Risk 2) The CCG does not achieve its target for 95% of A&E attendees to be treated within 4 hours, as per the NHS Constitution, due to poor performance by Barts Health and other key providers.

3c. (Risk Ref: Risk 3) The CCG fails to manage its commissioning budget within plan due to increased costs of acute Service Level Agreements leading to an overspend. 3d. (Risk Ref: Risk 5) There is a risk of significant disruption to patient care and other providers if PELC unilaterally reduce their existing provision. There is an associated risk within the Strategic Commissioning directorate.

4. Improving the patient experience across all services

4a. (Risk Ref: Risk 3) The CCG does not achieve its national cancer wait targets due to poor performance at Barts Health. This means that some patients are not receiving the quality care WFCCG commissions and some patients have a poor experience and are at risk of potential harm.

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WFCCG BAF, May 2016

4b. (Risk Ref: Risk 7) In November 2014 the CQC found Whipps Cross to be non-compliant with eight standards of care and was placed into special measures.

5. Involving patients, communities and hard to reach groups.

There are no BAF reportable risks associated with Corporate Objective 5. Risks associated with Corporate Objective 5 are managed and reviewed through the directorate risk registers.

Evidence sources to provide the Governing Body with the necessary assurances that risks to this Corporate Objective are being identified and effectively managed are included in the Assurance plan agreed by the Audit Committee. This includes updates and scrutiny of related management reports.

6. Commissioning good organisational development programmes for individuals, teams and the organisation

There are no BAF reportable risks associated with Corporate Objective 6.Risks associated with Corporate Objective 6 are managed and reviewed through the directorate risk registers.

Evidence sources to provide the Governing Body with the necessary assurances that risks to this Corporate Objective are being identified and effectively managed are included in the Assurance plan agreed by the Audit Committee. This includes updates and scrutiny of related management reports.

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WFCCG BAF, May 2016

Table 2: Board Assurance Framework.

Risk Description

Current risk rating

Directorate reporting the risk Progress to date

Risk No 1: NHS Waltham Forest Clinical Commissioning Group (WF CCG) does not achieve its targets for Referral to Treatment (RTT) waiting times due to poor performance by its providers, particularly Barts Health. There is an associated reputational risk for WFCCG as the lead commissioner for services at Whipps Cross Hospital (WXH). This risk aligns to Corporate Objective 1: Meeting our statutory requirements and to Corporate Objective 3: Strengthening collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS.

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Finance and Performance

First reported on the BAF : April 2014

First reported BAF risk rating: Changes in the risk rating since first reporting: 2014/15

2015/16

2016/17

Forecast rating of the risk to its acceptable level: The risk rating has remained unchanged since the last report to the Governing Body

Target risk rating: Date expected to reach Target Risk Rating December 2016

Latest predicted risk rating

Predicted rating last time reported to the Governing Body (March 2016)

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WFCCG BAF, May 2016

Management oversight of this risk is provided through the Performance and Quality Committee, in addition the CCG manage the patient safety through the Clinical Quality Review meeting and the Clinical Harm Review meeting.

. Risk Mitigation Actions: 1. Barts Health has consistently failed NHS Constitution targets for 18 week referrals to treatment since summer 2013/14. The Trust has identified a further delay to compliance based on needing to clear a known backlog of 12000 referrals. WF CCG has worked with the WEL acute collaborative to agree recovery plans. This includes encouraging GPs to consider alternative providers in key specialities. The CCG is funding the resource required to reduce the backlog of referrals in 2016/17. Target action complete date: Q3 2016/17 2. Performance is reviewed on a monthly basis at the Contract Review Group. In addition, Barts Health have identified data quality issues regarding their Patient Treatment List (PTL) which requires validating a further 300 000 records to ensure the Trust is reporting accurately. Data validation has identified circa 20 000 records which may remain open pathways. All remaining pathways have been written to and the deadline for responses was mid - April 2016 with the Trust now expecting 3 700 of these patients to be added back to the waiting list. Final validation will be complete in May 2016. Target action complete date: May 2016 3. Eighteen week waits at WXH have reduced slowly since January 2015, from 6600 to 2600, with total numbers on the waiting list down by 30%. The Trust has met its forecast reduction to the waiting list since April 2015 Target action complete date: Q3 2016/17 4. The Trust still has circa 60 waits greater than 52 weeks per month and has yet to complete capacity planning to ensure a trajectory to reach zero to be agreed. The CCG issued a Remedial Action Plan (RAP) in June 2015 which remains in place. Target action complete date: To be confirmed 5. The Chair of the Clinical Harm Review meeting wrote to the Medical Director November 2015 highlighting concerns the Review Group raised regarding the low number of cases reviewed. The Chair of the Clinical Harm Review Group wrote to the CEO January 2016 again highlighting concerns raised regarding the continued low number of cases reviewed. Target action complete date: Not applicable

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WFCCG BAF, May 2016

6. A Contract Performance Notice was issued to the Trust 15 January relating to the outstanding follow up ophthalmology appointments. The backlog has now been cleared with no 18 plus week breaches identified. Target action complete date: Complete 7. The CCG is negotiating with Barts Health to determine a date for resumption of reporting and return to the 92% standard early in 2016/17. The trajectory will be agreed as part of the 2016/17 contract and include clearance of data quality issues. The Trust are reviewing the demand and capacity plan and once the remaining data quality issues are known will agree with the CCGs a plan for resumption of reporting and compliance with the standard. Target action complete date: Q3 2016/17 Controls in place to manage this risk: 1. Contract Review Group 2. Contract Performance Notice 3 .Remedial Action Plan 4. Demand and Capacity Plan

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WFCCG BAF, May 2016

Risk Description

Current risk rating

Directorate reporting the risk Progress to date :

Risk No 2: NHS Waltham Forest Clinical Commissioning Group (WF CCG) is not achieving its target for 95% of A&E attendees to be treated within 4 hours, as per the NHS Constitution, due to poor performance by Barts Health and other key providers. There is an associated reputational risk for WFCCG as the lead commissioner for services at Whipps Cross Hospital (WXH). This risk aligns to Corporate Objective 1: Meeting our statutory requirements and to Corporate Objective 3: Strengthening collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS.

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First reported on the BAF : April 2014


2015/16

2016/17

The risk rating has remained unchanged since the last report to the Governing Body Forecast rating of the risk to its acceptable level:

Target risk rating: Date expected to reach Target Risk Rating March 2017


Predicted rating last time reported to the Governing Body (March 2016) Management oversight of this risk is provided through the Performance and Quality Committee

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WFCCG BAF, May 2016

Risk Mitigation Actions:1. WF CCG has developed a revised Urgent Care Strategy and is reviewing its options for procuring its current Urgent Care Centre service and has agreed to close the Walk-in-Centre at Oliver Road. Target action complete date: April 2017 2. WF CCG is supporting the Patient Flow work stream of the WXH Improvement Plan, which aims to achieve the 95% standard by improving assessments in A&E and freeing up capacity through reduced admissions and earlier discharge. WF CCG is investing in an ambulatory care pilot to reduce bed use and has worked with Barts Health and the London Borough of Waltham Forest (LBWF) to pilot an integrated discharge team to reduce length of stay and Delayed Transfers Of Care (DTOC). Target action complete date: Ongoing 3. A Contract Performance Notice was issued in June 2015 requiring the Trust to address its failure to meet the 95% standard, and a Remedial Action Plan (RAP) agreed with trajectories at WXH agreed. The CCG established formal fortnightly performance management meetings in August 2015 on the trajectory which will oversee improvements in delivery. Target action complete date: Ongoing 4. For the 2016/17 Operating Plan WXH and the CCG have agreed a recovery trajectory to reach 95% in Q4 2016/17. April performance was 83% against a trajectory of 85%. Target action complete date: March 2017 5. Linked to the Emergency Department target, Waltham Forest performance by the London Ambulance Service (LAS) remains below the London average and the 75% category A target. The CCG is working with other commissioners to monitor the LAS CQC report and performance action plans, including local proposals on care homes, rapid response and additional local capacity. Target action complete date: Q4 2016/17 Controls in place to manage this risk: 1. Urgent Care Strategy 2. WXH Improvement Plan 3. Contract Performance Notice 4. Remedial Action Plan 5. Monitoring of the LAS CQC report and performance action plans

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WFCCG BAF, May 2016

Risk Description

Current risk rating


Risk No 3: Cancer Waits: NHS Waltham Forest Clinical Commissioning Group (WF CCG) is not achieving its national cancer wait targets due to poor performance at Barts Health. This signifies that some patients are not receiving the quality of care commissioned by WFCCG. Therefore, there is a potential for some patients to have a poor experience and are at risk of potential harm. There is an associated reputational risk for WFCCG as the lead commissioner for services at Whipps Cross Hospital (WXH). This risk aligns to Corporate Objective 1 Meeting our statutory requirements and Corporate Objective 4: Improving the patient experience across all services.

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First reported on the BAF : January 2015


2015/16

2016/17


Target risk rating: Date expected to reach Target Risk Rating June 2016.

Latest predicted risk rating:

Predicted rating last time reported to the Governing Body (March 2016) Management oversight of this risk is provided through Performance and Quality Committee.

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WFCCG BAF, May 2016

Risk Mitigation Actions: 1. The Trust met the 62 day standard in Q3 2015/16 but fell back in February and March and missed the Q4 target. For 2016/17 a trajectory level has been agreed which achieves quarterly compliance based on an agreed action plan. A key risk is colonoscopy capacity where the Trust is working to increase its available resources. Target action complete date: Q1 2016/17 Controls in place to manage this risk: 1. Agreed action plan

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WFCCG BAF, May 2016

Risk Description

Current risk rating


Risk No 4: Commissioning Budget: NHS Waltham Forest Clinical Commissioning Group (WF CCG) fails to manage its commissioning budget within plan, due to increased costs of acute Service Level Agreements (SLAs) leading to an overspend. There is an associated reputational risk for WFCCG as the lead commissioner for services at Whipps Cross Hospital (WXH). This risk aligns to Corporate Objective 3: Strengthening collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS.

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First reported on the BAF : May 2016


This is the first time this risk has been reported to the Governing Body for the financial year 2016/17 Forecast rating of the risk to its acceptable level:

Target risk rating: Date expected to reach Target Risk Rating March 2017

Latest predicted risk rating: Management oversight of this risk is provided through the Finance and QIPP Committee. Risk Mitigation Actions: 1. The CCG has worked with Barts and WEL CCGs to agree a contract for 2016/17 which addresses activity issues, QIPP, non PBR credit and productivity. The overall value agreed for WFCCG is £1.5M above the sum agreed as part of the 2016/17 budget (and £9M collectively across the 12 CCGs). There is a further risk if QIPP of £4.2M is not achieved and an in–year review of current non PBR prices may cause further pressures. 2. The CCG has been unable to draw down on its historic surplus due to national funding constraints so will also need to manage pressures from £2.6M of headroom commitments as the new Operating Plan requires CCGs to withhold their 1% reserve in case of local providers in NE London not meeting deficit control totals. Target action complete date: Ongoing

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WFCCG BAF, May 2016

3. If Barts Health fail to meet RTT, A&E and cancer standards trajectories they will lose access to Sustainability Funding support and cause CCG surpluses to be required to increase to meet the control total for NE London. Target action complete date: Ongoing 4. The CCG will need to manage Barts and other acute contracts closely and potentially use reserves or other underspends to deliver the plan. Target action complete date: March 2017 Controls in place to manage this risk: 1. Operating Plan 2. Scheduled progress meetings with WEL CCGs, Barts and other acute providers

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WFCCG BAF, May 2016

Risk Description

Current risk rating


Risk No 5: Partnership of East London Co-operatives (PELC) Contracts There is a potential risk of significant disruption to patient care within Whipps Cross Hospital (WXH), Urgent Care Clinics (UCC), NHS111, and Out Of Hours (OOH), from changes to the CCG’s contract with PELC. There is an associated risk within the Strategic Commissioning directorate, whereby an impact on UCC, could potentially impact on A&E performance at WXH. There is an associated reputational risk for WFCCG as the lead commissioner for services at Whipps Cross Hospital (WXH). This risk aligns to Corporate Objective 3: Strengthening collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS

16


First reported on the BAF : July 2015


2016/17


Target risk rating: Date expected to reach Target Risk Rating July 2016


Predicted rating last time reported to the Governing Body (March 2016) Management oversight of this risk is provided through the Finance and QIPP Committee.

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WFCCG BAF, May 2016

Risk Mitigation Actions: 1. PELC identified significant financial issues in July 2015. Ongoing negotiations led by BHR CCGs have not resolved the issues and PELC have given notice that they will stop providing the UCC in June 2016. 2. The CCG has identified a step-in provider which will need to mobilise by July 2016 to avoid disruption to patient care. A full procurement of these contracts is due by April 2017. Target action complete date: July 2016 Controls in place to manage this risk: 1 Appointment of step in provider 2 Procurement process for contracts to complete by April 2017

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WFCCG BAF, May 2016

Risk Description

Current risk rating


Risk No 6: Primary Care Commissioning There is a risk that NHS Waltham Forest Clinical Commissioning Group’s (WFCCG) review of Primary Medical Services (PMS), as requested by NHS England, (NHSE) will not meet the required deadlines. This means that there could be delays in the delivery of elements of the primary care transformation agenda. There is an associated reputational risk for WFCCG, if they are unable to conduct the PMS review by agreed timescales. Note (26 May 2016) The initial deadline was March 2016 which was then extended to June 2016. Work was undertaken by the CCG to progress the review and PMS commissioning intentions developed. However, in March 2016 London wide Local Medical Committees (LMC) challenged NHSE in regard to processes, agreement of transitional support being given to practices and on the timescales of the review. London wide LMC directed local negotiation groups and practices to not engage with the review and as a result, the review has unofficially been ‘paused’. Further information is awaited from NHS England in regard to revised timescales and implications on the review.

There is a risk that the delays in the review caused by London wide issues may impact implementation dates of the review. Elements of the new commissioning intentions such as

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Strategic Commissioning

First reported on the BAF : July 2015


2016/17


Target risk rating: Date expected to reach Target Risk Rating September 2016


Predicted rating last time reported to the Governing Body (March 2016) Management oversight of this risk is provided through the Primary Care Commissioning Committee. Risk Mitigation Actions: 1. WF CCG maintains a primary care commissioning risk register which is monitored by the Primary Care Commissioning Committee. Target action complete date: Completed 2. The CCG has established a PMS working group which is supported by members of the PCCC and CSU (who are also supporting NHSE on PMS review across London) Target action complete date: Completed

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WFCCG BAF, May 2016

extended access and equitable commissioning of primary care services across all practices are linked to the wider CCG commissioning intentions. Delays could impact delivery of the wider primary care transformation agenda.

There is also a risk that practices will not accept the offer that is being developed.

NHSE support has been variable.

Information provision to deliver the review has been slow and reactive. NHSE resources will be required in finalising the agreement to the new contracts, implementation and ongoing monitoring. If the support is not given this will impact CCG resources and ability to deliver the review.

There is an associated reputational risk for WFCCG, if they are unable to conduct the PMS review by agreed timescales. This risk aligns to Corporate Objective 3: Strengthening collaboration across NEL CCGs and providers to transform services to achieve the national ambition for the NHS.

3. NELCSU has been selected to support NHS England to manage the review process across London. The CCG are working closely with the CSU and already has good relationships with them in respect to primary care. Target action complete date: Completed 4. The CCG has worked with NHS England to recruit a new senior manager to area team to provide support to WEL CCGs. Target action complete date: Completed 5. The CCG has undertaken a recruitment process in order to strengthen its primary care commissioning team. Target action complete date: Completed 6. Waiting feedback from NHS England on confirmation of revised timescales and provision of additional info required to enable completion of review process. Target action complete date: May 2016 7.Transition support will be made available to practices once guidance is shared from NHSE which will help to minimise impact on practices Target action complete date: June 2016 8. An engagement and communication process has been developed as part of a wider support programme to GP practices. Target action complete date: Completed Controls in place to manage this risk: 1. Meetings with NHS England 2. Guidance from NHS England 3. Development of an engagement and communication process

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WFCCG BAF, May 2016

Risk Description

Current risk rating


Risk No 7: In November 2014 the CQC found Whipps Cross Hospital (WXH) to be non-compliant with eight standards of care and was placed into special measures This could result in patients receiving poor quality of care, having a poor experience and being at increased risk of potential harm. Particularly in reference to;

High number of Never Events with repeated incidents and poor evidence of learning.

Poor incident including Serious Incident Management and organisational learning

Inadequate Complaints Management and poor organisational learning.

Low Family and Friends Test Response rates resulting in the patient voice not being heard.

Infection control, high levels of MRSA Bacteraemia and c.diff cases.

High number of Adult hospital acquired grade 3 and 4 pressure ulcers

Lack of compliance with duty of candour.

There is an associated reputational risk for WF CCG as the lead commissioner for services at WXH. This risk aligns to: Corporate Objective 1 - Meeting our statutory requirements.

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Quality and Governance Directorate

First reported on the BAF: August 2013


2014/15

2015/16

2016/17

The risk rating has increased to risk score 20 as a result of increasing numbers of Never Events being reported Forecast rating of the risk to its acceptable level:

Target risk rating: Date expected to reach Target Risk Rating July 2016


Predicted rating last time reported to the Governing Body (March 2016)

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WFCCG BAF, May 2016

Corporate Objective 4 - Improving the patient experience across all services

Management oversight of this risk is provided through Performance and Quality Committee. Risk Mitigation Actions: Never Events

1. Concerns regarding number of never events escalated as a quality/safety concern to Barts Health Trust.

2. Contract Performance Notice served to Barts Health Trust on 17/11/2015 in line with the contract management process CG9.

3. Internal meeting led by Barts Health to discuss with commissioners and NHS England the Never Events and what actions have been taken to address.

4. A Remedial Action Plan (RAP) has been developed by Barts Health Trust, reviewed by the CCGs and amended plan requested and for review 15/01/2016. RAP reviewed and in place.

Target action complete date: July 2016 Serious Incident Management

1. Monitor key performance indicators and review as part of the CQRM assurance process

2. Monthly meeting with the Director of Nursing Whipps Cross to review serious incidents.

3. Review of all serious incident reports completed by Whipps Cross in line with the best practice guidance in the Serious Incident Framework.

4. Establish a review meeting with WX and the CCG/CSU to review further information requests for outstanding incident reports.

Target action complete date: July 2016 Complaints Management.

1. Monitor key performance indicators and review as part of the CQRM assurance process

2. Monthly meeting with the Director of Nursing Whipps Cross to review complaints

3. Deep dive into complaints management at April 2016 CQRM to include KPI quality performance, trends and themes analysis and evidence that learning is shared across the organisation

Target action complete date: July 2016

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WFCCG BAF, May 2016

Family and Friends Test Response Rate1. Monitor key performance indicators and review as part of the CQRM

assurance process. 2. Monitor and review the outputs from Whipps Cross Hospital patient

experience and engagement plan. 3. CCG review staff understanding and local use of FFT at Whipps Cross by

attending the Quality Assurance visits monthly. 4. Monthly meetings with Patient Experience Manager at Whipps Cross to

review actions in place to improve response rate and use of patient feedback Target action complete date: May 2016 Infection Control

1. Monitor key performance indicators and review as part of the CQRM assurance process.

2. CCG review infection control standards at Whipps Cross by attending the Quality Assurance visits monthly.

3. CSU attend all post infection review meetings on behalf of the CCG to assist in identification in lapses in care.

Target action complete date: May 2016 The Care Quality Commission (CQC) will be carrying out a chief inspector of officers re-inspection during July 2016 at which point the CCG will be informed of the Whipps Cross Hospital progress against its special measures status. Controls in place to manage this risk: 1 .Contract Performance Notice 2. Remedial Action Plan 3. Review meetings 4 Performance reviews through monthly CQRM 5.Monthly Quality Assurance visits

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WFCCG BAF, May 2016

Table 2a: Interpreting the BAF Template

24


WFCCG BAF, May 2016

Table 3: Risks retired from 2016/17 BAF

Risk Last Reported to the Governing Body

Directorate Rationale for retiring the risk from the BAF

How the risk is now being managed

NHS Waltham Forest Clinical Commissioning Group (WF CCG) is not achieving its national cancer wait targets due to poor performance at Barts Health. This signifies that some patients are not receiving the quality of care commissioned by WFCCG. Therefore, there is a potential for some patients to have a poor experience and are at risk of potential harm. There is an associated reputational risk for WFCCG as the lead commissioner for services at Whipps Cross Hospital (WXH).

March 2016 Finance and Performance

Continuing improvements against performance targets

The risk continues to be managed through the Finance and Performance directorate

25


WFCCG BAF, May 2016

Table 4: Zero Tolerance Risks Zero Tolerance risks are those areas of risk that WFCCG Governing Body benefit from being aware of regardless of the risk rating at any particular point in time. Table 4 shows those risks that have been identified as zero tolerance risk areas for Waltham Forest CCG.

Risk Area Current Risk Rating How the risk is being managed Responsible Directorate

Risk Owner

Safeguarding of adults and children

The CCG’s Quality and Performance Committee and associated sub–committees and groups provide oversight of risks associated with ensuring the safeguarding of adults and children

Quality and Governance Deputy Director of Quality and Safeguarding Adults

Achieving planned surplus

The CCG’s Finance & QIPP Committee provides oversight of risks associated with achievement of financial balance

Finance Director of Financial Strategy

Any provider with non-compliance against CQC standards

Details on how risks associated with this area are described in Table 2 (see risk 6)

Quality and Governance Director of Quality and Governance

Counter Fraud, Bribery and Corruption

Arrangements in place with the CCG’s Internal Auditors and Local Counter Fraud Specialist

Finance Director of Financial Strategy

Health and Safety

The CCG has an approved Health & Safety policy in place.

Quality and Governance Deputy Director of Integrated Governance

26


WFCCG BAF, May 2016

Health and Safety forms part of the CCG’s annual mandatory Training schedule.

The CCG has appropriately trained fire wardens.

An effective BCP covering IT infrastructure, Staff availability and Access to premises

The CCG has an approved Business Continuity Plan in place.

The CCG attends NHSE Business Continuity and Emergency Planning events including joint events with the Local Authority and other agencies.


Bullying and Harassment

The CCG has relevant HR policies in place.

The CCG is supported by NELCSU through a specialist HR Business Partner.

Strategic Commissioning Director of Strategic Commissioning

Compliance to mandatory training requirements

The CCG has arrangements in place with an external provider which is managed through NELCSU.

The CCG has an internal tracking system to ensure all staff meet their mandatory training requirements.


Compliance to Information Governance Standards

The CCG has a plan in place to meet its IG toolkit requirements and works closely with NELCSU to achieve this.

The CCG has ASH level 1 accreditation status.

The CCG has established a data sharing protocol with its key providers.

All CCG staff complete relevant IG training on an annual basis.


27


WFCCG BAF, May 2016

Risk scoring matrix

Most Likely Consequence (if in doubt grade up rather than down)

Likelihood of Occurrence

1 = Insignificant 2 = Minor 3 = Moderate 4 = Major 5 = Catastrophic

1 = Rare 1 2 3 4 5

2 = Unlikely 2 4 6 8 10

3 = Likely 3 6 9 12 15

4 = Highly Likely 4 8 12 16 20

5 = Certain 5 10 15 20 25

28


WFCCG BAF, May 2016

Guide to the assessment of likelihood and consequence

Likelihood

Score 1 2 3 4 5

Description Rare Unlikely Likely Highly Likely Certain

Frequency The risk may occur but only in exceptional circumstances

The risk is not expected to happen but there is a possibility that it could occur at some time

The risk might occur at some time. There is some history of it, or similar occurrences, having occasionally happened in the past

There is a strong possibility that the risk will occur. There is a history of it, or similar occurrences, frequently happening in the past

The risk is expeced to occur

There is a history of it, or similar occurrences, regularly happening in the past

Consequence

Score Description Impact Description

5 Catastrophic There is a very major and potentially disastrous impact on the achievement of the corporate objective(s)

4 Major There is a major impact on the achievement of the corporate objective(s)

3 Moderate There is a significant impact on the achievement of the corporate objective(s)

2 Minor There is some impact, albeit not significant, on the achievement of the corporate objective(s)

1 Insignificant There is minimal impact on the achievement of the corporate objective(s)

Author: Dr David Pearce, Head of Governance

29

Item 2.2

Title of report Proposed Changes to Statutory Guidance for Managing Conflicts of Interest

From Helen Davenport, Director of Nursing, Quality and Governance - WFCCG

Author David Pearce, Head of Governance

Purpose of report

The purpose of this report is to present NHS Waltham Forest Clinical Commissioning Group’s (WFCCG) Governing Body with a summary of the key points that are contained within the NHS England publication ‘Managing Conflicts of Interest: Revised Statutory Guidance for CCGs (draft for discussion)’.

Changes/additions/amendments to paper as a result of discussions held at Audit Committee

None

Recommendations

The Governing Body is asked to note contents of this report. NHS England have issued, for consultation, a proposed revision to its existing statutory guidance

for the management of conflicts of interest in CCGs. Following the consultation period final guidance will be published June 2016 with the requirement for CCGs to review their existing policies and where necessary align the policies and Constitution to the guidance by the end November 2016.


A consistent approach to managing conflicts of interest in the NHS, and consequently WFCCG, will ensure the effective commissioning and provision of health care for patients and carers.

Risk implications

An inconsistent approach to the management of conflicts of interest could expose WFCCG to legal sanctions.


Financial implications are identified in the individual reported risks.

Equality analysis


Commissioned by the CCG are non-discriminatory on the grounds of any protected characteristics. The

30

Proposed Changes to Statutory Guidance for Managing Conflicts of Interest




NHS England publication: ‘Managing Conflicts of Interest: Revised Statutory Guidance for CCGs (draft for discussion)’; E – bulletins, Capsticks Solicitors, Hempsons Solicitors, NHS Clinical Commissioners (NHSCC).


None

31

Management of conflicts of interest in clinical commissioning groups

Proposed Updates to Existing Statutory Guidance

32


1

1 Introduction

As part of its process of delegating responsibility for some primary care co-commissioning activities to clinical commissioning groups (CCGs), NHS England published new guidance in respect to the management of conflicts of interest in its publication; ‘Managing Conflicts of Interest: Statutory Guidance for CCGs – NHSE Dec 2014’. NHS Waltham Forest CCG has reflected the requirements of this guidance within its Constitution and also within its Standards of Business Conduct and Managing Conflicts of Interests Policy.

Publication of an audit reviewing conflicts of interest management in those CCGs that co- commission primary care highlighted concerns that some CCGs did not have clearly defined processes for recording conflicts of interest and recording any breaches. In response to the audit findings, NHS England issued, April 2016, a draft updated guidance for consultation, the aim of which is to ensure consistency in dealing with conflicts of interest across CCGs.

2 Key changes to existing guidance on the management of Conflicts of Interest

The key changes between the current statutory guidance and the proposed new guidance include:

The recommendation for CCGs to have a minimum of 3 Lay Members on the Governing Body - in order to support conflicts of interest management

The introduction of a conflicts of interest guardian – it is expected that the CCG audit committee Chairs will assume this role

The requirement for CCGs to include a robust process within their conflicts of interest policy for managing breaches to be published on the CCG’s website

Strengthened provisions around decision making when a member of the Governing Body, or a committee or sub-committee is conflicted

Strengthened provision around the management of gifts and hospitality, including the need for a publicly accessible register of gifts and hospitalities

A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans and to include the findings of this audit within their annual end–of-year governance statement

A requirement for all CCG staff, Governing Body and committee members and GP members to complete mandatory conflicts of interest training, which will be provided by NHS England

3 Other areas of change to existing guidance on the management of Conflicts of Interest

3.1 Clarity that register(s) of interest should be maintained for:

All CCG employees, including: All full and part time staff Any staff on sessional or short term contracts Any students and trainees (including apprentices) Agency staff Seconded staff

33


2

In addition, any self-employed consultants or other individuals working for the CCG under a contract for services should make a declaration of interest in accordance with the guidance, as if they were CCG employees.

Members of the governing body: All members of the CCG’s committees, sub-committees/sub-groups, including:

Co-opted members Appointed deputies Any members of committees/groups from other organisations. Where the CCG is participating in a joint committee alongside other CCGs, any

interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG.

All members of the CCG (i.e. each practice) This includes each provider of primary medical services which is a member of the

CCG under Section 14A (1) of the 2006 Act. Declarations should be made by all employees of the practice, regardless of whether

they are directly involved with CCG commissioning or not, including: GP partners (or where the practice is a company, each director) GP locums Practice managers Practice nurses etc.

3.2 Clarity in respect to the Primary Care Commissioning Committee Chair:

The Primary Care Commissioning Committee (PCCC) must have a Lay Chair and Lay Vice Chair. To ensure appropriate oversight and assurance and to ensure the CCG Audit Chair’s position as conflicts of interest guardian is not compromised, the Audit Chair should not hold the position of Chair of the PCCC. This is because CCG Audit Chairs would conceivably be conflicted in this role due to the requirement that they attest annually to the NHS England Board that the CCG has:

Had due regard to the statutory guidance on managing conflicts of interest Implemented and maintained sufficient safeguards for the commissioning of primary

care

CCG Audit Chairs can however serve on the Primary Care Commissioning Committee provided appropriate safeguards are put in place to avoid compromising their role as conflicts of interest guardian. Ideally the CCG Audit Chair would also not serve as Vice Chair of the PCCC. However if this is required due to local circumstances (for example where there is a lack of suitable Lay candidates for the role), this will need to be clearly recorded and appropriate further safeguards put in place to maintain their integrity as conflicts of interest guardian.

34


3

3.3 Requirement of NHS England’s CCG Improvement and Assessment Framework:

NHS England is introducing a new Improvement and Assessment Framework for CCGs from 2016/17 onwards. The management of conflicts of interest is a key indicator of the new framework. As part of the new framework, CCGs will be required on an annual basis to confirm, via self-certification:

That the CCG has a clear policy for the management of conflicts of interest in line with the statutory guidance and a robust process for the management of breaches

That the CCG has a minimum of three lay members That the CCG Audit Chair has taken on the role of the conflicts of interest guardian The level of compliance with the mandated conflicts of interest on-line training, as of

31 December annually

In addition CCGs will be required to report on a quarterly basis, via self–certification, whether the CCG:

Has processes in place to ensure individuals declare any interests which may give rise to a conflict or potential conflict as soon as they become aware of it, and in any event within 28 days, ensuring accurate up to date registers are complete for:

conflicts of interest, procurement decisions gifts and hospitality

3.4 Clarity in respect to managing conflicts of interest throughout the commissioning cycle:

Clarity is provided in respect to:

Designing service requirements Provider engagement Specifications

Procurement and awarding grants

Register of procurement decision Declarations of interests for bidders / contractors

4 Impacts on the WFCCG Constitution

Changes to the statutory guidance for the management of conflicts of interest in CCGs will result in some amendments being made to the WFCCG Constitution. Based on the current proposed changes identified in the draft statutory conflicts of interest guidance (for discussion) amendments would likely be required to the following areas of the WFCCG Constitution:

35


4

Section 6 (Decision Making: The Governing Structure); paragraph 6.5.7: ‘Composition of the Governing Body’: amendment would be required to reflect the appointment of a 3rd Lay Member to the Governing Body.

Section 8 (Standards of Business Conduct and Managing Conflicts of Interest) paragraphs 8.1 to

paragraph 8.8: Standards of Business Conduct Conflicts of Interest Declaring and registering interests Managing Conflicts of Interest: general Managing Conflicts of Interest: contractors and people who provide services to the Group Transparency in Procuring Services Register of procurement decisions Procurement decisions relating to primary medical care

Amendments would be required to all or some of the above sections dependent upon the details contained within the final version of the new statutory guidance.

Updates to the Constitution would, unless advised otherwise by NHS England, be in line with the current procedures for Constitution updates which allows for applications to CCG Constitution changes to be formally submitted to NHS England twice per year by 1June and 1 November. Applications for Constitutional changes require assurance that the CCG Membership have approved the proposals. Final decision on any application to change the constitution remains the responsibility of NHS England.

Our auditors recently undertook a review of our primary care delegation arrangements and identified some areas of improvement; a report was due to be submitted to the Governing Body proposing some changes. However, the recent guidance also has implications for the governance of primary care and the Primary Care Commissioning Committee; both the guidance and the auditors review will therefore need to be carefully considered before any changes are made to the current arrangements.

5 Next Steps

Following issue for consultation of the draft statutory guidance for managing conflicts of interest for CCGs it is anticipated that:

Final guidance will be published in June 2016 CCGs will be required to carry out reviews of their existing processes and to strengthen them

where appropriate by the end of November 2016 NHS England will publish separate detailed guidance to address potential conflicts of interest

arising from new care models and integrated care models later in the year Amendments to WFCCG Constitution would be required based on the current proposed changes

to the statutory guidance for the management of conflicts of interest. In addition to the Constitutional changes arising directly from the draft guidance as currently

published, WFCCG has the opportunity to apply for additional Constitutional amendments. For example, given the difficulty in recruiting high calibre Lay Members the CCG may wish to consider the inclusion of an amendment to extend their terms of office from the current 2 years to 3 years in order to align with Clinical Directors.

36


5

A change in the composition of the Governing Body will further lead to: A requirement for changes and amendments to some existing committee memberships

and associated terms of reference Amendments to some Governing Body members job descriptions, ensuring clarity on

office holder responsibilities Amendments to some corporate policy documents

Commence the process for submission of an application for Constitution amendments recognising the requirement for Membership and stakeholder approvals. Given that final publication of the revised statutory guidance is anticipated June 2016 then it is likely that an application would need to be submitted by 1 November 2016 in order to meet NHS England approval time scales.

6 Conclusions

NHS England have issued, for consultation, a proposed revision to its existing statutory guidance for the management of conflicts of interest in CCGs. Following the consultation period final guidance will be published June 2016 with the requirement for CCGs to review their existing policies and, where necessary, align the policies and Constitution to the guidance by the end November 2016. It is anticipated that applications for Constitutional changes arising from changes to statutory guidance along with any additional amendments WFCCG may seek approval for would need to be formally submitted to NHS England by 1 November 2016.

37

Item 2.3

Title of report Planning and Innovation Committee Terms of Reference for 2016/17

From Jane Mehta, Director of Strategic Commissioning - WFCCG

Author D. Pearce, Head of Governance - WFCCG

Purpose of report

The purpose of this report is to present NHS Waltham Forest Clinical Commissioning Group’s (WFCCG) Governing Body with the Planning and Innovation Committee updated Terms of Reference for 2016/17 following annual review.

Changes/additions/amendments to paper as a result of discussions held at Planning and Innovation Committee meeting 9 March 2016

It was agreed that paragraph 6.1 of the existing Terms of Reference be amended to read: “Meetings of the Committee will normally be held monthly, with the exception of August. The Committee may also hold a number of informal meetings during the year.”

There were no other amendments or revisions.

Recommendations

The Governing Body is asked to agree the Planning and Innovation Committee Terms of Reference for 2016/17.


The Planning and Innovation Committee reviews and comments on new care pathways the CCG plans to introduce and consider the Joint Strategic Needs Assessment to ensure it is factored into future plans.

Risk implications

The lack of effective Terms of Reference will inhibit the effectiveness of the Planning and Innovation Committee in carrying out its duties and responsibilities.


None

Equality analysis


Commissioned by the CCG are non-discriminatory on the grounds of any protected characteristics. The



38

Planning and Innovation Committee Terms of Reference for 2016/17


WFCCG Planning and Innovation Committee.


None applicable for this report.

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of 3

Planning and Innovation committee Terms of Reference

1. Introduction

1.1 The Planning and Innovation committee (“the committee”) is

established in accordance with Waltham Forest clinical commissioning group’s constitution. 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.

1.2 The Committee will:

Identify opportunities for new, evidence-based ways of working in the context of our strategic plans

Review and comment on new care pathways the CCG plans to introduce;

Consider the Joint Strategic Needs Assessment and ensure it is factored into future plans, including the Sustainable Transformation plan and associated delivery plans;

Ensure feedback from relevant stakeholders is considered in future plans, including the Commissioning Strategy Plan; and

Oversee from a clinical perspective groups and functions within the CCG that have responsibility for planning and redesigning services.

Comment on the clinical efficacy of business cases Consider implications for research and education of new

pathways, models of working, business cases etc.

2. Membership

2.1 The Committee shall be appointed by the clinical commissioning group as set out in the clinical commissioning group’s constitution and may include individuals who are not on the Governing Body.

2.2 The Committee shall consist of a Chair, who will be a member of the

Governing Body with a lead role, together with two other members, at least one of whom will be another member of the Governing Body.

2.3 The membership of the Committee will comply with provisions set out

in regulations and within the CCG’s Constitution and associated standing orders.

2.4 The members of this Committee will be:

8 Clinical Directors Director of Strategic Commissioning Associate director of strategic commissioning Lay Member(s)

Deputy director of finance

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of 3

Deputy director of quality and governance

2.5 The Committee is presently chaired by the lay member and this will be

reviewed annually in April..

3. Attendance

3.1 The Chief Officer and other senior CCG managers should be invited to attend, and particularly when the Committee is discussing areas of risk or operation that are the responsibility of that manager.

3.2 The Chief Officer should be invited to attend and should discuss at

least annually with the Committee the CCG’s Commissioning Strategy Plan.

4. Secretary 4.1 The personal assistant to the Chair and secretary for governing body

committees shall be Secretary to the Committee and shall ensure that a minute of the meeting is taken and provide appropriate support to the Chair and Committee members.

5. Quorum 5.1 A quorum shall be 7 members of the committee including 2 clinical directors. 5.2 In the event of the Chair of the Committee being unable to attend all or

part of the meeting, he /she will nominate a replacement from within the membership to deputise for that meeting.

6. Frequency and notice of meetings 6.1 Meetings of the Committee will normally be held monthly, with the

exception of August. The Committee may also hold a number of informal meetings during the year.

7. Authority 7.1 The Committee is authorised by the Governing Body to pursue any

activity within these Terms of Reference and within the Scheme of Reservation and Delegation, including (without limiting the generality of the foregoing) to: a) Seek any information it requires from CCG employees, in line

with its responsibility under these terms of reference and the Scheme of Reservation and Delegation.

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b) Require all CCG employees to co-operate with any reasonable request made by the Committee, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation.

c) Review and investigate any matter within its remit and grants freedom of access to the CCG’s records, documentation and employees. The Committee must have due regard to the Information Governance Policies of the organisation regarding personal identifiable information and the organisation’s duty of care to its employees when exercising its authority

d) Obtain outside legal or other independent advice and to secure the attendance of persons with relevant experience and expertise if it considers this necessary.

e) Set up any joint working arrangements with other bodies. f) Establish task & finish groups to deliver its objectives.

7.2 In exercising its authority, the Committee is required to comply with: a) The CCG’s Standing Orders and Prime Financial policies b) The CCG’s Conflict of Interest Policy c) The section of the Scheme of Delegation which refers to this

Committee

7.3 The Planning and Innovation Committee is not a decision-making body, but will make recommendations to the Governing Body.

8. Remit and responsibilities of the committee

8.1 The minutes shall be formally recorded by the personal assistant to the Chair and governing body committee and submitted to the Governing Body.

8.2 The chair of the committee shall draw to the attention of the Governing

Body any issues that require disclosure or executive action.

9. Conduct of the committee 9.1 The committee will conduct its business in accordance with any

national guidance and relevant codes of conduct / good governance practice, including Nolan’s seven principles of public life.

9.2 The committee will review, at least annually, its own performance,

membership and terms of reference. Any resulting changes to the terms of reference or membership will be approved by the Governing Body.

42

Item 3.1

Title of report Performance and Quality Report (CCG Scorecard)

From Les Borrett, Director of Financial Strategy

Helen Davenport, Director of Nursing, Quality and Governance - WFCCG

Author

Enrico Panizzo, Senior Commissioning Manager

Anne Walker, Deputy Nurse Director of Quality and Clinical Governance - WFCCG

Purpose of report

The purpose of this report is to inform the Governing Body of the CCG’s performance against the CCG Scorecard and other national performance and quality standards at the end of March 2016 (Month 12). Based on the latest figures the CCG is reporting that 11 of the planned 22 targets were achieved in 2015/16 (50%). The report outlines the key performance achievements and challenges from 2015/16. As the financial year has closed detailed updates are only provided for those national performance and quality targets which the CCG is currently not meeting at the end of April 2016. Attached to the report is the proposed CCG Scorecard for 2016/17 which has been approved by the Performance and Quality Committee.

Changes/additions/amendments to paper as a result of discussions held at other committees

Not applicable

Recommendations

The Governing Body is asked to review the report and make any recommendations for further investigation.


The CCG is not meeting several performance targets, including the 4hr waiting time target for A&E at Whipps Cross Hospital. The report details the actions being taken by the CCG and by providers to address these and other areas of under-performance. The Scorecard is the principal tool for the CCG to ensure it is reporting on the impact of the CCG’s work programmes for 2016/17 in terms of improved patient care and outcomes. The report supports the delivery of improved care by providing a process for recording progress each month and highlighting any risks to delivery, so that these risks can be appropriately mitigated by the CCG.

43

Performance and Quality Report (CCG Scorecard)

Risk implications

Failure to ensure that there are improvements to the quality and performance of services commissioned may result in a failure to manage and mitigate risks with potential harm to patients and reputational damage to the CCG.


Failure to meet NHS Constitution standards or CCG Local Priorities may affect the size of the Quality Premium, an additional incentive payment made to CCGs.

Equality analysis

The report has considered the CCG’s equality duty and where relevant has identified relevant actions which address any likely impact on equality and human rights.


The report contains data from a range of sources. The main sources of data are: Health Analytics (HA) for primary care data, Secondary Use Services (SUS) for acute data, Health and Social Care Information Centre (HSCIC) and NEL CSU for performance data. The report also refers to performance and quality reports received from Barts Health and North East London Foundation Trust.


An earlier version of this report was presented to the Performance and Quality Committee. The committee approved the 2016/17 scorecard with no suggested changes. Updates to the 2015/16 scorecard have been included in the report where these have become available since the committee.

44


May 2016

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1. Scorecard Aims and Objectives (2015/16)

NHS Waltham Forest Clinical Commissioning Group (WFCCG) has developed the Scorecard to report progress against key performance and quality targets in 2015/16.

The 2015/16 Scorecard has been designed around the CCG workstreams as identified in the CCG Business Grid (Appendix A). In order to create the Scorecard each CCG workstream lead was asked to develop a maximum of two indicators and targets that reflect the key goals for that programme. These goals have been developed in collaboration with the relevant Clinical Director and/or Clinical Leads. They have been further refined through two CCG away-days (24 and 29 April 2015). The Scorecard has also been reviewed and signed-off by the Performance and Quality Committee (13 May 2015) and approved by the Governing Body (27 May 2015).

The intention of the Scorecard is to identify specific measurable indicators that can be used to demonstrate improvements in patient care and outcomes over the course of the year. The focus of the Scorecard is on improvements to patient outcomes. Where it has not been possible to measure health outcomes, or where outcomes cannot be tracked on a monthly basis, indicators have been chosen that most closely reflect the work being undertaken by the CCG workstreams to influence improvements in outcomes.

The Scorecard reflects Waltham Forest priorities and objectives rather than replicating national performance frameworks. This makes the Scorecard more meaningful and relevant to the CCG. It enables the CCG to measure the effectiveness of its local strategic plans. Where appropriate, the Scorecard has used existing national indicators and targets. This is the case for the key national targets that CCG was not meeting at the end of 2014/15. Local CCG plans should support national performance objectives. Where relevant the Scorecard targets have been aligned with the levels of ambition set out in the CCG Operating Plan and Quality Premium submissions to simplify reporting processes.

The CCG performance reporting process will focus on the latest performance information, progress made in the past month, the identification of any risks to delivery, and actions being taken to resolve underperformance or mitigate adverse impact. Whilst the reporting process will focus on performance of the Scorecard indicators, the intention is also to capture the key elements of the wider work being undertaken within each workstream, to the extent that this supports making a difference for the residents of Waltham Forest.

The monthly reporting process will also be used to report by exception on the CCG’s performance against national performance and quality targets not covered by the Scorecard so that the CCG is aware of any risks to the local population. This exception reporting includes the NHS Constitution standards and the CCG requirements outlined in the 2015/16 Operating Plan guidance.

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2. 2015/16 CCG Scorecard Month 12

Notes: Dementia and IAPT baseline figures are average values for 2014/15. IAPT performance will be assessed based on a quarterly basis in line with agreed targets with NELFT. Dementia performance is based on local data but will be updated to nationally published data as this becomes available over 15/16. RTT incomplete pathway shows the officially reported CCG position, but does not include Barts Health data (not reporting) - see narrative below for full update. A&E and Cancer (62 day) targets are based on CCG trajectories agreed with NHSE that assume mid-year compliance and are rated on the basis of this trajectory. RAG rating for other end-of-year targets (for example Virtual Ward and Prescribing) is also done on the basis of trajectories developed by the project leads. Methodology for Integrated Care and for District Nursing have been updated at M5 and Palliative care at M9 based improved information (see report for details). All changes have been approved by the Performance and Quality Committee.

Workstream # Indicator TargetProject lead

Apr‐15 May‐15 Jun‐15 Jul‐15 Aug‐15 Sep‐15 Oct‐15 Nov‐15 Dec‐15 Jan‐16 Feb‐16 Mar‐16YTD Average/Totals

Trend Target

1 Emergency admiss ions for targeted cohort patients 10% reduction GF ‐6% ‐16% 10% ‐7% ‐16% ‐15% ‐16% ‐34% ‐29% ‐35% ‐17% ‐33% ‐19% Achieved

2 Ambulance conveyances from care homes (QP) 5% reduction GF ‐5% ‐13% 9% ‐9% 20% 10% ‐4% 0% 0% 38% 5% 28% 7% Not Achieved

3 Dementia diagnos is rate 67.0% NA 77% 76% 76% 76% 76% 77% 77% 77% 76% 77% 76% 74% 76% Achieved

4 IAPT access rate 3.75% per Qtr* NA 14.55% Not Achieved

Chi ldren 5 RTT performance for paediatric services at NELFT 95% KH 100% 100% 100% 100% 33% 0% 100% 82% 83% 89% 89% 80% 80% Not Achieved

6 Patients admitted to Waltham Forest Virtua l Ward 40 KH 0 0 0 0 0 0 0 0 0 0 0 0 0 Not Achieved

Maternity 7 Early antenata l booking at Whipps Cross (13 weeks ) 85% KH 85% 92% 96% 96% 96% 95% 97% 97% 98% 94% 98% 99% 95% Achieved

Learning Disabi l i ty 8 Heal th and socia l care community assessments 95% at M12 KH 1% 7% 7% 26% 27% 33% 43% 48% 61% 66% 73% 95% 95% Achieved

9 Cancer GP referra l to fi rs t treatment within 62 days 85% from Q2 JD/EP 87% 76% 82% 73% 83% 77% 81% 92% 84% 80% 86% 86% 82% Achieved

10 Bowel cancer screening 57.7% JD 49% 52% 55% 49% 52% 46% 47% 57% 44% 48% 53% 43% 50% Not Achieved

11 Diabetes patients on new pathway with care plans 80% LS 25% 26% 26% 27% 30% 32% 42% 43% 44% 50% 50% ‐ 50% Not Achieved

12 Reduction in cardiology outpatient referra ls 5% reduction LS 11% 45% 67% 42% 44% 6% ‐20% 54% 11% 21% 16% ‐4% 22% Not Achieved

End of Li fe Care 13 Patients regis tered as pal l iative care 359 at M12 JR 270 273 283 293 297 305 325 375 395 394 441 397 397 Achieved

Integrated Commiss ioning 14 CHC el igibi l i ty assessments within 28 days 80% KH 50% 64% 60% 0% 0% 12% 18% 64% 76% 63% 88% 89% 89% Achieved

Community Health Services 15 District nurs ing waiting times – GP referra ls within 48hrs 90% KH 80% 72% 55% 69% 89% 89% 91% 65% 90% 84% 74% 85% 79% Not Achieved

Planned Care 16 RTT incomplete pathway performance 92% LB 97% 96% 95% 95% 95% 94% 94% 93% 92% 93% 93% 92% 94% Achieved

17 A&E 4hr al l types performance at Whipps Cross 95% from Q3 EP 87% 89% 90% 85% 89% 85% 83% 81% 81% 82% 80% 82% 84% Not Achieved

18 Proportion of patients us ing the WX Urgent Care Centre 34% EP 32% 31% 27% 27% 27% 26% 26% 29% 31% 32% 32% 33% 29% Not Achieved

Prescribing 19 Antibiotic prescribing in primary care <1.11 AO 1.057 1.042 1.031 1.024 1.018 1.008 0.997 0.988 0.959 0.944 0.947 ‐ 1.001 Achieved

20 Improvement in Whipps Cross A&E and Inpatient FFT score 91.4% AW 94% 91% 95% 93% 94% 93% 94% 93% 95% 93% 95% 93% 94% Achieved

21 Number of C.Di ff cases within planned tra jectory <=45 AW 2 2 4 2 9 5 5 6 2 2 2 3 44 Achieved

Primary Care 22 Genera l Practice FFT score (QP) 86.6% SR 81% 89% 86% 88% 87% 84% 85% 79% 84% 84% 81% 82% 84% Not Achieved

3.25% 3.87% 3.61% 3.82%

Cancer

Long term conditions

Urgent Care

Qual i ty and Safety

Integrated Care

Mental health

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3. 2015/16 CCG Scorecard Performance – Year End Summary

The table above summarises the latest performance against the 2015/16 scorecard.

Achievements in 2015/16

Eleven (half) of the 2015/16 indicators successfully met their targets. Key achievements include integrated care and antibiotic prescribing. Integrated care saw a 19% reduction in emergency admissions. This is equal to 844 fewer emergency admissions from the high risk patient cohort. Total emergency admissions at Whipps Cross fell by 17% in 2015/16 and the reduction for Whipps Cross has been 23% over the last two years, comparing 2015/16 to 2013/14. This demonstrates the effectiveness of the integrated care programme including the Rapid Response service (Rapid Response activity increased by 41% in 2015/16) as well as interventions by Barts Health such as Ambulatory Care in preventing unnecessary admissions to the hospital.

The chart below shows the fall in emergency admissions at Whipps Cross over the last two years.

Antibiotic prescribing also made a significant improvement in 2015/16 showing month on month reductions in the total volume of antibiotics prescribed, exceeding the target set by NHSE. There has also been a reduction in the proportion of broad spectrum antibiotics being prescribed. Both of these remain areas of continued focus for improvement in 2016/17. Other notable improvements in 2015/16 were for

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continuing healthcare (CHC) assessments and for learning disability reviews, both of which made significant improvement over the year. Dementia diagnosis, the Friends and Family Test at Whipps Cross and the Early Antenatal Booking indicators all remained well above their targets for almost the whole of the year. Although IAPT did not make its target the number of people entering treatment increased in 2015/16 and waiting times remained within the newly introduced targets.

Challenges and Learning from 2015/16

Where the targets for 2015/16 have not been achieved it is important to note that a number of factors often contributed towards this outcome.

In most cases where the target has not been achieved there has still been improvement in performance. 17 out of 22 targets (77%) showed improvement in 2015/16 compared to the previous year or within the year. This is the case for the district nursing, diabetes and urgent care centre targets. For district nursing and diabetes new targets were chosen in 2015/16 and improvements were made in operations in-year that benefitted patients. More patients were seen faster by the district nursing service. Where breaches have occurred the CCG has improved assurances that these have been managed appropriately. Changes in the diabetes pathway meant that patients were more likely to be given a care plan early in their treatment. At the urgent care centre innovation was delayed, but cooperation between PELC and Barts Health meant that an increasing proportion of patients were seen in the Urgent Care Centre in Q4 despite increased overall volumes of attendances at the Whipps Cross site towards the end of the year.

There have also been challenges to the delivery of some scorecard targets. This is particularly the case for some of the areas that require partnership working between stakeholders and where the overall CCG influence is limited. This is the case for the national A&E 4hr performance target. This is one of the few targets that has deteriorated in 2015/16. The performance of Whipps Cross is closely monitored by the CCG through fortnightly performance meetings and monthly meetings of the Urgent Care Working Group. Approximately half of the breaches of the 4hr target are non-admitted patients and attributed to internal A&E processes.

Other challenges in 2015/16 include the bowel cancer target, care homes work and GP Friends and Family Test. The bowel cancer and care homes projects suffered due to late implementation of projects. For bowel cancer it was not until the end of Q3 2015/16 that the majority of practices were signed up to the programme. To date there has not been evidence of an impact between GP practice sign-up and practice performance. CCG performance is partially restricted due to limited influence over the central screening programme and the ability to target patients that are eligible for screening. The Care Homes project received additional support in Q4 during which training was delivered to several high user locations. This had not yet demonstrated impact. This work is continuing in 2016/17 with the enhanced GP support to care homes.

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The GP FFT performance was volatile over 2015/16 and potentially reflects the fact that this was a new quality indicator and uptake of the patient surveys was itself variable. The CCG has since implemented a primary care dashboard which monitors a range of indicators at practice level that enables more focused assessment of quality improvement activities.

In addition to the Scorecard reporting the CCG has implemented regular reporting on its Delivery Plan in 2015/16. This process has been extended into 2016/17. Individual actions within the Delivery Plan have been linked where possible to scorecard targets. This should improve processes for ongoing project monitoring and quickly responding to challenges as they arise throughout the year.

4. Performance - Exception Reports

The Governing Body are asked to note the following updates regarding national performance standards.

A&E (4hr Waiting Times)

As noted above A&E performance has deteriorated in 2015/16. The end of year performance for Whipps Cross was 84.4% compared to 90% for 2014/15 (and 94% in 2013/14). Performance has remained below target for the first four weeks of 2016/17 at 80.6% YTD. Challenges remain in terms of recruitment of staff, managing peaks of demand and high bed occupancy driven by increase in length of stay. A revised trajectory for 2016/17 has been agreed by Barts Health with NHSE and NHS Improvement. This trajectory is modelled on the performance for 2015/16 and assumes that the site (and the trust) meet the 95% target at March 2017.

Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 2016‐17

% < 4 hours 84.90% 85.75% 87.61% 89.30% 90.87% 90.58% 88.01% 89.49% 91.10% 92.44% 92.79% 95.05% 89.85%

Actions being taken by the trust include work to match shift patterns with demand, fill vacancies, and ensure that clinicians are engaged in the improvement activity. The CCG is working with Barts Health to implement Discharge to Assess and other community pathways that should reduce the number of patients that are recorded as ‘medically fit’ but awaiting discharge. This work is being piloted and due to come into effect mid-year. The CCG is working with the ambulance service to reduce conveyances to the Emergency Department. It is also re-procuring the Urgent Care Centre (UCC) in 2016/17 and developing the potential for patients to access diagnostics from the UCC.

Referral to Treatment (18 Week Waiting Times)

The total number of patients waiting over 18 weeks at Whipps Cross reduced to 2,550 in February, from 2,802 in the previous month. Performance improvement had stalled since October 2015 and was attributed to cancelled operations some of which were linked to the

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industrial action taken by junior doctor strike and winter pressures. The backlog has reduced substantially from 8,911 in October 2014. There were 13 reported 52 week breaches at Whipps Cross in the following specialities: General Surgery (4); Trauma and Orthopaedics (2), Urology (2), Oral Surgery (1), Colorectal Surgery (1), Paediatric Urology (1), Vascular Surgery (1), Upper Gastrointestinal (1). The Trust expects to submit a plan in May 2016 detailing the strategy for recommencement of reporting including the assurances required. Barts Health reported that 340 patients were outsourced to the independent sector in February 2016. Whipps Cross has improved scheduling processes in order to support better theatre utilisation and increased booking horizons

Cancer Waiting Times

In February, Waltham Forest CCG met 7 of the 8 Cancer Waiting Times. The standard not met was the 31 day target to first treatment. Performance was 94.74% compared to a standard of 96.0% with 3 breaches out of a total of 57 patients. One breach was clinical; the other two were due to admin/capacity. This is the first month the standard has not been met after 3 consecutive months for which the standard was met. Ambulance Waiting Times

London Ambulance Service (LAS) Category A (8 min) performance fell to 48.7% in March 2016 against a target of 75%. This was a deterioration from the previous month of 51.6%. Performance across London was 57.3% Performance remains below target across London despite improvements in recruitment. Part of this deterioration is due to a change in counting (previously automatic external defibrillators administered on the scene prior to the arrival of the ambulance crews were counted in the LAS performance). Underperformance has also been attributed to low efficiency, measured in terms of job cycle time, which has in part been affected by the influx of new members of staff. Negotiations regarding the contract and investment for 2016/17 are in process and are focused on achieving CCG level trajectories and improvement targets.

5. Quality and Safety - Exception Reports

Improvement in Whipps Cross FFT score

The A&E and Inpatients combined score for February is 95% and year to date 94% above the target rate of 91.4%. Barts Health board reports states in February 92.7% of A&E respondents and 94.5% of inpatients at Whipps Cross would recommend the service to friends and family, this is an improvement in both areas. There was a slight increase in the response rate for inpatients from 23.8% in January 2016 to 26.4% in February and it is to be noted that the response rate for Whipps Cross is significantly higher than the other Barts Health sites. There has been a very slight increase in the A&E response rate from 1.6% January 2016 to 2.6% in February 2016.

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Whipps Cross Hospital have invested in I Want Great Care and this went live on the 1 March 2016 and is being used to manage the FFT responses and look to improve the response rate and sharing of learning across the Hospital.

Number of C. Diff cases within planned trajectory (monthly count of C. Difficile infections by CCG at any site)

For the third month in a row there have been two reported cases of C.Difficile each month for Waltham Forest CCG against a planned threshold of 4 cases and this has brought the trajectory to a forecast position of achievement of the target by year end. The C.Difficile data for Barts Health Trust shows 1 case at Whipps Cross Hospital and 3 for Barts Health.

To date review of the C.Difficile cases at Barts Health indicate there were three lapses in care all at Whipps Cross Hospital. All patients who have tested positive for C.Difficile at Barts Health are reviewed by the Consultant Microbiologist and an Infection Prevention and Control Practitioner. The Infection Prevention Control lead working within the CSU reviews all Root Cause Analysis monthly to establish themes and trends. The trajectories for 2016/17 have now been published at 46 for the year.

Serious Incident (SI) Management

Whipps Cross Hospital

Whipps Cross Hospital as of March 2016 have 7 SIs that have breached the required Strategic Executive Incident System (STEIS) reporting deadline, an increase of 3 on the previous month. The number of reports where further information has been requested has reduced to, reported as 8. 5 grade 2 incidents remain open and waiting a meeting that took place on 2 May 2016 with the Barts Health Patient Safety team to review evidence.

Barts Health have reported 4 Never Events since the beginning of April 2016. Three reported at the Royal London site, 2 relating to removal of incorrect tooth and 1 to the use of the incorrect implant. One Never Event was reported at Whipps Cross Hospital relating to the administration of medication via the incorrect route.

NELFT

NELFT have no overdue serious incident reports.

Duty of Candour

For March 2016 Barts Health reported that 54% of the Duty of Candour statutory requirements were met, this is a decrease from 61% in the previous month. The Whipps Cross site performance for March 2016 remains at 33% the same as the previous month. There is a concern that

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the reported figures do not include the total cohort of patients where the duty should be applied including only serious incidents. The concerns are to be formally raised to the SRG and the management team for Barts Health have been requested to provide further information about how the data is calculated and to provide a trajectory and plan to deliver compliance with the 100% target.

MRSA Bacteraemia

There were two post 72 hours MRSA cases declared by Barts Health in March 2016. One at Whipps Cross which was a case that involved an elderly patient not known to be MRSA positive on admission. The patient acquired MRSA in the hospital and developed an MRSA bacteraemia from an intravenous line.

Mixed Sex Accommodation Breaches

3 mixed sex accommodation breaches were reported for Waltham Forest patients in March 2016, all at the Whipps Cross Hospital site. Overall Barts Health has reported 42 breaches in March 2016 with 39 at the Royal London and 3 at Whipps Cross. Barts Health have an improvement programme in place to address the breaches, short term mitigation plans include employing nurse specials to facilitate level 2 care at ward level.

Pressure Ulcers Hospital Acquired Grade 3 & 4

Year-to-date (YTD) Barts Health have reported 114 grade 3 pressure ulcers against a zero target. YTD 6 grade 4 pressure ulcers have been reported. Whipps Cross Hospital reported 5 grade 3 pressure ulcers in March 2016 and remains the highest across the other sites in Barts Health.

Pressure ulcer prevention days were held in March and April across all Barts Health sites with the theme SSKIN with input from dietician, continence services and pressure relieving equipment suppliers. More sessions are planned over the next year with 'sign up to safety' support.

Complaints Management

Whipps Cross

Review of performance for March 2016 shows an increase in performance with the percentage of complaints responded to within 25 working days increasing from 33.3% in February 2016 to 57.9% March 2016. Whilst this is an improvement it is still significantly off target (80%). Barts Health performance has shown a slight improvement to 65.4% in March from 58.5% in February 2016. The number of complaints per 1000 bed days has increased to 4.6 for Whipps Cross which is slightly above the upper limit of 4.5.

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NELFT

In March 2016 NELFT have improved the position and now have no complaints that have been open longer than 90 days and all complaints were responded to within the required timeframe.

Venous Thrombo Embolism (VTE) Risk Assessment

Performance against a target of 95% shows Whipps Cross at 88.5% for March 2016, this being a slight decrease on previous months. Performance remains non-compliant with the target however Barts Health remains compliant with 95.5% year to date and 95.8% for March 2016.

Safeguarding

Whipps Cross

Safeguarding training for Whipps Cross is compliant for Adults training at level one and children’s level one and three against the 85% National target. The site in non-compliant with level 2 Adult (79.8%) and level 2 (79.6%) children’s training. An action plan is in place to be compliant by April 2016.

NELFT

NELFT is compliant with all levels of Safeguarding Adult and Children’s training. In March 2016 NELFT Prevent training compliance in Waltham Forest is 85% for level 1 and 80.9% for level 2 against a target of 85% and is amber rated, a trajectory is in place to be compliant by end March 2016.

Standardised Hospital Mortality Index (SHMI)

The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. It covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in hospital or within 30 days of discharge.

A SHMI is calculated for each trust and the baseline (national average) SHMI has a value of one. A SHMI is measured using a funnel, with upper and lower control limits. For the SHMI the control limits are set at 95% and enable trusts to be banded in one of the following ‘higher than expected’, ‘as expected’ or ‘lower than expected’.

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The SHMI YTD for Barts Health is 86 against an upper target of 100, which is lower than would be expected nationally based on the patient case mix. In the October Board report it was noted that the SHMI at Whipps Cross showed an upward trend with at that time a maximum figure of 102. The SHMI is reported by Trust and Barts Health is in the lower than expected range. The SHMI as reported in Barts Health board report indicates that at Whipps Cross this is at 105.

The higher SHMI at Whipps Cross was reviewed by the Site Management team and it was reported to the Clinical Quality Review Oversight and Assurance meeting March 2016 that for crude mortality Whipps Cross has the highest rate of deaths across Barts Health. The Trust mortality review group (TMRG) had identified that Whipps Cross has a higher elderly population which is a contributing factor and the Margaret Centre (hospice) also elevates figures. The TMRG completed a deep dive review of the crude mortality in A&E which is the highest across the sites and identified that the denominator is smaller, so the number of deaths over the denominator makes the figure higher.

Staffing Metrics

Whipps Cross

Barts Health staff turnover rate is below the 14% target YTD at 13.6% (March 2016 data), Whipps Cross is at 12.0% a reduction from 12.6% in the previous month. Sickness absence rates are at 3.4% slightly above the 3.2% Trust target.

NELFT

NELFT has not met the staffing metrics required targets year to date, showing in February 2016. The staff turnover is at 18.2% February 2016, against a Trust standard of 10%. The reasons for staff leaving is tracked by the Trust to identify any themes or trends. Positively there were 23 new starters in February. The vacancy rate is at 20.83% against a target of 10%, a slight improvement from the previous month’s reported 21.4%. This is monitored monthly at the Clinical Quality Review Meeting exception reporting.

The rolling average sickness rate for December reporting has improved from 4.22% and is at 4.15% against a trust target of 3.70%.

Statutory and Mandatory Training (excluding safeguarding)

Whipps Cross

Against a target of 90% for training Whipps Cross Hospital are compliant only with health and safety training at 92.1% February 2016. Fire training is at 76.9%; Moving and Handling 84.6%; Infection Control levels 1&2 all staff (86.1%), 1&2 clinical staff (85.1%) and level 3 (84.5%), all areas are non-compliant with the 90% target.

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NELFT Continuing Health Care (CHC) Reviews

There are currently 4 outstanding CHC community reviews, these have been booked but have not yet taken place. Of the outstanding reviews to date 3 are for 3 monthly reviews and 1 annual review. The children’s community nursing team have 2 transition cases with outstanding reviews, further information has been requested regarding the transition cases and the actual delay time period.

Organisational Integrity

The 2015 NHS Staff Survey involved 297 NHS organisations in England. Over 741,000 NHS staff were invited to participate and 299,000 responses from staff received equating to a response rate of 41%, which is 1% lower than 2014 and 8% lower than 2013. Fieldwork for the survey was carried out between late September and early December 2015. The reporting produced from the NHS Staff Survey focuses on 32 key areas, known as ‘Key Findings’. In 2015, the Key Findings were redeveloped following significant changes made to the questionnaire. The findings are reported using a comparison scale against other Trusts and ranges from; better than average; about the same; or worse than average Barts Health Below is the review of results for Barts Health in 2015 when compared with other Trusts. The response rate for Barts Health was 29.94% and is comparable with the response rate of the Whittington Hospital but below that of the Homerton’s 34.21% (comparison made with other acute and community Trusts). Of the 32 key findings Barts Health 87.5% were rated as worse than average. Barts Health compared most favourably (better than average) with other trusts for:

Quality of appraisals Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months

The areas where Barts Health performed worse than average were:

Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month Percentage of staff experiencing physical violence from staff in last 12 months Percentage of staff suffering work related stress in last 12 months

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Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months Percentage of staff working extra hours Percentage of staff experiencing discrimination at work in the last 12 months Percentage of staff reporting good communication between senior management and staff Percentage of staff agreeing that their role makes a difference to patients / service users Effective use of patient / service user feedback Staff recommendation of the organisation as a place to work or receive treatment Effective team working Organisation and management interest in and action on health and wellbeing Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months Percentage of staff/colleagues reporting most recent experience of harassment, bullying or abuse Percentage of staff reporting errors, near misses or incidents witnessed in the last month Staff satisfaction with resourcing and support Fairness and effectiveness of procedures for reporting errors, near misses and incidents Staff confidence and security in reporting unsafe clinical practice Staff satisfaction with level of responsibility and involvement Percentage of staff able to contribute towards improvements at work Staff motivation at work Recognition and value of staff by managers and the organisation Support from immediate managers Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion Staff satisfaction with the quality of work and care they are able to deliver Percentage of staff appraised in last 12 months

Barts Health displayed statistically significant results on the following Key Findings since 2014:

Staff recommendation of the organisation as a place to work or receive treatment better Staff motivation at work better Effective use of patient / service user feedback better % appraised in last 12 months worse % working extra hours worse

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% experiencing harassment, bullying or abuse from staff in last 12 months worse Staff confidence and security in reporting unsafe clinical practice worse

NELFT Below is the review of results for NELFT in 2015 when compared with other Trusts. The response rate for NELFT was 40.38% showing a large improvement from the previous year’s 30.01%. The response rate from NELFT is higher when compared with other combined mental health, community and learning disabilities trusts. Of the 32 key findings NELFT 65.2% were rated as worse than average and only one finding scored better than average. NELFT compared most favourably (better than average) with other trusts for:

Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months The areas where NELFT performed worse than average were:

Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months Percentage of staff experiencing discrimination at work in the last 12 months Percentage of staff working extra hours Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell Percentage of staff suffering work related stress in last 12 months Organisation and management interest in and action on health and wellbeing Percentage of staff satisfied with the opportunities for flexible working patterns Fairness and effectiveness of procedures for reporting errors, near misses and incidents Staff recommendation of the organisation as a place to work or receive treatment Effective use of patient / service user feedback Percentage of staff reporting good communication between senior management and staff Support from immediate managers Staff satisfaction with resourcing and support Recognition and value of staff by managers and the organisation Staff confidence and security in reporting unsafe clinical practice

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Percentage of staff able to contribute towards improvements at work Effective team working Quality of appraisals Staff satisfaction with level of responsibility and involvement Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion

NELFT displayed statistically significant results on the following Key Findings since 2014:

Staff recommendation of the organisation as a place to work or receive treatment better Staff motivation at work better % witnessing potentially harmful errors, near misses or incidents in last month better % working extra hours worse

6. 2016/17 Scorecard

The CCG has developed an updated scorecard for reporting in 2016/17. This scorecard has been developed with input from CCG Clinical Leads and Clinical Directors and reviewed at the CCG MDT meeting and the CCG Executive Team meeting. The CCG Performance and Quality Committee approved the new scorecard on 11 May 2016.

The indicators align with the CCG Business Grid (Appendix A) and develop the indicators from the previous scorecard.

The proposed 2016/17 Scorecard is attached to this report.

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Appendices

Appendix A Waltham Forest CCG Business Grid

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Item 3.3

Title of report Phlebotomy Services Report


Author Stephanie Grant, Senior Commissioning Manager - WFCCG

Purpose of report

This report provides an overview of the findings of Healthwatch and CCG reviews into the community phlebotomy service in Waltham Forest, and outlines a number of actions which could be implemented in order to improve the service and deliver a better patient experience during 2016/17, prior to the procurement of a new service to begin in April 2017. The Governing Body is asked to review the options for service improvement, identify a preferred option and approve funding of £23,591 - £33,207 to implement the relevant actions.

Changes/additions/amendments to paper as a result of discussions held at Finance & QIPP Committee

The paper will be presented to the Finance & QIPP committee on 18 May 2016.

Recommendations

The Governing Body is recommended to agree the implementation of option 2 for the actions to be taken and associated funding to increase capacity in the phlebotomy service. This recommendation is subject to discussion and agreement at the Finance & QIPP committee on 18 May.


It is envisaged that the proposed changes will lead to an improved patient experience at phlebotomy clinics, with reduced waiting times and lower probability of patients being turned away from clinics that have reached capacity. Depending on the option selected, some patients who currently access particular clinics may be required to attend different locations due to the reallocation of phlebotomists to other sites.

Risk implications

There is a risk that patients who currently access the clinics which are proposed as possible options for withdrawal may be unhappy at having to travel to a different site for blood tests. There is also a risk of diverting demand to sites which are already busy and are not able to increase phlebotomist capacity.

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Phlebotomy Services Report

The updated communication materials are intended to mitigate this risk by ensuring patients are fully informed about the alternative options. Previous patient engagement has also indicated that the majority of patients are happy to travel to another location if the service they receive improves.


A financial investment is requested in order to implement the proposed service improvements. The exact figure will depend on the option selected, but will be a minimum of £23,591 and a maximum of £33,207.

Equality analysis

Minimal impact is expected; the most likely impact is on those who live close to the sites which are potentially no longer going to deliver phlebotomy services, e.g. frail elderly. Travel to alternative venues is minimal and overall experience will be improved by having increased capacity and better compliance with infection control standards. Impact will be reviewed depending on option selected and feedback from Healthwatch.


Activity figures provided by Barts Health.


The paper has been submitted for discussion at Finance & QIPP committee on 18 May. The paper has also been shared with Healthwatch and Barts Health as the provider of the service; at the time of writing, their feedback is awaited.

Further patient feedback will be sought once an option for service changes has been agreed upon.

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Phlebotomy services report Proposal for in-year investment in phlebotomy services

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Phlebotomy services report

Page ii

Contents

1 Executive summary 1

2 Background and context 1

2.1 Current phlebotomy clinic locations 1

3 Review of phlebotomy services 3

3.1 Findings of Healthwatch review 3

3.2 CCG review of services 3

4 Proposed investment 4

4.1 Options for increasing phlebotomist capacity 4

4.2 Other investments required 6

4.3 Financial impact 6

5 Risks 7

6 Next steps 8

Appendices 9

Appendix A Activity at Claremont and Oliver Road phlebotomy clinics, April-December 2015 9

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1 Executive summary

The community phlebotomy service in Waltham Forest, currently delivered by Barts Health, has been the subject of a number of complaints and concerns raised to the CCG directly, via Healthwatch and via a local MP. The CCG’s ultimate intention is to put this contract out to tender, with a new service beginning in April 2017; however, with a view to identifying actions which can be taken to deliver an improved patient experience in the current year, reviews of the seven phlebotomy sites in the borough were undertaken by Healthwatch, Barts Health and the CCG between October 2015 and April 2016.

The reviews identified a number of issues with the current service, including long waiting times, insufficient capacity to deal with the level of demand at a number of sites, lack of adequate information given to patients about the clinics, and in some cases equipment and facilities which do not conform to the required standards. These findings are set out in more detail in section 3, and are being used to inform the development of the specification for the service to be tendered later in 2016.

This paper outlines a number of actions which can be taken over the coming months to improve the service, reduce waiting times and deliver a better patient experience prior to the mobilisation of a new phlebotomy contract. The proposed actions, set out in section 4, comprise potential increases to staffing capacity at some sites, investment in equipment to ensure that the clinics comply with infection control and privacy and dignity standards, and the production and circulation of updated communications material for patients and practices. The investment required to implement these actions ranges from £23,591 - £33,207 depending on the staffing capacity option chosen.

It is requested that these investments, including the three options presented in section 4.1 around changes to the staffing model of the phlebotomy service, are considered and an option selected for implementation.

2 Background and context

The community phlebotomy service in Waltham Forest is currently provided by Barts Health, and is delivered on seven sites in the borough. The contract value of £319,000 for 138,951 bleeds per year was agreed in October 2013.

Over the past three years, numerous concerns have been raised regarding the delivery of the service, particularly relating to long waiting times and patients being turned away a long time before the clinic’s scheduled closure time due to capacity being reached. These concerns led to the reviews undertaken by both Healthwatch and the CCG jointly with Barts Health, the findings of which are outlined below.

To fully address all of the service delivery issues, a full procurement with a new service specification will be required, and this specification, incorporating the recommendations made following the Healthwatch review, is currently in development. However, it is recognised that there are a number of actions that can be taken in-year to deliver an improved service and patient experience. This paper outlines the key issues identified with the phlebotomy service, a number of proposed actions to address these issues, and the investment required to implement these changes during 2016/17.

2.1 Current phlebotomy clinic locations

The locations of the current phlebotomy clinics are shown on the map on the next page. Each locality is currently served by at least two blood testing sites:

Leyton/Leytonstone: Oliver Road and Langthorne Walthamstow: Claremont, St James and Comely Bank Chingford: York Road and Silverthorn

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Figure 1: Map of phlebotomy clinic locations in Waltham Forest

Langthorne

Oliver Road

Comely Bank

St James

Claremont

York Road

Silverthorn

Current phlebotomy clinic location

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3 Review of phlebotomy services

As part of the phlebotomy review, representatives from both Healthwatch and the CCG have visited all of the sites currently delivering the community phlebotomy service in Waltham Forest. The CCG’s site visits were carried out jointly with Barts Health to identify actions which could alleviate patient concerns relating to long waiting times, patients being turned away and overcrowding in clinics.

3.1 Findings of Healthwatch review

Healthwatch Waltham Forest carried out its intelligence gathering exercise and site visits during October and November 2015. Representatives visited all seven of the phlebotomy sites in the borough to observe the services in action and gather patient feedback.

Key issues identified

The main issues identified by Healthwatch observers were as follows:

Waiting times and opening hours

There are often long queues of patients waiting for blood tests before clinics open, with services particularly busy in the first hour after opening. A majority of patients who responded to a Healthwatch questionnaire indicated that they would be happy with fewer locations offering blood testing if there were shorter wait times at each site. 90% of patients surveyed by Healthwatch indicated that their experience would be improved by longer opening hours at phlebotomy clinics.

Ticketing system

Most patients indicated that they were happy with the ‘first come, first served’ ticketing system for testing, although some feedback indicated that patients felt certain patient groups should be prioritised. This is being considered as part of the specification development for the new phlebotomy service. The main issue with the ticketing system is that tickets are often removed a long time before the service is due to close as there is insufficient capacity available to see more patients, leading to some being turned away. Those who are turned away either have to come back on another day or attend the phlebotomy service at Whipps Cross Hospital.

Information

The Healthwatch review found that the information available to patients about the phlebotomy service is inconsistent; this finding applied to both information given to patients by their own GP surgery and information displayed within the centres themselves. The main issues with information provided by GP surgeries were that it is not always up to date, does not make clear that the centres cannot carry out blood tests on children, and does not always make clear that tests are allocated on a ‘first come, first served’ basis. Information displayed within the centres did not always clearly indicate to patients how to use the ticket system or where to go if there were no more appointments available. The majority of patients said that they did not know how to give feedback on the service.

3.2 CCG review of services

Following on from the Healthwatch review, the CCG undertook a joint review with Barts Health in April 2016 to identify actions which could be taken to address the various issues raised in the Healthwatch report. This review also covered all of the phlebotomy sites in Waltham Forest.

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Key issues identified

The issues observed by the CCG and Barts Health representatives generally aligned to those raised by Healthwatch, and are summarised below.

Ticketing system

Staff in the centres reported that patients are often dissatisfied when the tickets are removed early due to the service reaching capacity.

Capacity

As noted above, clinics are not always able to see all patients who attend due to insufficient capacity. There is potential to add phlebotomists to a number of sites, which would reduce the number of patients being turned away.

Equipment

A number of sites require additional equipment, for example trolleys or divider curtains, in order to meet infection control and privacy and dignity standards. The review also found that rooms used on two sites were not fit for purpose due to size or cleanliness, although one has since undergone a deep clean which has been signed off by the provider; this site is due to reopen in the week beginning 16 May.

Information

It was noted that in some cases, patients are being given incorrect information about clinic opening times.

4 Proposed investment

Based on the reviews undertaken, a number of actions have been identified which would deliver improvements to the service in the short to medium term, prior to a full procurement being carried out. There are three possible options for changes to the staffing capacity available in the service, which are detailed in section 4.1. All options will include the equipment investment and communications work proposed in section 4.2.

Section 4.3 below sets out the possible financial impact of each option, depending on whether any phlebotomists are relocated from one site to another.

4.1 Options for increasing phlebotomist capacity

Three possible options are presented below for increasing the number of phlebotomy hours offered in Waltham Forest, involving a mix of moving phlebotomists from existing clinics and bringing new phlebotomists into the service.

Option 1: Relocation of phlebotomists from Oliver Road and Claremont to alternative clinics

The first option is to withdraw the clinics located at Oliver Road and Claremont, which are the least utilised in the borough, and move the phlebotomists to other sites to reduce waiting times.

The Claremont facility, which sees an average of 49 patients per session, requires work to bring it up to infection control standards, and although an extension is planned to the building with a new phlebotomy

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room included, this is unlikely to progress before late 2016; the provider has also indicated that the phlebotomist’s time could be used more effectively at another clinic to reduce waiting times.

The clinic offered at Oliver Road operates one morning per week on an appointment basis, but is only accessed by patients of two practices, and is often under-utilised, with an average of 27 patients per session seen against a target of 42. The provider is supportive of relocating this clinic, as the phlebotomist could see more patients in another location.

Withdrawal of these clinics and relocation of the phlebotomists would release 12 hours per week of phlebotomist time to be reallocated to other sites, and will also provide a more equitable service to all patients across the borough. Those patients currently accessing the Claremont site would be able to access phlebotomy services at St James, Comely Bank, York Road or Silverthorn, whilst those who use Oliver Road would be able to access the service at Langthorne, or could alternatively attend Comely Bank or St James. Appendix 1 shows the volume of patients seen on each site and performance against the target number of bleeds per session.

The benefit of this shift in capacity will be to provide additional phlebotomists at those clinics with the physical capacity to see more patients, leading to reduced wait times, a reduction in patients turned away and therefore an improved patient experience. Feedback from patients at a Patient Reference Group meeting, from the St James Patient Participation Group and from the Healthwatch phlebotomy survey indicates that patients would support having fewer sites available for blood tests if the service is improved and waiting times are reduced at the remaining locations.

Option 2: Relocation of phlebotomist from Oliver Road to another clinic

As an alternative to option 1, the clinic at Claremont could remain open with the phlebotomy service temporarily moved to another room within the practice while the work is undertaken to replace the carpet, which does not conform to infection control standards. There would then be potential to increase phlebotomist cover at this site to four mornings per week.

In this option, the clinic at Oliver Road would still be withdrawn due to under-utilisation, and the four hours of phlebotomist time per week would be reallocated to another site.

Option 3: Increase capacity without relocating any phlebotomists

The final option is for additional phlebotomists to be introduced into the service without moving any services from existing sites. There are number of clinics which could potentially have additional phlebotomist capacity introduced; these are Claremont (subject to replacement of the flooring in the phlebotomy room), Comely Bank and St James in Walthamstow and Silverthorn in Chingford. In the case of the site at St James, the phlebotomy room is currently vacant every afternoon, so there is potential to introduce an all-day service. The table below shows the possible total number of extra phlebotomist hours that could be introduced to the service:

Site Potential extra hours per week WTE Claremont (Walthamstow) 8 (increases service to 4 mornings per week) 0.21 Comely Bank (Walthamstow)

20 (would add an extra phlebotomist 5 mornings per week)

0.53

St James (Walthamstow) 20 (could introduce an afternoon service 5 days per week, subject to agreement with the site)

0.53

Silverthorn (Chingford) 13 (increases service to 3 phlebotomists 5 days per week) 0.35 TOTAL EXTRA HOURS 61 1.62

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If all possible extra resources were introduced to the service with no withdrawal of clinics, this would result in the addition of 1.62 WTE phlebotomists across four sites.

4.2 Other investments required

Aside from increasing phlebotomist capacity and potential changes to how resources are allocated across clinics, there are a number of other actions which are recommended to be undertaken. These actions are expected to be carried out irrespective of which staffing option is chosen.

Investment in equipment to meet required standards

A number of sites have been identified as requiring additional equipment in order to meet the required infection control and privacy and dignity standards. The additional equipment comprises trolleys and divider curtains, and will ensure that the standards are met by the existing service. The CCG could also support funding the replacement of the carpet at Claremont, if a decision is taken to bring the service up to infection control standards rather than moving the phlebotomist elsewhere. Exact details of the equipment required are subject to confirmation, so an estimate of £1,500 has been included in this proposal.

In addition, there is a cost associated with increasing capacity at Silverthorn; the service would require one phlebotomy chair, one chair for the phlebotomist and one stainless steel trolley.

Provision of communications material for patients and practices

The Healthwatch and CCG reviews both highlighted that patients are not always receiving correct information about the locations and opening times of phlebotomy services. It is therefore proposed that communications material to be given to patients or displayed in practices is refreshed to ensure that all clinic locations and opening times are displayed accurately, and patients are aware of the process for attending, including where to take a child requiring a blood test. Suggested communications material would be leaflets/flyers given to patients who require blood tests, and posters displayed in practices and blood testing clinics.

The expected benefit of this is an improvement in patient experience and a reduction in the number of patients turned away from clinics that are at full capacity or have already closed.

4.3 Financial impact

The financial investment required to implement the actions set out above is shown in the below tables, with one for each staffing option. It is assumed that any additional capacity is in place from 1 July 2016 – 31 March 2017.

Option 1: Financial impact

There is no cost associated with closure of the Claremont and Oliver Road clinics and relocation of the existing phlebotomists (12 hours per week) to other sites.

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Action Cost Increase in phlebotomist capacity of 1.1 WTE £20,341 Purchase of equipment to meet infection control/privacy and dignity standards and increase capacity at Silverthorn

£2,500

Production and circulation of communications materials

£750

TOTAL COST £23,591


There is no cost associated with closure of the Oliver Road clinic and relocation of the existing phlebotomist (4 hours per week) to another site.


£2,500


£750

TOTAL COST £31,358



£2,500


£750

TOTAL COST £33,207

5 Risks

The below table summarises the key risks associated with the implementation of the proposed actions.

Risk Mitigating action RAG Negative impact on patient experience through removal of existing clinics

Communication materials to set out clearly the location and opening times of alternative services. Increase in phlebotomist capacity at other clinics should lead to overall better experience due to reduced waiting times and fewer patients being turned away. Results of Healthwatch survey and engagement with St James PPG indicate that patients are

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Risk Mitigating action RAG happy with a reduced number of clinics if there is an associated improvement in service. Patient feedback on any proposed clinic changes will be sought throughout June 2016 via feedback forms and the CCG website. Engagement with Healthwatch will also be undertaken prior to service changes.

Risk of unsustainable increase in demand at Langthorne if Oliver Road clinic is withdrawn

Patients to be encouraged to access services at St James or Comely Bank, which are both within 2.5 miles of Oliver Road; at least one of these sites will have additional capacity following the changes.

Delay in purchase/installation of required equipment.

Subject to approval of funding, clear timeline to be requested from provider setting out expected dates for delivery and installation of new equipment.

Provider may be unable to recruit a sufficient number of additional phlebotomist hours.

Provider has a recruitment plan in place and an advert ready to go out subject to approval of funding from CCG. Provider to review existing phlebotomy resources to identify potential for staff to flex across sites; some staff are known to be willing to change/extend hours.

6 Next steps

Consideration and approval of the preferred option for changes to phlebotomy services is requested, along with the associated investment as detailed in section 6, in order to increase capacity, reduce waiting times and improve patient experience.

Following approval, the provider will be requested to proceed with their relevant actions, including the purchase of equipment and the recruitment of additional phlebotomists, if required. Progress will be monitored through ongoing discussions with Barts Health, and patient feedback will continue to be reviewed to identify any continuing issues.

Longer term, the CCG intends to run a full procurement for a new service, with a new phlebotomy service contract to begin on 1 April 2017.

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Appendices

Appendix A Activity at Claremont and Oliver Road phlebotomy clinics, April-December 2015

Patients seen

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15

Avg. per

month

Claremont Road 435 332 457 411 373 386 381 447 377 400Oliver Road 135 114 116 134 117 106 130 113 123 121 Sessions per month


Claremont Road 9 6 9 9 8 9 8 8 8 Oliver Road 5 4 4 5 4 4 5 4 5 Average bleeds per session (target: 42)


Overall avg. per

session

Claremont Road 48 55 51 46 47 43 48 56 47 49Oliver Road 27 29 29 27 29 27 26 28 25 27

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Item 5.1a

Title of report Transforming Care Partnership


Author Lindy Shufflebotham, Learning Disabilities Programme Manager and Kelvin Hankins, Associate Director of Contracting and Lead for Learning Disabilities - WFCCG

Purpose of report

The purpose of this report is to update the board on progress made in developing the Transforming Care Partnership. The partnership is to support children, young people and adults with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition.

NHS England have asked clusters to develop transforming care partnership commissioning collaborations between clustered CCGs, NHSE specialised commissioners and local authorities. Waltham Forest CCG and Local Authority has joined with Tower Hamlets, City & Hackney and Newham CCGs and Local Authorities to develop a transforming care partnership.

Changes/additions/amendments to paper as a result of discussions held at Committee

Not applicable

Recommendations

The Board is asked to note content of the high-level plan and progress made to date.


The expectation is that the plan improves the quality and services available for people with a learning disability and / or autism and their carers. The plan will be co-produced with local residents and builds on the system already in place.

Risk implications

As detailed within the paper the main non-financial risks are:

Programme Support o Engagement from the wide range of partners across the partnership o Suitability of programme management for the project o Patient and carer engagement

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Transforming Care Partnership


As detailed within the paper the main risk is:

Availability of funding to deliver the programme: o Ability to release funding from existing placements to invest in community provision o NHS England not awarding match funding


Not applicable


The plan has been developed by the WELC Transforming Care Partnership, which has been meeting since January 2016 onwards. The Partnership reports into the WELC Joint Management Team.

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Transforming Care Partnerships Improving services for people with a learning disability and / or

autism

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Transforming Care Partnerships

Page ii

Contents

1 Background and Context 1

1.1 National 1

1.2 Funding and Financial Arrangements 1

1.3 Local 2

2 WELC Draft Plan 2

2.1 Timetable for approval 2

2.2 Current position 2

2.3 WELC Governance 4

i) Board Terms of Reference 4

ii) Membership 4

3 Implications and Risks to programme 5

3.1 Financial Risk 5

3.2 Programme support 5

4 Next Steps 5

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Page 1

1 Background and Context

1.1 National

NHS England (NHSE), Department of Health (DH), Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS), Care Quality Commission (CQC) and Health Education England (HEE) have committed to strengthen the Transforming Care delivery programme for people (Adults and Children) with learning disabilities.

They have instigated the creation of 49 transforming care partnership-commissioning collaborations between clustered CCGs, NHSE specialised commissioners and local authorities. Waltham Forest CCG and Local Authority has joined with: Tower Hamlets, City & Hackney and Newham CCGs and Local Authorities to develop a transforming care partnership.

A National Service Model for commissioners was created, to support the development of the local plans, the nine principles that underpin it are:

People have a good and meaningful everyday life Care and support is person centred, proactive and coordinated People should have choice and control over how their health care needs are met People should be able to live locally to enable them to be supported by friends and families as well

as paid staff People should have a choice of housing & who they live with People should be well supported by mainstream NHS services Specialist health and social care in the community should be available to those who need it People should be supported to stay out of trouble High quality hospital treatment for health needs should only be when those needs cannot be met

in a community setting.

The purpose of the partnerships is to devise & deliver a joint transformation plan over three years that will develop local community based support for the group of people currently inappropriately admitted; or at risk of admission to Assessment and Treatment Units (ATUs).

1.2 Funding and Financial Arrangements

The Transforming Care Partnerships are intended to address the complications and fractures of the commissioning arrangements as they currently exist. These fractures exist because of the split of responsibilities between local authorities, CCGs and NHS England. There are problems moving funding around from one agency to another. From the CCG perspective the numbers of people that they are commissioning for are relatively small making it difficult to take a strategic approach to changing services across the system. The Transforming Care Partnerships bring together commissioners responsible for the funding of health and social care with the intention of aligning or pooling of budgets. Successful transformation will involve costs – including initial double running costs of in-patient facilities whilst new alternative community services are established. In the long haul it is anticipated that money saved from hospital admissions will be reinvested in local support services. To support local areas NHS England will make available up to £30 million transformation funding over a 3 year period. This national funding will be conditional on match funding from local commissioners. There will be an additional £15 million capital funding again over the 3 year period.

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1.3 Local

NHS England planning assumption is that in any Transforming Care Partnership area the number of commissioned beds will be between 10-15 per million population and that NHS England commissioned beds (e.g.in secure units) will be 20-25 per million by 2019.

Compared to other areas the WELC partnership has relatively low numbers in Assessment and Treatment Unit and secure environments. In Waltham Forest there are currently less than five people in an Assessment and Treatment Unit, and 9 places commissioned by NHSE in secure settings. Commonly these are forensic placements made after individuals, (sometimes with Asperger’s or autism spectrum disorders), come into contact with the justice system.

2 WELC Draft Plan

2.1 Timetable for approval

The tables below indicates the initial tight timelines for the transforming care work, there have been some minor adjustments that reflect national delays in implementation. The submission of the NHS England assured plan has been moved to June 2016.

What Who When

1 Confirm final partnership organisations and population coverage

TCP 15 December 2015

2 Confirm SRO and deputy TCP 15 December 2015

3 Confirm lead CCG TCP 15 December 2015

4 Confirm governance arrangements and board meeting schedule

TCP 15 December 2015

5 First TCP board meeting TCP January 2016

6 Draft Plan TCP 8 February 2016

7 Revise Plan TCP March 2016

8 Final Plan TCP 11 April 2016

2.2 Current position

The requirement to develop a local plan was communicated to CCGs in late November 2015, with an ambitious timetable for the final plan to be approved. WELCs final plan will be submitted to NHSE in June 2016, after two rounds of “assurance” undertaken by NHS England.

The WELC draft plan encompasses the development of an enhanced model of care and support that delivers:

20% reduction in “in-patient bed usage” Reduction in out of borough (WELC footprint) residential placements Local & robust positive behaviour support offer Better housing choices and opportunities to stay well supported locally Increased uptake of personal health budgets Availability of rented accommodation for crisis resolution

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Community Learning Disability teams that are equipped to offer clinical support to those from the cohorts that require it

These will scaffold the development of community based support options for people returning from assessment and treatment units and for those at risk of being admitted. In addition the partnership plan includes responsibilities:

To devise a live “Risk Register” of those people in danger of admission To target commissioning of resilient support providers To develop of a “capable community” of responsive local providers that reflects stakeholder voices,

including parent’s carers and people who use services. To ensure through the Section 75 arrangements, that the clinical team is structured & resourced in

terms of its skills mix and structure to be able to support, proactively, those at risk of placement breakdown and hence a prevent out of area moves.

To improve work with justice systems to prevent entry through forensic routes Continuing promotion of benefits of uptake of Personal Health Budgets WFCCG to work with the key local stakeholders to create an effective and local response -

Waltham Forest is leading on the engagement with stakeholders across the TCP patch.

The WELC Transforming Care Programme plan principles are based on existing patterns; of what is delivered well on a borough basis should continue to be delivered at a borough level and what would be better delivered at scale will be created and delivered across the patch.

Provision is required that will prevent younger people with learning disabilities and complex needs joining the cohort of individuals, traditionally at risk of being admitted to Assessment and Treatment Units. It will achieve this by using a positive behaviour methodology that supports people safely and robustly in a local setting. Multi-disciplinary, flexible community-based supports will provide the most appropriate, and effective approaches to meeting these needs.

Children, young people and adults with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition should have a home within their community, be able to develop and maintain relationships and get the support they need to live a healthy, safe and fulfilling life. They should also have rights to satisfying and valued lives and, to be treated with the same dignity and respect as others.

The challenge is as much about preventing new admissions to inpatient care by providing alternative care and support in the community (with a focus on early intervention and prevention); as it is about discharging those individuals who currently are inappropriately accommodated in hospital settings.

Research illustrates that people with learning disabilities are admitted to hospitals due to challenging behavior, exacerbations of mental illness, offending behavior and/or breakdown of community residential support. The TCP proposals on good local support will mitigate against this.

Each borough partnership of local authority and CCG has taken on responsibility for a specific area of the plan. Waltham Forest is responsible for engagement. There are currently three substantive work streams emanating from the engagement strand. The first is dialogue with carers and families of those people who have recently experienced an admission to an Assessment and Treatment Unit, to establish what happened and in particular what they think could have been done in a way that would have prevented that admission. This offers valuable insights to incorporate into our plans. The second piece of engagement work is the organization of a group of positive behavior practitioners with the intention of creating a consistent and effective delivery of proactive and preventative support across the WELC patch. This work will result in a Positive Behavior offer in line with NICE guidelines. The third element is the creation of local easy read materials to support engagement with people who use services.

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The outcomes of our actions will be congruent with the recommendations that resulted from the Winterbourne View scandal that people with complex support needs should be:

Living in settled accommodation in the community

Supported to gain meaningful employment

Having good health and access to health services.

2.3 WELC Governance

To support the programme we have needed to set up a Programme Board, based on guidance issued by NHS England. Terms of reference have been developed and high level detailed below, with membership across the partnership.

i) Board Terms of Reference

To be accountable to WELC Clinical Strategy Group and respective HWBBs To set strategic direction, formulate vision and agree key priorities To approve and monitor the 3 year programme plan Agree and monitor work streams delivery plans To oversee risk management within the programme To gain and retain high level cooperation with the plan across the partnership To be accountable to WELC Clinical Strategy Group and respective HWBBs To set strategic direction, formulate vision and agree key priorities To approve and monitor the 3 year programme plan Agree and monitor work streams delivery plans To oversee risk management within the programme

ii) Membership

Board Role Name Position Partner agency

SRO (Chair) Steve Gilvin Chief Officer Newham

Deputy SRO Tony Joblin Strategic Advisor, Learning Disability Improvement

Newham

Stakeholder Position TBC Expert by Experience

Clinical Leads

Dr.Stephanie Coughlin

GP Hackney

Dr. Annil Shah GP/LD Lead Newham

Dr. Ian Hall Lead Clinician, Learning Disability and Autism

Tower Hamlets

Specialised Commissioning Lead

Shepherd Ncube Senior Manager Specialised Commissioning

Children and Young People Lead

Debbie Jones Director of Children’s Services

Tower Hamlets

Area Leads

Lindy Shufflebotham

Commissioners Waltham Forest Kelvin Hankins

Gary Hamilton

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Caroline Billington

Commissioners Tower Hamlets Keith Burns

Carrie Kirkpatrick

Phil Hudson Commissioner Newham

Richard Bull Commissioner Hackney

TCP Programme Lead Susan Storrar TCP

3 Implications and Risks to programme

3.1 Financial Risk

The funding to operationalise these proposals is intended to be derived from a combination of NHS England funding and local match funding obtained through the release of funding from a reduction in hospital and out of borough placements. There are two anticipated risks to this:

1. NHS England have indicated that WELC is unlikely to be awarded additional funding to support the programme considering the small numbers of patients we currently have in Assessment and Treatment Units and Specialist Beds compared to other areas.

2. Supporting complex patients in the community is likely to cost similar or more than inpatient placements resulting in an impact on the ability to identify savings.

3.2 Programme support

For the programme to be successful full engagements is required between all four CCGs, Local Authorities and Specialist Commissioning. Although the programme has started strongly engagement across the organisations has been difficult to maintain, impacting on further development.

Programme support has been provided by Newham CCG in the short term, however the longer term support is still to be identified and might not be available depending on the availability of funding from NHS England.

In addition the WELC plan has been developed in isolation from provider and user engagement, which will take place from May to June submission. This may impact on the scope and range of the plan in the short term.

We have recognised as a TC partnership that we will need to improve (or in some cases create and develop) our relations with the justice systems and also find good ways of building on initiatives that look at support in a proactive way through the life course, rather than as a knee jerk response to crises.

4 Next Steps

The next steps for the project include:

Completion and submission of the final plan to NHS England June 2016 Development of user / carer / patient engagement across WELC June 2016 Development of stakeholder and provider engagement across WELC June 2016 Engagement with Health and Wellbeing Boards June 2016 Launch of WELC Plan Early July 2016 Development of Action Plan August 2016

The Board is asked to note the current position and progress made to date on the development of the WELC Transformation Care Partnership.

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Item 5.1b

Title of report North East London STP – proposal for delegated sign off


Author Tara-Lee Baohm – STP Lead – BHR CCGs

Purpose of report

To update the GB regarding the North East London (NEL) Sustainability and Transformation Plan (STP) arrangements and agree processes for sign off of the June submission.

Changes/additions/amendments to paper as a result of discussions held at Committee

None

Recommendations

The GB is requested to note the contents of this report and agree the proposed sign off

approach for the June submission as follows:

- the NEL STP is submitted in draft on 30 of June, subject to sign off. - delegated authority be made to an appointed group on behalf of the Governing Body to sign off

the draft NEL STP the w/c 20 June. - That a final NEL STP brought to this Governing Body in September 16 for agreement.


The NEL STP will define how NEL will deliver the requirements of the NHSE Five Year Forward View, with health and care services planned by place rather than around individual organisations. This will articulate how the finance, care and quality and well-being gaps will be closed in the north east London health and social care system.

This will ultimately delivery a better, more integrated and more sustainable health and social care system for patients and carers.

Risk implications

Failure to agree the above with respect to the June submission will result in the system failing to meet the requirements for delivery of the STP.

There is a risk that not all partners will sign off the draft STP meaning the system will not submit a

plan endorsed by all partners and in turn impacting on the ability of the system to secure sustainability and transformation funding.

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North East London STP – proposal for delegated sign off


Each CCG (x 7) and each major acute/community/Mental Health provider (x5) have agreed to commit an initial investment ask of £35K to support the STP development with a view to securing transformation funding from 2017/18 onwards. However, there is recognition across system leaders that the required ask is likely to be greater than this to ensure successful delivery of the programme.

Equality analysis

Although there is no specific guidance of Equality and Diversity in the NHSE guidelines for Sustainability and Transformation Plans, the NEL STP will adhere to the legal obligations regarding equalities as defined in the Equalities Act 2010 and further extended through the Health and Social Care Act 2013.


N/A


None

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www.southwark.gov.uk

To: Waltham Forest CCG Governing Body (GB)

From: Jane Milligan, North East London STP Executive Lead and Chief Officer Tower Hamlets

CCG

Date: 25th May 2016

Subject: Sustainability and Transformation Plan

Executive summary

Planning guidance was published on 22 December which set out the requirement for the NHS to produce two separate but connected plans:

- A five-year Sustainability and Transformation Plan (STP), place based and driving the Five Year Forward View; and

- A one year operational plan for 2016/17, organisation based but consistent with the emerging STP

North East London, as the agreed STP footprint, is required to deliver the following with respect to the STP:

- Delivery of an STP Base Case Submission by 15 April 2016 (complete) - Delivery of the draft STP by the end of June 2016

This paper will outline the above and propose arrangements for sign off of the June submission (draft STP).

Recommendations

The GB is requested to note the contents of this report and agree the proposed sign off approach for the June submission as follows:

- Waltham Forest CCG Governing Body to sign off the draft NEL STP on 22 June.

- the NEL STP is submitted to NHSE in draft on 30 June 2016, subject to sign off of the final STP

- That a final NEL STP is brought to this Governing Body following the NHSE assurance process

for agreement. 1.0 Purpose of the Report

To update the GB regarding the North East London (NEL) Sustainability and Transformation Plan (STP) arrangements and agree processes for sign off of the June submission to NHSE.

2.0 Background/Introduction

2.1 Planning guidance was published on 22 December which set out the requirement for the NHS to produce two separate but connected plans:

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- A five-year Sustainability and Transformation Plan (STP), place based and driving the Five Year Forward View; and

- A one year operational plan for 2016/17, organisation based but consistent with the emerging STP

2.2 Further guidance on the STP was published 16 March 2016 and set out the following deliverables

required for the STP.

1. Delivery of an STP Base Case Submission by 15 April 2016 (complete)

Consisting of a 10 a page slide deck which set out emerging arrangements and high level initial hypotheses regarding potential areas of focus for the STP, as follows:

- Leadership, governance and engagement - Health and wellbeing - Care and quality - Efficiency and finance - Emerging priorities - Support requirements and risks

2. Delivery of the draft STP by the end of June. It is worth noting the specific requirements of the

full STP currently remain unclear. 2.3 The constituent footprint across commissioners and providers of the NEL STP is:

Clinical commissioning groups: City and Hackney CCG Waltham Forest CCG Tower Hamlets CCG Newham CCG Barking & Dagenham CCG Havering CCG Redbridge CCG

Providers:

Barking, Havering and Redbridge University Hospitals Trust, Barts Health NHS Trust, East London NHS Foundation Trust, Homerton University Hospitals NHS Foundation Trust North East London NHS Foundation Trust.

Local authorities:

Barking and Dagenham City of London Hackney Havering Newham Redbridge Tower Hamlets Waltham Forest

Whilst local authorities are not signatories to the STP there is an acknowledgement that for an STP to be robust, local authorities must be engaged and supportive of the NEL STP. See section 3.6 for arrangements regarding local authority engagement.

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2.4 The NEL STP will focus on scaling/building up of local area accountable care system plans these being:

- The Accountable Care Organisation for BHR - Transforming Services Together for WEL - The Devolution pilot for Hackney

The NEL STP will identify and leverage any opportunities for delivery at scale.

2.5 A successful STP at a NEL level will:

- Show a whole system approach to health and social care planning - Require systems to work together to produce a sustainable plan that both meets quality

and performance standards and ensures financial sustainability - Require conjoined commissioner and provider plans which align activity and finance - Crucially, the NEL STP will be the single application and approval process for

transformation funding for 2017/18 onwards

3.0 Governance

3.1 Correspondence from NHS England dated 16 February 2016 specified a requirement to identify a Chief Officer lead, Provider lead and Local Authority lead for delivery of the STP, with one of these representatives to be confirmed as overall lead. For NEL, the following leads have been agreed:

• Executive STP lead: Jane Milligan, Chief Officer Tower Hamlets CCG • Provider lead: Matthew Hopkins, Chief Executive BHRUT • Commissioning lead: Terry Huff, Chief Officer Waltham Forest CCG • Clinical lead: Sir Sam Everington, Chair Tower Hamlets CCG • Local authority lead1: Cheryl Coppell, Chief Executive, LB Havering • Independent facilitator: Julian Nettel

They are supported by a programme team with a programme director and joint PMO, with external support to boost capacity.

3.2 The proposed governance structure for the development of STP can be referred to in Appendix 1 and builds upon arrangements which were already in place in NEL such as the North East London Advisory Group. The governance structure also recognises the interface between accountable care system plans and the STP development.

3.3 Each member of the Sustainability and Transformation Board will be responsible for internal briefing regarding the STP arrangements and progress.

3.4 An independent facilitator has been recruited for the purpose of providing external challenge and facilitation to ensure that the overall STP is successful from its initiation through to final completion and collective sign off.

3.5 Robust programme governance arrangements have been established including: a NEL PMO to oversee programme delivery, programme initiation document, risk management processes, assurance framework and communications and engagement plan.

1 Note: Cheryl Coppell is retiring on 20 May and will be replaced as the north east London STP Local Authority lead by Martin Esom (Chief Executive of the London Borough of Waltham Forest)

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3.6 Helena Pugh has started as a resource specifically committed to local authority engagement in order to ensure the NEL STP fully engages with local authority partners including via Health and Wellbeing Boards. Local authorities are also represented on the Steering Group and Sustainability and Transformation Board.

4.0 Proposals for Sign Off of the Full STP for submission 30 June

4.1 It is recognised that to achieve the 30 June milestone for the submission of the NEL STP to NHS England a robust decision making and approvals process that respects the sovereignty, governance and assurance requirements of the respective CCGs and Providers is required.

4.2 The programme team has mapped all Trust Boards and Governing Bodies between now and

June, and as a result has identified that full sign off through formal Trust Board/Governing Body meetings across NEL is currently unfeasible with a submission deadline of 30 June, as this would require the full STP to be developed by 18 May (paper deadline for the Waltham Forest CCG Governing Body meeting on 25 May).

4.3 It is therefore proposed that:

The NEL STP is submitted in draft on 30 of June, subject to sign off.

The Governing Body to sign off the draft NEL STP on 22 June.

4.4 Following submission, NHS England will undertake an assurance process (timelines are still to be confirmed). With the NEL STP then finalised to reflect feedback from NHS E assurance process, and signed off in public through the CCG Governing Body meeting.

5.0 Resources/investment

5.1 Each CCG (x 7) and each major acute/community/Mental Health provider (x5) have agreed to commit an initial investment ask of £35K to support the STP development with a view to securing transformation funding from 2017/18 onwards. However, there is recognition across system leaders that the required ask is likely to be greater than this to ensure successful delivery of the programme.

6.0 Risk

6.1 Failure to agree the above with respect to the June submission will result in the system failing to meet the requirements for delivery of the STP.

6.2 There is a risk that not all partners will sign off the draft STP meaning the system will not submit

a plan endorsed by all partners and in turn impacting on the ability of the system to secure sustainability and transformation funding.

Attachments:

1. Appendix 1 NEL STP Governance Structure 2. Appendix 2 Proposed sign off process for NEL STP

Author: Tara-Lee Baohm on behalf of the NEL PMO Date: 17 May 2016

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North East London Sustainability and Transformation Plan

NEL STP Governance Structure

Date: 17 May 2016

89

North East London Sustainability & Transformation Board

NEL Partnership Steering Group NEL Finance and Activity Group NEL Clinical Senate

STP Leadership Group

TST Programme Board

BHR Devolution Vanguard

Hackney Health & Social Care

Transformation Board

Provider Trust Boards

CCG Governing Bodies

Local Authority Cabinets HWBBs HealthWatch OSCs

Organisation governance and decision making

STP leadership and governance

Programme PM

O

Purpose: Oversee development and delivery of NEL STP in line with NHS E requirements. Senior cross organization group for collaborative decision making. Chair: Independent FacilitatorMembers: CCG Chief Officers (x5), Provider Chief Execs (x5), CCG Chairs (x2), NEL PH Lead, CCG CFOs (x3), NHSE, NHS TDA, LA Lead, NHSI

Purpose: Shape and define NEL STPChair: STP Executive LeadMembers: CCG leads (x3), Provider Leads (x6), STP CFO, PH Lead, NHS E Spec. Comm, HLP, Comms Lead

Purpose: Coordinate development and assurance of financial base caseChair: WF CCG COMembers: CCG CFOs (x3), Provider CFO Lead(s)

Purpose: Provide clinical assurance of STP developmentChair: GP Chair of C&H CCG / Co‐ChairMembers: GP Clinical Directors , CCG Chairs, Trust Medical Directors

Purpose: Set strategic direction for STP and resolve emerging risks / issuesChair: STP Executive LeadMembers: BHRUT CE, WF CCG Chief Officer, TH CCG Chair, LBH CE, Independent Facilitator

Programme delivery structure (see later for detail)

North east London STP leadership and governance arrangements

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DRAFT delivery structure for North East London STP

Prevention

Wider Determinants of

Health

Primary and

Community Care

Urgent Care

Mental Health

KGH ED Closure

Maternity

Cancer

Personalisation and Self Care

Whole System

Prevention and Early

Help

Care Close to Home

Strong and Sustainable Hospitals

Transformation

SRO: Conor Burke

Delivery Lead: Neil Kennett-Brown

Health and Social Care Integration

Ambulatory Care

Surgery

Outpatient Transformation

Productivity

SRO: Matthew Hopkins

Delivery Lead: Richard Quinton

Provider Productivity

CIP Delivery

Collective Productivity

CCG Productivity

CCG QIPP Delivery

Local Authority

Productivity

Infrastructure

SRO: Alwen Williams

Delivery Lead: Sven Bunn

PFI Savings

Barts

Royal London Hospital

Queen’s Hospital

Estates Redevelopment

Specialised Commissioning

SRO: Paul Haigh

Delivery Lead: Russ Platt

WhippsCross

Mile End Hospital

King George Hospital

St. Leonard’s

Homerton

Provider Specialist Services

Pathways

SRO: Tracey Fletcher

SRO: Jane Milligan

SRO: Terry Huff

Workforce

Comms & Engagement

Technology

Finance

SRO: Henry Black

Cross Cutting Enablers

North East London Sustainability & Transformation Plan

DiagnosticsPrimary

and Community

Estates

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North East London Sustainability and Transformation Plan

STP submission sign off timelines: NEL CCGs and Trusts

Date: 17 May 2016

92

Sign off timelines across NEL CCGs and Trusts:Existing GBs/ Boards or delegated sign off

B&D

Havering

Redbridge

Newham

Waltham Forest

Tower Hamlets

C&H

BartsHealth

BHRUT

HUHFT

ELFT

NELFT

CC

Gs

Pro

vid

ers

w/c 2/5 w/c 9/5 w/c 16/5 w/c 23/5 w/c 30/5 w/c 6/6 w/c 13/6 w/c 20/6 w/c 27/6

2 3 4 5 6 9 10 11 12 13 16 17 18 19 20 23 24 25 26 27 30 31 1 2 3 6 7 8 9 10 13 14 15 16 17 20 21 22 23 24 27 28 29 30 1

GB to receive information on proposed sign off timelines



( From 26th April GB ‐update on STP progress and timelines )


( From 29th April GB ‐update on STP progress and timelines )

4th Board ‐ update on STP progress and timelines

3rd Board ‐ update on STP progress and timelines

Board to receive information on proposed sign off timelines

( From 27th April Board ‐update on STP progress and timelines )

( From 28th April Board ‐update on STP progress and timelines )

Board to receive information on proposed sign off timelines

24th GB ‐ Proposal for delegated sign off



25th GB ‐ Proposal put forward for sign off at next GB

17th Exec Committee ‐review STP progress

25th GB ‐ Proposal put forward for sign off at next GB

25th Board ‐ Proposal for delegated sign off

24th Board ‐ Proposal for delegated sign off

17th Board dev. event ‐review STP progress


1st Board ‐ update on STP progress

1st Board (TBC) ‐Proposal for delegated sign off

w/c 20th ‐ Delegated authority sign off final STP draft submission






17th Exec committee ‐Sign off final STP draft submission

23rd Board dev. Session ‐ Sign off final STP draft submission

22nd GB ‐ Sign off final STP draft submission

21st Exec committee ‐Sign off final STP draft submission

29th GB ‐ Sign off final STP draft submission

22th Board ‐ Sign off final STP draft submission

Papers due

Papers due

Papers due

Papers due

Papers due

Papers due

93

Item 5.1c

Title of report Operating Plan 2016/17


Author Sharon Yepes-Mora, Associate Director of Strategic Planning - WFCCG

Purpose of report

As part of the NHS England’s national planning requirements for 2016/17, the CCG was required to produce a one year Operating Plan for 2016/17 which is organisation-based but aligned to a wider five year Sustainability and Transformation Plan (STP), setting out system plans for implementation of the Forward View.

The Operating Plan sets out the overall plan for the CCG and is classed as Year One of the developing STP. NHS England has clearly stated that it expects significant progress on transformation through the 2016/17 plan. The CCG is monitored and held to account for delivery of the plan through NHSE assurance meetings.

The national Operating Plan template requires the CCG to provide assurance and set out plans for a number of indicators that are aligned with strategic plans and deliver the NHS Constitution standards.

An early task for local system leaders was to run a shared and open-book operational planning process for 2016/17. This process covered activity, capacity, finance and 2016/17 deliverables from the emerging STP. The detailed requirements for commissioner and provider plans were set out in the technical Guidance (Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21). The plan needed to demonstrate the following requirements: Intentions to reconcile finance with activity (and where a deficit exists, set out

clear plans to return to balance); Contribution to the efficiency savings; Plans to deliver the key must-dos including NHS Constitution and new mental health standards; How quality and safety will be maintained and improved for patients; How risks across the local health economy plans have been jointly identified and mitigated through an agreed contingency plan How they link with and support with local emerging STPs The CCG’s final Operating Plan was submitted to NHS England on 18 April 2016 and formal approval is requested from the Governing Body. A Quality Premium (QP) template for submission was also required for submission setting out local quality premium proposal and levels of improvement.

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Operating Plan 2016/17

The 2016/17 Quality Premium focuses on the RightCare programme, with CCGs encouraged to identify three measures from their Commissioning for Value (CfV) packs, The local measures selected following discussion with programme and clinical leads and agreed with NHS England are:

1. To achieve delivery of the new Early Intervention in Psychosis (EIP) standards 2. To reduce Delayed Transfers of Care at Whipps Cross Hospital as a percentage of their bed base 3. To increase the number of patients recorded on the palliative care register for Waltham Forest CCG

for the year 2016/17.

Changes/additions/amendments to paper as a result of discussions held at previous Committees

Discussions on the planning process for 2016/17 took place at the Planning and Innovation Committee. The Performance and Quality Committee considered and agreed the level of ambition and agreed the Quality Premium indicators.

Recommendations

The Governing Body is requested to

1. Approve the 2016/17 Operating Plan 2. Approve the local Quality Premium measures


The delivery of the operating plan will have a positive impact on patients and carers. The implementation of the clinical and strategic priorities will significantly enhance service quality and health outcomes and also promote equality of access and enable more patients to be treated closer to home.

Risk implications

Failure to meet national performance targets will have a detrimental impact on patients and may result in reputational damage to WFCCG.


The CCG‘s Operating Plan is aligned to financial plans which are budgeted to achieve compliance with the NHS Constitution standards and reflect the cost of contracted activity. Financial risks and opportunities are an inherent part of any ambitious commissioning plan. However diligent planning and the availability of adequate resources will help ensure these organisational risks/opportunities are actively managed. The CCG Operating Plans need to be read alongside the CCG 2016/17 Budget, which has been coordinated with the Operating Plan.

Equality analysis

The report has considered the CCG’s equality duty and where relevant has identified relevant actions which address any likely impact on equality and human rights.

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Operating Plan 2016/17


QAR; Unify; 22/01/2016

SUS; temporary National Repository (tNR), 23/03/2016

MAR; Unify; 21/01/2016

Monthly Diagnostics Waiting Times and Activity; Unify2, 21/01/2016

Consultant-led Referral to Treatment Waiting Times; Unify2, 21/01/16

Monthly Cancer Waiting Times statistics; Open Exeter, 08/01/16

Monthly IAPT return; Unify2, 20/01/16

HSCIC, 06/01/16


1. The Performance and Quality Committee 2. The Planning and Innovation Committee 3. The WEL (Waltham Forest and East London) Planning Group 4. MDT (Multi-Disciplinary Team) Officers Meeting

Agreed in full with no suggested changes.

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Item 5.1d

Title of report Better Care Fund (BCF) Section 75 agreement

From Terry Huff, Chief Officer - WFCCG

Author Sian Therese - Interim Lead for Integrated Commissioning – WFCCG/LBWF

Purpose of report

A Section 75 (S.75) agreement will need to be revised and extended between Waltham Forest NHS Clinical Commissioning Group (CCG) and Waltham Forest London Borough Council (LBWF) in relation to the Better Care Fund (BCF) and this paper explains that requirement and the need to make supporting arrangements.

This paper explains the requirement to continue to have in place a pooled fund and to confirm hosting, governance and management arrangements between the CCG and LBWF.

The requirement for a S.75 agreement considered in this paper is for the financial year 2016-2017. This arrangement will be replaced in April 2017 with a new agreement that is supported by a single health and social care plan.

This report will also be considered by the Executive of the Council in May and the Council Cabinet in June 2016.

Changes/additions/amendments to the 2016/17 Better Care Fund

In January 2016 a questionnaire was circulated to members of the Better Care Together Board inviting comments on the delivery of the 2015/16 BCF plan.

On 11 February 2016 the Better Care Together Board held a self-assessment workshop to consider the findings of a stakeholder questionnaire on the BCF, to contribute to a review of work already undertaken and to put forward proposals for the 16/17 plan.

On 21 April 2016 the Better Care Together Board reviewed and approved the 2016/17 plan.

Recommendations

To approve the S75 agreement 2016/17, including:

To support the recommendation that the Council should continue to host the pooled Better Care Fund for 2016/17

To support the governance of the pooled fund as set out in schedule 2 of the S75 Better Care Fund agreement

To delegate authority to the CCG Chief Officer to sign the S75 Better Care Fund agreement on behalf of the CCG.

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Better Care Fund (BCF) Section 75 agreement


This decision is an enabling requirement for the funding of the BCF plan and as such has no innate impact on patients or carers. The impact assessment of the BCF plan has been undertaken and reported elsewhere, the summary of which is that it is expected to have a beneficial effect on the health and wellbeing of protected groups, especially those with health problems and older people.

Risk implications

The risks relating to the BCF programme are set out in a risk log. A risk sharing agreement is set out in schedule 3 of the agreement.


The CCG and the Council have agreed to pool in the Better Care Fund £18,748,838 which includes a transfer of health funding totalling £16,610,538, a local authority contribution of £1,707,300 and additional CCG contribution of £431,000 to support mental health services, previously in a section 256 agreement.

The CCG and the Council have agreed a BCF financial schedule and a summary of the projects that make up the plan are contained in schedule 1 of the agreement.

Equality analysis

Waltham Forest has a relatively deprived, diverse population which is ageing and increasingly suffering from multiple co-morbidities. There is a view that inequalities have worsened due to effects of welfare reforms with effects on health from overcrowding, anxiety and increased demand on GPs. The traditional divide between primary, community, acute and social care is not well suited to meeting these needs.


CCG and Council performance reports will monitor the implementation of the projects in the Better Care Fund Agreement.


On 23 February a discussion with Healthwatch regarding the findings from the self-assessment questionnaire.

On 31 March chairs of the Social Care Overview and Scrutiny Committee and Health Overview and Scrutiny Committee where asked to confirm arrangements for the revision of the s75 BCF agreement.

On 16 February, 16 March and 12 April 2016: the 2016/17 Better Care Fund was discussed Joint Commissioning Board (of Council and CCG).

On 10 March 2016 the Better Care Fund was discussed and revised at the Borough’s Health and Wellbeing Board.

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Better Care Fund (BCF) Section 75 agreement Revise and extend a legal agreement between the CCG and the

Council to govern a pooled fund for the delivery of services as set out in the Better Care Fund plan

99


Page ii

Contents

1 Summary 1

2 Background 1

3 Proposals 1

3.1 Commissioning 2

3.2 Governance 2

3.3 Contracting arrangements 2

3.4 Information sharing 2

3.5 Financial contributions 3

3.6 Pooled fund management 3

3.7 Risk share arrangements, overspends and underspends 4

3.8 Audit and right of access 5

3.9 Performance management 5

4 Conclusion 6

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Page 1

1 Summary

A Section 75 (S.75) agreement will need to be revised and extended between Waltham Forest NHS Clinical Commissioning Group (CCG) and Waltham Forest London Borough Council (LBWF) in relation to the Better Care Fund (BCF) and this paper explains that requirement and the need to make supporting arrangements.

This paper explains the requirement to continue to have in place a pooled fund and to confirm hosting, governance and management arrangements between the CCG and LBWF.

The requirement for a S.75 agreement considered in this paper is for the financial year 2016-2017. This arrangement will be replaced in April 2017 with a new agreement that is supported by a single health and social care plan.

This report will also be considered by the Executive of the Council in May and the Council Cabinet in June 2016.

2 Background

The CCG and the Council have had in place in 2015/16 a S.75 agreement made under section 75 of the National Health Services Act 2006, to manage the pooled Better Care Fund. The CCG and the Council, in December 2014, agreed to appoint the Council as the host partner to manage the BCF pooled fund.

This arrangement is required in 2016/17 by the Department of Health.

The purpose of the pooled fund is “to ensure a transformation in integrated health and social care and is a critical part of the CCG 2 year operational plans and the 5 year strategic plans as well as the Council’s planning”, (NHS England guidance, http://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/).


The S.75 agreement governing the creation and management of the pooled fund must be in place by June 2016.

3 Proposals

Waltham Forest’s BCF plan was considered by the Health and Well-being Board at its meetings in December 2015 and March 2016 and the initial and revised drafts were submitted in accordance with the Government’s time-table.

Following the final submission on 3 May 2016, the CCG and LBWF received confirmation from NHS England that the borough’s Better Care Fund plan had been approved.

On 3 May 2016, NHS England confirmed that the Waltham Forest plan was fully approved.

In order to secure the BCF funding allocation, together with the agreed local top-up, it will be necessary for Waltham Forest NHS Clinical Commissioning Group (the CCG) and the London Borough of Waltham

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Forest (the Council) to extend their existing agreement under s75 of the National Health Service Act 2006 for another year.

It is recommended that the CCG and the Council retain the current arrangements for the management of the pooled BCF and appoint the Council to be the Host Partner for the 2016/17 s75 Agreement.

It is the intention, in the s75 agreement 2016/17, that existing payments made by the CCG under existing contracts will normally be paid back to the CCG from the Council hosted fund, unless there is general agreement that it is appropriate to change this arrangement.

3.1 Commissioning

There will be no changes to the current commissioning arrangements as part of this S.75 agreement, although the CCG and the Council have commenced discussions about putting in place “Lead commissioning” arrangements for mental health and other services. These, however, will be subject to separate legal agreements and will be brought to the Governing Body on a separate occasion.

This BCF Section 75 Agreement will enable the Council and the CCG to continue to take their own decisions but: by delegation of functions and authority to officer members of the JCB; or by coordinating decision making reports so that the Council and the CCG board are sighted on each other’s commissioning intentions and decisions; the CCG and the Council retain a co-ordinated approach.

3.2 Governance

The CCG and the Council will retain the governance arrangements, put in place in 2015/16. These are set out in Schedule 2 of the Agreement. The following groups will continue to satisfy the local governance arrangements:

Waltham Forest’s Health and Wellbeing Board

The Joint Commissioning Board

The Project Steering Group

Each group, in 2015, has reviewed and revised its terms of reference to strengthen the governance arrangements for the BCF and the Better Care Together Programme.

3.3 Contracting arrangements

Existing contracts between the CCG and providers and the Council and providers should not be affected by the continuation of a single host for the pooled fund. Future contracts are linked to the discussion about commissioning options, above.

3.4 Information sharing

Organisations involved in providing services have a legal responsibility to ensure the way that they use personal data is lawful. Each partner is aware of their obligations and this has influenced both the CCG’s and Council’s work to improve methods of data sharing. It remains each partner’s individual responsibility to ensure that their organisation and security measures protect the lawful use of information.

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3.5 Financial Contributions


Schedule 1 to the Agreement sets out the detail for each scheme that is covered by the pooled fund. This includes associated costs such as premises, IT support and staff, which are necessary for the Council and the CCG to perform their obligations.

The Partners shall pay the Financial Contributions into the Pooled Fund in advance using the same payment schedule agreed for the 2015/16 agreement.

The Council and the CCG will provide such non-financial contributions to ensure the success of each scheme as deemed necessary by the scheme’s commissioner and this shall not count as a call upon the initial pooled fund.

The CCG and the Council will use their existing ratification processes for all future business cases that might advance the work of the Better Care Together programme, but are at present outside the agreed BCF, as set out in schedule 1 of the agreement.

Any arrangements for preparing capital expenditure need to be made separately and in accordance with section 256 (or section 76) of the NHS Act 2006 and Direction made thereunder. If a need for capital expenditure is identified this must be agreed by all Partners.

3.6 Pooled fund management

Each individual service where there is a pooled fund, shall have a designated pooled fund manager who will be an existing officer within one of the statutory partners, with the following duties and responsibilities:

the day to day operation and management of the pooled fund;

ensuring that all expenditure from the pooled fund is in accordance with the provisions of the S.75 agreement and the relevant scheme specification;

maintaining an overview of all joint financial issues affecting the Council and the CCG in relation to the services and the pooled fund;

ensuring that full and proper records for accounting purposes are kept in respect of the pooled fund;

reporting to the Joint Commissioning Board (JCB) as required (this would be through the overall pooled fund manager);

ensuring action is taken to manage any projected under or overspends relating to the pooled fund in accordance with the S.75 agreement;

in conjunction with the overall pooled fund manager, preparing and submitting to the JCB quarterly reports (or more frequent reports if required) and an annual return about the income and expenditure from the pooled fund together with such other information as may be required by

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the JCB to monitor the effectiveness of the BCF and to enable the CCG and the Council to complete their own financial accounts and returns.

in conjunction with the overall pooled fund manager, preparing and submitting reports to the Health and Wellbeing Board as required by it.

The JCB may agree to the viring of funds between Pooled Funds (in line with Council and NHS Financial Regulations).

Below is a diagrammatic representation of possible pooled fund management. The lines can represent reporting, accountability and line management (decisions yet to be made). Although it is not shown in the diagram, there will be a role for the BCF steering group and integrated health and care programme board.

3.7 Risk Share Arrangements, Overspends and Underspends

The risk share arrangements are set out in detail in Schedule 3 and deal with overspends and underspends. As in 2015/16, potential overspends will be identified by the scheme pooled fund manager and reported by them to the BCF finance manager who will decide what action to take.

It is recommended that the approach developed in 2015/16 to manage over and underspends is retained for the 2016/17 S 75 agreement. This arrangement is described below:

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Table 1: Example of Overspend and Underspend scenario

Risk share Investments Benefits

Overspend

Waltham Forest Council will be responsible for the overspend that takes place in programmes where they are currently lead commissioners

Waltham Forest CCG will be responsible for the overspend that takes place in programmes where they are currently lead commissioners

Waltham Forest Council will assume the loss of benefits associated with overspend for the programmes that they are lead commissioners of named services

Waltham Forest CCG will assume the loss of benefits associated with overspend for the programmes that they are lead commissioners of named services

Underspend

Waltham Forest Council will be responsible for the underspend that takes place in programmes where they are currently lead commissioners

Waltham Forest CCG will be responsible for the underspend that takes place in programmes where they are currently lead commissioners

Waltham Forest Council will assume the benefits associated with underspend (dependent on meeting minimum performance criteria) for the programmes that they are lead commissioners of named services

Waltham Forest CCG will assume the benefits associated with underspend (dependent on meeting minimum performance criteria) for the programmes that they are lead commissioners of named services

3.8 Audit & Right of Access

The parties will each have responsibilities for audit and so the arrangement needs to provide for the responsibilities of the host partner relating to audit and the right of internal and external auditors to be given access to anything they need to carry out their duties.

3.9 Performance Management

The performance management for the pooled fund is critical and underpins the governance and day-to-day operational arrangements to be implemented. The performance management arrangements are set out in schedule 5 of the agreement.

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Metrics and reporting

BCF Benefits & Outcomes

Non-elective admissions (NEL) and lengths of hospital stay

Permanent Nursing and Residential Home Admissions

Effective Reablement, number of referrals from hospital; and percentage of people still at home after 90 days from discharge

Patient and Service User Experience

Admission avoidance: Number of rapid response referrals

Number of delayed transfers of care.

Finance

Budget allocation

Actual spend

Other finance metrics

Issues & Risks

BCF programme-wide

Individual schemes

Other Key performance indicators (KPIs)

To be defined and should be related to individual schemes/programmes

4 Conclusion

The joint Council and CCG vision as expressed in the BCF plan is to create a simplified and easy to access health and social care system for Waltham Forest residents and their families where services are personalised to fit their individual needs and provide value for money across both voluntary and statutory services.

The S.75 agreement will continue to be an enabling agreement for the delivery of the BCF plan, which was approved by NHS England on 3 May 2016.

A Section 75 agreement between the Council and the CCG in relation to the BCF is required to be in place by June 2016. This will be the last BCF plan, but is an important step toward the development of a single health and social care plan to be published by the CCG and the Council in March 2017.

The CCG and the Council have over 2015/16 refined the content of the Better Care Together Programme and the governance arrangements of the Better Care Fund. These are included in the schedules of the S75 BCF agreement. The Council’s legal department is leading on the provision of legal advice to both the CCG and Council on the drafting of the final agreement.

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Highlights [Audit Committee][March 2016]

Item 6.1

Committee Minutes

Audit Committee – March 2016

From Alan Wells, OBE; Audit Chair - WFCCG

Key highlights

Risk Register A summary update on the directorate risk register was presented. There are a total of 60. Of these 7 have been identified for escalation to the BAF to be reported to the Governing Body at its meeting on 30 March. Internal Audit Progress Report Two reports are now final. The Budget Setting, Budgetary Control and Financial Reporting were green while Commissioning and Contracting are amber/green. Draft Head of Internal Audit Opinion (HOIAO) The key issues relating to monitoring and reporting on GP contracts were not robust, there were no signed MOUs with NHSE or primary care quality dashboard was in place and that KPIs set within PMS contracts were found to be out of date and not reflective of current service providers. Draft Internal Audit Plan 2016/17 An outline of the work to date was discussed. The aim of the report is to assist with meeting the NHSE timetable for the submission of Draft Head of Internal Audit Opinions. LCFS Progress Report The Counter Fraud Team will undertake an evaluation of fraud awareness at the CCG. This will include liaison with senior CCG staff. There will also be a “Fraud Awareness Month” in March to provide fraud and bribery awareness. The Governing Body development session was poorly attended by GPs. AW proposed that there should be an update session for GPs in 6 months and a request for an all staff presentation. Final External Audit Plan 2016/17 The Audit Committee was asked to note the progress report and technical update. The two risk areas are – Better Care Fund arrangements are not accounted for within the CCG’s accounts in accordance with MfA and accounting standards requirements.

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Highlights [Audit Committee][March 2016]

Value for money regarding Better Care Fund, Primary Care Co-Commissioning, Barts Health financial position. External Audit Progress Report Ahead of the meeting in May the aim will be to complete the 2015/16 interim audit to present at the next meeting and complete the final accounts.

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Audit Minutes 2 March 2016 Page 1 of 3

Minutes of the Waltham Forest Clinical Commissioning Group Audit Committee (Part 1)

Date: Wednesday 2 March 2016

Time: 10am –12 noon Venue: Kirkdale House

Members Present: Alan Wells, OBE (AW) (Chair) Lay Member Governance, CCG Vice-Chair Vineeta Manchanda Lay Member Audit Committee In Attendance: CCG Officers: Les Borrett (LB) Director of Financial StrategyDavid Pearce (DP) Head of GovernanceInternal Auditors John Elbake (JE) RSMKirsten Quinn (KQ) RSM External Auditors James Carroll (JC) KPMG Jack Stapleton (JS) KPMG

Item

Action

Apologies for absence Neil Hewitson, KPMG Declarations of Interest There were no declarations of interest Minutes of the meeting held on 4 November 2015 Minutes of the meeting held 6 January 2015 were approved.

1. Matters Arising See separate Table provided.

2. Risk Management Directorate risk registers:

DP presented a summary update on the directorate risk register. There are a total of 60 risks that have been identified for escalation to the BAF to be reported to the Governing Body at its meeting on 30th March. Currently the Strategic Commissioning team hold 3 new risks and Quality and Governance 4 new risks. Risk number 5 on the BAF which relates to PELC and out of hours services was discussed and changed to a red rating. AW wished for patient participation to be added as a risk for the CCG. There will be a further update to the BAF before the next governing body. The Audit Committee noted the directorate risk register and the BAF reports.

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3. Internal Audit (1) Internal Audit Progress Report

Two reports are now final. The Budget Setting, Budgetary Control and Financial Reporting were green while Commissioning and Contracting are amber/green. The medium priority was in relation to an ongoing action for the Primary Care Development sub-Committee merging with the Primary Care Committee for assurance purposes. A final decision from the Governing Body is expected on 30th March. The Better Care Together review will be held by the Local Authority to avoid duplication of work. It is important that all contracts are receiving appropriate clinical sign off during the planning phase. The CCG has failed to provide evidence of this in the past. CCG business cases should go to Planning & Innovation and Finance & QIPP to have clinical sign off through the committee reporting process. The audit also found that there are a large number of purchases going through the PO route. MH/CHC unsigned contracts. Commitment from CSU that these will be signed off and maintained on sharepoint in future. The Audit Committee were asked to note the progress report.

4. Internal Audit (2) Draft Head of Internal Audit Opinion (HOIAO)

The key issues relating to monitoring and reporting on GP contracts were not robust, there were no signed MOUs with NHSE or primary care quality dashboard was in place and that KPIs set within PMS contracts were found to be out of date and not reflective of current service providers. The final Service Auditor Report is due in April and will be reviewed at the next Audit Committee.

5. Internal Audit (3) Draft Internal Audit Plan 2016/17

An outline of the work to date was discussed. The aim of the report is to assist with meeting the NHSE timetable for the submission of Draft Head of Internal Audit Opinions.

6. Internal Audit (4) – LCFS

LCFS Progress Report The Counter Fraud Team will undertake an evaluation of fraud awareness at the CCG. This will include liaison with senior CCG staff. There will also be a “Fraud Awareness Month” in March to provide fraud and bribery awareness.

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The Governing Body development session was poorly attended by GPs. AW proposed that there should be an update session for GPs in 6 months and a request for an all staff presentation.

7. Finance (1)

Final External Audit Plan 2016/17 The Audit Committee was asked to note the progress report and technical update. The two risk areas are – Better Care Fund arrangements are not accounted for within the CCG’s accounts in accordance with MfA and accounting standards requirements. Value for money regarding Better Care Fund, Primary Care Co-Commissioning, Barts Health financial position. The risk to the Better Care Fund is that the CCG is not aware of how its BCF contributions are being expended and therefore cannot assure itself that it is achieving value for money. The risk to the primary care co-commissioning initiative is that the CCG has not established a robust control environment to ensure governance and oversight. The Audit Committee agreed the report.

8. Finance (2)

External Audit Progress Report The plan has been agreed by LB. Ahead of the meeting in May the aim will be to complete the 2015/16 interim audit to present at the next meeting and complete the final accounts.

9. Forward Plan

23 May confirmed for final accounts sign off. LB, AW, RH VM, External Auditors (Neil Hewitson and Ali Azam) must be in attendance. Communications Deep Dive from August moved to 6 July. No meeting in August.

10. Private discussion between Audit Committee and Auditors

There was no business to discuss on this occasion.

Next Meeting

23rd May 2016 Venue. Kirkdale House.

Signed …………………………………………… Date ………………………….

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Highlights [Performance and Quality Committee][March 2016]

1

Item 6.2

Committee Minutes

Performance and Quality Committee - March 2016

From Dr Dinesh Kapoor, Clinical Director Quality and Performance -WFCCG

Key highlights

Chair’s Report

The Chair raised that many GPs had sent emails with concerns about the workload at Barts Health and this was being reviewed with the Hospital Director.

GPs, especially from Chingford have informed the Chair DK of secondary care results being sent to GPs and they are unclear as to the required action. There is an issue with complex biopsies and histopathology results. The Chair has invited pathology consultants from Barts to attend the locality meetings.

Cancer Services The 62 day target has been met. NHS England has published new guidelines for prostate cancer, in particular, how

Trusts can manage in Trust/Trust transfer. Confirmed that patients with prostate cancer having monthly injections can have

them every 3 months. It was confirmed the Macmillan GP has returned from maternity leave and will

attend locality meetings to update on the work plan. Bowel Cancer Screening uptake. A small number of practices have not signed up.

Although a lot of practices have signed up there has not been an increase in the screening rate.

Public Health Nothing to report.

Patient Experience

Whipps Cross Friends and Family Test (FFT) is achieving above the 80% response target however the response rate for A&E was low – 2.1%.

Barts Health have recently rolled out ‘I want great care’ which processes FFT data and allows feedback within 24 hours.

Whipps Cross still not achieving the 80% response rate for complaints responded to within 25 working days.

Quality assurance visits were undertaken and feedback shared with the Whipps Cross team.

NELFT FFT scores are in excess of 90% and it is noted they need to improve response numbers on primary care.

Complaints – NELFT did not achieve 80% in December at 75%.

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2

The number of GP alerts doubled in Feb to 21 – themes were communications,

poor quality, timeliness and illegible discharge summaries. Performance and Quality scorecard

Predicting CCG will meet 12 of its 22 targets this year. There are 2 targets that are no longer predicted to be achieved: Ambulance

conveyances from care homes and bowel cancer screening. Targets identified as at risk: IAPT this has been at risk since December when

referrals and performance dipped. Communications have been sent out to medical directors. Learning disability assessments, the target was 65 assessments per month which has not been reached. Improvements were made earlier in the year. Longer term plan is to review the learning disability service.

The operating plan notes that: for A&E Whipps Cross and all the Barts Health sites will meet 95% by September 2016; Barts Health to start RTT reporting from July 2016.

The internal auditors commented that the Committee does not evidence that discussions are challenged.

Quality

The Committee received an update on the action plan in place following the NHS England Safeguarding Deep Dive undertaken 6 November 2016.

Waltham Forest is 1 of 5 boroughs involved in a FGM safeguarding pilot funded by the Mayor of London. This is due to conclude in June 2016.

Waltham Forest is above the national target for undertaking health assessments being up to date for looked after children.

There is a change to the inspection regime with the introduction of the joint targeted area inspections.

The committee received a paper relating to grade 3 and 4 pressure ulcers reported at Barts Health, noting a reduction of 66 in 2016 from previous year. It was confirmed that pressure ulcers was on the safeguarding agenda.

The group agreed to the amendments of the quality indicator for c.diff to lapses in care for 2016/17.

Medicines Management The committee were informed of practices that were overspent and that the

medicines management committee are going to send prescribing advisors into practices to highlight the issues.

Maternity Services

The Committee were presented with the key performance data from the primary provider of maternity services Barts Health, specifically Whipps Cross and key highlights:

January had 421 births at Whipps Cross and expect to see further increases to over 500 more births in this year than previous year.

The midwife led unit, Lilac Ward, had in January the highest number to date of babies delivered at 66 babies delivered.

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3

Antenatal bookings before 13 weeks are at 94.3%, a 3% drop but still within contract.

There has been a slight increase in Caesarean births. Dec 25.1%, Jan was 28%. An audit was completed and findings were 1) undiagnosed breaches, 2) fully dilated women.

Breastfeeding initiation remains high at 80%. Workforce is at the lowest level of vacancies at 4.6, consultant presence on the

delivery suite is 74 hours per week. In July, there was a cluster of antenatal stillbirths. An exception report was

completed but the CCG felt this needed to be improved upon and have requested additional assurances and will work with Whipps Cross to support improvements in the report.

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Performance and Quality Committee Meeting

Date: Wednesday 9th March 2016

Time: 10.00am – 12.00pm

Venue: Boardroom, Kirkdale House, Leytonstone

Chair: Dr Dinesh Kapoor (DK)

Attendees: Nuzhat Anjum (NA)

Les Borrett (LB)

Korkor Ceasar (KC)

Isabelle Davies-Tutt (IDT)

Carl Edmonds (CE)

Dr Naheed Khan-Lodhi (NKL)

Dr Tonia Myers (TM)

Ada Onyeagwara (AO)

Enrico Panizzo (EP)

Janice Richards (JR)

Kay Saini (KS)

Helen Sargeant Dar (HSD)

Kate Turner (KT)

Apologies: Helen Davenport (HD)

Kelvin Hankins (KH)

Anne Walker (AW)

Minutes

1. Welcome and apologies DK

Apologies were received from Helen Davenport, Kelvin Hankins and Anne Walker.

2. Declaration of interest register DK

There were no declarations of interest.

3. Minutes of last meeting

KT asked for item 1 in AOB of the February minutes to be amended to clarify the data requested was for Waltham Forest patients in the upcoming pilot. KT to send corrections.

Actions outstanding from previous meeting / Matters Arising Action

3.1 Workload of radiologists – DK said it will be picked up in the clinical forum. It may become an issue if we start to receive a lot of GP alerts. To be closed.

3.1 IDT has received 6 GP alerts on radiology workload and will discuss how to take it forward with AW.

3.1 Healthwatch review on patient experience with Phlebotomy services – CE confirmed the report has not been finalised. Will bring it to the next meeting.

3.3 Guidance helplines – ongoing.

3.5 Update on CQC mental health – KH not in attendance to give update.

3.6 HD not present to give update on enforcement notices served to Whipps Cross.

3.7 Oncology services at Whipps Cross – LB to pick up at the next Cancer Forum.

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Meeting minutes Performance and Quality Committee 9th March 2016

Page 2 of 10

3.8 Pathways for children with suspected cancer – HD not present. LB to pick up at the next Cancer Forum.

8.0 Ophthalmology SI to be added to the agenda of next meeting.

10.2 Heathlands visit to take place in early April. Update to be provided at the next meeting

11.0 KT informed all that midwives are offering referrals to women to the smoking cessation clinic, however, the women are declining them. Midwives will review how they offer referrals to improve uptake.

11.0 KT informed all that a manual audit into why vitamin K injections were not appearing on discharge summaries found that most summaries did have this information with a few exceptions. A new IT midwife has been hired to ensure this doesn’t happen again.

LB noted that where actions are for the following meeting, these should be chased up and completed on time.

4. Chair’s Report Briefing – WX Clinical Forum Minutes Chair

There was no February meeting. No briefing provided.

DK explained that he has received many emails from GPs regarding their workload by Barts Health. AW has raised this with Fiona Smith at Whipps Cross, who is looking into this.

DK is working on improving communications between GPs and Consultant.

GPs, especially from Chingford have informed DK of secondary care results being dumped on GPs. There is an issue with complex biopsies and histopathology results. DK has invited pathology consultants from Barts to attend the locality meetings. NKL added that GPs are unclear on what they are supposed to do with the results i.e. if they are for information only. Better access to Barts information is needed. TM suggested having an ‘opt in’ rather than a default share all option on HIE. NKL said Barts need to cc GPs for info only, otherwise they risk missing patients who need further action. In the Clinical Forum, DK and co are working on flagging results as secondary care.

5. Cancer Services Update NKL

NKL gave an update on Cancer:

- 62 day target has been met recently - NHSE has published new guidelines for prostate cancer, in particular,

how Trusts can manage in Trust /Trust transfer. - James Green (consultant urologist, WX) is attending the localities to give

an update on the urology pathway – 2 week wait cancer referral form and the new NICE guidance re follow ups

- Informed all that James Green has said that those with prostate cancer having monthly injections can have them every 3 months. AO asked for a copy of the letter about Zoladex.

TM asked how we pick up those discharged already – NKL explained patients should not be discharged unless safety mechanisms are in place.

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NKL informed all the Macmillan GP has returned from maternity leave and will attend locality meetings with an update on the workplan. DK asked about bowel screening uptake. NKL explained that a small number of practices have not signed up. Although a lot of practices have signed up, there hasn’t been an increase in the screening rate. Need to look at whether there is a correlation between practices who have invoiced and their screening rates. Uptake in BME communities is low. LB suggested assessing the pilot. DK informed all it was NKL’s last P&Q meeting. DK thanked NKL for his contributions to the meetings over the years and wished him well in his non-CCG role.

6. Public Health – Input

No one from Public Health was present. EP to pick up outside the meeting to ensure the dashboard is seen.

Dashboard to be seen at the next meeting.

7. Patient Experience Report and Quality Assurance Visit IDT

IDT highlighted from the patient experience report:

Whipps Cross

- Friends and Family Test (FFT) at Whipps Cross – are achieving above the 80% response target

- Response rate for A&E was low – 2.1% - Recently enrolled ‘I want great care’, which processes FFT data –

Whipps Cross will receive FFT data in 24 hours, - Whipps Cross complaints – still not achieving 80% response rate. They

now have an allocated lead.

Quality assurance visits –

- Birch ward – assured that patients are well cared for and staff were complimentary about working on the ward.

- Blackthorn ward - a member of the facilities department attended the visit to address cleaning and storage issues.

NELFT

- FFT – over 90% would recommend the service. Need to improve numbers on primary care

- Complaints – NELFT did not achieve 80% in December at 75% - There were 6 overdue complaints past 90 days - CE asked why there was a sharp rise of complaints in Dec 2015. IDT to

look into this.

GP alerts

Number of GP alerts doubled in Feb to 21 – themes were communications, poor quality, timeliness and illegible discharge summaries. Between Jan – Feb, IDT contacted practice managers to ensure they understood what GP alerts were and how to use them.

DK felt the GP alerts should be sent by practice managers and would like to promote GP alerts. IDT informed all that AW is taking forward the responses from Barts, which have not been comprehensive.

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TM asked for figures on GP alerts. IDT said they are all on the patient experience reports which are on the practice portal.

LB asked who is responsible at Barts for responding to complaints on time and to a good quality. IDT stated it is the complaints team.

TM informed all there will be a sub-committee to discuss bad discharges. TM asked IDT for a list GP alerts with issues about discharges from the last few months and the responses. IDT said 95% of GP alerts were about discharges.

LB suggested getting discharges on the agenda of a meeting next week with Terry Huff, AW and Fiona Smith.

CE asked about GP alerts for NELFT. TM confirmed they want GP alerts from NELFT and about private providers. CE asked whether GP alerts can take alerts from all providers. IDT said it is possible, as Newham do it already. IDT will be meeting with NELFT to set this up.

TM said there is a need for a single point of access for complaints about providers. DK added that GP alerts are used for everything. IDT stated that AW risk assesses the alerts before they go out. CE asked for the same process as Barts i.e. response times, to be applied to NELFT and independent providers to maintain expectations of GPs.

TM asked LB to share the letter Barts with GPs about an alert.

7.1 Action: IDT to look into why there was a sharp rise of complaints in Dec 2015

7.2 Action: IDT to provide a list of GP alerts about issues with discharges from the last few months and the responses

7.3 Action: TM to add discharges to the meeting AW and TH will have with Fiona Smith on Tuesday 29th March

7.4 Action: LB to share the letter from Barts with GPs about an alert.

8. Performance - CCG Scorecard 2015/16 EP

EP highlighted:

Predicting CCG will meet 12 of its 22 targets this year.

There are 2 targets that are no longer predicted to be achieved:

- Ambulance conveyances from care homes - some had large increases – lots were falls. CCG has commissioned a falls service which can support care homes. 12 care homes and supported housing locations are being supported with additional training. Healthlands and others have seen a decrease, others have had large spikes. TM asked if an audit had been done. We have data for LAS. TM asked about extra support for homes and having a GP. EP confirmed funding has been approved from April. Currently talking to FedNet about a pilot.

- Bowel cancer screening - hasn’t improved since last year, although 40 practices have signed up to do it.

The targets identified as at risk:

- IAPT – at risk since December when referrals and performance were dipping. Dec/Jan usually have low numbers, expected to pick up in Feb/March. Communications have been sent out to medical directors.

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Issues within the service have been identified - referrals and service. Issue with answering the phone. TM said it should be dual referral and added that service is good but access is an issue. LB added that we need to get to 15%, which is the national target.

- Learning disability assessments – target was 65 assessments per month which has not been reached. Improvements were made earlier in the year. Longer term plan is to review the learning disability service.

- GP FFT - Jan figures will be published tomorrow.

Improved performance is reported for:

- Integrated Care - had a good month and seen high reductions in admissions

- Palliative Care - 2 good months. May turn green by the end of March

- C.Difficile - good

Operating plan A&E – Whipps Cross and all the Barts Health sites will meet 95% by September 2016. RTT – most Trusts are not reporting. CCG will be submitting a compliant trajectory for RTT on the basis that BHRUT, Homerton and Barts Health are non-reporting. Barts Health to start reporting from July.

Cancer – performance dipped in January 2016 due to patient choice and holiday period. It is predicted CCG will meet the quarterly targets next year.

EP informed all the scorecard is currently being revised and will be taken to the officer meeting of MDT next week to look at how some of the targets can be revised for next year. New indicators and targets may be set. An update will be given at the next meeting. LB said Clinical Directors need to be engaged.

CE explained that most of the metrics are red on the scorecard. This could possibly reflect we are not taking the right action, not asking the right questions or putting resources in the right place. CE is optimistic about FFT next year with the new IT, website. Next year will be based on this year’s average figures. TM added that we need more amber ratings. From the scorecard, CCG currently looks like it is failing. EP reassured all that there have been improvements which are not shown. TM added that the scorecard doesn’t show outcomes for patients, for example IAPT - just referrals and wait times. TM said it is a branding issue and it is about seeing the improvement, rather than reaching targets.

LB informed all that internal auditors picked up that the committee doesn’t challenge very hard. However, this could be because the minutes did not reflect the discussions.

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8.1 Action: EP to look at the data from LAS re care home and supported housing calls.

8.2 Action: EP to audit and look into Care Home. AO asked if Meds can be looked at in the deep dive.

9. Quality

9.1

Maternity Dashboard KT presented key performance data from the primary provider of maternity services Barts Health, specifically Whipps Cross and highlighted: The maternity dashboard records data in 5 areas:

1. Activity 2. Quality 3. Clinical indicators 4. Workforce 5. Risk management

Maternity services also submit an exception report outlining any issues, actions plans and timelines. January was a busy month with 421 births at Whipps Cross. There were 440 in September. There has been a big increase but looks like it will be within capacity. Looking at 500 more births this year than last year.

- Low risk women can deliver safely in midwife led units. January saw the highest number to date - 66 babies delivered in the Lilac Ward.

- Antenatal bookings before 13 weeks are at 94.3%, a 3% drop but still within contract

- 71.9% of women unknown to the hospital before 10 weeks were seen before 13 weeks. Most of the women are new to the area. CCG has asked for an additional audit and action plan from Whipps Cross.

- There has been a slight increase in Caesarean births. Dec 25.1%, Jan was 28% which is a concern. An audit was done to find out why numbers are high and found the causes to be 1) undiagnosed breaches, 2) fully dilated women. A breach clinic has been opened to ‘flip’ babies. Barts are actively looking to recruit a locum to provide instrumental interventions before opting for C-sections.

- Clinical indicators – breastfeeding initiation remains high at 80%. Would like to see an improvement. Barts have 2 strategies – 1) every midwife will have 2 additional days of mandatory breastfeeding training in addition to training already being received, 2) embedding daily breastfeeding discussions in their discharge talks and leaflets.

- Workforce – at the lowest level of vacancies at 4.6, consultant presence on the delivery suite is 74 hours per week. Recruiting 2 new consultant positions and should get a locum soon. 1:1 care is high at 91%.

Stillbirths – in July, there was a cluster of antenatal stillbirths. Most of these were due to delayed placenta maturation. AW and KT are working with Barts on the exception report and seeking additional assurances as AW/KT were not satisfied with the quality of the exception report.

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Looking forward - to the newly refurbished postnatal ward in April, hoping it will increase breastfeeding initiation and patient experience. Will monitor the C-section action plan.

9.2

CCG Safeguarding Assurance Deep Dive Action Log KC referred to the Integrated Safeguarding report which provides an update on which initiatives in quarter 4. KC highlighted: NHSE Safeguarding assurance deep dive – took place 6 Nov – 14 Dec 2015, informed of the result in Feb 2016. Overall finding for WFCCG was assured as good. Limited assurance was in relation to workforce, which was a common finding London wide. An action plan is provided in Appendix 1 to address the findings around workforce. FGM – a safeguarding priority. Waltham Forest is 1 of 5 boroughs involved in a pilot which was funded by money provided by the Mayor of London and Department of Education, it will be concluding in June. A paper is going to the Safeguarding board today to assess the sustainability of the pilot after June 2016. There will be funding to bridge the gap, however, there will be funding applications for all statutory partners in Waltham Forest. Changes to inspection regime – introduction of Joint Targeted Area Inspections (JTAI) and part of the new methodology will be using a deep dive approach. The first inspection this year will be on Child Exploitation which started in Feb and concludes in August. Next year will be FGM. Training – KC highlighted the training undertaken in quarter 4. 4 Safeguarding sessions to GPs, 4 Safeguarding sessions to CCG managers with recruitment responsibilities and additional sessions to paediatric staff at Whipps Cross. Looked After Children – highlighted the health indicators for children in care for 12 continuous months showed that WF is above the national target for health assessments being up to date. Working on improving initial health assessments. DK commended KC on the training that was rolled out, which DK found useful and also thanked TM. NKL commented that Child Protection has come a long way. NKL observed that immunisations for LAC were lower than the national average and asked what is being done about it. KC explained that there are a number of challenges for this:

- the cohort of unaccompanied asylum seekers, last quarter was 21. Their immunisation status is unknown.

- There are also reporting issues. - Majority of LAC in WF are between 10 – 17yrs old and a lot of 16-17yr

olds are refusing to get immunised. - A new schedule of immunisations for younger children was introduced in

Sept 2015, which they are catching up on - 70% of children are out of borough – which can be anywhere in the UK - Reporting and recording needs improvement - KC has recommended to the (inaudible) board a follow up report in July

TM raised concern about an email that went out to all GPs asking them to share their NHS.net emails with social care by 16th March, otherwise GPs emails will

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be shared automatically. Issue is that some GPs don’t use their .net accounts or don’t look at it regularly. TM suggested it should be a practice based nhs.net account not individual GP email addresses. TM has emailed Julia Walsh (Communications) and Mayank Shah with concern. TM to email LB and David Pearce as well. KC confirmed the communications went to IG and the Clinical Lead. DK gets child protection reports sent to his own mailbox. It would become an issue if someone is on leave or mailbox was full. All agreed the message should be recalled. KC will inform the Clinical Lead, Sabeena. 9.2(i) Action: All agreed the message about sharing GP nhs.net email addresses should be recalled and consider asking for the Child Protection lead for each practice to provide their email addresses instead. KC to take forward

9.3 BH Pressure Ulcers SI HSD went through the report and highlighted:

- Grade 3 and 4 pressure ulcers reported as SIs between April – December 2015 saw Whipps Cross with the highest number of cases at 38.

- At the Feb CQRM, CCG requested the following information at the Feb meeting - Terms of reference for the pressure ulcer steering group; assurance that all PU SIs are reviewed by the group; a work plan for the group; and any themed analysis report that has been completed.

- A reduction in PUs reported. DK asked for a breakdown of existing ulcers and acquired ulcers.

- Has been a reduction of 66 PUs in 2015 - 3 top locations who identified the PUs are Chestnut ward (for elderly

patients), Currie (medical ward) and Sycamore ward (orthopaedic ward) - There will be monthly reviews of PUs KPIs by AW, who will also attend

the PU steering group and review safe and effective care by the CQROA at the Whipps Cross meeting

- PUs are also on the next agenda for the next safeguarding adults board meeting

9.3(i) Action: HSD to provide a breakdown of existing and acquired pressure ulcers for grade 3 and 4

HSD

9.4 C.Diff benchmarking report

- The annual trajectories across the Trusts vary significantly. Barts Health trajectory is 82 compared with University College London Hospitals which is 97.

- 2016/17 trajectories have not been published yet. - CDiff guidance will focus on lapses of care - AW wanted to know whether the target setting should be in line with

previous years or whether we want to look at a different measurement. HSD suggested waiting until the trajectories for 2016/17 have been released before making a decision.

All agreed.

HSD

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10. Medicine Management KS/AO

10.1 Q3 Overspent Practice Summary AO explained the reason for bringing this item to this meeting was because the quarterly report to MMC on overspend identified some quality issues around prescribing in the report. The report summarises the top overspending practices. The general theme across these practices are:

- Spending considerably higher per ASTRO PU (a weighted category) than other practices.

- Poor repeat prescription procedures – duplication, wastage and gave

examples of bad practice. It wasn’t clear whether it was electronic prescriptions. KS has also highlighted a pharmacy to anti-fraud. AO has also flagged the letter from the acute Trust which was not actioned by a practice. EPS has improved quality but is open to abuse. AO informed all about a recent meeting with the LPC about what is required from community pharmacists, to ensure they are not abusing the system.

MMC are going to send prescribing advisors and the prescribing lead into practices to highlight the issues. DK/TM said this needs to go to the Primary Care Commissioning Committee. CE would like to see more clarity in terms of where there is a clinical issue, a system/procedure issue, for KS/AO to determine what falls to the practice, the pharmacy and NHSE. Then devise a plan with what falls within CCG’s responsibility. CE suggested starting with the top 5 practices. AO explained that some practices have not learnt from the extra support given and would benefit from employing a pharmacist permanently. TM asked if there is a safety option EMIS for medication. KS said there are warnings. CE summarised that the way forward is to look at the paper with his team, submit it to the PCCC for the first week of April and identify which practices need to be escalated. TM raised an issue about writing messages on prescriptions for pharmacists to pass on to the patients. Some pharmacists have not been doing this, saying it is not within their contract. AO took this to the LPC last week and they have agreed to pass on the information to patients and will escalate this to their community pharmacist members. 10.2 Action: KS/AO/CE to devise a report to go to the next PCCC in early April

11 A.O.B

1. End of life care Following the CQC inspections of Barts Health and the Margaret Centre, and the inadequate rating on end of life care, it was requested that the CQRM monitor the CQC actions.

JR

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- Some contractual changes have been made to end of life care primarily, patients to consent to being admitted to the Margaret Centre and to be offered an alternative.

- Actions have been monitored by JR and Barts Health. There have been meetings which have not been progressive due to attendees changing. JR is working closely with Pam on care homes and attended the locality meetings.

- Patients are being discharged to care homes and home without their injectables and are not systematically being referred to the community palliative care team.

- Discharge summaries do not always indicate the patient is end of life to the GP.

- An audit of 16 patients admitted to the Margaret Centre in July 2015 showed that 3 were too ill to consent and in each case the family made the admission, 4 consented to going in for respite, 7 were too ill to be transferred to their preferred place of care.

There is a continued pattern of late identification and then automatically going into the Margaret Centre. JR has asked staff to offer hospice and document the discussions. Referrals to St Josephs have increased this year to 23 from 4 the previous year. JR made a recommendation to escalate to the CQRM to monitor the CQC actions and all the performance issues. JR has been asked to write the terms of reference for a Quality Assurance visit in April, which will come to the next P&Q meeting. 11.2 Action: JR to escalate end of life care to Whipps Cross CQRM 11.3 Action: JR to submit the terms of reference for the Quality Assurance visit to the next meeting in April

Details of next meeting: Date: 11 May 2016 Time: 11.00am – 1.00pm Venue: Boardroom Kirkdale House

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Highlights [Planning & Innovation Committee] [March 2016]

Item 6.3a

Committee Minutes

Planning and Innovation Committee – March 2016

From Richard Griffin, Chair of the Committee - WFCCG

Key highlights

Highlights of the March 2016 meeting are summarised below: 1. Terms of Reference

The ToR were agreed with some minor changes.

2. Delivery Plan 2016/17 The draft delivery plan for 2016/17 and transformation grid were presented to the Committee. Programme leads have worked to develop their key actions for the next 12 months which will be reviewed monthly at Directorate level and quarterly at MDT and the Board will get 6 monthly updates. The delivery plan will inform the Clinical Leads and Clinical Directors work programmes and all our business will be focussed on delivery of these plans. There were no comments. All were happy with the plan and grid.

3. Community Deep Vein Thrombosis (DVT) Service The Community DVT service specification was highlighted. Over half of the ambulatory care was DVT related at Whipps Cross. Currently, patients are seen in A&E and then ambulatory care.

It was explained it could be a 7 day service depending on which option is taken. If delivered in Primary Care – which is not the preferred option given the numbers, it won’t be 7 days. If delivered through Hubs or Urgent Care Centre, then it should be 7 days. The Committee supported the level 1 pilot.

4. Latent tuberculosis (TB) Programme and Pathway

The proposal for a Latent TB screening programme in primary care was highlighted. It involves screening newly registered patients who arrived in the UK in the last 5 years from particular countries, if positive, they are referred to secondary care for treatment. The programme is nationally funded, and CCGs need to bid for the funding. Barts had some concerns about resources and delivering secondary care and are now looking at doing a pilot with a small cohort of patients. It will be piloted in 5 – 10 practices where cases of TB are high; a screening criteria will be added. The screening programme and putting a bid in for funding was supported.

5. Community Ophthalmology Service The results of the Ophthalmology review were outlined for the Committee. The review looked at all the provisions in the borough and was undertaken for the CCG in 2015 by Poonam Sharma, NHS England Clinical Lead in Ophthalmology. The contract cannot be extended again so it was decided to incorporate Poonam’s findings in the review and

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Highlights [Planning & Innovation Committee] [March 2016]

come up with a Community Ophthalmology model which will include the current Glaucoma provision, stable diabetic retinal periphery patients from Whipps Cross, Age-Related Macular Degeneration (AMD) patients, minor eye condition service. All supported the service.

6. Mental Health Employment Services NA informed the committee that this is not a new service, and is joint with CCG and local authority. The service was redesigned by the local authority last year. They procured the service and have given the contract to Citizens Advice Bureau. The contract was held by the local authority on the CCG’s behalf and the proposal is to procure the service in the open market for £72K per annum for 3 years until March 2019. The service has been redesigned in line with new guidance, including CAMHS including young people transitioning. All supported the service.

7. Phlebotomy Services The Phlebotomy service specification was updated in light of the comments/feedback received at the last meeting and presented to the Committee. The committee were asked to approve the specification, subject to 2 aspects 1) the domiciliary element has been strengthened, 2) KH hasn’t seen the spec as yet. The content of delivery will not change. Various issues were discussed before sign off could be agreed and the Committee asked for these to be resolved quickly. It was agreed to update the specification and the final version would be circulated to all the Clinical Directors.

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PLANNING AND INNOVATION COMMITTEE Minutes of Meeting held on 9th March 2016

Chair: Richard Griffin (RG) Attendees: Nuzhat Anjum (NA) Ian Clay (IC) Carl Edmonds (CE) Dinesh Kapoor (DK) Tonia Myers (TM)

John Samuel (JS) Mayank Shah (MS) Julia Walsh (JW) Sharon Yepes-Mora (SYM)

In Attendance: Johra Alam (JA) Enrico Panizzo (EP)

Aysha Patel (AP) Sultana Rahman (SR)

Apologies: Jane Mehta (JM)

Item Action 1 Apologies The apologies were noted as above.

2 Declarations of Interest There were no declarations of interest.

3 Minutes of the last meeting / Matters Arising The minutes of the last meeting were agreed.

4 Terms of Reference It was agreed that 6.1 will read as “Meetings of the Committee will normally be

held monthly, with the exception of August. The Committee may also hold a number of informal meetings during the year.” All confirmed the terms of reference.

5 Delivery plan 2016/17 SYM presented the draft delivery plan for 2016/17 and transformation grid. The

delivery plan will summarise all the key actions across all the work programmes, built around the transformation grid. The final draft will go to the Governing Body in March and further discussions at the joint away day in April. Referring to the Transformation Grid, SYM explained that the new drivers from last year have been picked up – 5 year forward view – driving transformation, NHS Mandate Objectives, 9 national must dos, Sustainability and Transformation plan. SYM highlighted that TST and BCF have been absorbed in our planning and are now better aligned. The red lollipop sticks are the programme boards. Additional enablers have been added – Medicines optimisation, provider partnership and contracts. To the CCG Strategic Objectives – SYM has added system leadership, which is a key function of the CCG. Programme leads have worked to develop their key actions for the next 12 months which will be reviewed monthly at Directorate level and quarterly at MDT and the board will get 6 monthly updates.

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The delivery plan will inform the Clinical Leads and Clinical Directors work programmes and all our business will be focussed on delivery of these plans. There were no comments. All were happy with the plan and grid.

6 Community DVT service EP presented the Community DVT service specification and highlighted:

Over half of the ambulatory care was DVT related at Whipps Cross. Currently, patients are seen in A&E and then ambulatory care.

- 2 – 3 per day for Waltham Forest CCG - Clinicians can rule out DVT easily with a quick test but not good at

diagnosing DVT - Proposal is to implement a community service - GPs will refer to the service which would administer the d-dimer test which

will enable approx. 80% of suspected cases to be excluded and referred back to their GPs

- 10 – 20% of cases with DVT symptoms will be sent to ambulatory care for scans

From a Clinical perspective, JA added that this is being done in other parts of the country. It is a familiar way of working and looking to increase value in working this way. Currently, GPs do not have any other option other than sending patients to A&E or ambulatory care. MS asked if it will be a 7 day service. JA explained it could be depending on which option is taken. If delivered in Primary Care – which is not the preferred option given the numbers, it won’t be 7 days. If delivered through Hubs or Urgent Care Centre, then it should be 7 days. Level 1 is preferred. All supported the level 1 pilot.

7 Latent TB programme and pathway SR presented the proposal for a Latent TB screening programme in primary care

and highlighted: - Involves screening newly registered patients who arrived in the UK in the

last 5 years from particular countries, if positive, they are referred to secondary care for treatment

- Nationally funded, CCGs need to bid for the funding - Barts had some concerns about resources and delivering secondary care

- now looking at doing a pilot with a small cohort of patients - Was discussed and supported in P&I meeting in June 2015 - LMC support pilot - Looking to sign up a small number of practices - SR talked through the pathway – when a new patient registers, they will

do an IGRA blood test, if positive a referral is made to secondary care, then treatment.

- SR informed all that Newham have already trialled this and found that only 25% of those screened tested came back positive for Latent TB.

- Nationally set payments - £5 for a GP screening, £20 for a referral and £100 if positive.

DK said there was an issue with follow ups in Newham where patients moved. DK also mentioned that IGRA needs to be added to TQUEST. SR would need to add TQUEST for an IGRA blood test.

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It will be piloted in 5 – 10 practices where cases of TB are high. MS asked for a screening criteria to be added. The screening programme and putting a bid in for funding was supported.

8 Community Ophthalmology Service AP presented the specification:

- Background – Poonam Sharma, NHS England Clinical Lead in Ophthalmology, undertook an Ophthalmology review for CCG in 2015, looking at all the provisions in the borough.

- Currently have a Community Glaucoma service. The contract has been in place since 2004 and has never been reviewed and has grown from a monitoring service to diagnosis.

- Cannot extend the contract again so have decided to incorporate Poonam’s findings in the review and have come up with a Community Ophthalmology model which will include the current Glaucoma provision, stable diabetic retinal periphery patients from Whipps Cross, AMD patients, minor eye condition service.

- Contract would be a prime provider model. - Engaged with many inc local eye health leads to develop business case

and spec. - 70% of acute tariffs, including MFF tariffs . - Risks – current provision is unique as you need special accreditation to

carry out diagnosis in the community. Whipps Cross can’t afford to take back new patients because they have issues with the 18 week RTT times.

- Local optical committee would prefer the MEC (minor eye conditions) to be done by local optometric practices.

- Issue around referrals as Optometrists can’t take direct referrals as they do not have the IG infrastructure or e-referrals patient choice structure.

- MEC – can self-refer and turn up at the practice. - MEC will be 40 hours per week and includes one evening and Saturday.

TM asked why the patient can’t self-refer after two DNAs, rather than going to a GP. TM has also raised as a GP alert. KH will look into it from a contract perspective. DK supported the service as he felt it is currently too fragmented. MS and TM also supported. All supported the service.

9 Mental Health employment services NA informed all:

- It is not a new service, joint with CCG and local authority. - The service was redesigned by the local authority last year. They

procured the service and have given the contract to Citizens Advice Bureau.

- The contract was held by the local authority on the CCG’s behalf. - CCG took its part of the service by way of a waiver and a 6 month contract

due to end in June 2016. - Mental Health employment helps with recovery, developing new skills and

job retention. - Need to promote the service. - Proposal is to procure the service in the open market for £72K per annum

for 3 years until March 2019. - Have redesigned the service in line with new guidance, including CAMHS

including young people transitioning.

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- KH needs to update the spec to say it will include people from out of borough as well.

- Modelled on the IPS model which will provide individual support to mental health users, part of mental health teams. The worker will be part of the user’s care plan and help find vocational courses, training, link with colleges, employment services to get voluntary or paid work. The current service is provided by Richmond Fellowship, a voluntary organisation who work closely with NELFT.

- The provider will have strong links with various organisations. All supported the service.

10 Phlebotomy Services Phlebotomy was discussed at the previous meeting. CE highlighted the areas the

specification has been strengthened in light of the comments/feedback received. CE asked the committee to approve the specification, subject to 2 aspects 1) the domiciliary element has been strengthened, 2) KH hasn’t seen the spec as yet. The content of delivery will not change.

- Carried out a lot of engagement including various patient groups and Healthwatch.

- Need sites that are easily accessible to patients using public transport – haven’t specified which sites yet.

- Ensure there is a process to identify priority patients who need to be prioritised e.g. those who are fasting

- Reduce and maintain waiting times - Be able to evidence patient satisfaction - Offer choice and convenience - Provide a number of community based premises - Offer a wider choice of appointments including pre-booking and walk ins - Range of communications and publicity material for GPs and patients

CE informed all that the outcomes and objectives have come from the feedback received and following good practice from WHO. CE addressed the points raised in the previous meeting:

- There is a need for the complaints procedure to be robust and clear. - Sites need to be accessible and convenient. CCG will be willing to talk to

bidders about potential sites in the borough that we know of to use our estate efficiently.

- Waiting times – suggesting 30 mins standard for booked appointments and 60 mins standard for walk ins.

- Barts Health is interested in bidding and have spoken to other potential providers including Blood Limited.

- Transportation of blood is outside the specification. - KPIs – patient feedback – have provided more in the specification –

annual surveys, complaints and investigations. - GPs having enough specimen bottles - CE explained GPs won’t need

bottles as they will be referring the patients. MS explained this was about blood taken by GPs. CE to pick up outside the meeting.

- MS asked CE how many phlebotomy slots do we need for patients, both in terms of domiciliary and community. CE explained that in the original business case, there was a breakdown of how many appointments and slots are used. KH added that there is usually an activity plan in the specification which would have gone through the assurance processes.

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- Provider will need to be flexible. - DK stated that Barts Health will still be processing phlebotomy. DK also

informed all that they are now able to take blood tests without fasting. - DK informed all that 20% of the blood tests are done at DK’s practice. - Domiciliary service is required.

TM highlighted that the specification states blood tests will be for over 10 year olds. TM informed all that her current community provider for blood tests for children has stopped doing bloods and are sending children to Whipps Cross with limited hours of Tuesdays and Thursdays after 10am. This is a concern. There was a discussion about why taking blood from under 10 years is different. CE to look into this. TM observed there wasn’t a standard for domiciliary care in the specification. CE explained the current specification has been updated with a standard. TM raised concern about specimens being labelled urgent and non-urgent – TM does not have the facility on TQUEST to do this. TM suggested taking this to the pathology group. DK suggested a template. TM would like to see a weekend service but Barts would have to agree to analyse at weekends. TM said the provider should provide transport. TM informed all about a private company offering blood tests £10 in clinic and £20 at home. The current cost in the specification is £3. There was a discussion about the possibility of having more than one provider. The current Barts transport service is unreliable. The group discussed the logistics of having 2 systems to collect bloods. IC said transport can be built into the service. TM would like to see the provider take responsibility for the transport of the blood. All agreed to make the recommendation to include transport to be linked to this service. TM said most complaints have been about transport. There is an issue of what happens when it goes wrong. CE asked about sign off. TM asked for the questions to be resolved quickly. The 3 Clinical Directors can then sign off the queries raised. The final version to be circulated to all the Clinical Directors. DK offered to assist CE with any pathology questions.

11 AOB None

12 Date of next meeting

13th April 2016 4pm – 6pm

131

Highlights [Planning and Innovation Committee] [April 2016]

Item 6.3b

Committee Minutes

Planning and Innovation Committee – April 2016

From Richard Griffin, Chair of the Committee - WFCCG

Key highlights

Highlights of the April 2016 meeting are summarised below: 1. Acute Unplanned Admissions Direct Enhanced Scheme (AUA DES) / Integrated

Care Management Local Enhanced Scheme (ICM LES) proposal 16/17. The AUA DES/ICM LES proposal was presented. The proposal is to bring together the LES and DES into a single scheme for the year ahead. It is acknowledged that there is still a lot of work to do to bring these together including finalising the reporting framework and the payment framework. Support was sought for approach to integrate the schemes and it was acknowledged that further work needs to be done on finance and reporting. After some discussion this was approved.

2. Direct Referral from High Risk Podiatry to Vascular Surgeons

The case for pathway leads in podiatry to refer patients directly to the vascular surgeons at Barts Health was presented. A pilot vascular pathway took place during August 2015 to January 2016. The outcome of the pilot was that the average waiting time was 2 weeks, compared to 18 weeks previously, and surgery took place between 1 to 4 weeks, and it was much later previously. The Committee were happy to endorse the project and would like to see a similar pathway for GPs.

3. Integrated CHS Pilot The Governing Body approved the CHS pilot in January. A number of service lines are commissioned from NELFT, and these have increased over time meaning access becomes difficult. It is therefore proposed to move to commissioning services based on outcomes based on practices and the community. Focus on planned care is proposed and unplanned care pathways need to be clear. Integrated care will be built on and support for patients at home.

4. The Committee were asked for comments on the specification for the pilot, and asked for advice on how to engage with practices on their experiences on the pilot. It is proposed that a survey be taken at 6 monthly intervals.

5. Dementia Outreach and Advisor Service Background to the Dementia Outreach and Advisor Service was provided, informing the Committee that approximately 18 months ago the CCG were failing the target for people identified with dementia. There were 2 service providers at the time, NELFT provided a memory clinic and the Alzheimer’s Society provided post diagnostic support. Both providers were given increased funding in parity of esteem and were encouraged to do more. Originally the Alzheimer’s Society contract was a section 75 contract but was

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Highlights [Planning and Innovation Committee] [April 2016]

CCG funded. It has been decided to bring this post diagnostic support service in house and the specification for this was presented to the Committee. It was confirmed that no additional funding would be invested, the proposal was approved.

6. Dietetics It was confirmed that the dietetics service has been commissioned from NELFT. The service has been small and non-recurrent funding has been provided to improve the service including waiting times which have been improved. It has been decided to move the service to a cost and volume element as it is an isolated service. NELFT provide this service to all 4 CCGs. A holding service specification has been developed in preparation for redesigning the pathway for dietetics. This is based on how the current service is delivered and has been co-produced by the service. Approval was given to the proposal.

7. School Nursing The special school nursing specification was presented to the Committee. The Committee were informed that health visiting and school nursing responsibilities transferred over to Public Health from PCTs. Special school nursing however did not and remained with CCGs. It was felt that more information was necessary on what the gaps are currently. It was agreed that the specification will be redrafted filling in the gaps and submitted to a future meeting for approval.

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1

PLANNING AND INNOVATION COMMITTEE Minutes of Meeting held on 13 April 2016

Chair: Richard Griffin (RG) Attendees: Syed Ali (SA) Linda Finch (LF) Gail Foord (GF) Ravi Gupta (RGu) Jane Mehta (JM) Tonia Myers (TM)

Janice Richards (JR) Mayank Shah (MS) Abdul Sheikh (AS) Julia Walsh (JW) Kelvin Hankins (KH)

In Attendance: Karen Wise (KW) Evan James (EJ)

Lindy Shufflebotham (LS)

Apologies: Ian Clay (IC) Dinesh Kapoor (DK)

Anwar Khan (AK) Sharon Yepes-Mora (SYM)

ACTIONS LOG

Ref Who : Actions from last meeting When Complete

3 JM To circulate the finalised specification for phlebotomy. 11 May

5 KH KH agreed to check that there would be no contractual issues that would need to be addressed around the Direct Referral from High Risk Podiatry to Vascular Surgeons proposal with Barts Health.

11 May

6 All Comments on the Integrated CHS Pilot to be forwarded to GF

22 April

Item Action 1 Apologies Apologies were noted as above.

2 Declarations of Interest There were no declarations of interest.

3 Minutes of the last meeting / Matters Arising The minutes of the last meeting were agreed with the correction that KH had

attended the meeting. Matters Arising: TM queried whether the specification for phlebotomy had been finalised taking into account comments raised at the last meeting. JM agreed to feedback and circulate the final version to the committee as soon as it is completed for agreement. The paper will be taken to the Governing Body meeting in May.

JM

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2

4 Acute Unplanned Admissions Direct Enhanced Scheme (AUA DES) / Integrated Care Management Local Enhanced Scheme (ICM LES) proposal 16/17

GF/EJ/LF

GF presented the AUA DES/ICM LES proposal for 16/17 to the Committee. As part of the CCG’s delegated responsibility the CCG have the opportunity to manage the AUA DES. Both of the schemes have been running together this year, and reporting for both has been complex. One of the aims of integrating them is to continue to have high quality support in terms of integrated care, and secondly to improve reporting and the burden on practices. The reporting process has been quite onerous for the CCG this year. The proposal is to bring together the LES and DES into a single scheme for the year ahead. It is acknowledged that there is still a lot of work to do to bring these together including finalising the reporting framework and the payment framework. The Committee was asked for support and were informed that the proposals will be taken to the Primary Care Commissioning Committee and the LMC. EJ noted that the DES had interfered with the objectives of the integrated care programme and that funding saved by integrating the schemes could be utilised to support them better. RGu raised concerns that GPs are finding it difficult to refer patients and gave a specific example which GF confirmed she would be happy to discuss separately outside the meeting. EJ acknowledged the difficulties and confirmed that the ICM team are trying to direct GPs to the appropriate community resources. MS queried whether it is possible to bring DES in locally as this is a national scheme. LF clarified that as the CCG have delegated responsibility it does have the authority to adjust the arrangements. The DES must be offered to all practices and if optional, they are however encouraged to choose the local option and will be informed of the benefits of doing so. There have been some problems around the DES for practices as it is rigid with a 2% leeway, and there is a greater risk of admission. MS confirmed that as many practices as possible will be encouraged to engage in DES and queried whether the process will be simplified to do so and in terms of data extraction. It was confirmed that as long as the practices receive the list, the process will be simple and read codes that been looked at for EMIS and for Systm 1 practices and some examples have been given in the papers provided to the Committee. Support was sought for approach to integrate the schemes and it was acknowledged that further work needs to be done on finance and reporting. GF informed the Committee that there will be challenges as this change will take place in-year, and a transition plan will need to be developed to take forward integration to a single system. The proposal was approved.

5 Direct Referral from High Risk Podiatry to Vascular Surgeons KW KW presented the case for pathway leads in podiatry to refer patients directly to

the vascular surgeons at Barts Health. The Committee were informed that currently the patient journey is long and convoluted, and a pilot vascular pathway took place during August 2015 to January 2016. The outcome of the pilot was that the average waiting time was 2

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3

weeks, compared to 18 weeks previously, and surgery took place between 1 to 4 weeks, much later previously. Financial improvements were also seen during the pilot, A&E attendance reduced and amputations reduced and KW outlined other benefits of direct referral with the example of a case study. Direct referral meant that 6 extra vascular sessions were required. SA recommended approval to the Committee and outlined various further benefits of direct referral including pain management, dealing with depression, and cost effectiveness. TM would like to see direct referral extended to other services such as tissue viability as there were many benefits to be seen. It would be helpful to extend this to tissue viability and specialist wound care. GF confirmed that this is being done as part of on one of the CHS key pathways. It was felt that it would be useful for GPs to have access to urgent appointments. KW informed the Committee that BHRUT have set up a hot clinic where direct referrals are accepted from GPs, and this model could be extended to Waltham Forest. It was suggested that this proposal could be taken to the Whipps Cross Clinical Forum but confirmed that this was a CVD issue. The Committee were happy to endorse the project and would like to see a similar pathway for GPs. KH agreed to check that there would be no contractual issues that would need to be addressed around the proposal with Barts Health.

KH

6 Integrated CHS Pilot GF GF informed the Committee that the Governing Body approved the CHS pilot in

January. A number of service lines are commissioned from NELFT, and these have increased over time meaning access becomes difficult. It is therefore proposed to move to commissioning services based on outcomes based on practices and the community. Focus on planned care is proposed and unplanned care pathways need to be clear. Integrated care will be built on and support for patients at home. The Committee were asked for comments on the specification for the pilot, and asked for advice on how to engage with practices on their experiences on the pilot. It is proposed that a survey be taken at 6 monthly intervals. SA queried whether NELFT would be capable of managing the project as it is quite extensive, and how this will be monitored. It was confirmed that the process has been discussed with NELFT and in order to carry out this project they are restructuring and consultation with staff is taking place. KH confirmed that capacity has been built into the contract to drive this change and a process is being agreed on monitoring the transformational programme. Comments on the specification were requested by 22 April.

All

7 Dementia Outreach and Advisor Service JR JR provided some background to the Dementia Outreach and Advisor Service,

informing the Committee that approximately 18 months ago the CCG were failing the target for people identified with dementia. There were 2 service providers at the time, NELFT provided a memory clinic and the Alzheimer’s Society provided post diagnostic support.

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4

Both providers were given increased funding in parity of esteem and were encouraged to do more. Originally the Alzheimer’s Society contract was a section 75 contract but was CCG funded. It has been decided to bring this post diagnostic support service in house and the specification for this was presented to the Committee. It was confirmed that no additional funding would be invested, the proposal was approved.

8 Dietetics KH It was confirmed by KH that the dietetics service has been commissioned from

NELFT. The service has been small and non-recurrent funding has been provided to improve the service including waiting times which have been improved. It has been decided to move the service to a cost and volume element as it is an isolated service. NELFT provide this service to all 4 CCGs. A holding service specification has been developed in preparation for redesigning the pathway for dietetics. This is based on how the current service is delivered and has been co-produced by the service. It was confirmed that obesity is not covered in this service. A business case for obesity was developed however the CCG were unable to procure the service. Discussions are taking place with the local authority on setting up an integrated obesity service. It was suggested that a separate business case would be necessary for food allergies. Approval was given to the proposal.

9 School Nursing KH KH presented the special school nursing specification to the Committee and

explained that health visiting and school nursing responsibilities transferred over to Public Health from PCTs. Special school nursing however did not and remained with CCGs. There are 4 special schools in the borough and the service specification covers these. It was requested that it is ensured that inappropriate demands are reduced for primary care such as to provide certificates for sick children. TM would raise specific issues with the education department and public health. TM felt that more information was necessary on what the gaps are currently. It was agreed that the specification will be redrafted filling in the gaps and submitted to a future meeting for approval.

11 AOB None

12 Date of next meeting

11 May 2016 4pm – 6pm

137

Highlights [IT Committee][March 2016]

Item 6.4a

Committee Minutes

IT Committee Minutes - March 2016

From Dr Mayank Shah, Chair of the Committee - WFCCG

Key highlights

Discovery Project

Discovery project will be funded by a charity and supported by Dr Kambiz Boombla on behalf of WEL – based on context of getting a single patient record – EMIS, TPP, Cerner – stored for support of IC – data available in near real time

The data will be owned by the source organisation and can be controlled whether it is distributed or not

Dr Boomla is leading from WEL – for the 3 CCGs to have a stake, the programme is looking for funding from each organisation

Repository secure - moving data over will be over N3 meaning risk of data loss is minimised

The project is disruptive to IT commercial organisations as wouldn’t have happened within individual Cerner, Emis or TPP

Timescale -draft development Aug/Sept this year, testing and rollout by mid next year – 18 months to 2 years to develop

Update on Digital Roadmap 5 year forward view from NHSE Personalised heath care 2020 view - Paper free at point of care WEL Local Digital Roadmap needs to be endorsed by all - to explain where we are

now and how to get to 2020 Digital roadmaps need to be submitted by 30 June Guidance from NHSE still not available

Draft IT and Digital Strategy Refresh 2016/17 Aim is to start looking at being digital – includes objectives from last year, review

corporate systems and further development of dashboards, publish performance, metrics and measures, and publish on CCG website, has added new drivers.

Roadmap – what has been completed this year and projects for 2016/17 – MIG2, infrastructure support (dependent on funding), MIG1 to OOH and 111, managing transition from DTS to MESH, HA and NELIE gap analysis and comparison to Discovery, pilot HIE to NELFT Orion to have a view of hospital data, feasibility of EMIS app – how patients access care plans and hospital data, BI, patient online accelerated registration via SMS pilot with PK and TC practices, EMIS community for IC and community health services, business case for Skype rollout.

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Highlights [IT Committee][March 2016]

Strategic level discussions with EMIS

Series of meetings with EMIS – high level meeting every quarter – feedback update from WEL and get strategic direction from EMIS

Need to understand what EMIS plan to do with mobile solution – EMIS Anyware is not a recommended solution to move forward

EMIS mobile now has a published roadmap – there are no plans to make it a portable version of EMIS desktop – it will be a cut down version – don’t have roadmap

Care plans – New module – part of core system - EMIS care plan module – completion June 2016 – will eventually support multi authoring – by Dec 2016 – data coded so could share through HIE – existing care plans are not easy to share – work with Coordinate my Care

Mobile app – WEL strategy will utilise EMIS app – working with Cerner – how we present HIE info

IT implementation progress report EMIS migrations

Queen’s Road have further postponed their migration from proposed June go live to 7 Sept due to most of the training dates falling in the month of Ramadan (7 June-around 10 July), followed by staff summer holidays.

LL Medical - EMIS has been ordered and requested a go live date of 7 June. TQuest/Cyberlabs

Cyberlabs is working at all EMIS practices but not at SystmOne – to escalate to TPP via SystmOne usergroup, in parallel Barts have implemented a workaround by creating logons and password for all SystmOne users that have TQuest access – so they can login to Cyberlabs via the website (not direct from within SystmOne) – Logons have been shared with practices.

IE11 roll out has begun – communications shared re: error messages and printing issue. No date yet for go live for GP practices.

Clinysis are not forthcoming with utilisation figures for Cyberlabs. HIE Training was identified as an issue in practices. Moorfields Docman Moorfields have developed a solution to deliver electronic discharge summaries based on Docman. We have advised that this does not meet our strategy. iPlato (SMS)

Extend functionality to add extra text encouraging patients to register online Useful to share examples about how else iPlato can be used

Patient online access

Detail coded record – done incredibly well 2nd across London Uptake - only 8% patients have registered online, target is 50%.

139

IT Committee

Date: Wednesday 16th March 2016

Time: 15:00 – 17:00

Venue: Boardroom B/C, Kirkdale House, Leytonstone

Chair: Dr Mayank Shah (MS)

Attendees: Les Borrett (LB) Carl Edmonds (CE) Amanda Elias (AE) Joan Fratter (JF) Richard Griffin (RG) Phil Koczan (PK) Harry Nyantakyi (HN) Damian Pearce (DP) Bhagi Shah (BS) Martin Wallis(MW) Nina Worley (NW)

Apologies: Dinesh Kapoor (DK) Julia Walsh(JW) Luke Readman (LR) Dr Thaven Chetty (TC) Phil Woolley (PW)

Agenda items

1. Welcome and apologies MS

The chair welcomed attendees and apologies noted.

2. Updated declaration of interest forms MS

No changes advised

3. Notes from last IT committee & Matters Arising MS

Minutes from the February meeting were agreed and action log was updated.

Action: MS asked for the action log to be updated before the next meeting

4. Developing a learning Health System in East London - PID DP

DP gave the background on the Discovery Project:

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Meeting minutes IT Committee Wednesday 16.03.16

Page 2 of 7

Discovery project will be funded by the charitable Endeavour foundation supported by Dr Kambiz Boombla – based on context of getting a single patient record – EMIS, TPP, Cerner – stored for support of IC – data available in near real time

The data will be owned by the source organisation and can be controlled whether it is distributed or not

Dr Kambiz is leading from WEL – for the 3 CCGs to have a stake, the programme is looking for funding of approx. £75k per organisation

Repository secure moving data over N3 means the risk of data loss is minimised

Anyone with an open API can plug in Timeline - national programme is ongoing Documentation is being shared at finance groups BS added that crucially, this project will be part of the Prevent agenda, as it

gives us a data warehouse – to identify individuals to work with in a specific way

The project is disruptive to IT commercial organisations as wouldn’t have happened within individual Cerner, Emis, TPP

CE asked how it will work with Health Analytics, CEG, Cerner, do they align? CE raised concern that the HA contract ends in Feb 2017. Will Discovery replace HA and will it be ready by then? BS explained there will be a gap. LB said there needs to be clarity on what HA does and whether there will be a cross over with Discovery.

An issue was raised about how this will be explained to clinicians and the public. Will it be part of Public Health agenda? DP explained they are still looking at whether it will replace or work alongside local solutions

JF asked how patient consent for their data to be held will be obtained. DP said it will mirror the current consent process and anonymise data. Social care data will be input and consent will have been given by the patient.

The committee was being asked to support the project – funding will go through finance committee.

Programme governance will be by reporting into TST executive PK said there has been a lot of agreement to the proposal within WEL Will give us a richer set of data Timescale -draft development Aug/Sept this year testing and rollout by mid next

year – 18 months to 2 years to develop CE explained he has a draft specification for procurement of HA, for what is

needed. Needs clarity on whether we renew or not. Agreed to endorse that it is a good idea Meeting in April for 4 CCGs to discuss this and other projects

Actions Deadline Owner

CE - compare with HA procurement spec – due diligence – CE to meet with DP and HN to identify gaps

Circulate the full pack documents to attendees

20.04.16 20.04.16

CE DP

5. Update on digital roadmap paper produced by Martin Wallis MW

MW presented an update on the digital roadmap: 5 year forward view from NHSE

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Page 3 of 7

Personalised heath care 2020 view - Paper free at point of care Alignment to Strategic Planning Groups Need a document for WEL endorsed by all to explain where we are now and

how to get to 2020 Digital roadmaps need to be submitted by 30th June Guidance from NHSE still not available but have seen drafts and have a rough

idea of format and content required Need a feel for priorities – if there are similar requirements nationally, funding

may be provided nationally The digital roadmap pulls together health and social care Business change analyst post to identify what capability is needed Latest draft of NHS contract has more IT and digital than ever before Pulled together information that has previously been produced, TST, population

health etc. Place holder for advanced analytics is Discovery at WEL IT – probably best bet

given centralised funding – currently in the digital roadmap MW has been working on the digital roadmap since beginning Feb – attending

WEL IT meetings, held stakeholder engagement – another one on 6th April – need input from HN and BS – 2 page summary of strategy and milestones

Each organisation will need to go through sign off It will be a living document Stakeholders – to include patient representative. JF to be invited Do we want to create a patient view of document - a couple of pages? Document will contain the current problems and difficulties that the digital

roadmap can fix. This will need to be agreed locally. Linking into funding opportunities – PCTF funding aligned to digital roadmap.

There was a query over the PCTF deadline. MW thought it was 30th April but AE believes it is now end of June.


MW to get a verbal update in April on up to date guidance, full copy of the digital roadmap to May IT committee for endorsement

DP to Invite JF as patient rep and HN & BS to 6th April

digital roadmap meeting

20.04.16 18.03.16

MW DP

6. Draft IT and Digital Strategy Refresh 2016/17 HN

HN presented on the IT and Digital Strategy refresh.

Aim is to start looking at being digital – includes objectives from last year, review corporate systems and further development of dashboards, publish performance, metrics and measures, and publish on CCG website, has added new drivers.

Roadmap – what is completed this year and projects for 2016/17 – MIG2, infrastructure support (dependent on funding), MIG1 to OOH and 111, managing transition from DTS to MESH, HA and NELIE gap analysis and comparison to Discovery, pilot HIE to NELFT Orion to have a view of hospital data, feasibility of EMIS app – how patients access care plans and hospital data, BI, patient online accelerated registration via SMS pilot with PK and TC

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practices, EMIS community for IC and community health services, business case for Skype rollout.

PK asked about Orion. Yet to be agreed. Started conversations with NELFT yesterday – have NELFT strategic plans – need to be sure that information is available during unplanned care – currently being discussed.


7. IT implementation progress report NW

EMIS migrations Queen’s Road have further postponed their migration from proposed June go

live to 7th Sept due to most of the training dates falling in the month of Ramadhan (7th June-around 10th July), followed by staff summer holidays.

LL Medical (Agarwal) - The practice is keen to move ASAP. EMIS has been

ordered and requested a go live date of 7th June.

Waltham Forest Community & Family Health Services Ltd – Emis has been installed on 2 PCs in Feb – there was a problem with Emis as demo system didn’t connect when trainer attended, this has now been rectified and Ed Keating has reminded EMIS (Heather) that this is an influential practice that needs to be supported.

Handsworth Demo – Josie (PM) and EMIS are in communication. The practice

has requested that the Demo takes place on the 11th April.

Firs – Rehana (PM) has requested a meeting with Mayank and Les at the practice – after Terry John is back from leave (7/3) – Amanda or Ed to attend – 1st week April Monday (4/4) lunchtime – Ed Keating to attend. MS to set up meeting.

DTS

Radiology system at Whipps was upgraded 27/28th Feb - new radiology reports are now available via HIE

Feedback from PK - HIE on 3 patients in one session, two to review x-ray reports that had not been scanned into my system and one to read an outpatient letter for a patient who was seen only a few days later. Probably saved 2 phone calls a few days later and one repeat appointment.

DTS functionality can be enabled from Barts Health, but requires each practice to enable a different DTS message type (NHSRSR) – with CSU to rollout. Agreed to continue the current arrangement, in the interim, of a courier service from the hospital to practices on a daily basis at 5pm

TQuest/Cyberlabs

TQuest is working at all sites.

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Cyberlabs is working at all EMIS practices but not at SystmOne – NW met with DK 9/3/16 to escalate to TPP via SystmOne user group, in parallel Barts have implemented a workaround by creating logons and password for all SystmOne users that have TQuest access – so they can login to Cyberlabs via the website (not direct from within SystmOne) – Logons have been shared with practices on 14/3.

IE11 roll out has begun – communications shared re error messages and

printing issue. Sarah Jensen (Barts) has agreed to Cyberlabs upgrade at Barts being internally tested on 4/4. No date yet for go live for GP practices – have requested copy of roll-back plan.

Continue to share TQuest usage figures at the Locality meetings.

Clinysis are not forthcoming with utilisation figures for Cyberlabs – have raised with them about not continuing to fund licence fees – now agreed to produce some figures by month by practice to then drill down to individual – no date agreed.

NW went through the utilisation slides for TQuest and highlighted that

Chingford practice is at 82% usage and asked what we do about those not using it.

HIE

NW highlighted that utilisation by Barts has increased. PW asked whether for GP practices, it should be weighted in size of practice. Training was identified as an issue in practices.

Moorfields Docman

Moorfields have developed a solution to deliver electronic discharge summaries based on Docman. We have advised that this does not meet our strategy (only 4 practices now use Docman - Addison Road, Grove Road, Ridgeway & Sinnott Road).

GP IT operating model contract

NW/BS/HN met with CSU – issue is that the GP IT operating model is not available from NHSE – so not clear what is in the core contract. Therefore, agreed to generate an MOU by end March to enable agreement of a roadmap and ways of working for next 6 months with a view to designing the full costed contract by Sept.

Saxon contract will be rolled over for 1 year but will include a more detailed

service specification as an appendix.


MS, LB and Ed Keating to meet with Firs practice - Rehana (PM) and Terry John 4th April to discuss what is involved in migrating to EMIS

04.04.16

MS

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CSU to lead on rollout of DTS for Barts radiology reports

20.04.16 AE

8. Digital progress report HN/BS

SKYPE

3 practices on pilot – plus Harrow Road added Feedback from patients has been positive – HN will share the feedback

Website Pilot

Currently discussing with developers - got 3 quotes Website work will be patient centric and will include patient groups and

voluntary groups – asking them what digital service they would like.

iPlato (SMS)

Extend functionality to add extra text encouraging patients to register online – PK and TC to pilot

Useful to share examples about how else iPlato can be used Need to speak to iPlato about filtering out patients that have already registered

Patient online access

Detail coded record – done incredibly well 2nd across London Uptake - only 8% patients have registered online, target is 50%


HN to share patient feedback about SKYPE 20.04.16 HN

9. Care City – what is expected from WF CCG PK

Formal launch today Testbed – had a discussion with 12 innovation partners – focused on HIE,

Orion, how to link into the local infrastructure BHR – use of Orion and NELFT and community services

Actions PK to provide a detailed update at next meeting, including

what WFCCG is expected to do and what it will get out of it - add to April agenda

Deadline

20.04.16

Owner

PK

10. Strategic level discussions with EMIS DP

Series of meetings with EMIS – high level meeting every quarter – feedback update from WEL and get strategic direction from EMIS

Need to understand what EMIS plan to do with mobile solution – EMIS Anyware is not a recommended solution to move forward

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EMIS mobile now has a published roadmap – there are no plans to make it a portable version of EMIS desktop – it will be a cut down version – don’t have roadmap

PK commented that EMIS mobile is fantastic for home visits and use in the community, EMIS Anyware - access from home is useful – so concerned if not a supported product.

Care plans – New module – part of core system - EMIS care plan module – completion June 2016 – will eventually support multi authoring – by Dec 2016 – data coded so could share through HIE – existing care plans are not easy to share – work with Coordinate my Care.

Mobile app – WEL strategy will utilise EMIS app – working with Cerner – how we present HIE info – No dates

Action: LB asked for an update on EMIS at future meeting, in

order to promote it in May. Add to May agenda

Deadline 18.05.16

Owner DP

11. Agree outgoing messages and target audiences in-line with the Communications Strategy

JF

JF will be attending the Healthwatch meeting and will mention enhanced SCR and online access – NHSE.

Action: JF and RG to discuss communications further

Deadline 20.04.16

Owner JF/RG

12. AOB All

LB thanked BS for his personal effort and support to WF CCG Next meeting is 20th April. JF gave her apologies.

Action:

Deadline

Owner

Details of next meeting: Date: Wednesday 20th April 2016

Venue: Boardroom B/C, Ground floor - Kirkdale House

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Highlights [IT Committee][April 2016]

Item 6.4b

Committee Minutes

IT Committee Minutes - April 2016

From Dr Mayank Shah, Chair of the Committee - WFCCG

Key highlights

Terms of Reference (ToR) Update An update on the IT Committee ToR provided as part of the pack. The committee

were asked for any comments and approval. A bullet was requested to be added as follows:

The role of the Committee is to lead on IT components of projects or systems, and to advise any other committee as appropriate on IT matters.

o 3. Objectives – Point 1 add back in interoperability

o To advise the governing body and other committees as appropriate

o Add new bullet – in section 4 - The role of this committee is to lead on the IT component of a project or scheme

It was also agreed that an update of ToR would need to be sent the governing body. To be tabled in June. Primary Care Technology Funds Bids / Capital An overview was given:

CCG has obtained approval infrastructure money to support IT infrastructure from capital bid lodged earlier in the year.

To date have not provided the portal for submissions – Portal will not be open until June – which will give more time to prepare

Has to be aligned to the digital roadmap

WFCCG will also have to submit their local specific bids

The Portal will open for 3 weeks for submissions in June

The committee were advised that there were further discussion taking place in regards to presenting as WEL Linked or Local around the following items:

Telephony solution WEL wide

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The Committee were informed that Attracta (NHSE) was also looking at a WEL wide telephone solution to be submitted via the PCTF. However, it was strongly stressed that WFCCG would not be supporting the telephony bid unless otherwise funded from a separate pot of money, as this would consume all the current year’s PCTF allocation. Health and Wellbeing Pods Call-in boards / TV systems in GP practices Check-in in all GP Practices

End Of Life (EOL) An overview of presented paper:

CMC (Vendor) gave a presentation in current offering which has been significantly improved and offers more features than 12 months ago, but still requires dual entry of data into EMIS and CMC (via a separate login and password)

Dec 2016 – expected functionality for CMC to share data with EMIS recommendation to use CMC.

Decision was made - in November if CMC have delivered extra functionality required by WFCCG then WFCCG would recommend the CMC solution.

Roadmap implies that by end of this year EMIS will have a care planning module delivering a ‘codeable’ solution

Current version of CMC product has been linked through HIE to Cerner. It was discussed that there is a recommendation that the PRSB standards for Crisis and EOL plan data sets be agreed by organisations in WEL as the minimum acceptable standard. It had been advised that this had been a national standard that we should adopt. Update on Digital Roadmap - Guidance

NHSE LDR guidance received - sets out structure and content of roadmap required

CCG’s have begun populating detail of Universal Capabilities - 10 universal capabilities pitched at a relatively low level e.g. use of e-referral choose and book

Final document to be presented at the next IT committee

For WFCCG social care is one of our planned activities – Newham will be first to in Summer 2016 with WF and TH following – challenge being that social care funding for IT is worse than NHS and manpower in social care is limited

Pharmacies don’t have access to GP clinical information – Only one of the pharmacies is aligned with EMIS. National programme for all pharmacies to have access to SCR Digital roadmap is being submitted as WEL

Sign off process for LDR for 7 CCGs is being defined – May IT Committee will have final version presented.

Strategic Direction ICM Update There is to be a pilot using EMIS Community for care planning Business case for EMIS Community presented at April’s F&Q - IT manager in NELFT

also to present business case in April.

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The business case had not followed governance by not being presented to the P & I for clinical approval. LB confirmed P&I need to review for formal sign off. Business Case had been approved in principal by F&Q committee subject to P&I review.

IT implementation progress report DTS

The radiology results rollout on DTS progressing well 40 of the 45 practices have now been completed

TQuest / Cyberlabs

Tquest o HN attended locality meetings and shared usage data o Further training required o Meeting to be arranged to plan training schedule for Practices o Templates for Dementia (already agreed) & Mental Health - discussion

ongoing, both templates to be developed once agreed at the same time. Cyberlab

o Upgrade of IE11 errors - decision made to upgrade Cyberlabs to 9.5 to rectify error - BARTS instructed awaiting new upgrade date

o API for SystmOne URL information sent to TPP – awaiting TPP to implement HIE

Upgrade to Version 13.1 completed successfully – this is in preparation to enable ELFT & Homerton Info to be viewed

Pathology results testing completed Cyto and Histo scheduled to go live ending April Micro & Blood Sciences to follow shortly after that

SKYPE Current pilot phase to be stopped in its current state due to further issues

regarding security. Pilot practices have emphasised their disappointment, meetings arranged to further discuss options

General Feedback positive both from Doctors and Patients Currently investigating other options (e.g. EMIS / NHSMail 2 Video

Consultations) iPlato (SMS)

Initial contact made with Account Manager to enquire process / costing for adjustment of SMS template to invoke our agreed plan to encourage patient online access uptake – Issue raised by Account Manager as to promoting other parties services when they also offer similar services

Decision will need to be made whether to review the current strategy regarding usage of Smartphone Apps.

149

IT Committee

Date: Wednesday 20th April 2016

Time: 15:00 – 17:00

Venue: Boardroom B/C, Kirkdale House, Leytonstone

Chair: Dr Mayank Shah (MS)

Attendees: Les Borrett (LB) Carl Edmonds (CE) Amanda Elias (AE) Richard Griffin (RG) Harry Nyantakyi (HN) Damian Pearce (DP) Bhagi Shah (BS) Nina Worley (NW) Dr Thaven Chetty (TC) Phil Woolley (PW) Shahnaz Begum (SB) Julia Walsh (JW) Nicola Pearce-McGinn (NP-M)

Apologies: Dinesh Kapoor (DK) Luke Readman (LR) Phil Koczan (PK) Joan Fratter (JF)

Agenda items

1. Welcome and apologies MS

The chair welcomed attendees and apologies noted.

2. Updated declaration of interest forms MS

No changes advised.

3. Notes from last IT committee & Matters Arising MS

Minutes from the March meeting were agreed and action log was updated.

4. Terms of Reference Update (Approval) NW

NW gave an update on the ToR provided as part of the pack. Asked the committee for any comments. CE asked if a bullet point could be added under maintenance of:

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The role of the Committee is to lead on IT components of projects or systems, and to advise any other committee as appropriate on IT matters.

o 3. Objectives – Point 1 add back in interoperability o To advise the governing body and other committees as appropriate o Add new bullet – in section 4 - The role of this committee is to lead on

the IT component of a project or scheme

It was also agreed that an update of ToR would need to be sent the governing body.


NW – to update the ToR with CE’s comments and resend.

HN to ensure on Governing Body update

27.04.16 May

NW HN

5. Primary Care Technology Funds Bids / Capital HN

HN gave an overview from paper as provided as part of the pack:

To date have not provided the portal for submissions – Portal will not be open until June – which will give more time to prepare

Has to be aligned to the digital roadmap The Digital roadmap will be presented to the May IT committee, GP WiFi won’t

include TH WEL wide telephony solution being led by NHSE Attracta – she was intending

to put through PCTF funding – if they are putting through same funding WFCCG will not be supporting – Attracta leaving soon need new contact – haven’t really understood ‘as is’ infrastructure

As CCG hosts London Interoperability programme – WFCCG will also have to submit their bid

The Portal will open for 3 weeks for submissions in June The committee were advised that they had still been in discussion around the following items:

Telephony solution WEL wide Health and Wellbeing Pods Call-in boards / TV systems in GP practices Check-in in all GP Practices

AE asked if this had been in alignment with Homerton and Redbridge and would it have an impact, is there any new items that they were focusing on. DP confirmed Hackney/Homerton are part of the WLC digital roadmap. Added that the costs would need to be finalised. It was discussed that HN and AE would need to spend some time to go through this.

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CCG has obtained £288k infrastructure money to support IT infrastructure from capital bid lodged earlier in the year. HN stated that Attracta (NHSE) was also looking at a WEL wide telephone solution to be submitted via the PCTF, however HN stressed that WFCCG would not be supporting the telephony bid unless otherwise funded from a separate pot of money. As this would consume all the current year’s PCTF allocation. HN also looking at GP check in, call in boards, self-care data.


HN and AE to arrange a meeting to discuss the bids.

HN to bring back finalised report back to June meeting

NP-M to ensure on May agenda

TBC June May

HN/AE HN NP-M

6. End of Life Care DP

DP presented on the paper as provided as part of the pack: The following points were highlighted:

Paper was drafted after last informatics steering group - held a wider session with people from integrated care – which data set should we use and which system

DP stated that CMC gave a presentation in current offering which has been significantly improved and offers more features than 12 months ago, but still requires dual entry of data into EMIS and CMC (via a separate login and password)

Dec 2016 – expected functionality for CMC to share data with EMIS recommendation to use CMC. Decision to be made in November if CMC have delivered extra functionality required by WFCCG.

Currently EMIS is used by different people in different practices – received roadmap which implies that by end of this year EMIS will have a care planning module delivering a ‘codeable’ solution

Have linked CMC through HIE to Cerner. It was discussed that there is a recommendation that the PRSB standards for

Crisis and EOL plan data sets be agreed by organisations in WEL as the minimum acceptable standard. It had been advised that this had been a national standard that we should adopt.


DP to bring back to the November meeting to see if the CMC development date had slipped. Once approved to offer to GPs via the WEL IT informatics group.

NP-M to add to agenda for November

November November

DP NP-M

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7. Digital Roadmap - Guidance DP

DP gave an overview from the paper proved as per the pack.

Received NHSE LDR guidance sets out structure and content of roadmap CCG begun populating detail of Universal Capabilities (Please see the 10

Universal capabilities as part of the paper) - 10 universal capabilities pitched at a relatively low level e.g. use of e-referral choose and book

Final document to be presented at the next IT committee. For us social care is one of our planned activities – Terry Huff is now on

board with pushing social care integration here – strategy hasn’t changed – Newham will be first in Summer 2016 with WF and TH following – challenging that social care funding for IT is worse than NHS and manpower in social care is limited

Pharmacy – don’t have access to GP clinical information – Only one of the pharmacy is aligned with EMIS. National programme for all pharmacies to have access to SCR – Pharmacies would like to have more access

Digital roadmap is being submitted as WEL Sign off process for LDR for 7 CCGs is being defined –May IT committee

will have final version presented.


MW to bring final draft of the paper Bill Jenks, Annette Breslin and MW looking at 10

universal capabilities on 25/4/16

NP-M to add to May agenda

May June May

DP/NW BJ/AB NP-M

8. Health Analytics ICM tQuest Procurement

CE advised the committee has been working with HN on spec for primary care data procurement. He confirmed that it would go to the committee next month, but advised that he would send it around prior to the meeting. To agree the process reviewing HA along other options: Nelie CEG EMIS enterprise


HN to contact BHR to seek confirmation of end date and renewal process.

May HN

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9. Strategic Direction ICM Update

There is to be a pilot using Emis Community for care planning Business case for EMIS Community presented at April’s F&Q - IT manager in

NELFT also to present business case in April. LB stated that the business case had not followed governance by not being presented to the P&I for clinical approval. LB confirmed P&I need to review for formal sign off. LB further stated that this had been approved in principle by F&Q committee subject to P&I review.

The F&Q committee asked for two issues to be addressed in the revised P&I paper

How the decision had been made to pilot in Chingford only – a wider set of practices was proposed.

How will the move from HA affect systm one practices.

Actions:

BS to present this at P&I NP-M to add to P&I agenda May

Deadline

May

May

Owner

BS

NP-M

10. Improvement of Uptake tQuest NP-M/CE

NP-M gives an overview to the committee on the uptake of tQuest as per the paper provided in the pack:

NP-M will lead a group to target those that need more training and those that have zero percent

GP ordering the pathology tests through tQuest CCG have been working with partners for many months to make this

operational The benefits – 1) Instant requesting of pathology services, and 2) reducing the

need to repeat tests for lost results There is a variation in usage from 0% to 97% We are proposing a 50% target for the year (average in Q4 was 31% - average

over the year was 21.28% ) this will be reviewed in 6 months with a possible extension

Promotion and focused effort commenced in Q4 A total of 203,144 pathology tests were requested of which 43,225 were via

tQuest

It was added that HN had attended localities meetings and that feedback had been that more training had been needed. NP-M confirmed that she had set up a meeting with HN, NW, CD and herself to work on an action plan. Added that this will be taken back to the IT Implementation group.

NW advised that they had been currently working on 2 new templates Dementia and Mental Health. It was confirmed that DP had been leading on these along with

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Ruth Arling. These templates are currently in discussion and will both be uploaded at the same time.

The Action plan needs to include three things:

1) general training and support

2) target low using practices

3) improve functionality of tQuest

Committee agreed to adopt 50% for the year with a review mid-year to increase target.

MS raised his concerns on a tQuest results not defaulting back to the requesting GP.

NW confirmed that this needed to be reported to EMIS, suggested that MS should raise a ticket with EMIS to investigate.

Action: NP-M to bring action plan back to the IT Implementation

group, once done. MS to raise a ticket with regards to his tQuest problem

in order to investigate.

Deadline May 22.04.2016

Owner NP-M/HN MS

11. IT & Digital Implementation HN

HN gave the following updates:

DTS The radiology results rollout on DTS progressing well 40 of the 45 practices have now been completed

TQuest / Cyberlabs

Tquest o HN attended locality meetings and shared usage data o Further training required o CD has been informed and meeting to be arranged to plan training

schedule for Practices o Templates for Dementia (already agreed) & Mental Health - discussion

ongoing, both templates to be developed once agreed at the same time. Cyberlab

o Upgrade of IE11 errors experienced HN sort GP opinions and they find its annoying as the error message reoccurs frequently

o Decision made to upgrade Cyberlabs to 9.5 to rectify error has been taken and BARTS instructed awaiting new upgrade date

o Upgrade to version 9.7 (will include usage reporting) currently scheduled for April next year due to resource constraints at BARTS

o API for SystmOne URL information sent to TPP – awaiting TPP to implement

HIE Upgrade to Version 13.1 completed successfully – this is in preparation to

enable ELFT & Homerton Info to be viewed Current Version of HIE Roadmap received as part of presentation (HN to

chase for a full readable copy)

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Pathology results testing completed Cyto and HIsto scheduled to go live ending April Micro & Blood Sciences to follow shortly after that

GP IT operating model contract (Saxon / CSU / FedNet)

Saxon o Service Spec has been developed as a schedule to the existing

contract by means of a contract variation - MOU of understanding has been agreed

o HN To review priority out of hour call data o HN To review Saxon Contract – pertaining to upfront payment

CSU o GMC to update service spec when he returns from Annual leave

FedNet o Update required regarding contract between FedNet & CSU

SKYPE

Current pilot phase to be stopped in its current state due to further issues regarding security. Pilot practices have emphasised their disappointment meetings arranged by Sultana to further discuss options

General Feedback positive both from Doctors and Patients HN investigating other options (e.g. EMIS / NHSMail 2 Video

Consultations) Decision will need to be made to further pilot new options

TC expressed concerns with regards to ending this pilot as patients had been benefiting from this system. LB clarified that if patients are benefiting from this service that the CCG would not be stopping this. It was discussed that there had been a risk of using Skype as this could cause a virus. Need to work with Saxon in carrying out a risk assessment. Agreed to continue the pilot but to acknowledge that there is a risk. Harrow Road will join, but taking the opportunity to use a different system. DP stated that he had been happy to be involved in the conversations around the risk assessment. NW added that the pilot had been due to end at the end of April, and those patients that had already signed up would continue with the pilot with a report of recommendations. CE stated that he would feedback the concerns to SR and the rolling out of system. Website pilot

Ongoing – awaiting updated quote information

iPlato (SMS) Initial contact made with Account Manager to enquire process / costing for

adjustment of SMS template to invoke our agreed plan to encourage patient online access uptake – Issue raised by Account Manager as to promoting other parties services when they also offer similar services

IPlato have worked with HSCIC and further developed their Smartphone App and willing to make the adjustment via the Smartphone App but this conflicts with our Strategy to use the EMIS App which still lacks certain functionality

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Decision will need to be made whether to review the current strategy regarding usage of Smartphone Apps

Action: HN to review the current smart APP option AE to contact FS with regards to the creation of SKYPE risk

assessment Saxon to contact HN to discuss the creation of a risk

assessment of SKYPE CE to feedback to SR for a formal review on the pilot and to

produce a report. HN to distribute the EMIS roadmap to the team. HN to bring back a paper to the June IT Committee on

iplato app vs EMIS app and the timescales. NP-M to add iplato to the June IT Committee agenda.

Deadline May May May May May May June June

Owner HN AE AE/FS HN CE/SR HN HN NP-M

12. Agree outstanding message and target audience’s in-line with Commutations Strategy

JW

NP-M to ensure that JW is updated on the tQuest action plan. HN to update JW on the progress of the Skype project and to agree the comms

going forward – help on learning points

Action: NP-M to ensure that JW is updated on the tQuest action

plan. HN to update JW on the progress of the Skype project and

to agree the comms going forward – help on learning points

Deadline May May

Owner NP-M HN

13. AOB All

MS raised some concerns around locums having IT issues. The problem had occurred because the agency won’t give out the locum’s telephone number beforehand and therefore, their IT systems could not be set up. This had caused huge problems and delays. NW stated that she had contacted FS with regards to the guidelines, as he had made some changes, with regards to sharing logins. It was discussed that the patients would need to engage with comms on what changes had been made. MS advised the committee that the following practices had been experiencing some issues: Firs St James Street Addison Road

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NW confirmed that she would be asking FS to go revert back to the original SLA. PW asked for clarification around the Hayat Surgery management by Manor Road surgery. The committee were advised that the letters were going out to patients on the 1st May, advising them that the caretaking would be coming to an end. The patients are given the opportunity to either join the Manor surgery on a permanent basis or to find alternative GP. If the patient does engage in the process they will automatically be transferred on to the Manor Practices books. It was advised that the 2 systems will be merged together along with data. PW also raised concerns around the lack of notice from the Mircofaculty practice. They had contacted Saxon asking for PCs to be moved due to building work being done. Stated that they needed more than 1 week’s notice. CE added that the practice had only been notified by NHS England the week before and had been given the go ahead to do these works. Stated that PW could pick this up with AP.

Action: AE to speak to Saxon to see if the process had gone back

to the original SLA. JW to send HN the letter that had been sent to the Hayat

patients. PW to raise the issue with AP with regards to moving of the

PCs.

Deadline May May MAY

Owner AE JW/HN PW

Details of next meeting: Date: Wednesday 18th May 2016 – 3pm to 5pm

Venue: Boardroom B/C, Ground floor - Kirkdale House

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Highlights [Medicines Management Committee] [March 2016]

Item 6.5a

Committee Minutes

Medicines Management Committee Minutes - March 2016

From Dr Ravi Gupta, Clinical Director and GP Prescribing Lead - WFCCG

Key highlights

It has been agreed that the Medicines Management Committee will be known as

the Medicines Optimisation Committee as of 1 April 2016 to fully represent the work undertaken by the committee.

The MMC have approved the terms of reference for the WEL prescribing group for the managed entry of new drugs in the health economy. This is required because of the uncertainty of the continuation of NELMMN and the change in the accountability of Barts Health NHS Trust Drugs and Therapeutic Committee.

The Medicines Management Committee reviewed the Commissioning for Value: Where to Look January 2016 document for Waltham Forest CCG and agreed to include the recommendations relating to prescribing as a part of the 2016-17 work plan.

159

1

Minutes

Meeting Medicines Management Committee

Date and Time: Wednesday 9th March 2016 2:00pm-4:00pm

Venue: Boardrooms B&C, Kirkdale House, 7 Kirkdale Road, E11 1HP

Chair: Dr. Mayank Shah

Attendees: Name Title

Dr. Mayank Shah MS Waltham Forest CCG GP Clinical Director Ada Onyeagwara AO Associate Director, Head of Medicines Management Team for Waltham

Forest Hassan Serghini HS Senior Prescribing Advisor, Waltham Forest Medicines Management Team Kay Saini KS Senior Prescribing Advisor, Waltham Forest Medicines Management Team Natalie McCallam Thomas

NMT Team Administrator, Waltham Forest Medicines Management Team

Dr.Prakash Kawar

PK Local Medical Committee representative for Waltham Forest

Dr. Rishav Dhital RD GP Prescribing Lead for Walthamstow Mayur Patel MP Local Pharmaceutical Committee representative for Waltham Forest Anne Walker AW Interim Deputy Director of Quality, Waltham Forest CCG Dr Ravi Gupta RG GP Walthamstow Locality (Observer)

Apologies Name Title

Anisha Sharma AS Prescribing Advisor, Waltham Forest Medicines Management Team Dr. Imran Kazi IK GP Prescribing Lead for Chingford Dr.Thaven Chetty TC GP Prescribing Lead for Leyton/Leytonstone Carol Greening CG Assistant Director of Clinical Pharmacy Barts Health NHS Trust Kamaljit Takhar KT Deputy Chief Pharmacist, NELFT CSS Services Helen Davenport HD Director of Nursing, Quality and Governance Lynn Snowden LS Senior Commissioning Manager, Waltham Forest

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2

16/03/01 Welcome and apologies The chair welcomed the members to the meeting. Apologies received as above.

This was Dr Shah’s final meeting as chair of the MMC, as Dr Ravi Gupta will be taking over the role of CCG GP Clinical Director from April 2016.

16/03/02 Declarations of Interest and Register of Committee Interest The Medicines Management Team attended a training session with neoNavitas on 11

February 2016 on Influencing in Prescribing. This was provided at no cost, and declaration of interests have been submitted to NELCSU.

16/03/03 Minutes and matters arising Review of January 2016 Minutes

MMC minutes were approved by the Committee as accurate. A concern was raised in relation to action MMC174 which request governance around the administration of vaccines. It was expressed that if a query arose in relation to the administration of any vaccine, Community Pharmacists may experience difficulty getting in contact with a GP prior to administering, which would cause undue delay to the patient. This was discussed and it was highlighted in the interest of clinical governance that if a pharmacist does not have enough information regarding the patient’s medical history, or knowledge of whether they actually require the vaccine, then the vaccine should not be administered.

Review of Action Tracker MMC179 – MMT comments previously made about the epilepsy shared care guidelines to Dr Andrew Kelso, Consultant Neurologist at the Royal London Hospital, have been resubmitted so that they can be incorporated. This action is now closed. MMC 178 – The Prescribing Advisors have liaised with the clinical leads to discuss the formal visits to the top overspent practices, and will arrange visit dates in due course. The overspent practices report was also reviewed at the Performance and Quality Meeting who will hold discussions with primary care regarding any issues raised. This action is now closed. MMC 177 – The GP alert officer has now provided clarification on when GP alert system should be used. The system is only to be used for non-urgent clinical or governance queries. Any queries that are urgent in nature would require the GP to contact the acute trust directly. Queries that are sent via the GP alert system are risk assessed and are normally responded to within 13 days. The Performance and Quality Committee will also clarify this information to all GP practices. The action is now closed. MMC172 – This action relates the medicines leaflet, which is on the agenda and is being presented for approval. This action is now closed. MMC158 – The MMT are seeking clarity on which travel vaccinations can be issued on the NHS and are reviewing the GMC contract regarding the provision of travel vaccines on the NHS. It was noted at the meeting that GP contracts were previously based on the Statement of Fees and Allowances (also known as the ‘red book’). Action: MMT to review the Statement of Fees and Allowances (‘red book’) regarding provision of travel vaccines.

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16/03/04 Quality, Performance and Governance Risk Register

R03- Nursing Home The CQRM has reviewed the report received from the nursing home and found that it did not respond adequately to the specific medicines management issues raised. The nursing home has been asked to formulate an action plan to remedy the issues highlighted in the report. An unannounced visit to the nursing home will also be carried out in April with the Deputy Director of Quality and member of the MMT. If it is found that the recommendations have not been implemented, the matter will be escalated to the Care Quality Commission, or a contract performance notice may be issued by the CCG. RAG Rating: Remains the same as last month 16 (RED) – (4 for likelihood and 4 for consequence) R06- Antibiotic quality premium The CCG is currently not on target to meet part B of the Quality Premium (QP) for the prescribing of broad spectrum antibiotics, but prescribing continues to decline in the borough. The CCG will meet at least 70% of the QP. David Pearce, Head of Governance, will be contacted to ensure that this risk is included in the Board Assurance Framework (BAF) papers. Sinnott Road Surgery has been identified as a high prescriber of broad spectrum antibiotics, which they have confirmed is due to a large percentage of their patient population presenting with lymphoedema cellulitis, HIV and leg ulcers. Action: MMT to discuss high prescribing of antibiotics with Sinnott Road Surgery and provide additional support where necessary. Hannah Patton, Clinical Nurse Specialist- Tissue Viability Manager may be requested to assist in this matter. RAG Rating: Remains the same as last month 15 (RED) – (5 for likelihood and 3 for consequence) R07- Communication The MMT will discuss communication at the next contract meeting with Barts Health. A process has now been put in place to improve communication, which is working well. No subsequent issues have arisen, but the MMT will continue to monitor response times to queries sent to the Barts Health generic prescribing query inbox. This risk is now closed. R08- Escalation of issued identified by CCG in primary care to NHS England A response has now been received from William Rial at NHS England (NHSE). The unidentified prescriber has now been identified as a locum GP. The prescribing code that is being used by the prescriber is not linked to the practice code. For this reason the business Authority were charging NELFT as the address of the prescriptions generated by the prescriber had the Score building details on them which was the previous address assigned to the Non-medical Prescribers. The practice has now been advised to rectify this. MMT will continue to monitor the situation and NHSE will review whether the patients named on the prescriptions issued are legitimate.

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Mr Rial also confirmed that the MMT used the correct process to report the issue, however the delay in the identifying the prescriber was due to NHSE. Action: MMT to remind GP practices of the importance of using correct prescribing codes and ensuring they are linked to the correct practice. This risk is now closed. Medicines Management at Whipps Cross At the last CQRM meeting between WFCCG and Whipps Cross, a point was raised regarding the medicines management review, and that ‘further work was required to improve medicines management in clinical areas’. As the subtext was unclear, the CCG has asked Barts Health to provide some clarity. The MMT will also work together with the Pharmacy Lead at Whipps Cross to address the specific medicines management issues raised in the CQC report and ensure processes are put in place.

MMC Achievements The MMC looked at the achievements of the Committee and highlighted the progress made over the last three years. The MMC thanked Dr Shah for his hard work and dedication over the past three years, and wished him all the best in his new role.

Name Change The Medicines Management Team proposed changing the name of the team to reflect the breadth of work the team undertakes in their current roles. With the focus on medicines optimisation, it was suggested from 1 April the team should be known as The Medicines Optimisation Team. In line with this, the Medicines Management Committee would be known as the Medicines Optimisation Committee. The Terms of Reference will be reviewed and the proposed changes implemented. A paper will also be submitted to the Governing Body to inform them of the changes. Action: MMT to prepare a briefing paper for the Governing Body confirming the change of name to the MMT and MMC, making clear that the functions will remain the same. Action: Amended terms of reference to be brought to the next MMC meeting for approval.

Future of WEL Prescribing Group A case for change has been put forward following the disbanding of the Barts Health and local CCG Joint Prescribing Group (JPG) and the subsequent creation of a Drug and Therapeutics Committee (DTC). A gap has been identified in the current structure, so the proposal is to change the WEL Prescribing Group from an advisory committee to a decision making committee for medicines optimisation and commissioning decisions across primary and secondary care. The LPC, Bart Health and Primary Care will attend the meetings and decisions made will be brought to the MMC for final authorisation.

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Event sponsor summary A summary of the organisations who have sponsored events hosted by the Medicines Management Team in 2015-16 was presented to the MMC for information.

C.Difficile report The Barts Health Infection Control Team have compiled two reports highlighting the results of all C.Difficile cases within the trust from April to December 2015. This was presented to the MMC for information. It was noted that antibiotic and PPI medication usage were two of the main causes of C.Difficile. Whilst antibiotic usage is regularly reviewed by the MMT, PPI medication has not been addressed recently. The MMT will therefore plan for a potential review of PPI medication usage within the borough, engaging with other local CCGs and secondary care.

16/03/05 Finance and QIPP Dashboard

The dashboard for December 2016 was presented to MMC for information, and will be sent to practices at the end of March. The Committee also discussed whether the dashboard was of value to GP practices. The dashboard is currently produced by the MMT on a monthly basis, but is very time consuming. It was agreed that If practices do not use it often, or do not find it useful then other options to disseminate data should be investigated. Action: MMT to attend locality meetings to gauge GPs’ opinion on whether dashboards are a useful tool.

ScriptSwitch update An update on the use of ScriptSwitch by practices was presented to the MMC for information. The Committee was informed that there will be an update to the content on ScriptSwitch, which will change the current format and make it easier to manage messages. The MMT will receive training on managing the software and Optum (the providers of ScriptSwitch) will contact each practice directly to ensure a smooth transition.

CSS prescribing data An update on the prescribing costs by the CSS was presented to the Committee for information.

PSP savings report An update of the savings identified by the Practice Support Pharmacists in February 2016 was presented to the Committee for information.

Commissioning for value The Commissioning for Value document was produced by NHSE and Public Health England, personalised to Waltham Forest CCG and has been used to support local discussion about prioritisation to improve the value and utilisation of resources. The MMT reviewed the potential savings identified in the document and presented a report in response to this.

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Respiratory was identified as a large opportunity area for WF, but there is currently no respiratory lead at the CCG. The MMT will therefore engage with the NELFT asthma nurse and Whipps Cross asthma lead to take this forward. The findings of the report will also form part of the MMT’s work plan for 2016/17.

16/03/06 Medicines Optimisation Scheme 2016-17 The final version of the Medicines Optimisation Scheme 16/17 document was presented to

the MMC for approval. Both the LPC and the LMC have had sight of the document and no comments have been received by either organisations. The Medicines Optimisation and Polypharmacy Audit has been amended to incorporate comments previously received, but no further changes have been made to the Antibiotic Review and Pain Review. MMC approved the contents of the document and agreed to promote the value of undertaking audits to their peers. The Prescribing Leads will support the implementation of the scheme and answer queries raised by their peers. The launch of the MOS 16/17 will be on 28 April at the County Hotel and will be branded as the: Medicines Optimisation Scheme 16/17 – What does it mean for me, my patients and the CCG? The information will also be presented at the locality meetings and practice visits in May and June. A general discussion took place in relation to the incentive scheme and the continuing decline of engagement from practices over the years. The MMT put forward the idea of abolishing the scheme and recruiting Practice Support Pharmacists to support with the improvement of medicines optimisation in practices. There was no consensus amongst the Committee members as to the replacing the scheme in line with the proposal as it was felt that would further reduce practice engagement and instead agreed to discuss other options in more detail at the next MMC meeting. Action: Incentive scheme to be added to the next MMC agenda.

16/03/07 Medication leaflet for patients The leaflet which provides information to patients as to when and why changes are made

to their prescribed medicines has now been reviewed by the patient focus group and updated in line with the comments received. The final draft was presented to the MMC for approval. MMC approved use of the leaflet, which will also be added to the CCG website.

16/03/08 Drugs and Therapeutic Committee (formerly known as JPG) A summary of the February 2016 DTC meeting was provided to MMC. Some of the key

highlights included:

Issues regarding the DTC meetings being quorate have arisen, which is being looked into. The Committee’s revised terms of reference were also circulated.

A new declaration of interest form (including guidance on what to declare) for

members and non-members of the DTC was presented.

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The Committee approved the addition of IV Oxycodone for paediatric pain to the formulary. Oxycodone for acute pain will be administered in hospital if morphine or fentanyl are ineffective.

The Committee approved the addition of the contraceptive Levosert® to the formulary, which is newly launched in the UK and an alternative to Mirena®.

The NOAC initiation letter to GPs has been deferred to the next meeting.

A type 2 diabetes working group has been set up to review the medicines used for

the treatment of diabetes drugs across NE London. A meeting has been organised to establish the work that is required for this process. There will be representation from GPs, secondary care and hospital pharmacies.

16/03/09 WEL Prescribing Group The WEL Prescribing Group meeting is being held on 23 March 2016 and an update will

be provided at the next MMC.

16/03/10 NELMMN The NELMMN meeting is being held on 9 March 2016 and an update will be provided at

the next MMC.

16/03/11 NELFT update The NELFT meeting is being held on 15 March and an update will be provided at the next

MMC.

16/03/12 Queries Query Log (February 2016)

A log of queries received by the MMT were presented to the MMC for information. Following the review of the log, GP Committee Members were concerned with the fact that GPs may be required to prescribe erectile dysfunction devices where the patient is not skilled at administering safely, and would need to rely on secondary care to provide training. MMT will raise the issue of the drug tariffs with the contracts team, to establish whether funds can be transferred to secondary care who will then be able prescribe the treatments instead of primary care.

16/03/13 NICE Update A review of the recently issued NICE guidance relevant to Primary Care was presented to

the Committee.

16/03/14 LPC Update Following the scoping exercise held on 27 January in relation to repeat prescribing,

the LPC held a follow up workshop with representatives from the LMC and MMT to discuss agree principles. Final documentation from the meeting will be circulated in due course

The LPC are preparing a response to the consultation on the proposed 6% cut to

community pharmacy funding.

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The LPC have made a request to discuss with the MMC some of the services available from community pharmacists, but to date, no further information has been received from the LPC. This will follow this up, to ensure the matter can be discussed at the next MMC meeting.

16/03/15 LMC Update The draft Medicines Optimisation Scheme 16/17 has been presented to the LMC, but has

received no further comments. A comment has been received in relation to the Medicines Optimisation Scheme by a GP who has concerns over the work required as part of the scheme for 2016-17. A formal response was made by the clinical director.

16/03/16 AOB

Access to end of Life drugs – The service specification has been completed and will be forwarded to the LPC for comments and agreement.

The price of senna tablets has reduced significantly and thus this indicator has

been removed from the incentive scheme 2016-17. GPs can now prescribe for patients that have been discharged from secondary care on senna as this would be considered a cost effective option for the management of constipation.

RG enquired about local enhanced services with regards to DMARDS and whether

an incentive scheme for GPs could be set up in Waltham Forest, similar to the one set up by West Essex CCG. To initiate the process, RG will discuss this further with Dr Sheik, Primary Care Committee Lead to review.

Dr Shah thanked the MMC for their support over the past 3 years and wished Dr

Gupta all the best in his new role as CCG GP Clinical Director.

Wednesday 13th April 2016 2:00pm - 4:00pm

Boardrooms B & C, Kirkdale House, 7 Kirkdale Road, Leytonstone, E11 1HP

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Highlights [Medicines Optimisation Committee] [April 2016]

Item 6.5b

Committee Minutes

Medicines Optimisation Committee Minutes - April 2016

From Dr Ravi Gupta, Clinical Director and GP Prescribing Lead - WFCCG

Key highlights

The Private Prescription Policy was approved by the Committee. The policy clarifies the responsibilities of prescribers working within Waltham Forest CCG, relating to patients moving between private and NHS care settings.

The Committee has approved The Stoma Guidelines to help support GPs within

Waltham Forest with the prescribing and management of patients with stomas. The document aims to:

- Ensure high quality, cost-effective prescribing - Rationalise prescribing of stoma products to prevent waste - Provide information on the prescribing of stoma accessories

The Medicines Optimisation Scheme 2016-17 has been approved by the

Committee and will be launched on 28 April 2016 for all GPs within Waltham Forest CCG. There will be a presentation from The Royal Pharmaceutical Society on Medicines Optimisation and the session will introduce all attendees to the required work to be carried out for the audits.

The Committee have approved the budget setting model for 2016-17 for practices within Waltham Forest CCG. The has been set as follows:

- 30% was based on historic performance - 70% was based on ASTRO-PU with an uplift for practices with nursing

home and care home patients, deprivation and long-term conditions specific to the practice.

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Minutes

Meeting Medicines Optimisation Committee

Date and Time: Wednesday 13th April 2016 2:00pm-4:00pm

Venue: Boardrooms B&C, Kirkdale House, 7 Kirkdale Road, E11 1HP

Chair: Dr. Ravi Gupta

Attendees: Name Title

Dr. Ravi Gupta RG Waltham Forest CCG GP Clinical Director Ada Onyeagwara AO Associate Director, Head of Medicines Management Team for Waltham

Forest Hassan Serghini HS Senior Prescribing Advisor, Waltham Forest Medicines Management Team Anisha Sharma AS Prescribing Advisor, Waltham Forest Medicines Management Team Natalie McCallam Thomas

NMT Team Administrator, Waltham Forest Medicines Management Team

Mayur Patel MP Local Pharmaceutical Committee representative for Waltham Forest Dr. Imran Kazi IK GP Prescribing Lead for Chingford Dr.Thaven Chetty TC GP Prescribing Lead for Leyton/Leytonstone

Apologies Name Title

Kay Saini KS Senior Prescribing Advisor, Waltham Forest Medicines Management Team Dr. Rishav Dhital RD GP Prescribing Lead for Walthamstow Carol Greening CG Assistant Director of Clinical Pharmacy Barts Health NHS Trust Kamaljit Takhar KT Deputy Chief Pharmacist, NELFT CSS Services Helen Davenport HD Director of Nursing, Quality and Governance Lynn Snowden LS Senior Commissioning Manager, Waltham Forest Anne Walker AW Interim Deputy Director of Quality, Waltham Forest CCG Dr.Prakash Kawar PK Local Medical Committee representative for Waltham Forest

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16/04/01 Welcome and apologies The Chair of the Committee welcomed members to the meeting. Apologies received as

above.

16/04/02 Declarations of Interest and Register of Committee Interest There were no declared interests.

The Committee were reminded to submit their annual declaration for 2016/17. The Medicines Optimisation Team (MOT) will recirculate the template to the committee members.

16/04/03 Minutes and matters arising Review of March 2016 Minutes

MMC minutes were approved by the Committee as accurate.

Review of Action Tracker MMC180 – The practice has been contacted and will confirm a date when the Clinical Nurse Specialist-Tissue Viability Manager can attend. MMC 181 – MS raised the matter of the Committee’s and Medicine Optimisation’s name change at the Governing Body Meeting, which was approved. This action is now closed. MMC 182 – The terms of reference for the new Medicines Optimisation Committee (MOC) will be discussed in today’s agenda. MMC183 – The MOT will attend the locality meetings in May 2016 to gauge the GP’s opinion on whether dashboards are a useful tool for providing data relevant to their practice. MMC184 – Planning for the incentive scheme 2017-18 will be discussed at the next meeting in May.

16/04/04 Quality, Performance and Governance Risk Register

R03- Nursing Home Following the submission of an action plan by the nursing home, the CCG will be conducting a quality assurance visit within the next month to confirm whether the identified issues have been addressed and recommendations implemented. It was noted that that the CCG have commissioned an enhanced service with other care homes, nursing homes and sheltered housing. RAG Rating: Remains the same as last month 16 (RED) – (4 for likelihood and 4 for consequence. R06- Antibiotic quality premium Waltham Forest CCG is unlikely to meet part B of the 2015/16 NHS England Antibiotic Quality Premium (QP) for the prescribing of broad spectrum antibiotics. It was agreed that the rag rating will remain the same, antibiotic prescribing will continue to for part of the 2016/17 Quality premium. RAG Rating: Remains the same as last month 15 (RED) – ( 5 for likelihood and 3 for consequence).

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Terms of Reference review Following the change in name of the Medicines Management Committee (MMC) to the Medicines Optimisation Committee (MOC) on 1 April 2016, it was agreed to review the terms of reference (ToR) at this meeting. The following changes have been agreed: Page 1. Medicines Management Committee The name of the committee will be changed to Medicines Optimisation Committee, and all references made to medicines management will be amended to medicines optimisation. Page 1. Membership (core membership)

Waltham Forest CCG Executive Committee Representative should be removed from the core membership and replaced with a member from the Quality and Governance team.

Lay person/member of the public forms part of the core membership in the current

ToR for the MMC, though the committee has never had representation. The Committee agreed that the role was important to the membership for governance purposes and providing patient insight to matters. Due to the sensitive nature of some of the issues discussed at MOC, the person appointed will be required to complete a declaration of interest and confidentiality agreement.

ACTION: MOT to enquire about a lay person/member of the public attending the MOC.

Nurse prescriber should be removed from the core membership and be invited to

MOC meetings as required.

Practice Manager (PM) - It was suggested that this be added to the core membership, as a PM could provide valuable input into the MOC discussions and decision making. It was highlighted to the Committee that there is no additional funding available for this member, but if capacity is available, they will be added to the ToR. If there is no capacity available, a PM will be invited to attend the MOC meeting as required.

ACTION: MOT look into the practicality of having a practice manager attend the MOC meetings.

Page 2. Quorum The Committee agreed that for each meeting to be quorate, 5 members of the MOC must be in attendance, including the Chair or Assistant Director of the Medicines Optimisation Team and at least 2 GPs. Page 4. Whole system approach ‘The Committee will work closely with Barts Health Joint Prescribing Group and North East London Medicines Management Network’ will be amended as the JPG has been disbanded and the future of NELMMN has not been determined. The paragraph will now read ‘The Committee will work closely with the WEL prescribing board and any other local decision making bodies’.

Private prescription policy This document was presented to the MOC for approval. The policy has been produced to clarify the responsibilities of prescribers working within Waltham Forest CCG, relating to patients moving between private and NHS care settings.

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The document was based on the BMA General Practitioners Committee (GPC) document on Prescribing in General Practice and the BMA Ethics Department document on ‘The interface between NHS and private treatment: a practical guide for doctors in England, Wales and Northern Ireland.’ The general advice is that a patient who has previously been in private care should only be prescribed medications that are in line with NHS protocols. As this patient cohort is increasing, it was suggested that a template query form be developed to send to the private prescriber and a patient information letter clarifying that any drug that is not on the local formulary or is unlicensed will be at the discretion of the GP to prescribe. It was noted that the responsibility for issuing the first prescription was not mentioned in the private prescription policy. ACTION: The MOT will look at whether this information can also be included.

Joint working with industry proposal with Teva UK The pharmaceutical company Teva have submitted a business case proposal to MOC outlining a joint working respiratory project in Waltham Forest. The proposal is to provide funding for:

Pharmacists to carry out the respiratory work (the pharmacist will be commissioned by the MOT, and will be independent of Teva)

A patient engagement exercise Printing respiratory posters In-check dials for the GP practices, to assist with inhaler technique reviews

The proposal is an extension to the current established respiratory service within the borough and will provide funding for the pharmacist to work an additional two days. The governance arrangements of the proposal are in line Waltham Forest CCG’s working with industry policy. It was highlighted to the committee that Teva products have been included on the Waltham Forest formulary, but the decision was made by Bart’s Health Joint Prescribing Group prior to the proposal being submitted. The Committee approved the proposal and agreed that training can be provided to patients and the Local Pharmaceutical Committee. The proposal will now be taken to the Finance and QIPP committee for sign off.

End of life care document and update An ‘Improving the quality of care in the last days of life - ways to help get the medications right’ document produced by the Guy’s and St Thomas’ NHS Foundation Trust Consultant Pharmacist in Palliative and End of Life Care was presented to the Committee for approval. It can help support Waltham Forest CCG to work towards a framework for End of Life Care in terms of medication. The document is currently in draft form and is awaiting publication by NHS England. The committee will await publication of the document by NHS England before implementation of the document.

Stoma guidelines The guidelines were presented to the committee for approval. The guidance has been developed in collaboration with the stoma nurses from Barts Health to support prescribers with the management of patients with stomas, and aims to:

1. Ensure high quality, cost-effective prescribing 2. Rationalise prescribing of stoma products to prevent waste 3. Provide information on the prescribing of stoma accessories

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4. Provide advice on retrospective prescribing The Committee suggested that this may be a good area for support pharmacists to audit/review. Catheter prescribing was identified as an area to review next. These guidelines were approved by the Committee, and will be added to the GP intranet.

Adrenaline/Emerade® guidelines Barts Health has moved to using Emerade as the first choice adrenaline auto-injector pen. A guide to support this transition to help implement the use of Emerade® in primary care was presented to the Committee for approval. The advantages of the change have been:

Emerade® meets the dosing requirements of 500 micrograms for a child over 12 years and adult as stated in the Resuscitation council (UK) Anaphylaxis algorithm with treatment guidelines

Longer needle for better administration, a necessity as highlight by a MHRA safety report.

Easy to use design and injection procedure It has a longer shelf-life than the other adrenaline auto-injector products (30 months)

The guidelines also highlight the number of injector pens to be prescribed as recommended by the MHRA The plan is to move patients from the existing Epipen® to Jext® to Emerade. The company is also able to provide training as required. The guidelines were approved by the Committee. ACTION:

Emerade® switch to be added to ScriptSwitch®. LPC to cascade the change in prescribing to their contractors.

Zoladex briefing

Waltham Forest CCG’s position for the payment for administering LHRH analogues still stands. There is currently a process for reimbursing the practices for the administration of the LHRH injections via the Personal Administration (PADM) from the NHSBSA. There was uncertainty around whether there was an option for payment as a part of the Minor Surgery DES previously. This issue has been clarified and it was confirmed that LHRH administration was not a part of a Minor Surgery DES previously. The Committee was advised that payment for administration via the PADM route is currently being underutilised. GPs should be encouraged to obtain payment by this route. The Committee agreed that funding the administration of this drug can set precedence to other injectable medications and may have a negative impact on the patient. The Committee approved the position. Action: MOT to issue a letter to the LMC clarifying Waltham Forest CCG’s position on personally administered drugs.

Respiratory poster This poster was developed by the Medicines Optimisation team to support clinicians with selecting the most appropriate device for adults with Asthma. Key stakeholders have been involved in the development including GPs and local respiratory specialists. TEVA have provided the graphics and printing of the poster.

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The poster will be used in general practice, respiratory clinics and will be available on the GP intranet. It also works in conjunction with the asthma formulary, which will be taken to the Barts Health meeting in May. The Committee approved the poster, which will be launched at the MOS event on 28 April. ACTION: The medications on the poster to be amended and listed alphabetically.

16/04/05 Finance and QIPP Proposed prescribing budgets

The 2016-17 budget setting process and final allocations for all practices in Waltham Forest were presented to the Committee for approval. For 2016-17, the practice budgets has been set 30/70 - 30% based on historic performance and 70% based on ASTRO-PU (for 2015-16 it was 50/50). Some practices will receive extra weighting within the ASTRO-PU based on the nursing homes and care homes attached to the practice, deprivation and long-term conditions specific to the practice. The uplift has been capped at 3%. Practice A – This practice is no longer in operation, but as the patient list has not yet been dispersed, they have been allocated a nominal budget. The remainder of the budget they would have received has been allocated to the practice managing the patient list. As the patient list for Practice A is being dispersed in late July, and some changes are being made to another practice, it was proposed that the budget model be revisited in September 2016. The Committee approved the budget setting proposal.

Dashboard The dashboard was not be submitted to the Committee due to a technical issue. Once resolved, the dashboard will be made available to all practices.

ScriptSwitch update An update on the use of ScriptSwitch® by practices was presented to the MOC for information. ACTION: MOC to update the list of practice names currently on ScriptSwitch ®

CSS prescribing data An update on the prescribing costs by the CSS was presented to the MMC for information.

PSP savings report An update of the savings identified by the Practice Support Pharmacists in March 2016 was presented to the MOC for information.

2015-16 Practice diabetes review The Committee were asked to review the Diabetes Audit submitted by GP practice 2166 as part of the Prescribing Incentive Scheme for 2015-16. The practice has completed the data collection portion of the audit, but has not documented the review of their prescribing, not provided an action plan nor identified any learning outcomes. The Committee agreed that as the data collection portion of the audit has been completed, the practice should be given the opportunity to make the necessary amendments to their audit and resubmit it.

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ACTION: A letter will be sent to the practice from the Clinical Director, asking for appendices 2 and 3 of the diabetes audit to be completed and resubmitted.

16/04/06 Medicines Optimisation Scheme (MOS) 2016-17 The MOT will be holding a launch event on 28 April 2016 for GPs in Waltham Forest.

A member of the Royal Pharmaceutical Society (RPS) will speak at the event about

the general principles of Medicines Optimisation, and what it entails.

The session will introduce the attendees to the audits required for 16/17, but will not detail the indicators in the scheme. This will be completed during the annual practice visits.

The Committee members agreed that the session should include local data to help tailor the presentation to Waltham Forest.

Meetings Update 16/04/07 Drugs and Therapeutic Committee (DTC) A summary of the April 2016 DTC meeting was provided by AO. Some of the key highlights

included:

The prescribing of Medroxyprogesterone was approved by the committee. It is a subcutaneous LARC (Long-acting reversible contraceptive) which can be self-administered by the patient. The patient will need to make two visits – the first to receive training on using the LARC and the second to ensure effective use of the device. The drug will be issued by Barts Health.

It is not clear whether the local Waltham Forest sexual health clinics will also be issuing the drug. AO has contacted Public Health and is awaiting a response.

NOAC transfer of care documents reviewed have been approved and are now on the GP practice portal.

16/04/08 WEL Prescribing Group A working group was held in April to look at how the group will function going forward, and

how it will feed into the CCGs and Barts Health work plans. It has been agreed that the WEL prescribing group will be a decision making body, but all decisions made will need to be ratified by individual CCGs. Final notes from the working group have not yet been circulated.

16/04/09 NELMMN Funding to support the function of NELMMN has been approved by the CCGs, but not by

the acute trusts. A meeting has been planned for May, where the acute trusts will make a proposal about the future of the group. It has been agreed that if NELMMN does not progress further, the CCGs will work together to develop a similar advisory group, but the acute trusts may need to approach the CCGs individually to obtain funding decisions for new medications.

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16/04/10 NELFT update A summary of the Mental Health Services and Community Health Services meetings was

provided to the Committee. Some of the key highlights included:

A working with industry policy has been agreed, which provides guidance and recommendation relating to the process of on working with pharmaceutical companies.

A policy has been produced to support the implementation NICE guidelines and

technical appraisals to ensure acute trust compliance.

Lithium shared care guidelines are currently being reviewed. There have been some issues with poor uptake of patient leaflets and lithium books. NELFT are also considering implementing the lithium app for smart phones, which will be able to hold a patient’s dosing information and results. The app will replace the lithium books, but will only be available to some patients. Work in the CCG is underway to review the possibility of ECGs in Primary care to support the monitoring of therapy as outlined in the Shared Care Guideline

There is an updated NELFT psychotropic formulary, which will replace the one currently on the GP practice portal.

A review is being carried out on hypnotic and high dose antipsychotic prescribing within the acute trust which will support the Medicines Optimisation Scheme.

Direction to administer policy This policy relates to administration in the inpatient and community settings, and has been updated by the NELFT Pharmacy Team to standardise and formalise the process. The policy document was presented to the MOC to review and comment on any issues. The policy allows registered nurses and other health care professionals in the community to administer and supply medication. A direction to supply form will need to be filled out and signed by the prescriber for each drug, to allow practitioner to administer the drug during a visit. This applies to all medication including insulin, which has a separate direction to administer form to complete. The GPs noted that most are following the agreed process. Out of hours Where drugs have already been dispensed and are labelled, the nurse/HCP will administer the drugs according to the label/prescription. If the drugs have not been dispensed/labelled, the nurse/HCP will need to obtain authorisation to administer from the out of hours GP service. All comments and issues from the Committee regarding the policy will be forwarded to the MOT, who will raise with NELFT. ACTION: MOT to enquire whether it is possible to produce a direction to administer template for EMIS.

176

9

Standing Items 16/04/11 Queries Query Log (March 2016)

A log of queries received by the MOT was presented to the MOC for information.

16/04/12 NICE Update A review of the recently issued NICE guidance relevant to primary care was presented to

the Committee.

16/04/13 LPC Update The Committee were updated on the repeat ordering and dispensing work the LPC are

undertaking. A final meeting looking at this work will be arranged for mid-May, with sufficient notice given so that Waltham Forest GP Leads can attend. Minutes from the previous meeting have not yet been circulated. The Committee enquired if promotional materials such as patient information leaflets and posters for pharmacies and GPs relating to the Minor Ailment Scheme are available. The LPC confirmed that pharmacies do not have promotional material available. The MOT will recirculate the list of pharmacies that have signed up to the minor ailments scheme to all GP practices and host the information on the GP practice portal. ACTION: MOT to follow up with NHS England regarding the availability of promotional material and an up to date pharmacy list

16/04/14 LMC Update No update was submitted by the LMC

16/04/15 AOB Respiratory Clinical Lead:

As there is currently no clinical lead for Respiratory in Waltham Forest, it has been agreed that the MOT will lead on all aspects of commissioning for respiratory. The Clinical Director and the GP Lead for Respiratory were agreed at this meeting.

Wednesday 11th May 2016 2:00pm - 4:00pm

Boardrooms B & C, Kirkdale House, 7 Kirkdale Road, Leytonstone, E11 1HP

177

Item 6.6

Title of report Transforming Services Together: Care Closer to Home Project Documentation


Author Sharon Yepes-Mora, Associate Director of Strategic Planning - WFCCG

Purpose of report

The Transforming Services Together (TST) programme was established in September 2014 by Newham, Tower Hamlets and Waltham Forest (WEL) Clinical Commissioning Groups to deliver high-quality, safe and sustainable services for the population of East London.

Project initiation documents (PIDs) designed to drive forward implementation have been developed which capture each initiative’s approach and delivery plan. The Care Closer to Home PID aligns the 2016/17 plans with the TST strategy and serve as a local guide for delivering the strategy. From April 2016 the focus shifted from planning to delivery with local borough and enabler delivery groups in place with the Care Closer to Home Board providing oversight on delivery. The Waltham Forest PID is presented as a single program of work. It contains Urgent Care, Integrated Care and Primary Care programmes which form part of the CCG’s primary health services transformation programme. The PID outline the resources, responsibilities and governance for each initiative, define if business cases are required for funding (and which forum these will go to for approval) and capture key risks and issues for successful delivery. CCG Programme leads have been fully engaged in the development of the PID which is fully aligned with the CCG’s Delivery Plan and associated clinical director and clinical lead work plans. The core content of the Care Closer to Home PID is summarised below:

The overall strategic context and corporate governance for delivery. In addition a Strong Sustainable Providers group will be established from 2017 to support providers in driving transformation.

The route plan for the next five years highlighted

The specific governance structure for each programme, together with the aims and objectives:

1. Integrated Care - Integrated Care in Waltham Forest is part of the WEL Pioneer which is operating across the three boroughs of Waltham Forest, Newham and Tower Hamlets. This program will build on the work already undertaken and will deliver the nine key Integrated Care interventions. Integrated care is also a key part of Better Care Together (BCT) and is fully integrated into the BCT programme plan.

178

Transforming Services Together: Care Closer to Home Project Documentation

Page 2

2. Primary Care - The Primary Care programme involves a range of projects which are driven by existing and emerging local strategies which are in line with the London Primary Care Strategic Framework. The work runs across the three key themes of Accessible, Co-ordinated and Proactive care. The programme is linked to CCG’s primary care contracting delegated function which allows the CCG to use contractual levers and opportunities to deliver change and support the transformation programme. Key enablers to the programme include workforce, estates and IT which in themselves involve large scale projects.

3. Urgent Care – The CCG is working to develop an Integrated Urgent Care Service that enables

patients to access the most appropriate health and social care, advice and support in the right place and at the right time.

Key aims for the project are to reduce A&E attendances, emergency admissions and length of stay, as well as reduce the duplication of services in the system to support a more consistent high-quality patient experience. The project supports the TST goal of shifting activity from hospital out into primary and community care, as well as providing a stronger basis for the delivery of sustainable performance against national UEC standards. The delivery action plan constructed from the CCG’s 2016/17 Delivery Plan. The crucial content has already been shared with the Governing Body through the 2016/17 Delivery Plan.

The key risks and mitigations identified for each programme

It is important to note that the PID is in the final stages of completion and does not include at this stage the finance section which is currently being finalised.

Changes/additions/amendments to paper as a result of discussions held at previous Committee

The TST Strategy and Investment Case has been developed by over 1,000 clinicians, managers, staff, public and patients. The PID documentation has been shaped by discussions at the Care Closer to Home Steering Group, TST Board and MDT officer meeting. The PID has been submitted for approval to the TST Care Closer to Home Board and the Delivery Plan content submitted to the CCG Governing Body.

Recommendations

The Governing Body is requested to note the PID documentation.


Implementing the local Care Closer to Home PID delivers the Transforming Service Together ambitions which will:

Help people to stay healthier and manage illnesses; to access high quality, appropriate care earlier and more easily

179

Transforming Services Together: Care Closer to Home Project Documentation

Page 3

Enable better prevention of ill health Improve patient outcomes and experiences and drive up efficiencies Achieve a financially stable health and care economy

Communications and engagement have been an integral part of the development of the TST strategy and engagement has been made with overview and scrutiny committees, Healthwatch and key stakeholders about how to ensure patients, the public and their representatives are involved in future.

Risk implications

If the plans set out in the PID are not delivered there are risks involved including:

Access to services will become poorer and many residents will continue to receive fragmented care.

There will be later presentation of ill health to primary care due to capacity constraints.

There will be more attendances at emergency departments for urgent care needs.

Patients will continue to be cared for in care settings that are not fit for purpose.

Health outcomes will not improve for the local population.


Our commissioning plan will of course be founded on the principle of being achieved within available resources. Clinical and managerial capacity issues are being reviewed as part of the CET approval process for projects and programmes.

Equality analysis

Equality impact assessments have been undertaken and are included as an integral part of the PID documentation.


1. Transforming Services, Changing Lives Case for Change December 2014 2. Waltham Forest Delivery Plan 2016/17


The PIDs support delivery of the TST strategy was presented to the Governing Body in January 2016.

180

Highlights [Primary Care Commissioning Committee][April 2016]

Item 6.7

Committee Minutes

Primary Care Commissioning Committee – April 2016

From Alan Wells, Chair of the Committee - WFCCG

Key highlights

Highlights of the April 2016 meeting are summarised below:

1. Estates Update The Committee were informed that the draft estates consultation was signed off by the Estates Working Group and it was agreed that formal consultation will end in July. The Committee agreed that the results of the estates consultation would be presented at the PCCC and then at the Governing Body meeting in July.

2. Primary Care Strategy The Primary Care Strategy developed last year does not capture changes since it was finalised. It is proposed that the strategy will be refreshed to include changes by the end of May, and will be presented at the June meeting. Discussions had already taken place with the Development Committee in regard to the refresh. Members agreed to the proposal.

3. Delivery plan actions- Primary care, Estates, Workforce and IT The first draft of the primary care actions from the delivery plan were presented to the Committee for information for input and comments.

4. Quality and Performance Report A summary of the WEL GP Commissioning and Contracting Quality and Performance report that has been produced by NHSE was presented. This document is an NHSE document which provides information to primary care committees in regard to quality and performance in regard to GP practices. It was noted that some of the information is not accurate and this has been fed back to NHS England. The Committee expressed the need for data to be presented in a manner that is useful to commissioners to provide support to the practices that have quality issues.

181

1

PRIMARY CARE COMMISSIONING COMMITTEE Part 1

Minutes of Meeting held on 6 April 2016 Board Room, Kirkdale House

VOTING MEMBERS Initials Role Alan Wells (Chair) AW Chair, Lay Member, WFCCG Terry Huff TH Chief Officer, WFCCG Les Borrett LB Director of Strategic Finance, WFCCG Caroline White CW Lay Member, WFCCG Azeem Nizamuddin AN Clinical Director- Independent GP, WFCCG ATTENDEES Linda Finch LF Strategic Commissioning, WFCCG Abdul Sheikh AS Clinical Director, WFCCG Aysha Patel AP Senior Commissioning Programme Manager, WFCCG Sultana Rahman SR Head of Strategic Commissioning, WFCCG Dinesh Kapoor DK Clinical Director, WFCCG Attracta Asika AA Assistant Head of Primary Care Commissioning, NHSE Jane Mehta JM Director of Strategic Commissioning, WFCCG Alison Goodlad AG Head of Primary Care for NEL, NHSE Andrew Taylor AT Director of Public Health, LBWF Anne Walker AWa Deputy Director of Quality (Interim), WFCCG Rebecca Waters RW Healthwatch Laurence Knott LK Independent GP, WEL Advisory Group Sangeeta Kundra SK Minutes APOLOGIES

Anwar Khan AK Clinical Director, WFCCG Linzi Roberts-Egan LRE Deputy CO, WF Local Authority

ACTIONS LOG

Ref Who : Actions from last meeting When Complete

2.1 AA/SK

AA agreed to provide an update of how many practices had confirmed their interest in the scheme and this information would be circulated to the Committee

22.4.16 No

2.2 CE Update on kiosk to be discussed at next meeting Next meeting No

3 SR Primary care strategy refresh to be presented at next meeting

Next meeting No

5 AA To share and present NHSE quality data including GPOS data

Next meeting No

5 AP/SR To present dashboard data and ensure that motion to exclude is implemented.

Next meeting No

182

2

Item Summary / Actions

Action

1 Welcome and Apologies The Chair welcomed the members to the meeting of the PCCC and introduced

LK as an observer at today’s meeting. LK is an independent GP on the WEL Advisory Group. Apologies were noted as above.

2 Approve Minutes of the previous PCCC Part 1 – 3 February 2016 The minutes were agreed as a correct record.

Matters Arising 2.1

Minute 3 - Overview of Support for Vulnerable Practices It was confirmed that all practices had been informed that they had been put forward for selection for this national scheme, support for vulnerable practices. AA agreed to provide an update of how many practices had confirmed their interest in the scheme and this information would be circulated to the Committee.

AA/SK

2.2

Minute 4 - Kiosk Business Case It was confirmed the kiosks pilot had been extended for 3 months and an update will be provided at the next meeting.

2.3 Minute 5 – Estates Update There was concern at the last meeting that the length of the estates consultation was short. LB updated the Committee that the draft consultation was signed off by the Estates Working Group and it was agreed that formal consultation will end in July. The Committee agreed that the results of the estates consultation would be presented at the PCCC and then at the Governing Body meeting in July.

3 Primary Care Strategy SR informed members that the final Primary Care Strategy developed last year

does not capture changes since then. It is therefore proposed that the strategy will be refreshed to include these changes by the end of May, and will be presented at the June meeting. Discussions had already taken place with the Development Committee in regard to the refresh. Members agreed to the proposal.

SR

4 Delivery plan actions- Primary care, Estates, Workforce and IT SR presented the first draft of the primary care actions from the delivery plan to

the Committee for information. SR asked for input and comments.

- It was agreed that the RAG ratings need to be changed to reflect the actual progress of the action, as all actions seem to be green although they should be amber as they are not complete.

- Outputs are not measurable on the plan, and would need to be detailed clearly.

- It was confirmed that the Council would have an opportunity to make suggestions.

The first draft was noted.

183

3

5 Quality and Performance Report AP and AA presented a summary of the WEL GP Commissioning and

Contracting Quality and Performance report that has been produced by NHSE. This document is an NHSE document which provides information to primary care committees in regard to quality and performance in regard to GP practices. It was noted that some of the information is not accurate and this has been fed back to NHS England. It was unclear from the document what the different colours meant and where Waltham Forest was on performance compared to Tower Hamlets and Newham. There was a sense that the colour system was confusing and could be seen as judgemental. AG advised that the RAG rating had been developed with London wide LMC and that the feedback would be noted. The Committee expressed the need for data to be presented in a manner that is useful to commissioners to provide support to the practices that have quality issues. Individual practice performance information is available via the NHSE quality data including the GP Outcomes Standard (GPOS) and AA agreed to present this information at the next meeting. RW informed the meeting that Healthwatch provide quarterly reports which can be accessed online. A discussion followed about discussing the Primary Care dashboard to part 1 of the meeting as part of an analysis of performance data. This could be triangulated with the NHSE performance data. It was felt that it should not be taken to a public meeting until it was a robust document and accuracy is assured. It was confirmed that the public could be excluded from this item by passing a motion if necessary. It was agreed to add the dashboard to the next agenda with a notice that a motion will be passed if necessary. AN queried whether CQC performance data could be provided. AA confirmed that this would not be possible due to confidentiality issues. It was noted that the CQC information is part of the NHSE performance information that would be presented at the next meeting.

AA

AP

6 AOB None.

Date of the next meeting:

1 June 2016 15.00-16.00

184

Highlights [Finance & QIPP Committee] [March 2016]

Item 6.8a

Committee Minutes

Finance and QIPP Committee – March 2016


Key highlights

The Committee received the month 11 (February) Finance report forecasting achievement of the planned surplus of £8.6 million. Risks and mitigation to the delivery of the plan were discussed.

The Committee reviewed the month 11 QIPP performance report.

The Committee reviewed and approved the following business cases:

Community Deep Vein Thrombosis (DVT) pathway

Community Renal

Out of Hospital Pathway

The Committee received the second draft of the 2016/17 budget reflecting FOT at M9 and the latest available operating plan guidance. The Committee agreed to recommend that the budget be approved at the March Governing Body meeting.

185

Meeting Finance and QIPP Committee

Date and time 16 March 2016

Board Room, Kirkdale House

12.30-2.00pm

Chair Alan Wells (AW)

Attendees: Apologies: In attendance:

Les Borrett (LB), Ian Clay (IC), Kelvin Hankins (KH), (DC) Diane Clements (DC), Dr. Abdul Sheikh (AS), Dr. Syed Ali (SA), Enrico Panizzo (EP), Vineeta Manchanda (VM) Nuzhat Anjum (NA), Jane Mehta (JM), Sharon Yepes-Mora (SYM), Carl Edmonds (CE), Paul Larrisey (PL)

Agenda Items and Summary 1&2 Notes of last meeting The minutes of the last meeting were agreed. VM was introduced later in the meeting as the new lay member 3.0 Matters Arising There were no matters arising. 4.0 Finance Report month 11 LB presented the month 11 report to the committee. The CCG is still forecasting that it will deliver a total surplus of £8.6 million at year end. The committee to note CCG’s have now reached a settlement with BH contracts to year end. The committee noted the report.

5.0 QIPP Month 11 report EP took the committee through the main highlights There has been no change in overall forecast/rag rating at £9.14m (96.3%). The committee noted a reduction in falls data related to acute activity of 65 YTD. Diabetes activity have reached successful targets due to referral of 50/60 patients per week during the pilot. 6.0 Business Cases DVT EP outlined the business case to the committee. AW suggested in all future business cases going forward we need to emphasise patient benefit at the beginning of each business case before stating financial savings. Action : Approved Renal CE highlighted key points of the business case explaining savings in reduction. CE asked the committee to note the business case is based on EMIS system and not System 1. The change proposed by NHSE to move the cost of dialysis to CCGs has not yet been agreed nor implemented.

186

AW expressed a concern will GPs be able to withstand the increase in demand of their services. This was backed up by the business case supporting GPs with training, toolkits and consent communication with the specialist. Action : Approved Out of Hospital Pathway PL outlined the business case that was agreed in principle at January’s meeting. It was agreed for PL to go back to Barts Health to seek agreement of closure of Victory Ward at WX Hospital. BH have supported this case Action : Approved 7.0 16/17 Budget LB presented the proposed 2016/17 budget to the committee for approval to go to Governing Body 23 March 2016 LB ran through the most significant changes 2016/17 since the draft plan was brought to the committee in January 2016. The committee was asked to note that due to changes from 1 April 2016, Planning Guidance now require 1% uncommitted to be set aside, against the 1% originally for recurrent items. LB explained to the committee the process to hold the new 1% uncommitted, until needed to generate higher surplus. Action: Approved 8.0 Contract Waivers AW stated Declaration of interest was less than 5% for Dr Sheikh (AS) and Dr Ali (SA) KH explained each of the 15 contract waivers to the committee. Contract Waiver number 15, Orient Community Practice, should read “current end date of contract” 31 August 2016 and not 31 March 2016. Committee noted. Actions: All waivers were approved 9.0 PELC AW stated Declaration of interest was less than 5% for Dr Sheikh (AS) and Dr Ali (SA) EP wished for the committee to note the PELC update submitted. EP advised PELC are due to provide confirmation today (16 March 2016) of extending the contract and costs involved. Action: Update to be provided 10.0 SMS Texting CE presented the report to the committee. WFCCG agreed to fund a single 2-way SMS texting messaging service for 1 year for its practices to replace the free NHSmail messaging service which ended on the 30th September 2015. CE wished for the committee to note due to the success of 78% of patients providing contact numbers a cost pressure of £19,600 has incurred. The committee was asked to approve an additional one year extension with Ipato with a cost of £51,000 to cover the second year. Action: Approved

187

11.0 A.O. B NA

Next meeting: 20 April 2016

188

Highlights [Finance & QIPP Committee] [April 2016]

Item 6.8b

Committee Minutes

Finance and QIPP Committee – April 2016


Key highlights

The Committee received the month 12 (March) Finance report and noted that the CCG had achieved the planned surplus of £8.6 million and maintained running costs within the mandated “cap” (subject to final audit).

The Committee reviewed the month 12 QIPP performance report.

The Committee reviewed a business case to pilot EMIS Community. The Committee identified some further actions required and agreed that the case can then be approved through Chair’s action.

189

Meeting Finance and QIPP Committee

Date and time 20 April 2016

Board Room, Kirkdale House

12.30-2.00pm

Chair Alan Wells (AW)

Attendees: Apologies: In attendance:

Les Borrett (LB), Ian Clay (IC), Kelvin Hankins (KH), (DC) Diane Clements (DC), Dr. Abdul Sheikh (AS), Enrico Panizzo (EP), Vineeta Manchanda (VM), Sharon Yepes-Mora (SYM), Dr. Syed Ali (SA), Jane Mehta (JM), Bhagiyash Shah (BS)

Agenda Items and Summary 1&2 Notes of last meeting The minutes of the last meeting were agreed. EP provided an update on PELC. A procurement process has been put into place with a deadline for bids of 27 April 2016 3.0 Matters Arising There were no matters arising. 4.0 Finance Report month 12 LB presented the month 12 report to the Committee. The final draft accounts will be submitted on 22 April 2016. WFCCG is expected to meet a planned surplus of £8.6m, £54k ahead of the control target. The CCG will also meet the duty to maintain running costs within the mandated ‘cap’. The Committee noted the report.

5.0 QIPP Month 12 report EP took the Committee through the main points. The overall forecast remains at £9.14m, 96.3% of the target. Medicine Management and Acute Efficiencies forecasts have increased. EP advised the Committee that risks have not been included within this report due to year end. Ambulatory Care and FedNet have not made savings this year due to changed plans throughout the year. AS asked about the budget line described as ‘list cleansing’. He queried whether the CCG had undertaken any list cleansing and said that previous list cleansing exercises conducted by the PCTs and NHSE had been very poorly undertaken and had led to considerable problems for practices. IC reiterated that this related to a QIPP target inherited by the CCG from NHSE when the CCG took responsibility for commissioning primary care. He went on to say that no actual list cleansing had been undertaken by the CCG. 6.0 EMIS Community AW indicated that BS had to declare an interest as an employee of Prederi, a contractor who could benefit financially from this benefit. AW ruled that BS could present the case but could take no part in decision making because of this conflict.

190

BS presented the business case to the Committee for a three month pilot to be rolled out at a cost of £160k per year with £50k recurring costs if the pilot led to the scheme being introduced more widely. BS advised the PowerPoint presentation had been made to the Planning and Innovation Committee on this subject. AW made the point that P&I could not approve, as such, a PowerPoint presentation and that this specific paper would need to have been considered by P&I before coming to F&Q. Clinicians on P&I needed to have sight of the proposal before it could be approved. AW agreed that after being considered by P&I he was prepared to approve it using Chair’s Action. Members also asked for further clarification on the position of System One practices, how many practices would be involved in the pilot, why Chingford was chosen for the pilot and what specific benefits there would be for patients. BS confirmed that these points would be addressed in any revised draft. Action: BS to expand on patient benefits within business case Revise issue on visitor pilot Business case to be presented at Planning and Innovation Committee after which Chair’s Action could be taken for the Finance and QIPP Committee. 7 A.O.B There was no other business.

Next meeting: 18 May 2016

191

Action Log [Leyton/Leytonstone, Chingford and Walthamstow Localities] [March 2016]

Item 6.9a

Committee Minutes

Locality Meetings – Leyton/Leytonstone, Chingford and Walthamstow – March 2016

From Dr Dinesh Kapoor, Dr Anwar Khan and Dr Mayank Shah – Clinical Directors WFCCG

Key highlights

Please find attached the signed action log from Leyton/Leytonstone, Chingford and Walthamstow locality meetings- March 2016 ACTION LOG: Leyton/Leytonstone (Shahnaz) – Chair Dr Kapoor

Agenda Item Action Owner Due Date Status

Actions from previous meetings

Over‐performance of Independent Sector Action: CE to provide individual practice data and advice on the contract.

DNAs ‐ DK to raise issue with Barts and agreed position is that practices are not responsible for DNA follow‐up. Action: DK to report back to members.

On‐going issues with Pathology reporting – DK to give feedback on the outcome in April.

By next meeting

By next meeting

By next meeting

CE

DK

DK

Complete

6.1 BS to provide an update in next meeting on all the issues raised including plans for improved GP engagement.

completed

9.1 Members very concerned that for PSA – will BART lab reflect this – JG agreed to raise this with his team. Action: RG to raise concerns with BART.

RG

10.1. Action: Members requested that data from FEDNET be disaggregated and presented to

By next meeting

VB

192


Chingford Locality Meeting Action Log (Shahnaz) March 2016 – Chair Dr Anwar Khan Actions Log

Agenda Item

Target Date

Owner Status

11.1 Minor surgery inter‐practice referral/CSS service on C&B.

Action: CCG to provide quality metrics

Update:

DES and responsibility of NHS England.

complete CCG complete

11.5 NELFT GP Alert. Action: AK and CE to consider how this can be incorporated into NELFT CQRM meeting.

complete

AK/CE

complete

11.6 Action: To seek advice from Defence organisation on skype use and security concerns. Request for workshop on coding. Update: Skype security concerns to be addressed alongside project implementation. Members to be kept abreast of developments.

complete BH Complete

11.7 Diabetes Profile:

complete LS Complete

reflect comparison by locality – LF to contact Vijay Bagga.

11.1 Diabetes Data – Members to look at their individual data and compare with borough data, and consider 1 or 2 areas that you could try to improve on. Information to be emailed to [email protected]

By next meeting

GPs

12.1 Action: It was agreed that ID‐T would investigate and report back to members. This has been escalated to Fiona Smith Managing Director at Whipps Cross Hospital.

Next meeting

ID‐T complete

193


Action: LS to email individual profiles to practices and locality profiles will be made available on request.

11.8 Bart’s Health copying results to GPs. Communication issue between urology and GPs and patients not always being copied in. Concern expressed that this does not empower patients when it comes to PCA follow‐up. Action: James to take back

complete JG Complete

11.9 Medicines Management to be involved in future meetings Action: Toyin to arrange the next urology education session and James to confirm dates. Update: On the 30th June & 7th July, Cancer sessions are on the agenda and have been proposed as potential dates with the 7th July already booked as a session.

complete CCG Complete

Walthamstow Locality Meeting Action Log (Linda) March 2016 – Chair Dr Shah Actions Log

Agenda Item

Action Deadline Owner Status

Action 8.1 from January Meeting – Maternity Discharge Information – LF reported that information has been requested from Dr Myers – LF to follow this up.

By next meeting

LF

12.0 BS to report back on issues raised regarding Patient on‐line service and planned mitigation measures

Ongoing BS On‐going

12.1 Action: LS to email individual profiles to practices and locality profiles will be made available on request

Complete LS Complete

194

Action Log [Leyton/Leytonstone, Chingford and Walthamstow Localities][April 2016]

Item 6.9b

Committee Minutes

Locality Meetings – Leyton/Leytonstone, Chingford and Walthamstow - April 2016

From Dr Dinesh Kapoor, Dr Anwar Khan, Dr Mayank Shah – Clinical Directors WFCCG

Key highlights

Please find attached the signed action log from Leyton/Leytonstone, Chingford and Walthamstow locality meetings‐ April 2016 ACTION LOG: Leyton/Leytonstone (Shahnaz) – Chair Dr Kapoor

Agenda Item

Action Target date Owner Status

Action carried forward

Members very concerned that for PSA – will BART lab reflect this – JG agreed to raise this with his team. Action: RG to raise concerns with BART – action by RG to follow up by SB.

Next meeting

JG/SB

3.1 SB to liaise with contracting team to include benchmarking and link with MSK referral and orthopaedic if possible, these are interrelated.

Update: Discussed with contracting team, MSK and orthopaedic referrals is a large piece of work therefore the report will be available in May.

In two weeks

SB In progress

4.1 MC to send an anonymised copy to SB to take this up with NELFT to request this Clause be removed.

Update: Awaiting sample letter from MC

Next meeting

SB/MC

4.2 SB to provide IAPT managers email address for practices to send their concerns.

Update: all practices to send their concerns to

Next meeting

SB Complete

195


Chingford Locality Meeting Action Log (Shahnaz) April 2016 – Chair Dr Anwar Khan Actions Log

Agenda Item

Target Date

Owner Status

3.4 Linda Finch has captured some of the questions raised in the event and will be sending answers to practices.

Email sent to all practices on the 19th April.

complete LF Complete

5.2 Log feedback/comments on the estate engagement. complete SB Complete

6.2 HN to send out how to check the template for Emis and Systm one.

complete HN/SB

[email protected] (IAPT manager)

4.3 Cannot get through to ultrasound department at Barts to discuss the results. DK will raise this with Barts Health.

Next meeting

DK

7.1 Sputum for TB and Antibody cannot be found on the request form.

Update: practices to send a list to HN with the results they want to see that are not appearing.

Next meeting

GPs

7.2 HN to further clarify and solve the issue with locum doctors accessing tQuest.

Update: HN working with CSU to organise training program for the whole borough.

Next meeting

HN/SB Complete

7.3 Ecclesbourne and SMA practices are not showing on the usage list/ graph under their locality, need to rectify this.

Update: Corrected report attached with this pack.

complete SB

7.3 tQuest: When accessing the system or switching screens, a pop‐up appears which is rather annoying.

Update: practice to log a call with tQuest so they can investigate. Temporary solution: (press Alt+Tab to toggle between screen)

Next meeting

GPs

196


Included in the pack

6.3 GPs are told to fax forms for ultra sound when booking the appointment. GPs should not be sending or receiving faxes. Ultra sound waiting times increasing as patients are being sent back for not having hard copy of the form. This is a GP Alert issue.

Action: practices to initiate the GP Alert

complete GPs

6.4 AIRS to monitor trends and the locality wanted feedback on actions on the trends.

Update: Barts to provide update on AIRs and GP Alert trend at next CQRM meeting. SB to follow‐up

On‐going SB

8.1 Message “If you are not happy with response you received on GP alert, let us know”.

‐‐‐‐‐‐‐‐‐‐ ID‐T

10.1 Copy results issue around who has the clinical responsibility of care. This is a good to use as GP alert. Practice need to initiate this through GP‐Alert

complete GPs

10.2 Enquire with NHSE to make the form easier, AK happy to assist. Update: SB escalated to NHSE, comms will be sent out to practices on the “how to”.

On ‐ going SB

10.3 PELC Incident patients were not being screened as they arrive, streamers not on duty/ lack of knowledge what to do, as a result patients are waiting for hours. This is a clinical risk, MG asked to produce a GP alert. Practice need to initiate this through GP‐Alert.

complete GPs

Walthamstow Locality Meeting Action Log (Linda) April 2016 – Chair Dr Shah Actions Log

Agenda Item

Action Deadline Owner Status

4.2 Members to contact Frances if any further help is required in setting‐up a PPG.

As and when

GPs Complete

5.2 CE agreed to visit any practices who wish to discuss any part of the Estate Strategy in relation to their own Practice. CE to write an A4 sheet of paper in ‘plain English’ in relation to the strategy.

As and when By next meeting

GPs CE

Complete

197


6.2 GPs to provide common test request to HE to be built into the IT system. HE advised that discussions are taking place with CSU to create a plan to retrain all GPs in HIE, tQuest etc.

By next meeting

Chairs

10.2 Issues trying to log on Locum Doctors – Action HE to look into this and report back (is this a Governance Issue?). HE advised he has spoken to Saxon and further information/explanation will be sent out to GPS.

Harry to update IT Committee – Action HE to update IT. He advised that he had attended the IT Committee.

GPs cannot access CCG Website – Action: HE to report back. HE/Comms team advised that GPs have been informed about the changes to the website on the following date:

� 23/10 – announced in Practice Bulletin

� Presented at November Practice Manager and Practice Nurse forums

� Presented at January GP locality meetings

� 03/03 – in Practice Bulletin

� 13/03 – direct email re soft launch

� 18/03 – in CCG staff newsletter

� 31/03 – in Practice Bulletin

� 04/04 – Go live email sent

� Mentioned at April locality meetings

On 4 April, we launched the Practice Portal, this has replaced the GP Centre.

All practice staff should now have a link on their desktops named, ‘Practice Portal’, this takes you directly to the new website. You can also visit the site by clicking here.

By next meeting

HE

HE

HE

Complete

Complete

Complete

198

Item 8.1

PART 125/05/2016 22/06/2016 27/07/2016 28/09/2016 26/10/2016 23/11/2016 25/01/2017 22/02/2017

GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESS GENERAL BUSINESSChair's update Chair's update Chair's update Chair's update Chair's update Chair's update Chair's update Chair's update

Clinical Director update Clinical Director update Clinical Director update Clinical Director update Clinical Director update Clinical Director update Clinical Director update Clinical Director update

Questions from Members and Public








GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCE GOVERNANCEBAF BAF BAF BAF BAF

IT Committee ToR

Conflicts of Interest

Conflicts of Interest - Revised Governance

Arrangements

Planning and Innovation Committee ToR

PERFORMANCE AND QUALITY








P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report P&Q Report

Findings and Actions: Stroke QA visit WX

Hospital November 2015Safeguarding Adults

Annual Report

Phlebotomy Services Report

FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPP FINANCE AND QIPPFinance Report Finance Report Finance Report Finance Report Finance Report Finance Report Finance Report

STRATEGY AND PLANNING








Transforming Care PlanPrimary Care Estates Consultation Results

Process for signing off NEL STP

Sign off of final NEL STP draft submission PCCC Report

199

Item 8.1

Operating Plan

Better Care Fund

INFO INFO INFO INFO INFO INFO INFO INFO

Care Close to Home PID Reports from Safety Net Reports from Safety Net Reports from Safety Net Reports from Safety Net

Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports Locality meeting reports

PART 2

Procurement update Procurement update Procurement updateMSK Procurement

Urgent Care Step In Provider

Planned Care Bundle Procurement

200

Agenda Governing Body Board (Part 1) - Waltham Forest CCG€¦ · Committee (April 2016) For info...

Documents

Transcript of Agenda Governing Body Board (Part 1) - Waltham Forest CCG€¦ · Committee (April 2016) For info...