AGENDA - NHS Northumberland Clinical Commissioning Group · 1050 10 Locality meeting assurance/key...

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1 20180725 UC GB Agenda

Governing Body

Clinicians commissioning healthcare for the people of Northumberland

This meeting will be held at 10.00 on 25 July 2018 Corn Exchange, Morpeth Town Hall, Morpeth

AGENDA

Time Item Topic Decision Required

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Sponsor

1000 1 Apologies for absence J Guy

2 Declarations of conflicts of interest

J Guy

3 Quoracy*

J Guy

4 4.1 Minutes of the Annual Public Meeting 4.2 Action Log

3 11

J Guy

1010 5 Chief Operating Officer Report

12 S Brown

1015 6 Finance 6.1 Month 3 Finance Update

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R Turnbull

1025 7 Director of Public Health Update

47 L Morgan

1030 8 Strategic Items 8.1 Quarterly Operating Delivery Plan 2018/19 Update – Q1 8.2 Communication and Engagement Quarterly Report

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S Brown S Young

1045 9 Assurance, Risk and Governance 9.1 CCG’s Annual Complaint Activity Report

2017/18

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S Young

1050 10 Locality meeting assurance/key points S Young

11 Governing Body Forward Plan

90 S Young

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2 20180725 UC GB Agenda

Time Item Topic Decision Required

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12 Any other business (items submitted prior to meeting only)

J Guy

1100 13 Date and time of Governing Body: Wednesday 22 August 2018 – 10.00 Committee Room 2, County Hall

* 6 members, including at least two of the Lay Chair/Governors, the Clinical Director of Primary Care and two Locality Directors, either the Accountable Officer, Chief Operating Officer or the Chief Finance Officer.

Agenda Item 4.1

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Minutes of the Governing Body Annual Public Meeting Wednesday 27 June 2018, 10.00am Committee Room 1, County Hall, Morpeth

Present Karen Bower Lay Member Corporate Finance and Patient and Public

Involvement (Chair) Vanessa Bainbridge Accountable Officer Siobhan Brown Chief Operating Officer Ian Cameron Chief Finance Officer Steve Brazier Lay Member - Audit Chair John Unsworth Governing Body Nurse Dr Paula Batsford Locality Director - Blyth Valley Dr Charles Dean Locality Director - North Dr Ben Frankel Locality Director - West Dr John Warrington Locality Director - Central In Attendance Elizabeth Morgan Director of Public Health, Northumberland County Council Rachael Long Corporate Affairs Manager Melody Price Business Support (Minutes) Agenda Item 1 Welcome and introductions Karen Bower welcomed members of the public to the meeting and explained she was chairing the meeting on behalf of Janet Guy, Lay Chair of NHS Northumberland Clinical Commissioning Group (CCG) who was unable to attend. This is the annual public meeting of the Governing Body and provides an update on the work of the CCG and progress made in 2017/18. This is a public meeting and there will an opportunity to ask questions towards the end of the meeting. Copies of the CCG’s Year in Review summary are available at the meeting. The full annual report is available on the CCG’s website and printed copies are available on request. Agenda Item 2 Key aspects of the annual report 2017/18 Karen Bower and Siobhan Brown gave a presentation on the key areas in the annual report. Our working environment: High performing providers Provider CQC Ratings:

• Northumbria Healthcare NHS Foundation Trust – Outstanding • Newcastle upon Tyne Hospitals NHS Foundation Trust - Outstanding • Northumberland, Tyne and Wear NHS Foundation Trust – Outstanding

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Primary Care: • 42 GP practices in Northumberland • Rated 12 out of 207 CCGs nationally for quality

Major areas of work for the CCG in 2017/18

• Significant Financial Recovery and refocusing of the CCG which remains in Special Measures and under Legal Directions

• Maintaining high levels of service quality and provider performance for our patients and the wider public

• Being a proactive member of the wider Sustainability and Transformation Partnership (STP) and regional integrated care discussions – noting the pause of the Accountable Care Organisation (ACO). Focus on vulnerable services and commissioning on a wider scale

The main CCG achievements in 2017/18 Care Navigators:

• New care navigation system embedded in Primary Care throughout Northumberland • This involved training reception staff as care navigators in 33 GP practices • Enhancing the patient experience by signposting patients to the most appropriate care

channel, not always medical or in the NHS. Includes many community based programmes and services

GP Extended Access Service

• Provides patients with the ability to see a GP or other members of the team until 8pm each weekday and at weekends

• Delivered from 5 hubs evenly spread across Northumberland • Equates to an additional 50,000 primary care appointments per year • Challenges include workforce and preparing for Winter

Integrated Clinical Care

• Building on existing Multi-Disciplinary Teams. An initiative to transform community services and how they interact with Primary Care including:

o Emergency Health Care Plans - a systematic approach where patients needs and wishes are known

o Developing a new Care at Home Complex Health Team (CATCH Teams). Pilot in the North locality followed by roll out across Northumberland

o Trusted assessor initiative - ensuring a smoother transfer to a care home after a hospital admission

Mental Health: Improving Access and Waiting Times

• In September 2015, the CCG commissioned a new provider, Talking Matters Northumberland (TMN) for Improving Access to Psychological Therapies (IAPT) services. Following a wide range of collaborative working between the provider and the CCG, performance during 2017/18 has significantly improved achieving at least the 50% threshold recovery rate

• Waits in Children and Young People’s services (CYPS) deteriorated during the year but the CCG has worked closely with the service and performance is now improving

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The main challenges in 2017/18

• Being in Special Measures and starting the journey of recovering the CCG’s financial position. Delivered a £17.3m in year deficit and ended 2017/18 with a cumulative deficit of £57.8m

• Managing a long and hard Winter as a whole system • Performance in urgent and emergency care • Reducing the use of the hospital system and unlocking the resources in primary and

community settings Performance monitoring in 2017/18

• CCG overall performance was rated amber • Referral To Treatment 18 weeks and Diagnostic Waits performance were rated green • Ensured our providers have met the vast majority of our constitutional performance

targets • Areas that still require improvement include ambulance services, A&E and some areas

of cancer (early figures from 2018 show a marked improvement) Impact on patients and the public

• Less time in hospital settings • More choice on times and locations for services including telephone, digital and group

options • Greater access at an earlier stage to mental health services • The ability to find and deal with issues earlier to prevent and manage further

deterioration • More planned care - safer than unplanned care and supported by research

Patient and Public Engagement

• Two county wide patient forums were held in Alnwick and Morpeth using workshops and case studies to encourage comments and ideas

• Together with partners in Northumbria Healthcare NHS Foundation Trust and Northumberland County Council (NCC), the CCG led an extensive engagement exercise to consider the possibility of a new hospital in Berwick upon Tweed being part of an integrated development including health, social care and leisure services

• Final decision making business case for Rothbury Community Hospital was considered at a full public meeting in September 2017. The CCG awaits the outcome of the Independent Review Panel

Agenda Item 3 Overview of the 2017/18 accounts Ian Cameron presented an overview of the CCG’s accounts, which are set out in the full annual report. Ian Cameron said the annual audit letter from the external auditors had been received. It stated that the financial statements gave a true and fair view of the CCG’s financial position and had been properly prepared. The opinion on regularity and Value for Money conclusion notes the CCG reported a deficit.

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At the close of 2017/18, the CCG had not met the statutory requirement to ensure expenditure in the financial year did not exceed its allocated resource. The CCG’s in-year deficit for 2017/18 was £17.3m with a cumulative deficit of £57.8m. The CCG total revenue resource allocation for 2017/18 was £518.6m and the total spend was £533.9m. Ian Cameron said 50% of the CCG’s net spend was for acute care and highlighted the breakdown of the CCG’s administration costs. Agenda Item 4 The work of the Governing Body and Committees Agenda Item 4.1 Governing Body Karen Bower said the structure and responsibilities of the Governing Body changed in April 2018 due a revision of the CCG’s Constitution and governance arrangements. Karen Bower reported on the work of the Governing Body in 2017/18. The Governing Body consisted of local GPs, senior managers, a secondary care doctor, nurse practitioner and three lay members, and is chaired by Janet Guy, Lay Chair. The Governing Body meets bi-monthly and meetings were held in public. Dates were publicised in the local press and papers were available on the CCG’s website. The Governing Body’s role is to take an independent and objective view of the work of the CCG, to provide the member practices and the public with assurance that the CCG is exercising its functions efficiently, effectively and economically and in accordance with the principles of good governance. In 2017/18, the Governing Body was supported by two key committees:

• Joint Locality Executive Board • Audit Committee

The CCG also has a Primary Care Commissioning Committee. Agenda Item 4.2 Joint Locality Executive Board Siobhan Brown reported on the work of the Joint Locality Executive Board. The Joint Locality Executive Board met monthly and was responsible for delivery of the CCG’s executive management functions including the CCG’s strategy and annual plan, target outcomes and outputs set by the national/regional authorised bodies, financial and non-financial performance, organisational policies and procedures, and agreeing contracts with organisations or individuals providing clinical or other services to the CCG. The Joint Locality Executive Board was clinically led. Lay members were present at the meetings but not voting members. Agenda Item 4.3 Audit Committee Steve Brazier, Chair of the Audit Committee, said the Committee concentrates on ensuring the CCG adheres to the principles of good governance. It provides assurance to the Governing Body that the CCG has effective system control, financial information and compliance with laws, regulations and directions governing the CCG in so far as they relate to

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finance. The committee is questioning of the CCG and seeks additional assurance as required. The committee meets bi-monthly and is supported by external audit and internal audit, the CCG’s Chief Finance Officer and the Strategic Head of Corporate Affairs. Agenda Item 4.4 Primary Care Commissioning Committee Karen Bower said that Primary Care Commissioning Committee was chaired by Janet Guy. It was established to enable the members to make collective decisions on the review, planning and procurement of primary care services in Northumberland, under delegated authority from NHS England (NHSE). The functions of the Committee are undertaken to promote delegated commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. The committee meets bi-monthly in public and comprises of representatives from the following organisations:

• NHS Northumberland CCG – lay members and officers • Northumberland Local Medical Committee • Northumberland County Council • Healthwatch Northumberland • NHS England

The following were some of the reports discussed in 2017/18:

• Alnwick practice mergers - the two surgeries were very close and the merger provided patient benefits and reduced duplication

• There was a presentation by Glynis Gaffney, CQC lead inspection lead, on the changes to the inspection regime. Overall good and outstanding practices will have fewer inspections in future. 97% of Northumberland practices are good or outstanding.

• Vanguard evaluation • GP patient survey - 87% rated Primary Care in Northumberland as good, which is

higher than the national average Revised CCG governance arrangements Karen Bower said the revised CCG Constitution was approved by CCG member practices and NHSE earlier in the year and implemented from April 2018. She outlined the revised governance structure and arrangements. Governing Body have become the strategic decision making body of the CCG supported by the Clinical Management Board, the tactical/operational decision making body of the CCG. Both have a clinical voting majority and lay members have increased involvement in decision making. Governing Body is also supported by the Audit Committee, Corporate Finance Committee and the Appointment and Remuneration Committee. The Primary Care Commissioning Committee remains an independent decision making committee for Primary Care services in Northumberland, under delegated authority from NHSE.

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The CCG is a member of the new and developing Joint CCG Committee Cumbria and North East. The revised governance arrangements will be reviewed in September 2018. Agenda Item 5 Pre submitted questions from members of the public There were no pre submitted questions. Agenda Item 6 Questions from the floor Member of the public: Integrated Care Systems (ICS) appear to have no rules or handbook. Are the regulations keeping up with the changes? What is the plan to protect patients? Are there any rules or a handbook? Vanessa Bainbridge said primary legislation had not changed. The governance and decision making processes are the same and sit with the CCG. The Joint CCG Committee Cumbria and North East is looking at commissioning and providing services in systems, where they are best done at scale, and what can be done collectively, such as ambulance services and NHS 111. Christine Briggs, Director of Delivery and Commissioning, NHSE said the NHS 5 Year Forward View documents describe this. NCC Councillor: There are five hubs in Northumberland that provide GP appointments until 8pm and on weekends. Where are they? Ben Frankel said the GP Extended Access hub in the West locality was based at Corbridge Health Centre. The utilisation rate of appointments is between 70% to 80%. Paula Batsford said the Blyth Valley locality hub was based at the Village Surgery in Cramlington. The utilisation rate of appointments is between 85% to 90%. Additional services are offered. Information about the service is available in all local practices. Charles Dean said Belford, Glendale and Well Close practices co-ordinated to cover the extended access period in the North locality, along with Alnwick Medical Group, Gas House Lane Surgery, Greystoke Surgery and Widdrington Surgery. Information is available on practice websites and Patient Participation Groups are aware of the service. Christine Briggs said she had personal experience of using the service having called 111 and being triaged to Alnwick. John Warrington said the Central locality hub worked on a rota between Brockwell Medical Group in Cramlington, Lintonville Medical Group in Ashington and Wellway Medical Group in Morpeth. The utilisation rate of appointments is over 90%. Information is available on practice websites. The hub provided cover over the Easter Bank Holiday period for Northumberland. There is a further hub in the Central locality based at Wansbeck which works a rota across Bedlington Medical Group, The Gables Medical Group, Guide Post Medical Group, Seaton Park Medical Group and Laburnum Surgery. The utilisation rate of appointments is between 85% to 90%. NCC Councillor: A major issue is the communication about where people should go when they are ill i.e. Cramlington, Alnwick, etc. This needs to be sorted. Advertising

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needs to be considered as some people do not have access to the web or local newspapers. Vanessa Bainbridge said it was the responsibility of both commissioners and providers to produce clear and understandable information explaining what people should do when they are unwell. There is the important message around self-care and people need to be signposted to the most appropriate services. Care navigators have been introduced in most practices in Northumberland and support planners are in place in social care. Representative from Glendale Medical Surgery PPG: A high proportion of males are colour blind. Information being produced relies on the use of colour. Blue and yellow are more easily recognised. Need to consider this when producing information. The annual report executive summary mentions the success of the patient forums. The forum in Morpeth was excellent but only 12 people attended and some people were already involved in patient groups. The forums need to be better communicated. Not everyone uses the web. Advertising on television or radio could be powerful. I live in a rural location between Berwick and Wooler, a 1 hour drive from Ashington/Wansbeck and the Borders. It is fine for a first appointment to be in Wansbeck General Hospital but follow up appointments for 10 minutes are a problem. Airedale General Hospital relies on Skype. The CCG could make more use of iPads/technology. Siobhan Brown said different ways of working using technology are on offer and further work is being considered. Patient representative from Guide Post Medical Group: ‘Easy speak’ is needed. A lot of people would not understand the annual report summary. Information needs to be clearer. A lot of people do not use computers. Young people need to be targeted and encouraged to get involved. Vanessa Bainbridge said the CCG is proactively working with Healthwatch Northumberland regarding patient communication and engagement. There are dedicated roles actively working with Children’s Services. Patient representative from Wellway Medical Group: The CCG should consider the use of village halls and person to person contact. Need to communicate health services to everyone. Lynne Hodgson, Director of Finance and Resource, North East Ambulance Services NHS Foundation Trust: The annual report summary states that ambulance response times deteriorated month on month which is not accurate. New ambulance response categories were introduced from October 2017 and C1 targets were met in February and March 2018. Vanessa Bainbridge said 2017/18 response time data used in the report would be reviewed and an update provided to Lynne Hodgson. Representative from Allendale Medical Practice PPG: I am uncomfortable about not understanding the structure of the NHS, role of the CCG and language used to connect

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with patients. The CCG needs to consider how to make better use of patient groups and people who are willing to help. Training is needed. Vanessa Bainbridge said the structure of the NHS and terminology can be difficult to understand. The CCG has an allocated budget from NHSE to purchase services that ensure the population health needs of Northumberland are met. The CCG also monitors performance and quality of services provided. Primary Care and other providers also want to engage with patients and the public to hear their views but it’s important not to duplicate. Audrey Barton, Communication and Engagement Manager, CCG said locality patient forums are being reviewed. Work is ongoing with NCC’s Youth Service and more engagement sessions are planned Agenda Item 7 Formal meeting close Karen Bower thanked everyone for attending the meeting and contributing to such a lively debate.

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NCCGGB/18/18/01 25/04/2018 23/05/2018 David Shovlin to provide an update regarding the ‘Unable to book 2 week wait issues’ to Governing Body.

David Shovlin Ongoing Awaiting results of 2 week wait audit.

NCCGGB/18/20/02 25/04/2018 23/05/2018 Siobhan Brown to add the integrated care diagram to Operational Plan 2018/19.

Siobhan Brown Ongoing Work underway to capture system strategy work, patient pathways and integration

NCCGGB/18/35/01 23/05/2018 27/06/2018 David Shovlin to discuss the Quality Exception Report ‘ongoing monitoring’ outcomes with Annie Topping.

David Shovlin Completed

NCCGGB/18/39/01 23/05/2018 27/06/2018 Siobhan Brown to ensure Stephen Young amends the CMB ToRs and circulates for out of committee approval.

Siobhan Brown Ongoing

NCCGGB/18/41/01 23/05/2018 27/06/2018 Stephen Young to organise risk session with AuditOne for Paula Batsford, Charles Dean and Ben Frankel.

Stephen Young Ongoing Session to be organised for all new CCG staff. September 2018 Date TBC.

Description and Comments Owner Status CommentNumber Date Identified

Target Completion

Date

Governing Body DATE: July 2018

NHS Northumberland Clinical Commissioning Group Agenda Item 4.2Governing Body - REGISTER OF ACTIONSLog owner: Governing Body Chair

Agenda Item 5

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1 20180725 UC Agenda Item 5 Chief Operating Officer Report


Meeting title Governing Body

Date 25 July 2018

Agenda item 5

Report title Chief Operating Officer Report

Report author Chief Operating Officer

Sponsor Chief Operating Officer

Private or Public agenda

Public

NHS classification Official

Purpose (tick one only)

Information only

Development/Discussion

Decision/Action

Links to Corporate Objectives Ensure that the CCG makes best use of all available resources

Ensure the delivery of safe, high quality services that deliver the best outcomes

Create joined up pathways within and across organisations to deliver seamless care

Deliver clinically led health services that are focused on individual and wider population needs and based on evidence.

Northumberland CCG/external meetings this paper has been discussed at:

N/A but elements (governance and Locality Directors) discussed with the CCG’s membership

QIPP N/A Risks Strategic Risk 946 – Financial Balance

Strategic Risk 403 – Member Engagement Resource implications N/A Consultation/engagement Locality clinical engagement

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20180725 UC Agenda Item 5 Chief Operating Officer Report 2

Quality and Equality impact assessment

Attached.

Research N/A Legal implications N/A Impact on carers N/A Sustainability implications N/A

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QUALITY and EQUALITY IMPACT ASSESSMENT 1. Project Name Chief Operating Officer Report

2. Project Lead Director Lead Project Lead Clinical Lead Chief Operating Officer

Chief Operating Officer NA

3. Project Overview & Objective

Provide an operational update to Governing Body

4. Quality Impact Assessment

Impact Details Pos/ Neg

C L Scores

Mitigation / Control

Patient Safety NA Clinical Effectiveness NA Patient Experience NA Others including reputation, information governance and etc.

NA

5.Equality Impact Assessment


C L Scores


What is the impact on people who have one of the protected characteristics as defined in the Equality Act 2010?

NA

What is the impact on health inequalities in terms of access to services and outcomes achieved for the population of Northumberland? (which is in line with the legal duties defined in the National Health Service Act 2006 as amended by the Health and Social Care Act 2012), for example health inequalities due to differences in socioeconomic circumstances?

NA

6. Research Reference to relevant local and national research as appropriate.

NA

7. Metrics Sensitive to the impacts or risks on quality and equality and can be used

Impact Descriptors Baseline Metrics Target NA

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for ongoing monitoring. 8. Completed By Signature Printed

Name Date

Chief Operating Officer

S BROWN 13/07/18

Additional Relevant Information:

8. Clinical Lead Approval by Signature Printed Name

Date


9. Reviewed By Signature Printed Name

Date

Comments

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Governing Body 25 July 2018 Agenda Item: 5 Chief Operating Officer Report Sponsor: Chief Operating Officer Members of the Governing Body are asked to: 1. Consider the Chief Operating Officer report and provide comment.

Purpose This report provides an update on significant meetings and developments in NHS Northumberland Clinical Commissioning Group (CCG). Other important clinical issues will be addressed in the Clinical Management Board report. CCG Assurance Rating for 2017/18 The national CCG Assurance ratings were published on My NHS Website on 12 July 2018. The 2017/18 CCG assessment recognised many positive examples of work. Consequently the CCG’s overall rating has improved from ‘inadequate’ in 2016/17 to ‘requires improvement’. This reflects the good progress the CCG has made in relation to the objectives set out under the Legal Directions and Special Measures placed upon it, but it is understandable given the financial position at the close of 2017/18. NHS England (NHSE) acknowledged the significant commitment and efforts of staff and member practices and noted important areas of progress, in particular, the CCG met the revised forecast deficit following the initial deterioration of the financial position in 2017/18; the strengthened governance processes and continually delivering the majority of NHS constitutional standards. The leadership rating for the CCG has also improved from a red to amber rating. Appendix 1 contains additional detail concerning the overall assessment . The CCG’s key priority is to continue the strong focus on finance and reducing the deficit; whilst maintaining high quality care and performance. The Directions currently in place for the CCG will remain, in conjunction with the Special Measures. NHSE will continue to support the CGG and the status of the Directions and Special Measures will be reviewed later in the year. CCG Improvement Plan: Capacity and Capability The CCG is in the final stages of recruitment and almost every position has been filled and the CCG is expecting all vacancies to be filled by early September 2018. There are plans for a

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whole team away day later that month to share the collective vision and actions required to build upon the CCG’s success over the last year. The CCG has agreed with NHS England that PricewaterhouseCoopers will review the initial operation of the revised governance structure in October 2018. Commissioning and Capability Programme The CCG has participated in Wave Two of the National Commissioning and Capability Programme; a twelve week programme focused on building skills with CCG leadership teams to deliver at strategic, financial and implementation levels; alongside its ability to manage and influence stakeholders. The programme is complete and the CCG is now entering a formal buddying programme with organisations that have successfully delivered in areas it is currently working on, such as model of care and whole system redesign. System Leaders’ Workshop System Transformation Board (STB) members attended a workshop facilitated by Carnall Farrar on 11 July 2018. This was to share the key findings of the independent analysis undertaken and agree system actions that will then be presented to the regulators at a national level in October 2018. The agreed actions from the workshop are senior level commitment to:

• Developing a financial plan for the system by the end of August 2018 • Creating a compelling ten year strategy that addresses health outcomes and the wider

determinants of health • Resourcing a system team for delivery – at least 0.5 to 1.0 whole time equivalent (WTE)

per organisation dedicated to system delivery • Operating at each of the different levels of commissioning and delivery as required (for

example, integrated care partnerships and systems), with the development of place-based care in Northumberland as a key priority

• Creating a stronger mandate for the System Transformation Board to hold people to account for delivery and resetting the work of the Board.

Hexham General Hospital – Urgent Care Centre Due to the staffing pressures currently experienced by Northumbria Healthcare NHS Foundation Trust (NHCFT) the Urgent Care Centre at Hexham General Hospital closed overnight (2200 to 0800) from 18 July 2018 for at least four weeks. NHCFT have advised all key stakeholders and issued public messaging to direct patients who may have used the service to NHS 111 or, in an emergency, 999. The decision was taken as a last resort in an effort to ensure that the best possible care is available across the system during peak demand periods. The temporary closure will be kept under constant review. Local Medical Committee (LMC)

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The CCG attended the LMC meeting on 12 July 2018. The majority of the meeting focused on the decision to disperse the Collingwood practice, the impact on neighbouring practices and the need for practical support to manage the dispersal. The CCG is playing a fundamental role in supporting practices and patients through this dispersal and has agreed practical steps with the affected practices to support and manage the process. As ever the CCG remains open to any learning and new solutions. Health and Wellbeing Board The Health and Wellbeing Board (HWBB) in July 2018 considered a progress report from the STB including the update on the Carnall Farrah system leaders’ workshop, Northumbria Healthcare NHS Foundation Trust’s Five Year Plan and the Northumberland Local Plan. This is particularly important as it outlines the volume and location of current and planned builds. The CCG raised the need to plan in a very integrated way so that the right health infrastructure to support the new communities can be implemented. The HWBB were reminded that it was vitally important that this issue was closely monitored and fully addressed. Regional Meetings There have been a range of regional meetings including the CCG Joint Reference Group and the Urgent and Emergency Care Strategic Network. The main theme remains streamlining and preparation for the future of integrated care systems and partnerships; balanced with local place based delivery where it matters most.

• Urgent and Emergency Care Strategic Network: The main items included the learning and evaluation from last Winter and preparation for the Winter ahead, alongside updates on the implementation of 111 Online; and mobilisation of the recently procured 111 and Clinical Advice Service.

• CCG Joint Reference Group: The Group considered the planned developments in pathology services across the region and progress on the delivery requirements for the new General Data Protection Regulations across the care system.

Recommendation The Governing Body members are asked to consider the content of the report and provide comment. Appendix 1: Northumberland CCG Assurance Letter

Dear Vanessa

2017/18 CCG Annual Assessment

The CCG annual assessment for 2017/18 provides each CCG with a headline assessment against the indicators in the CCG improvement and assessment framework (CCG IAF). The IAF aligns key objectives and priorities as part of our aim to deliver the Five Year Forward View. The headline assessment has been confirmed by NHS England’s Commissioning Committee. This letter provides confirmation of the annual assessment, as well as a summary of areas of strength and a focus for improvement in 2018/19 (Annex A). Detail of the methodology used to reach the overall assessment for 2017/18 can be found at Annex B. The categorisation of the headline rating is either; Outstanding, Good, Requires Improvement or Inadequate. The final draft headline rating for 2017/18 for Northumberland CCG is Requires improvement. 2017/18 has been a challenging year however Northumberland CCG has made good progress in relation to the objectives set out in the Directions / Special Measures regarding governance and financial performance. Due to the significant commitment and efforts of the leadership team and staff, there have been important areas of progress as follows:

The development and implementation of a CCG Improvement Plan following a

review by Price Waterhouse Cooper with many of these actions already

addressed.

The CCG has joined the Commissioning Capability Programme to further

strengthen CCG arrangements, linked to the Improvement Plan.

Development of a new CCG Constitution to strengthen governance.

NHS England

Waterfront 4 Newburn Riverside

Newcastle-Upon-Tyne Tyne and Wear

NE15 8NY [email protected]

Telephone Number – 0113 825 3314

Monday, 09 July 2018

Vanessa Bainbridge,

Accountable Officer,

Northumberland CCG,

County Hall,

Morpeth,

Northumberland,

NE61 2EF.

Following initial deterioration of the financial position in 2017/18 the CCG did

meet the revised forecast deficit.

Continued delivery of the majority of NHS constitutional standards.

Collaborative work with the other CCGs in CNE.

The Directions currently in place for the CCG will remain in conjunction with special measures. Acknowledging the progress made by the CCG to date, we will continue to actively work and support the CGG and the wider system in order that, subject to a review later in the year, the directions and special measures can be lifted during 2018/19.

The 2017/18 annual assessments will be published on the CCG Improvement and Assessment page of the NHS England website on 12 July. At the same time they will be published on the MyNHS section of the NHS Choices website. The dashboard with the data will be issued with year-end ratings in July. I would ask that you please treat your headline rating in confidence until NHS England has published the annual assessment report on its website. This rating remains draft until formal release. Thank you for your CCG’s contribution to the delivery of the Five Year Forward View, and your continued focus on driving improvements across health and social care for local people working with partners. I look forward to working with you and colleagues during 2018/19 to deliver better outcomes for patients and local communities both through place based integration locally and working at scale across Cumbria and the North East.

Yours sincerely

Alison Slater

Director of Commissioning Operations

NHS England, Cumbria and the North East

Annex A – 2017/18 summary

Key Areas of Strength / Areas of Good Practice According to the latest available data, Northumberland CCG is rated in the top

quartile of CCGs nationally on the following indicators:

People with diabetes diagnosed less than a year who attend a structured

education course

The proportion of carers with a long term condition who feel supported to

manage their condition

Staff engagement index

Progress against Workforce Race Equality Standard

Provision of high quality care: hospitals

Provision of high quality care: primary medical services

Cancer patient experience

Completeness of the GP learning disability register

Neonatal mortality and stillbirths

Percentage of patients admitted, transferred or discharged from A&E within 4

hours

Delayed transfers of care per 100,000 population

Primary care access - percentage of registered population offered full

extended access

Patients waiting 18 weeks or less from referral to hospital treatment

Percentage of NHS Continuing Healthcare full assessments taking place in an

acute hospital setting

Key Areas of Challenge According to the latest available data, Northumberland CCG is rated in the lowest

quartile of CCGs nationally on the following indicators:

Injuries from falls in people aged 65 and over

Antimicrobial resistance: appropriate prescribing of antibiotics in primary care

Provision of high quality care: adult social care

People with first episode of psychosis starting treatment with a NICE-

recommended package of care treated within 2 weeks of referral

Reliance on specialist inpatient care for people with a learning disability and/or

autism

Emergency admissions for urgent care sensitive conditions

Population use of hospital beds following emergency admission

Key Areas for Improvement

Maintain a relentless focus on finance and delivery of QIPP, including a continued focus on delivery of:

o CHC savings o Prescribing efficiencies programme o Right Care initiatives including Cardiology, MSK and Respiratory o Mental health services efficiency projects o Demand management to address variations across all member

practices

To progress urgent and emergency care transformation including the use of Northumbria’s Specialist Emergency Care Hospital and base sites.

Key Areas for Development

Continue to build strong relationships including the development of system

wide working at a number of levels (including partners within the local footprint

and CNE wide) to improve health and care outcomes, drive improvements in

quality, ensure the sustainability of services and demonstrate increased

efficiency and productivity.

Ensure proactive leadership in the development and implementation of the

CNE STP and the emerging ICS particularly in regard to the governance

framework and delivery of the key objectives in the workstreams.

Working jointly with other CCGs in local geographies to collectively make the

best use of resources (e.g. joint committees, joint /shared management

arrangements) in order to drive transformation at scale and pace.

Working across CNE and the North Region, share learning and good practice

in order to drive transformation and implement new models of care at scale.

Annex B – overall assessment methodology

NHS England’s annual performance assessment of CCGs 2017/18 1. The CCG IAF comprises 51 indicators selected to track and assess variation

across policy areas covering performance, delivery, outcomes, finance and leadership. This year, assessments have been derived using an algorithmic approach informed by statistical best practice; NHS England’s executives have applied operational judgement to determine the thresholds that place CGCs into one of four performance categories overall.

Step 1: indicator selection

2. A number of the indicators were included in the 2017/18 IAF on the basis that they were of high policy importance, but with a recognition that further development of data flows and indicator methodologies may be required during the year. However, by the end of the year, there was just one indicator that was excluded as there is no data available for the measure: mental health crisis.

Step 2: indicator banding

3. For each of the 207 CCGs, the remaining indicator values are calculated. For each indicator, the distance from a set point is calculated. This set point is either a national standard, where one exists for the indicator (for example in the NHS Constitution); or, where there is no standard, typically the CCG’s value is compared to the national average value.

4. Indicator values are converted to standardised scores (‘z-scores’), which allows

us to assess each CCG’s deviation from expected values on a common basis. CCGs with outlying values (good and bad) can then be identified in a consistent way. This method is widely accepted as best practice in the derivation of assessment ratings, and is adopted elsewhere in NHS England and by the CQC, among others. 1

5. Each indicator value for each CCG is assigned to a band, typically three bands of

0 (worst), 2 (best) or 1 (in between).2

Step 3: weighting

6. Application of weightings allows the relatively greater importance of certain components (i.e. indicators) of the IAF to be recognised and for them to be given greater prominence in the rating calculation.

7. Weightings have been determined by NHS England, in consultation with

operational and finance leads from across the organisation, and signal the significance we place on good leadership and financial management to the commissioner system:

1 Spiegelhalter et al. (2012) Statistical Methods for healthcare regulation: rating, screening and

surveillance 2 For a small number of indicators, more than 3 score levels are available, for example, the leadership

indicator has four bands of assessment.

Performance and outcomes measures: 50%;

Quality of leadership: 25%; and,

Finance management: 25% 8. These weightings are applied to the individual indicator bandings for each

CCG to derive an overall weighted average score (out of 2).

Step 4: setting of rating thresholds

9. Each CCG’s weighted score out of 2 is plotted in ascending order to show the relative distribution across CCGs. Scoring thresholds can then be set in order to assign CCGs to one of the four overall assessment categories.

10. If a CCG is performing relatively well overall, their weighted score would be

expected to be greater than 1. If every indicator value for every CCG were within a mid-range of values, not significantly different from its set reference point, each indicator for that CCG would be scored as 1, resulting in an average (mean) weighted score of 1. This therefore represents an intuitive point around which to draw the line between ‘good’ and ‘requires improvement’.

11. In examining the 2017/18 scoring distribution, there was a natural break at

1.45, and a perceptible change in the slope of the scores above this point.

This therefore had face validity as a threshold and was selected as the break

point between ‘good’ and ‘outstanding’.

12. NHS England’s executives have then applied operational judgement to determine the thresholds that place CCGs into the ‘inadequate’. A CCG is rated as ‘inadequate’ if it has been rated red in both quality of leadership and financial management.

13. This model is also shown visually below:

(1.33

1) × 25% + (

2

1) × 25% + (

49.5

48) × 50% = 𝟏. 𝟑𝟓

Figure 1: Worked example

Anytown CCG has:

- Quality of leadership rating of “Green” (equivalent to a banded score of 1.33) - Finance management rating of “Green” (equivalent to banded score of 2) - For the remaining 48 indicators, the total score is 49.5. - These scores are divided through by their denominator and weighted to

produce an overall domain weighted score:

Agenda Item 6.1

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1 20180725 UC Agenda Item 6.1 Month 3 Finance Update



Date 25 July 2018

Agenda item 6.1

Report title Month 3 Finance Update

Report author Chief Finance Officer

Sponsor Chief Finance Officer


Public



Information only


Decision/Action Links to Corporate Objectives Ensure that the CCG makes best use of all available

resources





M3 finance update presented to Corporate Finance Committee on 18 June 2018

QIPP Incorporates overall 2018/19 QIPP programme delivery

Risks Strategic Risk 946 – Financial Balance Operational Risk 1799 - QIPP

Resource implications N/A Consultation/engagement N/A Quality and Equality impact assessment

Completed report below.

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20180725 UC Agenda Item 6.1 Month 3 Finance Update 2

Research N/A

Legal implications CCG statutory financial duties Impact on carers N/A

Sustainability implications N/A

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QUALITY and EQUALITY IMPACT ASSESSMENT 1. Project Name Month 3 Finance update

2. Project Lead Director Lead Project Lead Clinical Lead Chief Finance Officer


Month 3 Finance update



C L Scores


Patient Safety N/A Clinical Effectiveness N/A Patient Experience N/A Others including reputation, information governance and etc.



C L Scores



N/A


N/A


N/A

7. Metrics Sensitive to the impacts or risks on quality and equality and can be used

Impact Descriptors Baseline Metrics Target N/A

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for ongoing monitoring. 8. Completed By Signature Printed

Name Date

Head of Financial Management

R Turnbull 16/07/2018



Date



Date

Comments

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Governing Body 25 July 2018 Agenda Item: 6.1 Month 3 Finance Update Sponsor: Chief Finance Officer

Members of the Governing Body are asked to: 1. Consider NHS Northumberland Clinical Commissioning Group’s financial position at

30 June 2018 and provide comment.

Purpose

This report presents the financial position of NHS Northumberland Clinical Commissioning Group (CCG) for the period to 30 June 2018. The Appendices show the position broken down across the relevant areas of expenditure. This report was considered by the Corporate Finance Committee on 18 July 2018. Background The CCG has a control total deficit of £8m for the financial year 2018-19. If the CCG can achieve this position it qualifies for an additional non-recurrent allocation of £8m Commissioner Sustainability Funding (CSF). This will enable the CCG to report an in-year breakeven position for 2018-19. By achieving breakeven, the CCG will maintain the same level of historic debt that it started the financial year with of £57.8m. For 2018-19 reporting, additional expenditure categories have been added to appendix 1 to increase transparency and bring the CFC reporting more in line with the national reporting categories used in the financial planning submissions to NHS England (NHSE). These include separate sections for Acute, Mental Health, Community Services, Continuing Healthcare, Primary care, Primary Care Co-commissioning, Other Services, Commissioning Reserves and Contingency. Appendix 7 shows the CCG level performance for primary medical (GP) care in more detail. For this month, an additional appendix 8 has been added to show what Risks and Mitigations the CCG is reporting in its financial returns to NHSE. Financial Position Overview Appendix 1 shows the financial performance of the CCG for the year to date to 30 June 2018. The in-year resource allocation is shown in the top section split between Programme,

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Delegated Primary Care and Running costs allocations excluding the brought forward historic deficit from 2017-18 (£57.8m). The middle expenditure section then shows the expenditure and budget variance as at Month 3 (£8.0m forecast outturn). The bottom section adds back the anticipated successful achievement of the CSF and Historic debt to show what the ‘in year’ position and historic debt are forecast to be at the end of 2018-19 (breakeven and £57.8m respectively). Appendix 2 shows the total confirmed 2018-19 allocation for programme and running costs as at 30 June 2018 is £522.8m. The allocation table in appendix 2 shows the individual allocation information for each of the allocations received by the CCG in year, who is the commissioning lead, and where required, whether the funding has been approved by Governing Body to be committed. The following table shows all the allocations received in June 2018, which are all non-recurrent:

June Allocations £000’s GP WIFI Maintenance 2018/19 27 Cancer Quality of Life Metric Project Q1 9 2018-19 CYP IAPT Trainee staff salary support funding 4 Ambulance Funding 18/19 966

Financial Position Detail The CCG shows the individual budget line positions on appendix 1 net of their QIPP target. The following positions for Month 3 show the variance against these lines reflecting expected QIPP delivery achieved in 2018-19. Acute At the time of income and expenditure (I&E) reporting, the CCG had access to one months’ worth of PbR contract data validated through the SLAM system. This is not a large enough sample to do trend analysis and profiling. The CCG has therefore reported a breakeven I&E position for the main acute contracts as at Month 3. The main ambulance contract with North East Ambulance Service NHS Foundation Trust (NEAS) is mainly a block payment arrangement so is also reported breakeven. In the smaller acute contracts there has been over performance identified in City Hospitals Sunderland NHS Foundation Trust (47k) and County Durham and Darlington NHS Foundation Trust (34k) in NHS, and small over performance against the non NHS providers (5k). Mental Health The main Mental Health contract is with Northumberland Tyne and Wear NHS Foundation Trust (NTW). For 2018-19, the CCG has an agreed contract value to work to with the provider. The target outturn requires both parties to share some risk on achieving efficiencies and at this stage of the financial year the CCG is reporting this contract as breakeven as has classed this as low risk to the CCG in terms of QIPP delivery.

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Section 117’s represent a potential risk for the CCG in 2018-19 with a number of high cost cases potentially becoming the responsibility of the CCG in-year. At Month 3, this is reported as 37k over performance but the CCG have flagged additional risk on top of this and captured this in risk reporting to NHSE, the CCG is able to mitigate this through reserves and non-recurrent measures (appendix 8). There are other block contracts included in this section that will continue to be shown as breakeven throughout the year. They are the Talking Matters Northumberland (TMN) IAPT contract and the Mental Health Pool contract with the local authority. In other mental health services, there is overspend against budget of 34k for Section 12 claims where the QIPP scheme achievement looks unlikely and subsequent pressure has therefore been played out in the reported position at Month 3. Community Services In Community Services the CCG reports its main block contract with Northumbria Healthcare NHS Foundation Trust (NHCFT) which is and will be reported as breakeven throughout the year. There is a smaller community contract with Newcastle Hospitals NHS Foundation Trust (NUTHFT) and a budget for continence products with NHCFT under Other community contracts NHS. The Non NHS community line includes the JELS contract (block) and smaller contracts with the Local Authority and St Oswald’s for Palliative care which is reporting an underspend by 46k. Continuing Healthcare Early data indications are that the main Continuing Healthcare (CHC) contract outturn with the Local Authority will be in line with the agreed contract value and is therefore reported as breakeven for Month 3. Other CHC spend includes smaller children’s CHC package recharges from the local authority and Nurse Assessor payments to NHCFT and is also expected to be in line with budget at this stage of the year. Prescribing and CCG funded Primary Care services Prescribing data runs two months in arrears. At the time of reporting, there was one months’ worth of data available from the Business Services Authority (BSA) for reporting variances in the Month 3 position. The data has moved to a new platform called ePACT2 and the detailed reports the CCG normally receives were not available for month 3 reporting due to implementation problems of the new system. However, high level numbers were available and were closely in line with the planned budget. The CCG has reported a variance of £4k overspend in Month 3 to reflect this data. The out of hours contract is due to be re-procured later in the year and will show breakeven until this point, when the revised contract value will be known.

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Commissioning schemes contain local enhanced services and until the level of achievement/participation of each of the individual schemes and practices is determined, they will be reported as breakeven. GP forward view contains allocations for extended access, online consultation and GP clerical training. Along with the Practice transformation support line they are expected to spend in line with budget. Primary Care dressings are showing a pressure of 91k due to initial QIPP saving projections being forecast less than planned. Finally, the Other Primary care line is made up of GPIT, Oxygen and the medicines management element of the NECS contract. Oxygen is cost is above budget and an over spend of 23k has been reported at Month 3. Primary Care Co Commissioning The delegated primary care budgets are under more pressure than they have been in previous years. There is a possibility that increased costs in GP contracts (increasing at a percentage growth above the annual growth applied to the ring fenced delegated allocation) may cause the CCG to subsidise some of the payments via its own contingency. In previous years, this has always been able to be contained and managed within the delegated allocation. Reported forecast breakeven at Month 3 but this will require close monitoring throughout the year to identify any potential risk to the overall bottom line. Other Programme Services The Core Better Care Fund (BCF) payment to the Local Authority is a core pass through payment as indicated by NHSE and is a block arrangement paid in twelfths. The 111 Contract is part of a re-procurement later in the year and is to be reported as breakeven until that point. The Other Services line includes costs for private transport, exceptional treatment approved and voluntary sector contract with Barnardo’s and British Pregnancy Advice Service (BPAS). £41k overspend reported relates to BPAS 26k and Barnardo’s £15k. Running costs Running cost budgets are showing a 271k underspend at Month 3. For 2018-19 there will be an in year under performance against staffing budgets due to the implementing of the new CCG staffing structure part way through the financial year. Budgets for the new staffing structure are set on a full year basis to ensure affordability to the CCG. Posts that are vacant or yet to be appointed to will create an under spend and that’s been reflected in Month 3 reporting. Further work on pay forecasts will continue through the year with the new agenda for change pay structure and bandings set to commence from July 2018 and back pay being processed in August 2018.

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Risk Appendix 8 summarises the main risks to the CCG outside of its reported I&E position narrated above and shown in appendix 1. Appendix 8 is consistent with what the CCG reports to NHSE on the non ISFE finance returns monthly. Risks are identified and reported where there is uncertainty in an outcome and that outcome would have a material impact on the reported position, a value is then applied to that risk based on the likelihood of that outcome happening. The main risks to the CCG in this financial year are QIPP under delivery, historic acute contract challenges and high cost packages of care within mental health. The CCG’s QIPP tracker identifies where there is risk in delivery by RAG rating each QIPP scheme on a monthly basis. Mitigation, Commissioning Reserves and Contingency To mitigate the above risks the CCG has been able to set aside in planning assumptions a 0.5% contingency and a general reserve of just over 1%. It is to act mainly as mitigation for under delivery of PbR QIPP scheme delivery, which has historically been hard to deliver and transact with the CCG’s main acute providers. The general reserve will also go to offset other potential slippage in other QIPP schemes areas if they arise. The CCG is reviewing 2017-18 year end positions to identify areas of benefit or pressure from close out positions. Any favourable benefits will act as further non recurrent mitigation for 2018-19. The CCG is continuing to develop a QIPP pipeline. These schemes which will act as a further level of mitigation to the current reported position if they are able to be progressed through the PMO gateways and are up and running in the 2018-19 financial year. The CCG is currently reporting that its net risk adjusted position (position after expected risk and mitigations are taken into account) is the same as it’s I&E reported position. Activity As mentioned above under acute, at the time of I&E reporting the CCG had access to one months’ worth of PbR contract data validated through the SLAM system. However, appendix 6 includes the latest possible activity data at time of the meeting and therefore includes Month 2 flex position. NHCFT have flagged data issues in the A&E and some outpatient datasets. This is not be corrected until future months.

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Northumbria Healthcare NHS Foundation Trust (NHCFT) Appendix 6a details an activity overview at Month 2 flex data comparing actual performance at PoD level with the SLAM plan. The analysis shows the most significant variances to be in Elective (T&O), Non Elective and Ambulatory Care admissions and Outpatients (Data issue). A number of these variances are created by numerous existing coding challenges the CCG has previously raised with NHCFT and are reflected in CCG plan figures. Joint investigations are still underway to explain the changes to service which have caused the increases versus the desired plan levels in ambulatory care and elective. PoD’s underperforming includes A&E, Critical Care and Drugs and devices and need to be closely monitored to continue positive start to the year. The SLAM model profiles the forecast outturn for activity and cost based on the early months data received, therefore further months data will be require to understand if these activity levels are to continue at the level seen in April 2018 and May 2018 flex data. Newcastle Upon Tyne Hospitals NHS Foundation Trust (NUTHFT) Appendix 6b details an activity overview at Month 2 flex data comparing actual performance at PoD level with the SLAM plan.

The early SLAM forecasts are encouraging and they show that activity and cost is below plan across most PoDs although there is over performance against elective procedures, the over performance is mainly in specialties Ophthalmology, Dermatology and Neurology and requires further monitoring as the year progresses. Drugs and devices are also over performing versus plan and require further analysis. Statement of Financial Position and Cash Flow The Statement of Financial Position (appendix 3) shows the closing positions at the end of June 2018 in comparison to May 2018 reported. There has been an increase in creditors in month mainly due to the CCG holding payments relating to contract challenges and disputes. Debtors increased in month due to an invoice for Northumberland County Council (NCC) being raised in June 2018 for £1.2m. This has since been paid in July 2018. NHSE expect the CCG to proactively manage the cash it draws down each month and the amount it actually spends. The target is to have no more than 1.25% of the monthly drawdown of cash left in the main bank account each month. The cash balance at the end of June 2018 was £0.4m (appendix 5) which equates to 0.96% of the June drawdown, and meets the target level. Better Payment Practice Code for year to 30 June 2018

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The Better Payment Practice Code requires that all valid invoices should be paid by their due date or within 30 days of receipt, whichever is later. The CCG is measured against a target of 95% achievement.

Appendix 4 shows the cumulative value of NHS invoices paid within 30 days at 30 June was 99.99% as a percentage of invoice value and 99.80% by invoice count. The cumulative value of Non NHS invoices paid within 30 days at 30 June was 99.91% as a percentage of invoice value and 99.68% by invoice count. Appendix 1: Year to date income and expenditure report Appendix 2: Allocation breakdown Appendix 3: Statement of financial position

Appendix 4: Better payment practice code Appendix 5: Cash flow forecast Appendix 6: SLAM Contract Analysis Appendix 7: Primary care expenditure

Appendix 8: Risk and Mitigation

APPENDIX 1

YTD Budget YTD Actual

YTD Variance (Under)/

Overspend


Overspend 2018-19 BudgetForecast Outturn

Forecast Variance (Under)/

Overspend


Overspend

£000's £000's £000's % £000's £000's £000's %

ResourceProgramme Baseline 118,347 118,347 0 471,453 471,453 0Primary Care Co-commissioning Baseline 11,095 11,095 0 44,368 44,368 0Running Costs Baseline 1,794 1,794 0 6,967 6,967 0In Year Allocation 131,235 131,235 0 522,788 522,788 0

Expenditure

Acute ServicesNorthumbria Healthcare NHS FT 44,072 44,072 0 0.00% 171,644 171,644 0 0.00%Newcastle Upon Tyne Hospitals NHS FT 16,544 16,544 0 0.00% 65,423 65,423 0 0.00%North East Ambulance Service 3,546 3,546 0 0.00% 14,185 14,185 0 0.00%Acute Contracts NHS 867 887 20 2.34% 3,462 3,543 81 2.34%Acute Contracts Non NHS 2,033 2,034 1 0.06% 8,131 8,136 5 0.06%Other Acute NCA 697 697 0 0.00% 2,241 2,241 0 0.00%Other Acute Non Rec 1,215 1,215 0 0.00% 4,860 4,860 0 0.00%Total acute services 68,974 68,995 22 269,946 270,032 86

Core Mental Health servicesNorthumberland Tyne & Wear NHS Foundation Trust 11,336 11,336 0 0.00% 42,856 42,856 0 0.00%Section 117's (LA) 1,657 1,666 9 0.56% 6,627 6,664 37 0.56%Talking Matters Northumberland 989 989 0 0.00% 3,954 3,954 0 0.00%Mental Health Pooled budget (LA) 675 675 0 0.00% 2,698 2,698 0 0.00%Mental Health Other services 456 465 9 1.87% 1,824 1,858 34 1.87%Total Core Mental Health 15,112 15,130 18 57,960 58,031 71

Community ServicesNorthumbria Healthcare NHS FT (Comm) 7,264 7,264 0 0.00% 29,054 29,054 0 0.00%Newcastle Upon Tyne Hospitals NHS FT (Comm) 76 76 0 0.00% 305 305 0 0.00%Other Community Contracts NHS 162 162 0 0.00% 650 650 0 0.00%Community Contracts Non NHS 472 460 -11 -2.41% 1,883 1,838 -46 -2.42%Total Community Services 7,974 7,963 -11 31,892 31,846 -46

Continuing HealthcareContinuing Healthcare Main contract 8,616 8,616 0 0.00% 34,463 34,463 0 0.00%Other Continuing Healthcare 211 211 0 0.00% 845 845 0 0.00%Continuing Healthcare Reserves 764 764 0 0.00% 1,173 1,173 0 0.00%Total Continuing Healthcare 9,591 9,591 0 36,481 36,481 0

Prescribing and CCG Funded Primary Care ServicesPrescribing 13,762 13,763 1 0.01% 55,715 55,718 234 0.01%Out of Hours 702 702 0 0.00% 2,365 2,365 0 0.00%Commissioning Schemes 544 544 0 0.00% 2,175 2,175 0 0.00%GP Forward View 523 523 0 -0.14% 2,091 2,091 0 -0.17%Practice Transformation support 121 121 0 0.00% 483 483 0 0.00%Primary Care Dressings 348 371 23 6.57% 1,391 1,482 -139 6.57%Other Primary Care 366 372 6 1.58% 1,464 1,487 23 1.58%Total Prescribing and CCG Funded Primary Care Services 16,365 16,395 30 65,684 65,803 118

Primary Care Co Commissioning (appendix 7) 11,095 11,092 -2 -0.02% 44,368 44,368 0 0.00%

Other Programme ServicesCore BCF (Social Care) 1,841 1,841 0 0.00% 7,365 7,365 0 0.00%111 contract 275 275 0 0.00% 1,006 1,006 0 0.00%Other Services (inc. PTS & IFR) 215 228 13 6.24% 845 886 41 4.86%Total Other Programme Services 2,331 2,344 13 9,216 9,257 41

Commissioning Reserves & ContingencyGeneral Reserve 0 0 0 0.00% 5,535 5,535 0 0.06%Non Recurrent Allocations 0 0 0 0.00% 128 128 0 0.00%Contingency 0 0 0 0.00% 2,610 2,610 0 0.00%Total Commissioning Reserves 0 0 0 8,273 8,273 0

Planned Deficit Control Total -2,000 0 2,000 -8,000 0 8,000

Total Commissioned Services 129,441 131,510 2,069 515,821 524,092 8,271

Running Costs 1,794 1,725 -69 0.00% 6,967 6,696 -271 0.00%

Total Expenditure 131,235 133,235 2,000 522,788 530,788 8,000

Commissioner Sustainability Fund 2,000 0 -2,000 8,000 0 -8,000

In Year 2018-19 Breakeven 133,235 133,235 0 530,788 530,788 0

B/F Deficit 57,807

Cumlutaive Deficit 57,807

INCOME & EXPENDITURE REPORT - YTD & FOT POSITION AS AT 30 JUNE 2018

APPENDIX 2

Recurrent Non Recurrent Total£000's £000's £000's

April Initial CCG Programme Allocation 469,387 0 469,387 Initial allocation - ProgrammeInitial CCG Running Cost Allocation 6,959 0 6,959 Initial allocation - Running CostsInitial CCG Primary Care Co-Commissioning Allocation 44,534 0 44,534 Initial allocation - Primary Care Co CommissioningParamedic Rebanding Allocations 132 132 Baseline AdjustmentMarket Rent - Running Costs 5 5 Baseline AdjustmentMarket Rent 634 0 634 Baseline AdjustmentHSCN 128 128 Baseline AdjustmentHSCN - Running Costs 3 3 Baseline Adjustment

Total NHS England Allocation April 2018 521,514 268 521,782May

Deficit Carry Forward - Planned 0 (57,807) (57,807) Technical Adjustment

Total NHS England Allocation May 2018 0 (57,807) (57,807)June

Moved from Delegated to Programme - GPFV 166 166 Technical Adjustment Moved from Delegated to Programme - GPFV (166) (166) Technical Adjustment GP WIFI Maintenance 2018/19 27 27 Brian Moulder/ Alan Bell Implement Wi FI nexwork in GP practicesCancer Quality of Life Metric Project Q1 9 9 Hilary Brown / Susan Boyd Pass through allocation to Northumbria HC FT2018-19 CYP IAPT Trainee staff salary support funding 4 4 Kate O'Brien IAPT TrainersAmbulance Funding 18/19 966 966 Pamela Phelps Winter resilience funding regional total for NEAS

Total NHS England Allocation June 2018 0 1,006 1,006Total YTD Confirmed NHS England Allocation 2018-19 521,514 (56,533) 464,981

In Year Allocation 2018-19 522,788

NHS ENGLAND IN YEAR ALLOCATIONS ASSIGNMENT & APPROVAL STATUS

Commissioning Manager Lead Narrative

Board Approval

(Y/N)

Board Approval

Date

APPENDIX 3

June 2018 May 2018 Movement£000's £000's £000's

Non Current Assets Property, plant and equipment 1,251 1,273 (22)Intangible Assets 0 0 0Other Financial Assets 0 0 0

Total Non Current Assets 1,251 1,273 (22)

Current Assets Trade and other Receivables 3,325 1,917 1,408Cash and cash equivalents 362 402 (40)

Total Current Assets 3,687 2,319 1,368

Total Assets 4,938 3,592 1,346

Current Liabilities Trade and other payables (36,576) (32,564) (4,012)Other liabilities 0 0 0Provisions 0 0 0Borrowings 0 0 0

Total Current Liabilities (36,576) (32,564) (4,012)

Non-Current Assets plus/less Net Current Assets/Liabilities (31,638) (28,972) (2,666)

Non-Current liabilities Other liabilities 0 0 0Provisions 0 0 0Borrowings 0 0 0

Total Non-Current Liabilities 0 0 0

TOTAL ASSETS EMPLOYED (31,638) (28,972) (2,666)

Financed by Taxpayers EquityCapital & Reserves General Fund (31,638) (28,972) (2,666)

Revaluation Reserve 0 0 0Other reserves 0 0 0

TOTAL TAXPAYERS EQUITY (31,638) (28,972) (2,666)

STATEMENT OF FINANCIAL POSITION

APPENDIX 4

Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 1,540 31,345 Total Non-NHS Trade Invoices Paid Within 30 Day Target 1,535 31,317 Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 99.68% 99.91%

NHS Total NHS Trade Invoices Paid in the Year 495 86,732 Total NHS Trade Invoices Paid Within 30 Day Target 494 86,732 Percentage of NHS Trade Invoices Paid Within 30 Day Target 99.80% 99.99%

BETTER PAYMENT PRACTICE CODEFOR THE THREE MONTHS TO 30 JUNE 2018

APPENDIX 5

Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast ForecastApril May June July August September October November December January February March

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

IncomeBalance bfwd 346 355 402 362 157 37 70 68 149 118 210 165DOH Income 36,600 41,900 37,900 38,100 37,300 37,700 38,000 37,800 37,800 37,500 37,900 42,200Supplementary /Cash Return 0 0 0 0 0 0 0 0 0 0 0 0Prescribing Charge to Cash Limit 3,671 4,044 3,942 4,342 4,321 4,381 4,622 4,239 4,389 4,426 4,566 4,450CHC Risk Pool 0 0 0 0 0 0 0 0 0 0 0 0Better Care Fund 0 0 0 0 0 0 0 0 0 0 0 0Other Income 1,522 60 38 1,402 200 200 200 200 200 200 200 200Total Income 42,139 46,359 42,282 44,206 41,978 42,318 42,892 42,307 42,538 42,244 42,876 47,015

ExpenditurePay (186) (181) (206) (207) (207) (207) (207) (207) (207) (207) (207) (207)NHS Payments including contracts (28,175) (30,929) (27,730) (28,213) (27,627) (27,627) (27,603) (27,603) (27,603) (27,603) (27,603) (30,431)Other Payments - BACS/CHAPS/CHQS (4,892) (5,558) (3,225) (6,628) (5,442) (5,274) (5,336) (5,265) (5,365) (5,282) (5,375) (5,564)Prescribing/Home Oxygen Therapy (3,671) (4,044) (3,942) (4,342) (4,321) (4,381) (4,622) (4,239) (4,389) (4,426) (4,566) (4,450)CHC Risk Share (3,793) (4,034) (5,601) (3,443) (3,128) (3,543) (3,840) (3,628) (3,640) (3,300) (3,744) (2,909)Better Care Fund (838) (1,022) (1,022) (1,022) (1,022) (1,022) (1,022) (1,022) (1,022) (1,022) (1,022) (3,210)Other (229) (189) (194) (194) (194) (194) (194) (194) (194) (194) (194) (194)Total Expenditure (41,784) (45,957) (41,920) (44,049) (41,941) (42,248) (42,824) (42,158) (42,420) (42,034) (42,711) (46,965)

BALANCE CFWD 355 402 362 157 37 70 68 149 118 210 165 50

CASHFLOW FORECAST

APPENDIX 6

CONTRACT SUMMARY

RTF - Northumbria RTD - Newcastle Other Providers Total

Finance 2,206,685 408,438 24,567 2,639,690Activity 175,529,118 64,531,421 6,071,594 246,132,134Finance % 83.6% 15.5% 0.9% 100.0%Activity % 71.3% 26.2% 2.5% 100.0%

POD CATEGORIESYEAR TO DATE

PLANYEAR TO DATE

ACTUALYEAR TO DATE

VARIANCE ANNUAL PLANFORECAST OUTTURN

OUTTURN VARIANCE

Non Elective 12,811 12,940 129 76,865 78,318 1,453Elective 8,394 9,305 912 50,370 55,666 5,296Outpatient First 2,350 2,294 (57) 14,104 13,751 (354)Outpatient Follow Up 3,066 3,103 37 18,401 18,613 212Outpatient Procedures 1,434 1,455 21 8,607 8,731 124Outpatient Diagnostics 683 711 28 4,100 4,268 168AandE 2,437 2,164 (273) 14,619 13,860 (759)Ambulatory Care 1,128 1,745 617 6,766 10,468 3,702Challenges 0 (1,407) (1407) 0 (6,198) (6,198)Critical Care 1,333 1,163 (170) 7,995 6,977 (1,018)Drugs and Devices 1,969 2,022 53 11,813 12,100 287Emergency Readmissions (1) (73) (72) (5) (436) (431)Emergency Threshold 0 0 0 1 1 0Excess Beddays 360 344 (16) 2,161 2,063 (97)Maternity Pathways 923 928 5 5,538 5,569 31Other Services 3,654 3,725 72 21,923 22,430 507Penalties 0 (47) (47) 0 (47) (47)QIPP (610) 0 610 (3,661) 0 3,661Other Contract Areas 0 0 0 0 0 0Grand Total 39,930 40,372 442 239,596 246,132 6,536


PLANYEAR TO DATE

ACTUALYEAR TO DATE


OUTTURN VARIANCE

Non Elective 5,615 5,565 (50) 33,693 33,402 (291)Elective 7,733 7,625 (108) 46,403 45,755 (648)Outpatient First 17,060 17,933 873 102,370 107,608 5,238 Outpatient Follow Up 43,958 44,767 809 263,796 268,635 4,839 Outpatient Procedures 9,398 9,330 (68) 56,392 55,984 (407)Outpatient Diagnostics 6,961 7,489 528 41,767 44,935 3,168 AandE 23,280 24,270 990 139,675 158,809 19,134 Ambulatory Care 2,866 4,243 1,377 17,197 25,458 8,261 Challenges 0 0 0 0 0 0 Critical Care 1,275 1,159 (116) 7,652 6,954 (698)Drugs and Devices 0 0 0 0 0 0 Emergency Readmissions 0 0 0 0 0 0 Emergency Threshold 0 0 0 0 0 0 Excess Beddays 1,446 1,387 (59) 8,674 8,322 (352)Maternity Pathways 992 950 (42) 5,953 5,700 (252)Other Services 303,561 313,021 9,460 1,821,368 1,878,129 56,761 Penalties 0 0 0 0 0 0 QIPP 0 0 0 0 0 0 Other Contract Areas 0 0 0 0 0 0 Grand Total 424,145 437,739 13,594 2,544,939 2,639,690 94,751

Month 2 data position £000's Full Year forecast £000's

ACTIVITY OVERVIEW

Month 2 data position - Activity Full Year forecast - Activity

FINANCE OVERVIEW

Service Level Agreement Monitoring (SLAM) Overview

Summary Bottom Line Position £'000

The positions below are based on month 2 Service Level Agreement Monitoring (SLAM) flex data produced via NECS for forecasting for the Full year effect of the CCG's main acute contracts.

* The SLAM Tables exclude NTW, NEAS and Community Contracts data from SLAM due to their block arrangements (cost entered but no activity).After Northumbria Healthcare NHS FT (Appendix 6a) and Newcastle Hospitals NHS FT (Appendix 6b) data is accounted for there remains 0.9% activity and 2.5% cost from other PbR providers. The Main other providers activity comes from Gateshead Healthcare, North Cumbria University Hospitals Trust and Ramsey Healthcare.

* Note: Figures for Specialty:- 501 Obstetrics have been removed from Outpatient First, Outpatient Follow Up & Outpatient Procedures due to anomalies between activity being recorded but no cost being incurred as part of maternity pathway costs, and therefore adjusted to show the actual variance versus plan.

APPENDIX 6A

CONTRACT SUMMARY

The position below is based on month 2 Service Level Agreement Monitoring (SLAM) flex data produced via NECS for forecasting for the Full year effect.


PLANYEAR TO DATE

ACTUALYEAR TO DATE

VARIANCE TARGET O/T SLAM O/T VARIANCENON ELECTIVE 10,215 10,362 148 61,287 62,203 916ELECTIVE 5,337 5,978 641 32,022 35,868 3,846A&E 2,120 1,792 (327) 12,718 11,632 (1,087)AMBULATORY CARE 1,007 1,640 633 6,040 9,840 3,800OUTPATIENT FIRST 1,554 1,524 (30) 9,327 9,146 (181)OUTPATIENT FOLLOW UP 1,970 2,036 67 11,818 12,218 400OUTPATIENT PROCEDURES 486 517 31 2,917 3,101 183OUTPATIENT DIAGNOSTICS 357 389 32 2,139 2,332 193EXCESS BEDDAYS 250 171 (79) 1,501 1,028 (473)CRITICAL CARE 982 863 (118) 5,890 5,181 (709)DRUGS AND DEVICES 864 761 (103) 5,186 4,567 (619)MATERNITY PATHWAYS 904 922 19 5,421 5,535 113OTHER SERVICES 3,173 3,216 43 19,038 19,296 259EMERGENCY THRESHOLD 0 0 0 1 1 0PENALTIES 0 0 0EMERGENCY READMISSIONS 0 (71) (71) 0 (423) (423)CHALLENGES 0 (1,204) (1,204) 0 (5,995) (5,995)QIPP (610) 0 610 (3,661) 0 3,661Grand Total 28,607 28,970 292 171,644 175,529 3,885

Less QIPP Delivery/Further Challenge Assumptions not in SLAM model 0 (3,885) (3,885)Board Report Position 171,644 171,644 0


PLANYEAR TO DATE

ACTUALYEAR TO DATE


FORECAST OUTTURN VARIANCE

NON ELECTIVE 4,449 4,275 (174) 26,693 25,660 (1,033)ELECTIVE 4,557 4,351 (206) 27,339 26,106 (1,233)A&E 20,188 20,678 490 121,131 137,263 16,132 AMBULATORY CARE 2,631 4,037 1,406 15,786 24,222 8,436 OUTPATIENT FIRST 12,120 13,002 882 72,722 78,012 5,290 OUTPATIENT FOLLOW UP 30,170 31,285 1,115 181,020 187,710 6,690 OUTPATIENT PROCEDURES 3,012 2,954 (58) 18,072 17,724 (348)OUTPATIENT DIAGNOSTICS 4,157 4,504 347 24,942 27,024 2,082 EXCESS BEDDAYS 1,029 717 (312) 6,172 4,302 (1,870)CRITICAL CARE 885 805 (80) 5,310 4,830 (480)DRUGS AND DEVICES 0 0 0 0 0 0 MATERNITY PATHWAYS 964 935 (29) 5,782 5,610 (172)OTHER SERVICES 270,719 278,037 7,318 1,624,315 1,668,222 43,907 Grand Total 355 366 10,699 2,129 2,207 77,401

Reconciliation to board report

ACTIVITY OVERVIEW* An adjustment has been made to the Activity data in Outpatients firsts, follow ups and Procedures for 501 Obstetrics, as the activity is record in SLAM for reconciliation purposes but doesn’t have a plan figure to offset against so shows a misleading variance.

Month 2 data position - Activity Full Year forecast - Activity


Northumbria Hospitals NHS FT


* The latest SLAM data (Month 2 flex) used in the tables below is made available after the financial ledger for the current reporting period closes, therefore there are differences between what is reported in the board report and what the SLAM data forecast for Northumbria Healthcare shows. The CCG reports the risk of under delivery of QIPP separately in the non ISFE monthly reporting to NHS England.

FINANCE OVERVIEW

APPENDIX 6B

CONTRACT SUMMARY

The position below is based on month 2 Service Level Agreement Monitoring (SLAM) flex data produced via NECS for forecasting for the Full year effect.


PLANYEAR TO DATE

ACTUALYEAR TO DATE



NON ELECTIVE 2,502 2,265 (237) 15,012 14,266 (746)ELECTIVE 2,851 3,048 197 17,105 18,289 1184A&E 272 265 (7) 1,635 1,591 (43)AMBULATORY CARE 117 97 (20) 704 585 (119)OUTPATIENT FIRST 762 711 (51) 4,571 4,266 (305)OUTPATIENT FOLLOW UP 1,031 986 (46) 6,188 5,915 (273)OUTPATIENT PROCEDURES 924 899 (25) 5,547 5,396 (151)OUTPATIENT DIAGNOSTICS 308 289 (18) 1,847 1,736 (111)EXCESS BEDDAYS 109 170 60 655 1,017 362CRITICAL CARE 302 293 (8) 1,812 1,761 (51)DRUGS AND DEVICES 1,081 1,226 145 6,484 7,356 872MATERNITY PATHWAYS 18 4 (13) 106 27 (80)OTHER SERVICES 473 428 (45) 2,836 2,580 (255)PENALTIES 0 (47) (47) 0 (47) (47)CHALLENGES 0 (204) (204) 0 (204) (204)Grand Total 10,750 10,430 (320) 64,500 64,531 31

Adjust for Budget Difference / Contract Reserves 923 892 -31Board Report Position 65,423 65,423 0


PLANYEAR TO DATE

ACTUALYEAR TO DATE



NON ELECTIVE 1,113 1,049 (64) 6,675 6,294 (381)ELECTIVE 2,993 3,083 90 17,961 18,498 537 A&E 2,485 2,485 0 14,909 14,910 1 AMBULATORY CARE 227 189 (38) 1,360 1,134 (226)OUTPATIENT FIRST 4,717 4,398 (319) 28,300 26,388 (1,912)OUTPATIENT FOLLOW UP 13,093 12,535 (558) 78,560 75,210 (3,350)OUTPATIENT PROCEDURES 6,266 6,143 (123) 37,599 36,858 (741)OUTPATIENT DIAGNOSTICS 2,631 2,606 (25) 15,788 15,636 (152)EXCESS BEDDAYS 414 657 243 2,485 3,942 1,457 CRITICAL CARE 357 350 (7) 2,142 2,100 (42)DRUGS AND DEVICES 0 0 0 0 0 0 MATERNITY PATHWAYS 27 13 (14) 162 78 (84)OTHER SERVICES 32,553 34,565 2,012 195,317 207,390 12,073 PENALTIES 0 0 0 0 0 0 CHALLENGES 0 0 0 0 0 0 Grand Total 66,876 68,073 1,197 401,258 408,438 7,180

Newcastle Upon Tyne Hospitals NHS FT


* The latest SLAM data (Month 2 Flex) used in the tables below is made available after the financial ledger closes, therefore there are differences between what is reported in the board report (appendix 1) and what the SLAM data forecast for Newcastle Hospitals NHS FT shows, however to provide the most up to date information the latest data available at board report close is used. The CCG reports the risk of under delivery of QIPP separately in the non ISFE monthly reporting to NHS England.

FINANCE OVERVIEW


Reconciliation to board report

ACTIVITY OVERVIEW

Month 2 data position Full Year forecast

APPENDIX 7

2017-18 Annual Budget YTD Budget YTD Actual


OverspendForecast Outturn


OverspendNHS NORTHUMBERLAND CCGGeneral Practice - GMS 8,647,987 2,164,974 2,170,041 5,067 8,680,165 32,178General Practice - PMS 22,044,248 5,511,022 5,502,490 -8,532 22,009,958 -34,290QOF 4,983,831 1,245,889 1,326,355 80,466 5,247,575 263,744Enhanced Services 1,999,049 499,631 420,584 -79,047 1,827,969 -171,080Premises Cost Reimbursement 4,323,184 1,080,665 1,079,239 -1,426 4,314,412 -8,772Dispensing/Prescribing Drs 1,650,796 412,643 412,643 0 1,566,227 -84,569Other GP Services 909,773 227,375 226,455 -920 910,398 625CCG Prescribing -190,868 -47,698 -45,553 2,145 -188,704 2,164Grand Total 44,368,000 11,094,501 11,092,254 -2,247 44,368,000 0

Medical - Monthly Budget Monitoring Report Month 3

APPENDIX 8

RISK AND MITIGATION

£000'sRISKS

AcutePotential Impact of unsuccessful challenges with Northumbria Healthcare NHS Foundation Trust 3,575

Risk rated QIPP under delivery - Technical Contract changes and PbR delivery 6,389Total Acute Risk 9,964

Mental HelathHigh Cost packages 500Risk rated QIPP under Delivery - Rebasing 450Total Mental Health Risk 950

Primary careRisk rated QIPP under Delivery - Prescribing 657Total Primary Care Risk 657

Other Programme ServicesRisk rated QIPP under Delivery - 111 Procurement 47Total Other Programme Services Risk 47

Running costsRisk rated QIPP under Delivery - PALS 100Total Running Costs Risk 100

Total Risks Reported 11,718

MITIGATIONSContingency -2,610General Reserve / Contract reserve -5,539Other Mitigations and Non Recurrent measures -3,569Total Mitigation Reported -11,718

Net Risk to Reported Position 0

Agenda Item 7 OFFICIAL

1 20180725 UC Agenda Item 7 Director of Public Health Update



Date 25 July 2018

Agenda item 7

Report title Director of Public Health Update

Report author Director of Public Health

Sponsor Director of Public Health

Private agenda

Private



Information only


Decision/Action






The draft Northumberland Local Plan was approved for public consultation at the Council’s Cabinet meeting 15 June 2018.

QIPP N/A Risks N/A Resource implications N/A Consultation/engagement Public, stakeholder, clinical Quality and Equality impact assessment

Completed

Research N/A

OFFICIAL

20180725 UC Agenda Item 7 Director of Public Health Update 2

Legal implications N/A Impact on carers There are no specific implications for carers Sustainability implications N/A

OFFICIAL


QUALITY and EQUALITY IMPACT ASSESSMENT 1. Project Name Director of Public Health Annual Update

2. Project Lead Director Lead Project Lead Clinical Lead Director of Public Health Director of Public Health N/A


To provide an update to the Board on strategic public health issues and considerations.



C L Scores


Patient Safety N/A Clinical Effectiveness N/A Patient Experience N/A Others including reputation, information governance and etc.

N/A



C L Scores



N/A


N/A


N/A

7. Metrics Sensitive to the impacts or risks on quality and equality

Impact Descriptors Baseline Metrics Target N/A

OFFICIAL


and can be used for ongoing monitoring.

8. Completed By Signature Printed Name

Date

Director of Public Health

E R Morgan 17/07/2018



Date



Date

Comments

OFFICIAL


Governing Body 25 July 2018 Agenda Item: 7 Director of Public Health Update Sponsor: Director of Public Health

Members of the Governing Body are asked to: 1. Consider the Director of Public Health report and provide comment.

Purpose This report outlines developments and issues at a local, regional or national level which are relevant for both public health and NHS Northumberland Clinical Commissioning Group (CCG). Release of smoking rate figures Figures published on 3 July 2018 suggest that adult smoking rates in the North East have nearly halved since 2005. Prevalence among adults fell from 17.2% in 2016 to 16.2% in 2017 according to the Annual Population Survey from the Office for National Statistics (ONS). This fall is nearly twice the national average since 2016 and also means smoking rates have fallen by over 44% since 2005 when 29% of North East adults smoked – around a quarter of a million fewer smokers across the region. In Northumberland, adult smoking rates have decreased from 16.9% in 2016 to 13% in 2017 (England rate 14.9%) and continues a general downward trend since 2011. There is also a falling trend in smoking rates in routine and manual workers from 28.2% in 2011 to 23.9% in 2017 however, the socio-economic gap in smoking rates remains persistent and continued focus is required on this group. Northumberland is one of five LA areas in the North East in which smoking prevalence is now below 15%. Report of the Royal College of Physicians. Hiding in plain sight: Treating tobacco dependency in the NHS (26 June 2018) The link between smoking and cancer was first characterised in the 1950s. Although the UK is considered to have the most advanced tobacco control policies in Europe, smoking remains the largest avoidable cause of death and disability, and of social inequalities in health, in the UK. This report argues that supporting patients to stop smoking is the one area where policy and practice have failed to achieve their potential. Despite the availability of evidence-based clinical guidelines on smoking interventions in the UK for 20 years, smokers who use NHS facilities, particularly hospitals, continue to be admitted and discharged without being asked if

OFFICIAL


they are a smoker, or if asked, without being offered help, or if offered help, without that help being delivered at the time of the admission. The report states that that is a situation that must be remedied and argues that existing models of delivering stop smoking services separately from mainstream NHS services, while successful in the past, may now not be the best approach. It also argues that responsibility for treating smokers lies with the clinician who sees them, and that NHS services should be delivering default, opt-out, systematic interventions for all smokers at the point of service contact. Systematic intervention is a cost-effective means of both improving health and reducing demand on NHS services. Smoking cessation is not just about prevention; for many diseases, smoking cessation represents effective treatment. The report’s recommendations can be summarised as:

• The principle of autonomy requires that patients who smoke and who are in contact with health services have their smoking ascertained, and information and treatment offered, to enable autonomous decisions on future smoking.

• The principle of justice requires that smokers are offered help to quit smoking; failure to do so implies that smokers’ health is less important than that of other patients.

• Failing to provide help to quit smoking while delivering other similarly or less cost-effective interventions to smokers represents distributive injustice which both perpetuates and exacerbates health inequalities. Opt-out models of treatment help to sustain autonomy and justice in treating smoking, and should be the norm.

• It is at least as important to address smoking in patients using secondary care as those in primary care.

• Treating the physical health of patients is also no less important than treating mental health. Treating smoking improves both.

• Since most people would prefer to avoid being ill than to go through illness and treatment, prevention should be given a proper place in the allocation of health service resources.

• Proper use of health service resources also requires that more cost-effective treatments are used in preference to less cost-effective treatments.

• Smoke-free NHS estates protect the health of patients and staff, signals that smoking is a crucial health issue, and supports smokers who are trying to quit.

• Heath service commissioners and practitioners have a responsibility to ensure that cost-effective smoking interventions are provided and properly implemented. Failure to identify and treat smokers is no less negligent than failure to identify and treat patients with cancer. Systems failure is no less negligent in this respect than individual failure.

• Smoking cessation should be incorporated, as a priority, as a systematic and opt-out component of all NHS services as a complement to local authority services, and delivered in smoke-free settings. It is unethical to do otherwise.

Northumbria Healthcare Foundation Trust (NHCFT) has successfully become a smoke-free estate. It has a process in place to assess the smoking status of all patients and where appropriate deliver an intervention which could be brief advice and signposting or the provision of nicotine replacement therapy (NRT) and support. There is also a specific focus in maternity services. For inpatients, this includes NRT whilst in hospital plus a 2 week supply on discharge; patients are handed over to ongoing support of their choice. Northumberland, Tyne

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and Wear NHS Foundation Trust (NTW) and Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTHFT) are also looking at implementing this model. The Governing Body is asked to support the report’s recommendations report with a view to translating them into local action through the system wide clinical strategy and System Transformation Board. Childhood obesity: A Plan for Action - Chapter 2 Chapter 1 of the childhood obesity action plan was published in August 2016 and included:

• Industry levy on soft drinks, requiring companies to pay a charge for drinks with added sugar and total sugar content ≥5 g/100 mL, and a higher charge for the drinks that contain ≥8 g/100 mL

• Voluntary reformulation of selected products to remove 20% of sugar • Voluntary healthy rating scheme for primary schools, in which schools were

encouraged to show progress made towards tackling obesity • Support for the voluntary food guidelines in early years settings

The action plan was criticised by some for not going far enough in setting mandatory targets for those areas which were voluntary; and for having insufficient ‘upstream’ (i.e. population and preventive measures) to achieve the stated goal of halving childhood obesity and reducing the gap in obesity between children from the most and least deprived areas by 2030. Chapter 2 of the plan was published on 25 June 2018. Key commitments span five areas of action. The five areas are:

• Sugar reduction • Calorie reduction • Advertising and promotions • Work with local authorities and local areas • Schools

Many of them will require consultation so this is the setting out of intentions for some areas and firm commitment to legislate for others. For instance, subject to consultation the Government will:

• Introduce legislation to end the sale of energy drinks to children • Mandate consistent calorie labelling for the out of home sector (e.g. restaurants, cafes

and takeaways) in England • Introduce a 9pm watershed on TV advertising of HFSS products and similar protection

for children viewing adverts online • Ban price promotions, such as buy one get one free and multi-buy offers or unlimited

refills of unhealthy foods and drinks in the retail and out of home sector • Ban the promotion of unhealthy food and drink by location (at checkouts, the end of

aisles and store entrances) in the retail and out of home sector

OFFICIAL


There is also an intention to develop a trailblazer programme with local authority partners to show what can be achieved within existing powers and understand ‘what works’ in different communities; and develop resources that support local authorities who want to use their powers e.g. to support planning. Government may also consider further use of the tax system to promote healthy food if the voluntary sugar reduction programme does not deliver sufficient progress. It will also only monitor progress against the voluntary calorie reduction programme target (which challenges food and drink companies - manufacturers, retailers, restaurants and takeaways - to reduce the calories by 20% in a range of everyday foods consumed by children by 2024) and consider what additional steps could be taken if progress is not delivered. Chapter 2 is stronger in tone than its predecessor, laying down a commitment to legislation albeit that that is subject to consultation and political reprioritisation. The commitment to a number of upstream prevention activities is welcome. There has been some criticism that there is little in the plan for children who are already overweight or obese. From a Local Authority perspective, there are some lessons that can potentially be learned from the trailblazer programme but the plan should be seen in the context of a shrinking Public Health budget which constrains local action. Recommendation The Governing Body is asked to consider Director of Public Health Update and provide comment.

Agenda Item 8.1

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1 20180725 UC Agenda Item 8.1 Quarterly Operating Delivery Plan 2018/19 Update Q1



Date 25 July 2018

Agenda item 8.1

Report title Quarterly Operating Delivery Plan 2018/19 Update – Q1

Report author Head of Performance and Assurance

Sponsor Chief Operating Officer


Private. Contains commercially sensitive information.



Information only


Decision/Action






Project Leads Meetings

QIPP 2018/19 QIPP Risks Project Leads Risk Register.

Sustainability in Primary Care. Lack of engagement from acute providers.

OFFICIAL

20180725 UC Agenda Item 8.1 Quarterly Operating Delivery Plan 2018/19 Update Q1 2

Resource implications The combined work plan for 18/19 will require full and comprehensive operational delivery from the CCG team. New posts and additional capacity have been secured.

Consultation/engagement Patient, public, stakeholder, clinical. This will be addressed in individual actions and procurement plans.


QEIA assessments will be completed for each of the service areas.

Research Addressed within individual work plans.

Legal implications Actions associated with procurement of services will be managed within the appropriate legal frameworks.

Impact on carers Newly procured pathways of care and service specifications will make clear reference to carer issues.

Sustainability implications N/A

OFFICIAL


QUALITY and EQUALITY IMPACT ASSESSMENT 1. Project Name Quarterly Operating Delivery Plan 2018/19 – Q1

2. Project Lead Director Lead Project Lead Clinical Lead Clinical Director of Primary Care

Head of Commissioning Clinical Director of Primary Care


QEIA assessments will be completed for each of the service areas.



C L Scores


Patient Safety Clinical Effectiveness Patient Experience Others including reputation, information governance and etc.



C L Scores





7. Metrics Sensitive to the impacts or risks on quality and equality

Impact Descriptors Baseline Metrics Target

OFFICIAL


and can be used for ongoing monitoring.


Date


S Brown

13/07/2018



Date



Date

Comments

OFFICIAL


Governing Body 25 July 2018 Agenda Item: 8.1 2018/19 Operating Delivery Plan – Quarter 1 update Sponsor: Chief Operating Officer

Members of the Governing Body are asked to: 1. Consider the 2018/19 Operating Delivery plan update and provide comment. 2. Agree to consider quarterly reports throughout 2018/19.

Purpose This report outlines Quarter 1 (Q1) progress made against delivery of the 2018/19 Operating Plan for 2018/19. QIPP delivery progress is reported separately; this report concentrates on NHS Northumberland Clinical Commissioning Group’s (CCG) wider deliverables. Background The June 2018 Governing Body meeting considered the CCG’s actions to deliver the refreshed 2018/19 Operating Plan for 2018/19. Many of the Q1 actions were associated with scoping the current position, baselining activity and agreeing the actions for delivery throughout the rest of the year. As a consequence, the impact of the actions cannot as yet be observed in many of the metrics chosen to monitor progress due to the information not yet being available. Work Plan Tracker Progress Progress against the actions are summarised below:

• Scaling prevention, health and wellbeing. o Joint Health and Wellbeing strategy development commenced; due to be consulted

upon throughout August 2018 o The CCG and Public Health are supporting the Diabetes Prevention Programme

which is being rolled out across the North East as a part of a NHS England (NHSE) initiative. There has been a delay in the roll out of the programme due to referral process problems. Eight trailblazer practices have been identified of which two have made referrals to date into the service. It is uncertain if any training has taken place yet due to poor communication with the external provider. A local health economy meeting has been organised between the provider and the local CCG to improve communication and the referral process. A monthly steering group of representative CCGs is held to monitor progress at which both Northumberland CCG and Public Health are represented

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o Making every contact count (MECC) - a training programme has been delivered to the Fire and Rescue service to support MECC

o The new NHS Health Checks programme for people living in more deprived areas has been completed; the impact is currently being audited

Delivery Progress Green Long term risk Amber - Issues currently being

experienced with the Diabetes Prevention Programme.

• Mental Health o Review of the 5 mental health pathways is underway as mandated by the System

Transformation Board o Development of the programme to transform children and young peoples’ services is

underway enhanced recently by the appointment to the CCG of an experienced member of staff from the service

o Revised pathways have been mapped for psychiatry for old age along with a plan for the reduction of beds

o The Northumberland Tyne and Wear NHS Foundation Trust (NTW) contract has been restructured however the CCG is awaiting the publication of the standard contract

o Comprehensive review of the workforce required for the learning disability enhanced model is underway

o The more challenging wider coverage 2018/19 CCG target increasing the coverage from 15 % to 19% for IAPT services should not pose a risk as the increased threshold has been achieved by the provider over the last two years.

Delivery Progress Green Long term risk Green

• Long term conditions

o Scoping of projects to improve Atrial Fibrillation and Disease of the arteries has been undertaken to reduce stroke risk in the population

o Ongoing review of diabetes education is enabling the continued CCG strong performance when compared nationally

o Ongoing review of respiratory pathways through joint working with North Tyneside CCG and the local acute trusts. The major focus for 2018/19 is COPD and asthma with a view to reducing non elective admissions and improving patient experience


• Transforming Cancer Services

o To improve the CCGs rate of early diagnosis of cancer the CCG is working with the local acute providers on revising the pathways relating to lung, urology and colorectal which is expected to make the most significant impact on the overall performance. This will be achieved by adopting the standardised pathways

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o Through the engagement of a community cancer awareness co-ordinator the CCG has established links with community leaders, groups, centres and hubs working with local and national charities and organisations to help with the dissemination of information and signposting to services to promote the early detection of cancer and associated screening services. The post holder continues to promote the national cancer campaigns including the recent Cervical Screening Awareness week

o To promote the approach to support people living with and beyond cancer, the recovery package has been revised for the low-risk breast cancer survivors and is now in place.

o Ongoing implementation of the strategy to reduce smoking, alcohol, healthy life styles and MECC. The most recently published smoking prevalence data for Northumberland shows a reduction form 16.9% to 13%


• Demand Management

o An outpatient review group has been very active during the first quarter of the year working on ways to reduce the review of outpatient appointments. The findings will be used to review the potential commissioning of services within the community

o Practice activity scheme has now been developed and is now in place o Latest value based commissioning policy continues to be implemented with GP

Practices o Procurement of MSK services underway following CCG approval that North East

Commissioning Support Unit (NECS) manage the procurement process o Whilst the report outlining the impact of the Sunderland devised Consultant First

programme has been received, it was considered to be of limited value due to the reservations the GP Practices had over the scheme


• Primary Care and Five Year Forward View

o Managing GP variation programme is well underway with a wide range of practices visited in Q1. The redesign of the VIS wall in the CCG has attracted interest and is the focal point for both clinicians and managers.

o A 10 high impact event has been undertaken with GP Practices. A plan outlining the actions required was delivered to NHSE on 29 June 2018

o An Information Technology infrastructure GP online consultation event has been held at the end of May with practice engagement and expressions of interest collated. The CCG priorities and principles have been established. The work plan to implement this is currently being developed

o The CCG has been working with Health Education England on service planning o Primary representatives continue to be an active part of the System Transformation

Board o The locality meeting structures have been reviewed to enable an increase in clinical

focus at practice and locality level

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• Prescribing

o The wide range of schemes associated with prescribing are well underway including the roll out of the 32 items on the self-care agenda which will reduce prescribing costs for the CCG over the year. The CCG will now longer prescribe drugs such as paracetamol and hay fever remedies


• Out of hospital care/New models. Optimal use of the acute sector

o Series of workshops held to develop pathways to transform Community Services - Care at Home Team Complex Health (CATCH)

o Monthly contract meetings held to review the community contract o The case for the redevelopment of Berwick Infirmary is complete and will be

considered by the various governance structures in July 2018 o The CCG is overseeing Northumbria Healthcare NHS Foundation Trust’s (NHCFT)

review of Maternity services to follow current clinical advice from regional groups and based on recent activity levels


• RightCare

o Gastrointestinal – additional clinical support has been secured for this project. The pathway for the upper GI scope for the pathway has been consolidated. The review of the pathway for the lower GI scope is continuing to progress

o Orthopaedics – Ongoing review to identify realistic opportunities for foot and ankle and joint aspirations. The impact on shared decision making based upon a Berkshire and South Tees CCG model is being progressed by PricewaterhouseCoopers (PwC)

o NECS identified to support the procurement of the MSK service


• Urgent Care and Transport

o Consultant Connect introduced to optimise the use of Northumbria Specialist Emergency Care Hospital (NSECH) at NHCFT. This has contributed to improving the performance of both the CCG and NHCFT against the A&E 4 hour wait target in recent months

o All the providers have been assessed against the requirements of the 111 Directory of Service

o An Urgent Care discussion document has been developed and a locally focussed model design event hosted. The provider stakeholder engagement event has been delayed pending the procurement process being instigated

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o A steering group has been formed to develop an optimum pathway for falls and fragility to reduce trauma and orthopaedic related admissions

o A comprehensive review for value for money has started for urgent and the patient transport service

o An audit is being developed jointly between the CCG and NHCFT to enable the thresholds to be established for ambulatory care


Conclusion Overall CCG performance against the actions has been strong and deadlines have been met. This level of progress now needs to be maintained to ensure that the CCG’s key priorities are delivered in 2018/19. Recommendation Governing Body is asked to consider, and provide comment on, the Q1 Operating Delivery Plan update and agree to consider quarterly reports throughout 2018/19.

Agenda Item: 8.2

OFFICIAL

1 20180725 UC Agenda Item 8.2 Quarterly Communication and Engagement Report



Date 25 July 2018

Agenda item 8.2

Report title Quarterly Communication and Engagement Report

Report author Communication and Engagement Manager

Sponsor Strategic Head of Corporate Affairs


Public



Information only


Decision/Action






EMG discussed the overarching Communication and Engagement improvement plan

QIPP NA Risks Strategic Risk 401 – Stakeholder Engagement

Strategic Risk 304 – Member Engagement Resource implications NA

OFFICIAL

20180725 UC Agenda Item 8.2 Quarterly Communication and Engagement Report 2

Consultation/engagement As outlined in the attached report Quality and Equality impact assessment

Completed.

Research NA Legal implications Legal Implications of future engagement and consultation will

always be considered Impact on carers CCG Engagement lead visited the CE of Carers Northumberland

in July 2018 to discuss Sustainability implications NA

OFFICIAL


QUALITY and EQUALITY IMPACT ASSESSMENT 1. Project Name Quarterly Communication and Engagement Report

2. Project Lead Director Lead Project Lead Clinical Lead


Strategic Head of Corporate Affairs


Quarterly Communication and Engagement Report



C L Scores



NA



C L Scores



NA


NA

6. Research Reference to relevant local and national

OFFICIAL


research as appropriate. 7. Metrics Sensitive to the impacts or risks on quality and equality and can be used for ongoing monitoring.

Impact Descriptors Baseline Metrics Target NA


Date


S Young 19/07/2018



Date



Date

Comments

OFFICIAL


Governing Body 25 July 2018 Agenda Item: 8.2 Quarterly Communication and Engagement Report Sponsor: Strategic Head of Corporate Affairs

Members of the Governing Body are asked to: 1. Consider the quarterly Communication and Engagement Report and provide

comment. Purpose This report constitutes NHS Northumberland Clinical Commissioning Group’s (CCG) communications and engagement quarterly activity report. Headline Activity The following work has recently been undertaken since the last report presented to the Joint Locality Executive Board in March 2018: Risk 401 Stakeholder Engagement – There is a risk that a lack of appropriate engagement with key stakeholders including the public and patients, will mean that the CCG will fail to take feedback and evidence into account when designing and commissioning new services.

• Berwick Integrated Hospital Development Listening Exercise – Working with partners at Northumbria Healthcare NHS Foundation Trust (NHCFT) and Northumberland County Council (NCC) the CCG completed its engagement concerning the possibility of the new hospital in Berwick being part of an integrated development including health, social care and leisure services. The listening exercise which has now concluded included informal drop in sessions at community venues around Berwick, Belford and Wooler to give members of the public to give their views about the:

o Potential for the new integrated development to include health, social care and leisure services

o Available development sites The CCG also commissioned Healthwatch to engage with harder to reach groups and this engagement ended in April. A final public meeting took place in May at the Town Hall in Berwick to feedback the emerging themes and offer the public the opportunity to highlight any issues. Initial feedback was given to NCC’s Health and Wellbeing Overview and Scrutiny Committee in May 2018 where a committee member voiced support for the integrated concept and another said that the engagement had been comprehensive and well received. The associated feedback report will be considered

OFFICIAL


during the CCG, NHCFT and NCC decision making processes and made publically available thereafter.

• Rothbury Community Hospital – In May 2018, the CCG received a letter from the Secretary of State for Health confirming he had asked the Independent Reconfiguration Panel (IRP) for initial advice in relation to the referral. The 12 in-patient beds remain closed and the proposed Health and Wellbeing Centre cannot be further developed while the Secretary of State’s response to the referral by the Health and Wellbeing Overview and Scrutiny Committee is awaited

• Collingwood Medical Group – Collingwood Medical Group (CMG) has taken the difficult decision to terminate its contract and will stop delivering GP services on 30 November 2018. The Primary Care Commissioning Committee (PCCC) met on 20 June 2018 to discuss the options available and concluded that it would not be feasible to offer a new contract for the service. Consequently, there was a need to engage with local patients and stakeholders as the PCCC proposed to disperse the patient list and close the practice permanently. The CCG wrote to all patients to inform them of this decision and ask them to register with an alternative practice in the coming months. The letter included a list of nearby practices that patients can approach and answers to some frequently asked questions. Engagement has included three drop in events during afternoons and an evening which were advertised in the patient letter sent to all patients registered with the practice. The CCG will continue to assist future communication and engagement undertaken by both CMG and the affected local practices as requested.

• Northumberland CCG Communications and Engagement Strategy – The strategy was approved by Governing Body in May 2018 after the main work priorities were discussed. A comprehensive work plan has since been developed and elements are being implemented. Initially discussed at an extended Executive Management Group (EMG) further discussions will take place at the Governing Body development session.

• Northumberland CCG 360 Stakeholder Survey 2018 – The annual survey was published in April 2018 and the results were presented to Governing Body in May 2018. The results were also discussed in more detail at EMG and form part of the future communications and engagement work plan with the public and stakeholders. The CCG has engaged in the regional feedback programme and all regional CCG’s have been asked to submit a stakeholder survey improvement plan by 30 September 2018

• Joint Health and Wellbeing Strategy (JHWS) – Engagement is taking place on the draft Joint Health and Wellbeing Strategy (JHWS) with Northumberland residents, GPs, and Patient Participation Groups (PPGs). An online survey has been produced by the CCG and Council for the general public to give their views over the summer period

• Patient Engagement – Work to re-energise the locality Patient Participation Groups (PPGs) has begun with support from the new Locality Directors and locality meetings. Four locality PPG events are planned for August 2018 to focus on engagement for the JHWS

• Press Releases – The CCG issued a series of press releases relating to Berwick Listening Exercise, the Patient Forum, and the Annual Public Meeting

• Press Inquiries – The CCG has responded to media inquiries in relation to the referral to the Independent Reconfiguration Panel re: Rothbury beds, historic subsidy charges, and the Annual Public Meeting

OFFICIAL


• Patient Forum – The Patient Forum Steering Group met in March 2018 to decide the themes for the next Patient Forum which was held in County Hall, Morpeth on 26 April 2018 and was unfortunately poorly attended. The themes were the CCG’s Operational Plan and How Best to Involve the Public in the CCG’s work. These events have now been replaced by a more targeted approach to engagement using multiple channels and targeting specific audiences.

Risk 403 CCG Member Engagement. There is a risk that a failure to engage the CCG’s membership means that vital intelligence is not taken into account when developing future delivery strategy.

• Northumberland CCG 360 Stakeholder Survey 2018 – This annual survey is discussed above. Member practice feedback, while understandable given the issues experienced by the CCG in 2017/18, was more negative than previous years. Member engagement was discussed at the extended EMG and will be a key focus of the 2017/18 communications and engagement work plan

• Collingwood Medical Group – The CCG continues to work closely with CMG and neighbouring practices to best safeguard future primary care sustainability in the area. Lines of communication are open between the practices and the Chief Operating Officer, Engagement Manager and Locality Manager

• Senior Management Changes – The new appointments of David Shovlin as interim director of primary care, and three new locality directors Paula Batsford (Blyth Valley), Ben Frankel (West) and Charles Dean (North) were communicated to members

• Members Meeting – A members meeting was held on 21 March 2018 in Morpeth Town Hall and was reasonably well attended

• Locality Meetings – Locality meetings continue to take place at the start of each month and the engagement manager has attended and proposed agenda items for discussion. The communication and engagement team are now attending the locality agenda setting meetings

• Joint Health and Wellbeing Strategy – Engagement is taking place with GPs who have been asked to feedback their views on the draft strategy before it is published later this year

• Locality Bulletin – The CCG’s weekly bulletin continues to be well received by practices but readership appears to have reduced recently. This will be closely monitored over the coming weeks. The usage of GPTeamNet remains high (Appendix 1 refers)

Locality Bulletin Issue Viewed Figure 86, 7 March 2018 381 87, 13 March 2018 414 88, 20 March 2018 451 89, 27 March 2018 400 90, 3 April 2018 315 91, 10 April 2018 397 92, 17 April 2018 414

OFFICIAL


93, 26 April 2018 438 94, 2 May 2018 331 95, 9 May 2018 295 96, 16 May 2018 345 97, 23 May 2018 368 98, 29 May 2018 337 99, 6 June 2018 357 100, 12 June 2018 282 101, 20 June 2018 289 102, 28 June 2018 236 103, 3 July 2018 219 104, 11 July 2018 258

• Social media and MP inquiries – Analysis of March to June 2018 engagement via social media (Facebook and twitter) and MP inquiries is in appendix 2.

Conclusion This has been another busy period and Audrey Barton is to be commended for her efforts ahead of the communication and engagement team doubling its resource on the return of Emma Robertson. The increased capacity will enable the CCG to take a far more proactive approach to communications and engagement in an effort to engage more people in the earlier stages of commissioning proposals, to raise the CCG’s general profile and promote the positive activities being undertaken. There are some exciting opportunities ahead and the team is looking forward to delivering further improvements. The opportunity to further discuss current plans and explore other ideas will be taken in the Governing Body development session. Recommendation Governing Body is asked to consider the CCG’s quarterly communication and engagement report and provide comment. Appendix 1: GP TeamNet - Practices Activity March - July 2018 Appendix 2: Northumberland Evaluation Metrics - March to June 2018 combined

How active are our practices?Date from: 01/03/2018Date to: 15/07/2018

Portal Name Parent Portal Active Users Logins Unique Logins Internal Views External Views Total ViewsBlyth Valley Locality area 265 4961 170 2521 1825 4346Blyth Valley Locality Northumberland CCG 5 0 0 0 0 0Brockwell Centre Blyth Valley Locality 57 263 15 3 238 241Collingwood Medical Group Blyth Valley Locality 27 676 28 609 283 892Cramlington Medical Group Blyth Valley Locality 29 170 11 45 198 243Forum Family Practice Blyth Valley Locality 21 1562 20 86 222 308Marine Medical Group Blyth Valley Locality 17 29 7 0 30 30Netherfield House Surgery Blyth Valley Locality 17 33 7 0 35 35Railway Medical Group Blyth Valley Locality 62 656 57 874 142 1016The Surgery, Elsdon Avenue Blyth Valley Locality 12 1382 13 896 416 1312Village Surgery Blyth Valley Locality 18 190 12 8 261 269North Northumberland Locality area 260 4359 177 3258 1106 4364North Northumberland Locality Northumberland CCG 8 0 0 0 0 0Alnwick Medical Group North Northumberland Locality 90 2632 87 2745 407 3152Belford Medical Group North Northumberland Locality 19 333 18 491 26 517Cheviot Medical Group North Northumberland Locality 7 56 5 0 52 52Coquet Medical Group North Northumberland Locality 15 37 11 0 43 43Felton Surgery North Northumberland Locality 11 4 1 0 4 4Glendale Surgery North Northumberland Locality 8 16 5 3 12 15Rothbury Practice North Northumberland Locality 29 952 28 11 311 322Union Brae & Norham Practice North Northumberland Locality 22 46 9 0 97 97Well Close Medical Group North Northumberland Locality 33 54 7 8 7 15Widdrington Surgery North Northumberland Locality 18 229 6 0 147 147Northumberland Central Locality area 288 17941 183 19613 2654 22267Northumberland Central Locality Northumberland CCG 6 52 1 0 1 1Bedlingtonshire Medical Group Northumberland Central Locality 28 891 17 38 142 180Gas House Lane Surgery Northumberland Central Locality 17 257 5 688 203 891Greystoke Surgery Northumberland Central Locality 21 161 7 10 60 70Guide Post Medical Group Northumberland Central Locality 30 794 23 1103 332 1435Laburnum Medical Group Northumberland Central Locality 4 6 5 0 43 43Lintonville Medical Group Northumberland Central Locality 46 953 39 581 628 1209Seaton Park Medical Group Northumberland Central Locality 70 14742 71 17193 994 18187The Gables Medical Group Northumberland Central Locality 17 54 8 0 121 121Wellway Medical Group Northumberland Central Locality 49 31 7 0 130 130Northumberland West locality area 261 3382 155 985 2815 3800Northumberland West locality Northumberland CCG 6 0 0 0 0 0Branch End Surgery Northumberland West locality 20 45 9 0 48 48Burn Brae Medical Group Northumberland West locality 4 7 1 0 7 7Corbridge Medical Group Northumberland West locality 15 127 10 0 82 82Haltwhistle Medical Group Northumberland West locality 23 246 11 8 142 150Haydon Bridge & Allendale Medical Practice Northumberland West locality 23 107 15 10 167 177Humshaugh & Wark Medical Group Northumberland West locality 22 138 8 0 96 96Ponteland Medical Group Northumberland West locality 52 1756 50 785 1604 2389Prudhoe Medical Group Northumberland West locality 23 513 19 165 190 355Riversdale Surgery Northumberland West locality 10 21 6 0 33 33Scots Gap Medical Group Northumberland West locality 5 4 2 0 7 7The Adderlane Surgery Northumberland West locality 7 10 2 0 16 16The Bellingham Practice Northumberland West locality 18 135 8 0 221 221The Sele Medical Practice Northumberland West locality 25 18 6 0 29 29White Medical Group Northumberland West locality 8 255 8 17 173 190

1

Quarterly communications metrics report: March 2018 – June 2018

MP enquiries

• Guy Opperman x 1 – CAMHS provision • Anne-Marie Trevelyan x 2

o PIP assessment o Funding of epidural injections as pain relief

Parliamentary hub enquiries

• Mental health services for young people • BBC Tees - NEAS funding (regional story) • Northumberland Gazette – Cancer treatment times • Northumberland Gazette – GB meetings

Media handling

• NEAS funding – regional issue, with several BBC and press enquiries • Cancer treatment targets – Northumberland Gazette • Heart failure/blood pressure rates – Northumberland Gazette • GP extended access appointments – Northumberland Gazette • Continuing care enquiry (enquiry from family member, not media)

Media evaluation

51 mentions:

• Rothbury Community Hospital • Health funding • CCG annual general meeting • High blood pressure statistics in Northumberland • Cancer waiting times • Smoking rates among expectant mothers • Rural winter deaths • ACO plans • Berwick Hospital • Dementia diagnosis rates • Carers week

Value: £156,638 Reach: 3,528,929

2

Additional projects/work

• Annual report summary

My NHS Membership

Membership of MY NHS is 815 – a reduction of two members over the period.

Social media

Twitter

Mar

18 Apr

18 May

18 June

18 Followers 2.1k 2.1k 2.2k 2.2k

Reach 181k 120.3k 122k 104k

Klout 44 39

NB: Klout has previously been measured as a means of identifying social media influence. This ranking system ended in May 2018 and has not been replaced

Facebook

Mar 18 Apr 18 May 18 June 18

Likes 376 379 378 380

Message sentiment

The tone of tweets made to the CCG across the quarter was:

• 53% positive • 30% neutral • 17% negative

Message sentiment

The tone of comments made to the CCG across the quarter was:

• 36% positive • 48% neutral • 16% negative

3

Website (rolling statistics: March - June)

NB: The CCG website became GDPR compliant in May 2018. As a result, tracking cookies are no longer automatic which has had an impact on the number of recorded visitors. This trend has been replicated across the region

4

Additional information

The press cutting recipient list has been updated. It now includes:

• [email protected] • [email protected] • [email protected] • [email protected] • [email protected] • [email protected]

mailto:[email protected]






Agenda Item: 9.1

OFFICIAL

1 20180725 UC Agenda Item 9.1 CCGs Annual Complaint Activity Report 2017-18



Date 25 July 2018

Agenda item 9.1

Report title CCG’s Annual Complaint Activity Report 2017-18

Report author Strategic Head of Corporate Affairs

Sponsor Strategic Head of Corporate Affairs


Public



Information only


Decision/Action Links to Corporate Objectives Ensure that the CCG makes best use of all available

resources





Complaint data considered by each Quality Safety Group

QIPP NA Risks Strategic Risk 401 – Stakeholder Engagement Resource implications NA Consultation/engagement NA

OFFICIAL

20180725 UC Agenda Item 9.1 CCGs Annual Complaint Activity Report 2017-18 2


Completed.

Research NA Legal implications NA Impact on carers NA Sustainability implications NA

OFFICIAL


QUALITY and EQUALITY IMPACT ASSESSMENT 1. Project Name CCG’s Complaints Annual Report 2017-18

2. Project Lead Director Lead Project Lead Clinical Lead



Director of Nursing, Quality and Patient Safety




C L Scores



NA



C L Scores



NA


NA


7. Metrics Impact Descriptors Baseline Metrics Target NA

OFFICIAL


Sensitive to the impacts or risks on quality and equality and can be used for ongoing monitoring.


Date


S Young 19/07/2018



Date



Date

Comments

OFFICIAL


Governing Body 25 July 2018 Agenda Item: 9.1 CCG’s Annual Complaint Activity Report 2017-18 Sponsor: Strategic Head of Corporate Affairs

Members of the Governing Body are asked to: 1. Consider the North of England Commissioning Support’s Complaint Activity Report

for 2017-18 and provide comment. Purpose This report outlines the North of England Commissioning Support (NECS) Complaint Activity Report for 2017-18. Background NECS provide complaint management to NHS Northumberland Clinical Commissioning Group (CCG), in addition to other regional CCGs, as part of the Clinical Quality Service. Appendix 1 provides details of the complaints received for the CCG, benchmarking data with other CCGs and a summary of the service improvements identified as a result of the consequent investigations. To ensure that any lessons identified have been considered by the CCG the report has been forwarded to the Deputy Director for Commissioning and Contracting (DDCC)for any actions deemed necessary Governing Body should note that Appendix 1 is not the sole source of complaint data for example Northumberland County Council deal with Continuing Healthcare complaints on behalf of the CCG and Healthwatch Northumberland provide extensive feedback from patients and the public. The CCG also receives a quarterly complaint report from NECS which has previously been considered by the Quality Intelligence Group. The Quality Safety Group (QSG) will now undertake this task and will ensure that the DDCC is aware of any action required by the commissioning team. The CCG’s Director of Nursing, Quality and Patient Safety and Strategic Head of Corporate Affairs are currently working to ensure a comprehensive system of overall complaint management, including consideration of all data and triangulation, exists within the CCG. The QSG will consider emerging issues and raise exceptions to the Clinical Management Board as necessary.

OFFICIAL


Recommendation Governing Body is asked to consider the NECS Complaint Activity Report and provide comment. Appendix 1: NECS Complaint Activity Report 2017-18

1

Summary of Complaint Activity

for Clinical Commissioning Groups 1 April 2017 to 31 March 2018

1 Purpose of Report The NHS North of England Commissioning Support Unit (NECS) provides complaints management to Clinical Commissioning Groups (CCG) across the North East and North Cumbria as part of the Clinical Quality Service. The purpose of this report is to provide a summary of complaints and concerns about the CCGs which have been managed by or reported to the NECS Complaints Team during the period 1 April 2017 to 31 March 2018. For the purpose of benchmarking, transparency and lessons learned, the report includes data relating to the CCGs which NECS manages complaints on behalf of. The report also provides a summary of service improvements identified as a result of investigations and within the complaints handling process. It should be noted that this report provides a breakdown only for complaints which relate directly to the CCGs. Although complaints/concerns about services commissioned by the CCGs can be made via the commissioning organisation, the majority of complaints regarding provider organisations are made direct with the service provider. Provider complaints received by the CCGs or the Complaints Team are normally referred to the service provider for initial investigation. Complaint reports from provider organisations which detail trends, themes and lessons learned relating to their services are reviewed as part of the Clinical Quality Review Group for that provider. 2 Complaint activity 2.1 Performance Against Key Performance Indicators All cases handled in the year on behalf of the CCGs were acknowledged within three working days in line with the requirement of the National Health Service Complaints (England) Regulations 2009. All formal CCG complaints were managed in line with the agreed complaint plan. Responses were reviewed and approved by the CCG prior to sharing with the complainant and, where an extension to the timescale for responding to a complaint was required, this was agreed with the parties involved.

2

2.2 Overall Activity A total of 668 new complaints/concerns were received in the year; in addition, a number of cases were also reopened in the reporting period. The chart below shows the month-on-month activity of the Complaints Team over the previous 12 month period; this takes into account cases which were brought forward from the previous month, received (opened) or closed during the month and those which were reopened/reclosed. It should be noted that this chart relates to all case types ie cases relating to CCGs, NECS and other organisations.

2.3 Grade of Cases A breakdown of the cases by grade is shown in the table below.

CCG cases in reporting period

Formal complaint ie handled in line with the NHS Complaints Procedure

Managed under other process eg advice, informal concern, MP enquiry

2017 to 2018 2016 to 2017 2017 to 2018 2016 to 2017 Darlington 6 9 7 1 DDES 15 18 13 5 HaST 23 15 12 10 Newcastle Gateshead 39 44 29 34 North Cumbria 21 44* 13 21* North Durham 10 32 13 12 North Tyneside 15 11 14 9 Northumberland 5 5 15 7 South Tees 20 17 17 8 South Tyneside 4 14 8 4 Sunderland 4 10 7 14 * 2016/17 activity figures relate to the former NHS Cumbria CCG, predecessor of NHS North Cumbria CCG

0

10

20

30

40

50

60

70

80

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Overall activity in year

Brought Forward Opened Closed Re-Opened Re-Opened Closed

3

2.4 Carried forward from previous year and reopened in year This table shows the CCG cases which remained ongoing as at 31 March 2017 and those which were reopened in the year as a result of enquirer/complainants with outstanding issues following closure of their complaint.

CCG Number carried forward from previous year Number reopened in year

Darlington 0 1 DDES 1 4 HaST 4 11 Newcastle Gateshead 5 13 North Cumbria 0 7 North Durham 3 3 North Tyneside 1 0 Northumberland 1 2 South Tees 1 5 South Tyneside 2 2 Sunderland 3 1 2.5 Categories of Cases The CCG-led complaints/concerns received in the year were categorised as follows.

Category

CCG

Cat

egor

y To

tal

Dar

lingt

on

DD

ES

HaS

T

New

cast

le

Gat

eshe

ad

Nor

th C

umbr

ia

Nor

th D

urha

m

Nor

th T

ynes

ide

Nor

thum

berla

nd

Sout

h Te

es

Sout

h Ty

nesi

de

Sund

erla

nd

Attitude of staff 0 0 1 1 0 0 0 0 0 0 0 2 Commissioning – Diabetes 0 0 0 0 6 0 1 0 0 0 0 7 Commissioning – Medicines 1 3 1 6 1 0 3 2 0 0 0 17 Commissioning – Mental health 1 0 0 0 1 1 0 1 4 0 1 9 Commissioning – MSK 0 1 1 1 0 0 2 1 1 0 0 7 Commissioning – OOH 0 1 0 0 1 0 1 0 3 0 0 6 Commissioning – Pain management service

0 0 0 0 11 0 0 0 0 0 0 11

Commissioning – Primary care 0 0 0 1 0 0 6 0 0 0 0 7 Commissioning – Respite care 0 0 1 1 0 0 0 0 0 0 1 3 Commissioning decision other 0 3 0 0 2 1 3 3 1 1 2 16 Communication/information to patients/public

0 1 0 0 1 0 0 1 1 0 0 4

Continuing Healthcare – current cases

3 10 6 16 5 2 4 0 5 3 2 56

Continuing Healthcare – restitution 2 4 18 30 2 5 0 3 15 0 0 79 Contracting process/contract management

1 0 2 1 0 0 0 0 0 2 0 6

Individual Funding Request (IFR) process/decision

2 3 2 3 2 4 1 2 3 5 1 28

Miscellaneous 0 0 0 0 1 0 0 0 2 0 1 4 Patient transport commissioning 3 2 1 2 0 7 2 3 1 1 2 24 Personal health budgets 0 0 2 1 0 0 0 0 0 0 0 3 Value based clinical commissioning policy/criteria

0 0 0 5 1 3 6 4 1 0 1 21

CCG total 13 28 35 68 34 23 29 20 37 12 11 310

4

The graph below demonstrates the categories of complaint/concern by CCG.

2.6 Outcomes The outcomes of the formal CCG-led complaints closed in the year were as follows.

CCG Number and % of formal complaints

Complaint withdrawn Not upheld Partially

upheld Upheld

Darlington 0 - 2 40 2 40 1 20 DDES 0 - 6 40 5 33 4 26.6 HaST 5 22.7 8 36.3 6 27 3 13.6 Newcastle Gateshead 6 13.9 18 41.8 11 25.5 8 18.6 North Cumbria 3 15 9 45 5 25 3 15 North Durham 1 8.3 4 33.3 3 25 4 33.3 North Tyneside 0 - 12 85.7 2 14.2 0 - Northumberland 1 16.6 3 50 2 33.3 0 - South Tees 4 23.5 3 17.7 7 41.1 3 17.6 South Tyneside 1 25 0 - 1 25 2 50 Sunderland 0 - 4 66.6 2 33.3 0 -

0

10

20

30

40

50

60

70

80Categories of concerns/complaints by CCG

Attitude of staff Commissioning – Diabetes Commissioning – Medicines Commissioning – Mental health Commissioning – MSK Commissioning – OOH Commissioning – Pain management service Commissioning – Primary care Commissioning – Respite care Commissioning decision otherCommunication/information to patients/public Continuing Healthcare – current cases Continuing Healthcare – restitution Contracting process/contract managementIndividual Funding Request (IFR) process/decision MiscellaneousPatient transport commissioning Personal health budgets

5

2.7 Stage 2 of the NHS Complaints Procedure/Ombudsman Where a complainant remains dissatisfied following local resolution of their complaint, they may request the involvement of the Parliamentary and Health Services Ombudsman (PHSO) or Local Government Ombudsman (LGO) as the second stage of the process. During the reporting period, the NECS Complaints Team received contacts from officers at the PHSO or LGO regarding 44 cases. Of these, 15 progressed to investigation by the Ombudsman and the outcomes by CCG are shown below.

CCG Outcome following Ombudsman investigation Outcome

awaited as at 31 March

2018 Upheld Partially Upheld Not Upheld

Darlington - - - - DDES - - - - HaST - - 1 - Newcastle Gateshead 1 1 2 1 North Cumbria (inc former Cumbria CCG) - 1 1 -

North Durham - - 1 North Tyneside - - - 1 Northumberland - 1 - 1 South Tees 1 - - South Tyneside - 2 - - Sunderland - - - - 4 Themes in Complaints Received The key themes identified in complaints/concerns across all CCGs are as follows: • Continuing Healthcare (CHC) funding decisions and processes – This was

the subject most frequently reported in all CCG complaints and concerns. The key themes identified were challenges to CHC funding decisions (particularly restitution claims), delays regarding the CHC review and disputes/delays regarding payments

• Individual Funding Request (IFR) process/decisions and Value based clinical commissioning policy (VBCCP) and eligibility criteria – This was a further theme involving patients challenging the outcome of IFRs submitted by the referring clinician or eligibility criteria for access to treatment outline in the VBCCP. In response, patients were provided with advice letters clarifying the rationale for the eligibility criteria along with advice on the next steps in the process

• Access to patient transport - Another theme identified across CCGs was the eligibility criteria and booking process for the NHS Patient Transport Service (PTS)

• Commissioning decisions – Concerns were raised about the commissioning of a variety of services, for example, CCG decisions which resulted in changes to services. The most frequently raised subjects were access to specific of medications on NHS prescription, the pain management service (in North Cumbria) and mental health services

6

5 Continuous Improvement 5.1 Recommendations and service improvements from Complaints

Investigations Examples of recommendations and service improvements from complaint investigations concluded in the year are as follows: Continuing Healthcare • Current cases - Improvements have been identified and/or introduced with regard

to: communication with patients/representatives; CCG responsibilities in relation to case management of CHC funded patients; continuity of cases during staff absence; recruitment of staff to provide capacity to manage the backlog of cases; review of process for ordering equipment to reduce delays and improve communication; transfer of CHC funded patients between CCGs

• Restitution process – Improvements have been made to strengthen communication with claimants such as automated responses to emails and the introduction of performance measure with regard to responding to queries.

Where NECS provides a CHC service on behalf of a CCG, service improvement and transformation plans have been developed supporting the above points which are in the implementation phase. Individual Funding Requests • Systems have been reinforced to ensure that the correct outcomes/decisions are

included in correspondence. The term 'and/or replacement' has been removed from the IFR system and replaced with 'breast implant removal'.

Commissioning of services • A review is to take place of aspects of out of hours services • The CCG is to make arrangements to ensure that clients of the counselling

service are made aware of criteria which might impact on access to care should they move outside of the CCG area eg students

• Joint working will take place across the North East and Cumbria to prevent local discrepancies in the prescribing of PDE-5 inhibitors for post radical prostatectomy

• Communication to take place with GP practices to advise that in exceptional circumstances, patients may continue on Nefopam

• Improvements will be made to communication with families regarding arrangements during long term staff sickness

• A review will take place of the pathway for Cognitive Analytic Therapy (CAT) to ensure patients receive the most appropriate/timely service for their needs

Access to patient transport • Changes have been made to the contract to between NEAS the CCG to provide

appropriate transport to patients between 1am and 9am • Measure have been introduced to ensure that call handlers within the Patient

Transport Booking Team (PTAT) take a patient's individual circumstances into account in determining whether to approve an escort to accompany the patient on the ambulance

7

• PTAT staff have been reminded of the contact details for the Complaints Team and volunteer driver services in order that these can be shared with callers as required

5.2 Complaints Process A number of internal and outward facing improvements have been introduced within the complaints process during the year by the Complaints Team. Examples are shown below. • Guidance notes for investigating officers - Review and refresh of guidance

notes for investigating officers, including comments from engagement with CHC investigating officers

• Interface between MP enquiries and complaints processes - Review and revision of the process for managing MP enquiries which contain a complaint about an individual’s care/funding

• Complaints form - Development of a template for use by complainants in providing details of their complaint. This will be made available via CCG/NECS websites. The views of CCG patient participation group members were sought in development the form and process

• Management of cases relating to Individual Funding Requests (IFR) - Update to the process for managing concerns relating to IFRs and eligibility criteria

• Service improvement tracking process - Development and introduction of a process for tracking implementation of recommendations identified in upheld/partially upheld formal complaints

• Website review - Review of CCG/NECS website content regarding complaints Author Katharine Humby Senior Clinical Quality Officer (Complaints) North of England Commissioning Support Unit Approved by Khalid Azam Head of Clinical Services North of England Commissioning Support Unit 26 April 2018

Agenda Item 12 OFFICIAL

1 20180725 UC Agenda Item 12 GB Public Forward Plan 2018/19

NHS Northumberland Clinical Commissioning Group

Governing Body - Forward Plan 2018 Standing items Lead

• Chief Operating Officer Report • Clinical Management Board Report (including Quality & Performance exceptions) • Finance Report • Corporate Finance Committee - Update/Referrals (in month) • Public Health Update • Improvement Plan 2018/19 Update • Clinical Management Board minutes • Corporate Finance Committee minutes • Health & Well Being Board minutes • Governing Body Forward Plan

Siobhan Brown David Shovlin Ian Cameron Ian Cameron Liz Morgan Siobhan Brown David Shovlin Stephen Young Stephen Young Stephen Young

August 2018 Governance

• Assurance Framework & Risk Register (Quarterly) Information

• Primary Care Commissioning Committee Minutes (June 2018) • Audit Committee Minutes (May 2018)

Stephen Young Stephen Young Stephen Young

September 2018 • Communications & Engagement Report (Quarterly) Stephen Young

October 2018

• Impact Metric Report (Quarterly) • Joint CCG Committee for CNE – 4 October meeting feedback

Siobhan Brown Vanessa Bainbridge

2 20180627 CONF Agenda Item 12 GB Public Forward Plan 2018/19

Governance • Governance Review • Safeguarding Children Report 2017/18 • Safeguarding Adult Report 2017/18

Information

• Primary Care Commissioning Committee Minutes (August 2018) • Audit Committee Minutes (July 2018)

Stephen Young Siobhan Brown Siobhan Brown Stephen Young Stephen Young

November 2018 Governance

• Assurance Framework & Risk Register (Quarterly) • Looked After Children Annual Report 2017/18

Stephen Young Siobhan Brown

December 2018 • Communications & Engagement Report (Quarterly)

Information

• Primary Care Commissioning Committee Minutes (October 2018) • Audit Committee Minutes (Sept 2018)

Stephen Young Stephen Young Stephen Young

January 2019 • Impact Metric Report (Quarterly)

Siobhan Brown

February 2019 Governance

• Assurance Framework & Risk Register (Quarterly)

Stephen Young

3 20180627 CONF Agenda Item 12 GB Public Forward Plan 2018/19

Information • Primary Care Commissioning Committee Minutes (Dec 2018) • Audit Committee Minutes (Nov 2018)

Stephen Young Stephen Young

March 2019 • Communications & Engagement Report (Quarterly)

Stephen Young

AGENDA - NHS Northumberland Clinical Commissioning Group · 1050 10 Locality meeting assurance/key...

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Transcript of AGENDA - NHS Northumberland Clinical Commissioning Group · 1050 10 Locality meeting assurance/key...